ENT: Hearing Loss, Nosebleeds & Cleft Palate

Question 1

Give 3 causes of congenital hearing loss

Answer 1

1) Maternal rubella or CMV infection during pregnancy

2) Genetic deafness

3) Associated syndromes, for example Down’s syndrome

Question 2

Give 2 perinatal causes of hearing loss

Answer 2

1) Prematurity

2) Hypoxia during or after birth

Question 3

Give 4 causes of hearing loss after birth

Answer 3

1) Jaundice

2) Meningitis & encephalitis

3) OM and glue ear

4) Chemotherapy

Question 4

Screening test for hearing loss in neonates?

Answer 4

The UK newborn hearing screening programme (NHSP) tests hearing in all neonates. T

Question 5

Children with hearing difficulties may present with parental concerns.

What might these concerns be?

Answer 5

• Ignoring calls or sounds
• Frustration or bad behaviour
• Poor speech and language development
• Poor school performance

Question 6

What is an audiogram?

Answer 6

Charts that document the volume at which patients can hear different tones.

Question 7

What is plotted on the x axis of an audiogram?

Answer 7

The frequency in hertz (Hz), from low to high pitched

Question 8

What is plotted on the y axis of an audiogram?

Answer 8

The volume in decibels (dB), from loud at the bottom to quiet at the top.

Question 9

Audiogram results in sensorineural hearing loss?

Answer 9

Both air and bone conduction readings will be more than 20 dB, plotted below the 20 dB line on the chart.

This may affect only one side, one side more than the other or both sides equally.

Question 10

Audiogram results in conductive hearing loss?

Answer 10

Bone conduction readings will be normal (between 0 and 20 dB), however air conduction readings will be greater than 20 dB, plotted below the 20 dB line on the chart.

Question 11

What happens in conductive hearing loss?

Answer 11

Sound can travel through bones but is not conducted through air due to pathology along the route into the ear.

Question 12

What is the most common cause of hearing loss in older adults?

Answer 12

Presbycusis

Question 13

What is Presbycusis?

Answer 13

A gradual, age-related hearing loss that occurs due to changes in the inner ear.

Question 14

How does presbycusis present?

Answer 14

Difficulty hearing high-pitched sounds and understanding speech in noisy environments.

Question 15

Where do nosebleeds (epistaxis) originate from?

Answer 15

Kiesselbach’s plexus, which is also known as Little’s area.

Question 16

What is Kiesselbach’s plexus?

Answer 16

An area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels.

Question 17

What may bleeding from both nostrils indicate?

Answer 17

Bleeding from both nostrils may indicated bleeding posteriorly in the nose.

Question 18

Management of nosebleeds?

Answer 18

1) Sit up and tilt the head forwards

2) Squeeze the soft part of the nostrils together for 10 – 15 minutes

3) Spit any blood in the mouth out rather than swallowing

If doesn’t stop within 15 mins:
- Nasal packing using nasal tampons or inflatable packs
- Nasal cautery using a silver nitrate stick

Question 19

What is the most common congenital deformity affecting the orofacial structures?

Answer 19

Cleft lip and palate

Question 20

What is a cleft lip?

Answer 20

A congenital condition where there is a split or open section of the upper lip.

This opening can occur at any point along the top lip, and can extend as high as the nose.

Question 21

What is a cleft palate?

Answer 21

Cleft palate is where a defect exists in the hard or soft palate at the roof of the mouth.

This leaves an opening between the mouth and the nasal cavity.

Cleft lip and cleft palate can occur together or on their own.

Question 22

What are the 3 most common variants of cleft lip and palate?

Answer 22

1) Combined cleft lip and palate (45%)

2) Isolate cleft palate (40%)

3) Isolated cleft lip (15%)

Question 23

What is the most common variant of cleft lip and palate?

Answer 23

combined cleft lip and palate (45%)

Question 24

What is a risk factor for cleft lip/palate?

Answer 24

Maternal antiepileptic use

Question 25

What are some complications of a cleft lip or palate?

Answer 25

Not life threatening, but can lead to significant problems with feeding, swallowing and speech.

Can also have significant psycho-social implications, including affecting bonding between mother and child.

Children with cleft palates can be more prone to hearing problems, ear infections and glue ear.

Question 26

What are 3 complications of a cleft lip/palate?

Answer 26

1) feeding: orthodontic devices may be helpful

2) speech: with speech therapy 75% of children develop normal speech

3) increased risk of otitis media for cleft palate babies

Question 27

What infection are those with cleft palate at increased risk of?

Answer 27

Otitis media

Question 28

Management of cleft lip/palate?

Answer 28

MDT:

Specialist nurses to support and coordinate care
Plastic, maxillofacial and ENT surgeons
Dentists
Speech and language therapists
Psychologists
General practitioners

Question 29

What is the 1st priority in Mx of cleft lip/palate?

Answer 29

The first priority is to ensure the baby can eat and drink.

Question 30

What is the definitive treatment of cleft lip/palate?

Answer 30

Surgery

Question 31

When is cleft lip surgery vs cleft palate surgery performed?

Answer 31

Cleft lip - around 3 months

Cleft palate - around 6-12 months

Question 32

When is cleft lip typically repaired?

Answer 32

From first week of life to three months

Question 33

When is cleft palate typically repaired?

Answer 33

Between 6-12 months of age

Question 34

Use of which antiepileptic during prengnacy carries the highest risk of cleft lip or palate?

Answer 34

Topiramate