ENT + Ophthalmology

Question 1

What are grommets?

Answer 1

Tiny tube inserted into tympanic membrane. This allows fluid from middle ear to drain through tympanic membrane to ear canal. Usually fall out within a year.

Question 2

What is otitis media?

Answer 2

Infx in the middle ear (space that sits between the tympanic membrane (ear drum) and the inner ear (this is where the cochlea, vestibular apparatus and nerves are found)

Question 3

What are the bacterial causes of otitis media?

Answer 3

MC - streptococcus pneumoniae
Other:
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

Question 4

Sx of otitis media?

Answer 4

• Ear pain
• Reduced hearing in affected ear
• Upper airway infx sx (fever, cough, coryzal symptoms, sore throat)
• Vertigo and balance issues
• If perforated - ear discharge

Question 5

Ix for otitis media?

Answer 5

Otoscope - bulging, red, inflamed looking tympanic membrane

Normal tympanic membrane = “pearly-grey”, translucent and slightly shiny

Question 6

Tx of Otitis media?

Answer 6

Most cases will resolve within 3 days w/out abx. Give simple analgesia

If pts have significant co-morbidities - prescribe abx
1st line - amoxicillin (5 days)
Alternatives - erythromycin and clarithromycin

Question 7

What is glue ear?

Answer 7

Otitis media w/effusion. Middle ear becomes full of fluid causing hearing loss in that ear.

Question 8

Findings on an otoscopy in glue ear?

Answer 8

Dull tympanic membrane with air bubbles or a visible fluid level

Question 9

Mx of glue ear?

Answer 9

Usually tx conservitavely and resolves w/out tx within 3 mths.

If severe - may require hearing aids or grommets

Question 10

Common causes of hearing loss in the following stages:
* Congenital
* Perinatal
* After birth

Answer 10

Congenital:
* Maternal rubella or CMV infx
* Genetic deafness - autosomal recessive/dominant
* Syndromes i.e. Down’s syndrome

Perinatal:
* Prematurity
* Hypoxia (during/after birth)

After birth:
* Jaundice
* Meningitis/encephalitis
* Otitis media/glue ear
* Chemo

Question 11

What’s the name of the programme that tests hearing in all neonates?

Answer 11

Newborn hearing screening programme (NHSP)

Question 12

What does audiometry tests identify?

Answer 12

Identify and differentiate conductive and sensorineural hearing loss.

• Conductive = when sound is not efficiently conducted through the outer ear or middle ear to the inner ear. Essentially, there’s an obstruction or dysfunction in the pathway.
• Sensorineural = damage to the inner ear (cochlea) or the auditory nerve that transmits sound signals to the brain.

Question 13

What is orbital cellulitis?

Answer 13

Infx of the structures behind orbital septum - sight/life threatening

The orbital septum is a membranous sheet that forms the anterior border of the orbit, extending from the orbital rims (superior and inferior) and into the eyelids.

Question 14

What is preseptal cellulitis?

Answer 14

Infx of tissue anterior to orbital septum. MC than orbital cellulitis and less severe. Occurs mostly in children <10yrs.

Question 15

RF for orbital cellulitis?

Answer 15

• Trauma
• Surgical - ocular, adnexal or sinus
• Sinus disease
• Other facial infections - dental abscess

Question 16

Sx of orbital cellulitis? How do sx differ in preseptal cellulitis?

Answer 16

In orbital cellulitis:
* Periocular pain and swelling
* Fever
* Malaise
* Erythematous, swollen and tender eyelid
* Chemosis
* Proptosis
* Restricted eye movements +/– diplopia

In preseptal cellulitis:
* No proptosis
* Normal eye movements
* No chemosis
* Normal optic nerve function

Typically = child with an erythematous swollen eyelid, mild fever and erythema surrounding the orbit.

Proptosis = exophthalmos
Chemosis = swelling of the tissue that lines the eyelids and surface of the eye (conjunctiva)

Question 17

Ix for orbital/preseptal cellulitis?

Answer 17

Bloods - FBC, CRP
Swabs
GS - CT orbit (distinguish orbital cellulitis from preseptal cellulitis)

Question 18

Mx of orbital cellulitis vs preseptal cellulitis?

Answer 18

Orbital:
* IV abx + close monitoring

Preseptal:
* If young/systemically unwell = IV abx
* Otherwise = oral abx + outpatient review

Question 19

What is squint?

Answer 19

Aka strabismus. Misalignment of the eyes. Images on the retina do not match and the person experiences double vision. If this becomes progressively worse and disconnected from the brain this is called amblyopia.

Question 20

Define the following terms:
1. Strabismus
2. Amblyopia
3. Esotropia
4. Exotropia
5. Hypertropia
6. Hypotropia

Answer 20

1. Strabismus: the eyes are misaligned
2. Amblyopia: the affected eye becomes passive and has reduced function compared to the other dominant eye
3. Esotropia: inward positioned squint (affected eye towards the nose)
4. Exotropia: outward positioned squint (affected eye towards the ear)
5. Hypertropia: upward moving affected eye
6. Hypotropia: downward moving affected eye

Question 21

Causes of squint?

Answer 21

Hydrocephalus
Cerebral palsy
Space occupying lesions, for example retinoblastoma
Trauma

Question 22

Ix for squint?

Answer 22

• Hirschberg’s test
• Cover test
• Fundoscopy
• Visual acuity

• Hirschberg’s test: shine a pen-torch at the patient from 1 meter away. When they look at it, observe the reflection of the light source on their cornea. The reflection should be central and symmetrical.
• Cover test: cover one eye and ask the patient to focus on an object in front of them. Move the cover across to the opposite eye and watch the movement of the previously covered eye.