ENT PassMedicine

Question 1

Who should be referred in ENT to be seen within 24 hours?

Answer 1

Sudden onset (over 3 days or less) unilateral or bilateral hearing loss which has occurred within the past 30 days and cannot be explained by external or middle ear causes.

Unilateral hearing loss associated with focal neurology
(such as altered sensation or facial droop).

Hearing loss associated with head or neck injury.

Hearing loss associated with severe infection such as necrotising otitis externa or Ramsay Hunt syndrome.

Question 2

What is the biggest risk factor for malignant otitis externa?

Answer 2

Diabetes

Also immunosuppression is a risk factor

Question 3

What are the findings on otoscopy in acute otitis media?

Answer 3

bulging tympanic membrane → loss of light reflex

opacification or erythema of the tympanic membrane

perforation with purulent otorrhoea

decreased mobility if using a pneumatic otoscope

Question 4

When should antibiotics be prescribed immediately for acute otitis media?

Answer 4

Symptoms lasting more than 4 days or not improving

Systemically unwell but not requiring admission

Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease

Younger than 2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal

Question 5

What are nasal polyps associated with?

Answer 5

Chronic rhinitis or sinusitis
Asthma
Samter’s triad (nasal polyps, asthma and aspirin intolerance/allergy)
Cystic fibrosis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Question 6

When are antibiotics given in paranasal sinusitis?

Answer 6

oral antibiotics are not normally required but may be given for severe presentations.
The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection

Question 7

What type of hearing loss can ototoxic medications cause?

Answer 7

Sensorineural hearing loss

Question 8

What is the first line treatment for otitis externa?

Answer 8

Topical antibiotics, with or without steroid drops e.g. ciprofloxacin and dexamethasone