ENT pathology - inner ear

Question 1

Meniere’s disease

Answer 1

Disorder affecting the inner ear which is characterised by:

• Vertigo
• Fluctuating hearing loss
• Tinnitus
• Lasts minutes to hours

Associated with a feeling of fullness in the affected ear

Can get positive Romberg test

Caused by abnormal endolymph production

Question 2

Mx of Meniere’s disease

Answer 2

To confirm diagnosis - refer to ENT

Advise the person not to drive when they are dizzy, or if they might experience an episode of vertigo while driving

1st line - Betahistine

N/V - prochlorperazine

Question 3

Vestibular neuronitis

Answer 3

Inflammation of the vestibular nerve

Acute, spontaneous and prolonged vertigo

Question 4

Labyrinthitis

Answer 4

Involves inflammation of the labyrinth

Acute, spontaneous and prolonged vertigo and hearing loss

Question 5

BPPV

Answer 5

Repeated episodes of positional vertigo due to head movements

Loose calcium carbonate debris

Dix Hallpike manoevre

Epley manoevre
Brandt-Daroff exercises

Question 6

Vestibular neuronitis presentation and mx

Answer 6

Vertigo
Recent viral infection
Nystagmus - Head impulse test

Mx:
nausea or vomiting - prochlorperazine

Question 7

Romberg’s test

Answer 7

Close eyes

If unbalanced, problem with ear or brain in terms of balance.

Question 8

Sinusitis

Answer 8

Inflammation of the paranasal sinuses that completely resolves within 12 weeks

recurrent - 4+ annual episodes

Chronic - more than 12 weeks

Question 9

Causes of acute sinusitis

Answer 9

Triggered by a viral upper respiratory tract infection

Sinus mucosa oedema, obstruction of the sinus ostia, and reduction in mucociliary action allow secretions to stagnate and give bacteria a suitable environment to grow

Question 10

Acute sinusitis associations

Answer 10

Asthma
Allergic rhinitis
Smoking.
Anatomical variation - deviated nasal septum, nasal polyps, trauma
Seasonal variation
CF - impaired ciliary motility

Question 11

Presentation of acute sinusitis

Answer 11

Presence of nasal blockage or discharge

Tenderness, swelling, or redness over the cheekbone or periorbital areas which gets worse when leaning forward

Cough

Question 12

Mx of Sinusitis

Answer 12

If a person has had symptoms for 10 days or less: Do not offer an antibiotic prescription as viral

10+ days - high-dose nasal corticosteroid for 14 days or 3 months for chronic

Consider nasal irrigation with saline solution

Avoid allergic triggers
Stop smoking
Good dental hygiene

Question 13

Allergic rhinitis

Answer 13

IgE-mediated inflammatory disorder of the nose causing a release of histamine and other inflammatory mediators

Question 14

Triggers for allergic rhinitis

Answer 14

House dust mites 
Pollen 
Mould 
Animal dander 
Occupational

Question 15

Mx of allergic rhinitis

Answer 15

Allergen avoidance techniques

Mild:

• an intranasal antihistamine first-line
• non-sedating oral antihistamine - cetirizine

Moderate:
- Intranasal corticosteroid - fluticasone furoate - action after 6–8 hours after the first dose, but the maximal effect may not be seen until after two weeks

Severe: prednisolone for 5 - 10 days

Question 16

Nasal polyps

Answer 16

Lesions arising from the nasal mucosa

Presentation:
- Nasal airway obstruction
- Nasal discharge:
Watery anterior rhinorrhoea, sneezing, postnasal drainage
- Green secretions suggest infection
- Unilateral, blood-tinged secretion suggests a tumour, foreign body, nose picking, or misapplication of nasal spray.
- Dull headaches.
- Snoring and obstructive sleep symptoms.
- Hyposmia or anosmia (decreased smell) and reduced taste.
`

Question 17

Ix and mx of nasal polyps

Answer 17

Secondary care:

• Rigid or flexible endoscopy (rhinoscopy)
• Xray

Mx:

• Topical corticosteroids
• Nasal drops - fluticasone
• Antihistamine if allergic rhinitis

Question 18

Vestibular migraine

Answer 18

Intermittent vertigo - variable duration
Headache may or may not be present - at least half
Fatigue following attack
Nausea and vomiting
Phonophobia
Photophobia
Vertigo associated with head movements

Atleast 5 episodes and presence of migraines in PMHx

Question 19

Nasal septum defect mx

Answer 19

Decongestants
Antihistamines
Nasal steroid spray
Nasal strips

Surgery: septoplasty

Question 20

Mx of vestibular migraine

Answer 20

Conservative:
Avoid triggers

Pharmacological:
Triptans - when headache occurs 
Vestibular suppressant - benzodiazepines (lorazepam) 
Anti-emetic - promethazine 
Antihistamines - meclizine 

Frequent/disabling:
Antiseizure - gabapentin 
Antihypertensives - Beta blocker, CCB verapamil 
Antidepressants - amitriptyline  
CGRP inhibitors - new

Question 21

BPPV diagnosis and treatment

Answer 21

Diagnosis- Dix Hallpike manoeuvre

Treatment - Epley manoeuvre