Minimal ENT

Question 1

Differential of acoustic neuroma?

Answer 1

Meningioma

Question 2

Which MEN syndrome is associated with acoustic neuroma?

Answer 2

Neurofibromatosis Type 2

Bilateral schwannoma

Question 3

Tests for determining cause of vertigo?

Answer 3

EHx: CNS, cerebellar function, gait, Rhomberg’s test, Unterberger’s (march on spot with arms out, +ve if moving 45 degrees round by 50 steps)

Audiometry, electronystagmography
Calorimetry (water in ear canal to induce nystagmus)
CT/MRI

Question 4

Rx for Méniére’s disease?

Answer 4

Medical:
Betahistine
Prochlorperazine for vomiting

Surgical:
Endolymphatic shunts

Question 5

What is acute vestibular failure and how does it present?

Answer 5

Occurs after a febrile illness, vertigo and vomiting are exacerbated by head movement
Lasts >30 hours

Rx: cyclizine, recovers within 3 weeks

Question 6

What happens in the Hallpike test and Epley manoeuvre?

Answer 6

For benign positional vertigo:

Hallpike test- turn head to one side and rapidly lower 30 degrees below couch back
+ve if vertigo and rotatory nystagmus towards the underside ear
Cetral cause if
no 5 second latency before nystagmus onset
no vertigo reported
nystagmus does not fatigue

Epley- drop head down + turn to one side, turn head to other side, turn head to face down, sit up

Question 7

Definition of rhinosinusitis:

Answer 7

Inflammation of nose + paranasal sinuses with nasal congestion or discharge and one of:
Facial pain or pressure
Reduced smell
Endoscopic signs of polyps or mucus
Pus discharging from sinuses
CT showing mucosal changes in sinuses

Question 8

Management of allergic rhinosinusitis:

Answer 8

Medical: antihistamines, steroid nasal drops (< 1month), decongestants

Nasal steroid + leukotriene agent if asthmatic

Sublingual immunotherapy: grass allergen tablets

Question 9

Drugs which may cause nasal congestion or rhinitis?

Answer 9

Congestion- topical vasoconstrictors, tricyclics

Rhinitus- the Pill, b-blockers, NSAIDs

Question 10

What do polyps show on histology:

Answer 10

Ciliated columnar epithelium with a thickened basement membrane and oedematous stroma
90% are eosinophilic

Question 11

Aspects of management for epistaxis:

Answer 11

1. DRABC
2. Labial pressure + leaning forward
3. Ice + decongestant- ephedrine 0.5%
4. Anaesthetic + silver nitrate cautery
5. Anterior nasal pack if continues
6. If bleeding continues or can’t see bleeding point > refer to ENT, postnasal pack (Foley catheter + water)
7. Endoscopic ligation of sphenopalatine artery or maxillary artery

Question 12

Definition of sudden sensorineural hearing loss:

Answer 12

Loss of 30dB in 3 pure tone frequencies in under 72 hours

Question 13

What is otosclerosis?

Answer 13

Autosomal dominant condition with incomplete penetrance, vascular spongy bone replaces lamellar bone around the oval window (which fixes the stapes footplate)

Question 14

Symptoms associated with an acoustic neuroma?

Answer 14

CN V- ipsilateral numbness, loss of corneal reflex and jaw jerk
CN VII- unilateral motor weakness
CN VIII- unilateral sensorineural hearing loss + tinnitus

MRI needed