More ENT review

Question 1

Sinus Barotrauma

what sinus is most commonly affected?

Answer 1

Frontal sinus is most commonly affected

*Just like the ear, sinus barotrauma usually occurs on descent

Question 2

Sinus Barotrauma

Aeromedical disposition for isolated episode

Answer 2

Isolated episodes of sinus barotrauma are NCD (you can fly once symptoms resolve)

*imaging immediately after an episode is not indicated and may not be required in mild cases. If severe, CT w/o contrast can be obtained 2 weeks after episode

Question 3

Sinus Barotrauma

Aeromedical disposition for recurrent episodes

Treatment?

Answer 3

Patients with recurrent sinus barotrauma should be placed in a down status and request an ENT consult

Sinus surgery (FESS) is a highly effective treatment for recurrent sinus barotrauma

Question 4

Conditions leading to reoccurring vertigo carry significan safety-of-flight concerns and are CD

Answer 4

Look at page 27 of the study guide

Question 5

BPPV

S/S:

Dispo

Tx

Answer 5

BPPV

1. vertigo in BPPV is positional and caused by pitch-plane movements
2. Diagnose with Dix-Halpike maneuver
   
   1. remember: there will be a delayed onset of nystagmu
3. Tx: Epley or other repositioning maneuvers
   
   1. DO NOT PRESCRIBE VESTIBULAR SUPPRESSANTS OR ANY MEDICATIONS FOR BPPV
4. DISPO:
   
   1. CD with waiver required after successful treatment and patient is asymptomatic for at least 4 weeks (depending on the platform and occupation)

Question 6

Vestibular neuronitis/labrinthitis

S/S

Answer 6

Usually preceded by URI

Vertigo (severe and lasting hours to days) followed by days toweeks of instability and/or imbalance

Labryhthitis involves vertigo and sensorineural hearing loss (no hearing loss in vestibular neuronitis)

Question 7

Vestibular neuronitis/labrinthitis

Treatment

Dispo

Answer 7

1. Treatment
   
   1. treat acutely with oral steroids, vestibular suppressants, and antiemetics
   2. once recovering, avoid vestibular suppressants to allow for faster central compensation
2. Dispo:
   
   1. CD and waiver are required if not recovered by 4 weeks

Question 8

What is the most common cause of vertigo?

Answer 8

Vestibular migraine is (probably) the most common cause of vertigo

Question 9

What is the aeromedical disposition for vestibular migraines

Answer 9

migraines are CD for all flight classes and service groups

Question 10

What is meniere’s triad?

Answer 10

Meniere’s triad

recurrent vertigo episodes (lasting minutes to hours)

low-frequency sensorineural hearing loss and tinnitus

fullness

Question 11

Meniere’s Disease

Management

Dispo

Answer 11

Meniere’s Disease

1. management
   
   1. URGENT ENT and audiology eval
      
      1. exactly the same as labyrinthitis or sudden sensorineural loss
2. Dispo:
   
   1. CD