OSCE cases (not covered in other topics)

Question 1

What is microtia?

Answer 1

Deformity of the external ear

Question 2

What grading system is used for microtia?

Answer 2

Marx or nagata

Question 3

Risk factors of microtia

Answer 3

Non-syndromic vs syndromic

1. Teratogens:
   - mycofenolate
   - isotretinoin
   - thalidomide
   - Alcohol
   - Colchicine
2. Folate deficiency
3. Genetic + associated syndromes
   - Goldenhar
   - Digeorge
   - Branchiootorenal
   - Treacher Collins
   - Nager

Question 4

Management for microtia

Answer 4

Hearing rehabilitation
- BAHA (if internal ear is normal)
- Atresiaplasty

Cosmesis
- Prosthesis
- Autologous reconstruction with rib graft or medpor

Question 5

If blue TM seen in otoscope, DDX is?

Answer 5

Haemotympanum

Question 6

Associated injuries causing haemotypanum

Answer 6

Temporal bone fracture
Intracranial hemorrhage
Facial palsy
CSF leak
Carotid artery injury
EAC laceration

Question 7

What hearing loss is expected in haemotympanum?

Answer 7

Conductive hearing loss

Question 8

Ix + Management for haemotympanum

Answer 8

CT temporal bone
Await spontaneous resolution
Rule out facial palsy
Repeat audiogram 3 month

Question 9

Patient’s PTA indicates asymmetrical SNHL, what investigation should be done next?

Answer 9

MRI Internal Acoustic Meatus

Question 10

Ddx for space occupying lesions causing asymmetrical SNHL

Answer 10

CPA mass
Vestibular schwannoma
Meningioma
Mets

Question 11

Management options for CPA mass

Answer 11

Observe
RT
Surgery

Question 12

Complications of CPA mass if left untreated

Answer 12

Mass effect: cerebellar and 4th ventricle compression, headache and seizures

Facial palsy, facial numbness, SNHL, tinnitus, disequilibrium

Bleeding into tumor