Other ENT

Question 1

Otitis externa

Answer 1

• inflammation of skin of external ear canal (bacterial, fungal, dermatitis)
• Pseudomonas aeruginosa and Staphylococcus aureus
• ear pain, discharge, itching, conductive hearing loss
• erythema, swelling, tenderness, discharge, pus, lymphadenopathy
• mild - treat with acetic acid 2% - OTC
• moderate - topical antibiotic + steroid
• Neomycin and betamethasone, Gentamicin and hydrocortisone
• exclude perforation before gentamicin
• ear wick with topical treatment
• if malignant - admit, IV abx, CT/MRI head

Question 2

Benign paroxysmal positional vertigo

Answer 2

• head movements trigger up to 60 seconds of vertigo, no hearing loss
• calcium carbonate crystals in semi-circular canals disrupt endolymph
• Dix-Hallpike for diagnosis, Epley manoeuvre for treatment

Question 3

Vestibular neuronitis

Answer 3

• inflammation of the vestibular nerve
• distorts signals from vestibular nerve, causing vertigo
• may have N&V, balance problems but no hearing loss
• head impulse test - eyes saccade
• manage with prochlorperazine and antihistamines (short-term), refer for vestibular rehab (if chronic)

Question 4

Labyrinthitis

Answer 4

• inflammation of the bony labyrinth
• presents with acute onset vertigo, hearing loss, tinnitus
• usually due to URTI
• head impulse test as peripheral cause
• manage with prochlorperazine and antihistamines (short-term), antibiotics if bacterial

Question 5

Meniere’s disease

Answer 5

• build-up of endolymph in labyrinth
• above 40, unilateral vertigo, hearing loss and tinnitus (+ aural fullness)
• vertigo intermittent, sensorineural hearing loss and tinnitus increase
• refer to ENT if suspected
• manage with prochlorperazine and antihistamines (acute)
• prophylaxis with betahistine

Question 6

Acoustic neuroma

Answer 6

• benign tumour of Schwann cells surrounding auditory nerve
• above 40, unilateral sensorineural hearing loss, tinnitus, dizziness, fullness
• may have facial nerve palsy + forehead
• do audiometry, MRI > CT
• conservative + monitor if no symptoms; surgery for removal; radiotherapy reduces growth
• surgery can cause vestibulocochlear or facial nerve injury