Other ENT disorders

Question 1

What is Presbycusis?

Answer 1

Age related hearing loss- from degeneration of cochlea and inner ear structures

Question 2

What are features of Presbycusis?

Answer 2

Progressive irreversibly bilateral sensorineural hearing loss
Normally begins in older adults
Hearing loss with high frequency sound
Symptoms worse in loud areas
Difficulty hearing telephone/ using telephone

Question 3

What are causes of Presbycusis?

Answer 3

Unknown likely multifactorial
- arteriosclerosis
- diabetes
- accumulated exposure to noise
- drug exposure
- stress
- genetic

Question 4

What investigations are required for Presbycusis?

Answer 4

Otoscopy- normal
Tympanometry- normal middle ear function with hearing loss
Audiometry- bilateral SNHL
Blood tests- normal

Question 5

What is Otosclerosis?

Answer 5

Abnormal bone remodelling in the inner ear with bone replaced by vascular spongy bone

Is autosomal dominant and affects young adults
Normally strong family historyW

Question 6

What are clinical features of otosclerosis?

Answer 6

Gradually worsening conductive hearing loss- normally bilateral
Seen in ages 20-40
May have tinnitus
No pain

Majority have normal examination

Question 7

What is the management of otosclerosis?

Answer 7

Hearing aid
Stapedectomy

Question 8

What is Glomus Jugulare?

Answer 8

Rare slow growing paraganglioma that develops within the jugular foramen

Pulsatile tinnitus
Aural fullness
Hearing loss
Otoscopy- red/blue coloured mass may be seen behind TM

Question 9

What is Epistaxis?

Answer 9

Nose bleed
Most commonly occurs in Kiesselbach plexus within Little’s area on anterior nasal septum

Posterior bleed are less common- suggested by profuse bleeding from both nares, cannot identify bleed point, bleeding down throat

Question 10

What are exacerbating features of epistaxis?

Answer 10

Nose picking
Nose blowing
Trauma to the nose
Insertion of foreign bodies
Bleeding disorders
Juvenile angiofibroma
Cocaine use
Hereditary Haemorrhagic Telangiectasia

Question 11

What is the management of epistaxis?

Answer 11

First aid measures
- lean forwards and mouth open
- pinch cartilaginous area of nose firmly for at least 20mins

If ongoing bleed 10-15 mins
- nasal cautery- if bleed site obvious and is tolerated
- nasal packing-if cautery not viable/bleeding point not visualised

if ongoing bleeding/unstable- secondary measures
- electrocautery
- formal packing
- arterial embolisation