Otoscopy

Question 1

Describe examination in ENT sore ear assessment

Answer 1

Observe pinna and mastoid for redness and swelling

observe and palpate mastoid

Otoscopy (start with good ear)
-look at external auditory meatus for redness, flaking, wax and erythema

-observe the tympanic membrane. looking for erythema, bulging, retraction, perforation, pus, fluid level, build up of flaky skin etc

Question 2

Describe gross hearing assessment

Answer 2

check patient can hear you

assess gross hearing by masking other ear and whispering 3 numbers (both ears)

preform rinnes and webers

look inside the ears

Question 3

Typical findings in cholesteatoma

and management

Answer 3

age- 10-20

pathophysiology- build up of squamous cells which can invade local structures

presentation- hearing loss and foul smelling discharge

type of hearing loss- conductive

seen on otoscopy- attic crust

management- refferal to ENT for consideration of surgical removal

complications- facial nerve palsies and vertigo

Question 4

typical findings in acute otitis media

Answer 4

bulging red or yellow membrane. may be cloudy

Question 5

typical findings in otitis media with effusion

Answer 5

conductive hearing loss

retracted mebrane with fluid behind the TM

Question 6

management for acute otitis media

Answer 6

usually self resolving. antibiotics shorten course of illness by less than 1 day on average

give amox or claryth in those who are systemically unwell or if otorrhoea is present

Question 7

management for otitis media with effusion

Answer 7

most self resolve

when to refer to ENT for grommets?

is school/development being affected?

Question 8

Sinusitis presentation and management

Question 9

Tonsillitis management

Answer 9

depends on feverPAIN score
if feverPAIn 4 or more, antibiotics

if 2-3, consider delayed rpescription

Question 10

tonsillitis examination

Answer 10

mouth- tounge depressor, neck lymph nodes

Question 11

Describe feverPAIN criteria and points for each

Answer 11

Fever 1 point
Pus 1 point
Attends within 3 days 1 point
Inflamed tonsils 1 point
No cough/cold 1 point

4 or more give abx
2-3 consider delayed script

Question 12

Otitis externa presentation

Answer 12

external auditory canal swollen, erythematous, tender, debris might be present

Question 13

Otitis externa management

Answer 13

ear care (dont get wet)

ear calm

sofradex/otomize

Question 14

Otitis externa management

Answer 14

most are conservative

-tympanometry
-pure tone audiometry

ask about smoking in house, cleft defects and development in school

if hearing not resolved by 3 months, refer to ENT

Question 15

Key anatomical landmarks to look for in otoscopy

Answer 15

lateral process of malleus
cone of light
pars densa and flaccida
attic