Red flags for ENT

Question 1

Red flags for nasopharyngeal carcinoma?

Answer 1

Chinese ethnicity
Male
EBV infection
High salt intake, cured meats, certain fish (in Asia)
FHx
Smoker, alcohol

Question 2

Red flag ear symptoms?

Answer 2

• Persistent unilateral hearing loss
• Sudden hearing loss
• otalgia >4 weeks
• Facial nerve palsy
• Unilateral tinnitus
• Pulsatile tinnitus
• Discharge from the ear (esp in immunocomp. indiv = malignant otitis externalities)
  Non-healing ulcer

Question 3

What are the 5T’s for referred otalgia?

Answer 3

Throat
Tongue
Tonsils
TMJ
Teeth

Question 4

Red flag = unilateral hearing loss. What are you worried about?

Answer 4

Nasopharyngeal cancer
Vestibular schwannoma

Question 5

Red flag = sudden hearing loss. What are you worried about?

Answer 5

Ramsay-Hunt syndrome
CPA lesion (cerebellopontine angle)

Question 6

Red flag = pulsatile or unilateral tinnitus. What are you worried about?

Answer 6

Unilateral: CPA lesion
Pulsatile: Vascular lesion

Question 7

Red flag symptoms for nose?

Answer 7

• Blood stained mucous
• Facial pain - especially unilateral, progressively worse, or persistent
• Sinusitis in immunocompromised pts
• CSF leak
• unilateral polyps
• orbital signs - watering of eye
• Anosmia
• epistaxis: recurrent, persistant
• non-healing ulcer

Question 8

Red flags for throat?

Answer 8

• Dysphonia -hoarse voice 3+ weeks
• Dysphagia - difficulty swallowing e.g. choking.
• Odyonphagia - painful swallowing
• White or red lesions in mouth or oropharynx
• Unexplained persistent sore/painful throat
• non-healing ulcers
• any persistent growing lump
• stridor

Question 9

Red flag = dysphagia. What are you worried about?

Answer 9

Malignancy until proven otherwise!!
- SCC
- Adenocarcinoma

Ddx = achlasia, pouch, stricture