Rhinology and otology cased based discussion Flashcards
A 25 year old woman presents with a two week history of pain and discharge from her ear. The most appropriate treatment would be:
A. systemic antibiotics
B. topical antibiotics
C. syringing
D. myringoplasty
Answer = B, always start with topical antibiotics in short term infections.
Myringoplasty is the closure of the perforation of pars tensa of the tympanic membrane, and perforation is not indicated from history. Ear syringing is used to remove earwax
What is a myringoplasty??
Myringoplasty is the closure of the perforation of pars tensa of the tympanic membrane
A 30 year old man presents with a 3 year history of intermittent, offensive discharge from the right ear. The most appropriate treatment would be:
a. systemic antibiotics
b. topical antibiotics
c. myringoplasty
d. mastoidectomy
Answer = D. History typical of chronic suppurative otitis media, which can often affect the mastoid
A 5 year old girl is brought to clinic by her parents who are concerned about her hearing. An audiogram shows a conductive hearing loss around 25dB
bilaterally. The most appropriate treatment would be:
a. nasal decongestant
b. systemic antibiotics
c. grommet insertion
d. review in 3 months
Answer = D. Grommet can be inserted if persistent though usually wait and review as it can heal by itself
A 60 year old man presents with a 5 year history of bilateral tinnitus. The most appropriate treatment would be:
a. systemic steroids
b. cochlear nerve section
c. ear plugs
d. hearing aids
Answer = D
A 60 year old man presents with a 5 year history of episodes of vertigo associated with hearing loss, tinnitus and pressure in the right ear. The most appropriate treatment would be:
a. betahistine
b. vestibular rehabilitation
c. propranolol
d. Epley manoevre
Answer: Betahistine, only drug on list for Menieres disease
A 25 year old man presents with left sided nasal obstruction following a nasal injury 3 months ago. The most appropriate management would be:
a. manipulation under anaesthesia
b. septoplasty
c. septorhinoplasty
d. CT scan of sinuses
Answer: C. Too late for manipulation under anaesthesia (usually within a couple of days of injury
A 30 year old woman presents with episodes of severe pain above the left eye, associated with photophobia and visual disturbance and not improved by a nasal steroid spray. The most appropriate management would be:
a. oral steroids
b. amitriptiline
c. CT scan of sinuses
d. endoscopic sinus surgery
Answer = B. History is typical of migraines, amitriptyline is only therapy for migraine prevention while others are aimed at inflammatory conditions or sinusitis.
A 25 year old man presents with nasal obstruction. No response to maximal medical treatment. Otology shows enlarged smooth lump in nose of the same appearance as normal mucosa in colour and texture. The most appropriate management would be:
a. nasal polypectomy
b. septoplasty
c. reduction of inferior turbinates
d. endoscopic sinus surgery
Answer = C. Inferior turbinate was enlarged, it is not a polyp as they appear more granular and not as smooth.
A 25 year old man presents with nasal obstruction. No response to maximal medical treatment. Otology shows a lump in the nose with a bumpy appearance. The most appropriate management would be:
a. nasal polypectomy
b. septoplasty
c. reduction of inferior turbinates
d. endoscopic sinus surgery
Answer = A. Appears like there is polyps in the nose rather than inflamed turbinates, so a polypectomy would be carried out
A 5 year old girl presents with a 2 month history of an offensive discharge from the left nostril. Uncooperative with examination. The most appropriate management would be:
a. examination under anaesthesia
b. systemic antibiotics
c. nasal steroid spray
d. CT of sinuses
Answer = A. Cardinal signs of foreign body are pain, redness and unilateral discharge (or discharge from orifice affected), and foreign bodies are common in young children.
