ENT

Most common cause of conductive hearing loss in childhood is: GLUE EAR/ OTTITIS MEDIA WITH
EFFUSION. Bluish grey retracted or bulging tympanic membrane, ear pain is rare, parental
smoking is a R/F, audiogram show conductive hearing loss, reassure and review after 3 months,
surgery grommet insertion, hearing aids

ACUTE OTTITIS MEDIA: usually preceding viral URTI, red, erythematous or cloudy bulging
tympanic membrane, absence of cone reflex or light reflex not visible rapid onset of ear pain,
fever, bacterial [s.oneumonia] or viral [conservative treatment, PCM, analgesics] , Amoxicillin 5
days course. erythro or clarithromycin.

Malignant otitis externa: in diabetes or immunocompromised patients, severe ear pain,

headaches, conductive hearing loss, foul smelling discharge, cranial nerve involvement [7,1 CN],
IV antibiotics. Acute otitis externa: itch first then ear pain, discharge, bacterial, hearing
diminished, topical gentamycin + hydrocortisone, oral flucloxacillin if infection spreading.

Tonsillar CA: SCC [70%] Lymphomas, smoking, plummer vinson syndrome [R/F]

Laryngeal CA: last resort: chemoradiation + larynx preservation, cordectomy, initial advice s/b to
avoid smoking [major R/F], HPV 16

NASOPHARYNGEAL CA; EBV, smoking & Alcohol [R/F], SCC

Lipoma: soft, mobile, round and painless mass within dermal layer of the skin. Epidermoid cyst:
firm, round nodules of various sizes with a central punctum, cutaneous cyst results from
proliferation of epidermal cells within a circumscribed pace of dermis. Cystic hygroma:
transilluminates. Branchial cleft cyst: do not transilluminate

Conductive hearing loss Sensorineural hearing loss

Glue ear/OTTITIS MEDIA WITH EFFUSION Labyrinthitis viral

[childhood], chronic otitis media
Malignant otitis externa
Cholesteatoma [progressive deafness]
Otosclerosis [progressive] flamingo tinge TM
due to hyperemia
Presbycusis [age-related] progressive bilateral
high frequency hearing loss
Meniere’s d/s low frequency hearing loss
Vestibular schwannoma high frequency
hearing loss [acoustic neuroma] MRI
Noise induced hearing loss high frequency
hearing los
Stensens duct drains the parotid gland. Whartons duct drains the submandibular glands. Stones
are common in submandibular glands.

Parotid gland: most tumors; submandibular gland: most stones

Viral sinusitis: no fever and clear nasal discharge. Bacterial sinusitis: fever present and nasal
discharge can be colored

Allergic rhinitis: for mild to moderate cases oral or intra-nasal antihistamines can be used; for
moderate to severe cases intranasal corticosteroids can be used. Topical decongestants should
not be used for more than a week as they may cause rebound congestion [rhinitis
medicamentosa] on withdrawal, also tachyphylaxis.

Nasal polyps: if small and bilateral not causing severe nasal obstruction managed with saline
nasal douche and intranasal steroids. If unilateral, large polyps causing obstruction or bleeding
present refer to ENT or nasal endoscopy.

Abscess will usually present with fever and general malaise.

Pure tone audiometry or MRI: to investigate Sensorineural type of hearing loss

Otoscopy for examination of external auditory canal, tympanic membrane, and the middle ear.

CT scan FOR HEAD INJURIES AND CSF RHINORRHEA

Auditory brainstem response (ABR) is a test that can help to identify

neural or brainstem abnormalities in the auditory pathway, such as an
acoustic neuroma. However, it is not the first-line test for a simple
sensorineural hearing loss and would not typically be used unless
there was a concern for a central cause of the patient's hearing loss.

Pure-tone audiometry is the initial test of choice for assessing

sensorineural hearing loss. It is a subjective test that measures the
softest sound an individual can hear at various frequencies. This test
provides an audiogram, which is a graphical representation of the
auditory threshold as a function of frequency. The test can distinguish
between conductive and sensorineural hearing loss and can quantify
the degree of hearing loss. This test is preferred over other options
because it directly assesses the patient's perception of sound across
a range of frequencies and can differentiate between types of hearing
loss.
Tympanometry is typically used to assess the function of the middle
ear, looking for evidence of fluid, wax, or perforation of the tympanic
membrane that might be causing conductive hearing loss, which does
not fit with this patient's presentation.

Otoacoustic emissions (OAE) are sounds produced by the inner ear

that can be measured with a sensitive microphone placed in the ear
canal. This test can provide objective evidence of damage to the
cochlea, particularly to the outer hair cells, but does not directly
assess a patient's hearing.