ENT - Overview

• Study notes summarizing ear diseases, their symptoms, and treatments.

Otitis Externa

• Inflammation/infection of the external auditory canal (pinna ± canal).
• Causes: Bacterial (Pseudomonas, Staph. aureus), fungal (Aspergillus, Candida), mechanical irritation (earbuds), skin conditions.
• Treatment: Topical antibiotic ± steroid ear drops; antifungal drops if fungal cause; avoid further trauma/moisture.
• Prevention: Keep ears dry, avoid aggressive cleaning or foreign objects in the canal.
• Symptoms: Not specified in text

Necrotising (Malignant) Otitis Externa

• Severe, invasive form of external ear infection that can spread to bone; more common in immunocompromised, elderly diabetics.
• Causes: Often Pseudomonas aeruginosa.
• Treatment: Aggressive IV antibiotics (e.g., anti-pseudomonal) ± surgical debridement.
• Prevention: Early treatment of external ear infections, good diabetic control.
• Symptoms: Not specified in text

Auricular Haematoma → Cauliflower Ear

• Bleeding between cartilage and skin on the external ear, leading to cartilage destruction and a deformed shape if untreated.
• Causes: Trauma (sports injuries).
• Treatment: Prompt drainage; compression dressing to prevent re-accumulation.
• Prevention: Protective headgear; timely drainage of any haematoma.
• Symptoms: Not specified in text

Keloid

• Overgrowth of scar tissue beyond wound edges.
• Causes: Exaggerated fibroblast response; more common in darker skin types, or after ear piercing/surgery.
• Treatment: Steroid injections, pressure therapy, surgical excision (risk of recurrence).
• Prevention: Minimise trauma, careful surgical technique if prone to keloids.
• Symptoms: Not specified in text

Basal Cell Carcinoma (Ear)

• A slow-growing malignancy from basal cells; can ulcerate and erode locally.
• Causes: UV light exposure (sun-exposed helix).
• Treatment: Surgical excision, possibly Mohs micrographic surgery on ear.
• Prevention: Sun protection, early detection.
• Symptoms: Ulcerations that erode locally

Squamous Cell Carcinoma (Ear)

• A potentially aggressive malignancy from squamous epithelium of the external ear or helix.
• Causes: UV exposure, chronic irritation.
• Treatment: Surgical excision ± radiotherapy if invasive.
• Prevention: Avoid excessive sun, early biopsy of suspicious lesions.
• Symptoms: Not specified in text

Acute Suppurative Otitis Media

• Infection of the middle ear with pus behind the tympanic membrane, typically in children.
• Causes: Often bacterial (S. pneumoniae, H. influenzae) or preceded by viral URTI.
• Treatment: Analgesics (paracetamol), antibiotics (if severe), possible myringotomy for drainage.
• Prevention: Manage URTIs early, pneumococcal vaccination in children.
• Symptoms: Not specified in text

Otitis Media with Effusion (“Glue Ear”)

• Non-purulent fluid in the middle ear → conductive hearing loss, common in under 5s.
• Causes: Eustachian tube dysfunction, repeated infections, allergies.
• Treatment: Watchful waiting; nasal decongestants or grommet insertion if persistent.
• Prevention: Managing allergic rhinitis, reducing repeated middle ear infections.
• Symptoms: Conductive hearing loss

Cholesteatoma

• Abnormal growth of keratinising epithelium in the middle ear, expanding and eroding bone.
• Causes: Chronic negative middle ear pressure ± eustachian tube dysfunction.
• Treatment: Surgical removal to prevent serious complications (bone erosion, intracranial spread).
• Prevention: Early treatment of chronic ear disease, monitoring retraction pockets.
• Symptoms: Not specified in text

Mastoiditis

• Infection of the mastoid air cells, typically after severe/untreated otitis media.
• Causes: Spread of middle ear infection into mastoid bone.
• Treatment: IV antibiotics, mastoid drainage if abscess forms.
• Prevention: Adequate treatment of acute otitis media.
• Symptoms: Not specified in text

Tympanosclerosis

• Scar tissue/calcification on the tympanic membrane or middle ear structures post-infection or trauma.
• Causes: Healing changes from chronic ear infections, ventilation tube use.
• Treatment: Usually, no intervention unless ossicular chain is affected → hearing loss (surgery).
• Prevention: Reduce recurrent infections, grommet care.
• Symptoms: Not specified in text

Otosclerosis

• Bony overgrowth around the stapes footplate in the middle ear, causing progressive conductive hearing loss.
• Causes: Genetic predisposition.
• Treatment: Hearing aids, stapedectomy with prosthesis if severe.
• Prevention: None known specifically; early audiology assessment.
• Symptoms: Progressive conductive hearing loss.

Acoustic Neuroma (Vestibular Schwannoma)

• A benign tumour of CN VIII (vestibulocochlear nerve) can compress structures as it grows.
• Causes: Typically sporadic, some genetic (Neurofibromatosis type 2).
• Treatment: Observation (small tumours), surgery, radiosurgery (Gamma Knife).
• Prevention: No specific preventive measure; MRI if unilateral hearing loss suspected.
• Symptoms: Not specified in text

Meniere’s Disease

• An inner ear disorder causing episodic vertigo, tinnitus, fluctuating hearing loss, and aural fullness.
• Causes: Endolymphatic fluid volume dysregulation in the labyrinth.
• Treatment: Lifestyle changes (low salt), diuretics, vestibular sedatives; surgery if severe.
• Prevention: Not definitively preventable; trigger avoidance (salt, caffeine).
• Symptoms: Episodic vertigo, tinnitus, fluctuating hearing loss, and aural fullness.

Vestibular Neuronitis

• Inflammation (often viral) of the vestibular nerve → acute vertigo, no hearing loss.
• Causes: Viral infection or post-viral inflammation.
• Treatment: Vestibular sedatives (short term), physiotherapy for balance.
• Prevention: None specific; general health measures.
• Symptoms: Acute vertigo, no hearing loss

Benign Paroxysmal Positional Vertigo (BPPV)

• Brief vertigo episodes caused by otoliths in semicircular canals triggered by head movement.
• Causes: Displacement of otoconia from the utricle into the canals.
• Treatment: Epley manoeuvre or other repositioning techniques.
• Prevention: No absolute prevention; avoid precipitants once known.
• Symptoms: Brief vertigo episodes caused by head movement

Hoarseness (Symptom)

• An abnormal change in voice quality due to laryngeal involvement.
• Causes: Vocal cord polyps/nodules, chronic laryngitis, nerve palsy, tumour.
• Treatment: Depends on cause—voice rest, ENT referral if persistent (>2 weeks).
• Prevention: Avoid vocal abuse, smoking cessation.
• Symptoms: An abnormal change in voice quality

Sore Throat & Dysphagia (Symptom)

• Throat pain & difficulty swallowing; can be mild infection or something serious.
• Causes: Viral/bacterial infections, tonsillitis, malignancy if persistent/unilateral.
• Treatment: Treat infection if present, urgent referral if red flags (weight loss, unilateral pain, neck mass).
• Prevention: Good oral hygiene, prompt treatment of infections, watch for alarming signs.
• Symptoms: Throat pain & difficulty swallowing.

Lump in the Throat

• A sensation or actual mass that can be benign (anxiety, reflux) or malignant (thyroid, pharyngeal).
• Causes: Anxiety “globus,” reflux, tumour if progressive.
• Treatment: Investigate suspicious lumps, imaging, endoscopy, treat underlying cause.
• Prevention: Regular check-ups, address reflux, early referral for suspicious lumps.
• Symptoms: A sensation or actual mass in the throat

List of Drugs Mentioned: Usage & Mechanism (Brief)

• Gentamicin-Steroid Ear Drops
  • Use: Treatment of acute otitis externa (bacterial).
  • Mechanism: Gentamicin is an aminoglycoside antibiotic (inhibits bacterial protein synthesis); steroid reduces inflammation.
• Antifungal Ear Drops (not a specific brand given)
  • Use: For fungal otitis externa (e.g., caused by Aspergillus).
  • Mechanism: Typically alter fungal cell membrane (e.g., clotrimazole or miconazole derivatives).
• Paracetamol (Calpol)
  • Use: Analgesic/antipyretic to reduce pain and fever (e.g., in acute suppurative otitis media).
  • Mechanism: Inhibits prostaglandin synthesis centrally, reducing pain/fever.
• Antibiotics (general mention)
  • Use: For bacterial ear infections (e.g., acute otitis media, mastoiditis). Often amoxicillin or broad-spectrum penicillins.
  • Mechanism: Depends on antibiotic type—common are beta-lactams that inhibit cell-wall synthesis, or macrolides, etc.
• Decongestants (general mention)
  • Use: Otitis media with effusion or nasal congestion that can affect Eustachian tube function.
  • Mechanism: Vasoconstriction of nasal vessels, improving Eustachian tube aeration.

Tools Used: Usage & Mechanism (Brief)

• Tuning Fork Tests (Rinne & Weber)
  • What they’re used for: Basic clinical assessment to distinguish between conductive and sensorineural hearing loss.
  • Mechanism
    • Rinne: Compares air conduction (AC) vs bone conduction (BC).
    • Weber: Sound localizes to one ear (lateralization) in unilateral hearing loss.
• Pure Tone Audiometry (PTA)
  • What it’s used for: Quantitative measurement of hearing thresholds across different frequencies.
  • Mechanism: Patient in soundproof booth indicates when they hear beeps at varying intensities/pitches (air and bone conduction).
• Electric Response Audiometry (ERA)
  • What it’s used for: Objective test of hearing (brainstem or cortical evoked responses), useful if patient can’t cooperate (e.g., children).
  • Mechanism: Measures the auditory evoked potentials via electrodes, eliminating patient subjectivity.
• Myringotomy + Grommets
  • What they’re used for: Draining fluid in Otitis Media with Effusion (“glue ear”) and placing ventilation tubes.
  • Mechanism: A small incision in the tympanic membrane allows fluid drainage; a grommet is inserted to equalize middle-ear pressure.
• Gentamicin + Steroid Ear Drops
  • What they’re used for: Topical treatment of Otitis Externa (particularly bacterial or severe inflammation).
  • Mechanism: Gentamicin is an aminoglycoside antibiotic; steroid reduces inflammation in the ear canal.
• Cholesteatoma Surgery
  • What it’s used for: Removing the destructive collection of keratinizing squamous epithelium in the middle ear.
  • Mechanism: Mastoid surgery or tympanoplasty to excise the cholesteatoma and reconstruct ear structures.
• Gamma Knife (Acoustic Neuroma)
  • What it’s used for: Focused radiation therapy for small acoustic neuromas (vestibular schwannomas).
  • Mechanism: High-dose, precisely targeted radiation arrests tumour growth with minimal damage to adjacent tissues.