Disease Key features treatment

Tonsillitis FBC, Paul Bunnel, LFT Broad spectrum

Analgesia +/- Steroid bolus
– Analgesia, antipyretics,
rehydration, rest
– Antibiotics if bacterial
• Amoxicillin +/- clavulanic
aciD
Quinsy= • Pus collection between tonsillar Tx: antibiotics +steroids
Peritonsillar abscess capsule and the superior constrictor • Admit, intravenous antibiotics and
muscle drainage of the abscess

Epiglottis- – Fever ANTIBIOTIC

– Recent URTI
– Sitting forwards, drooling
– Sore throat
– Plummy voice
– Dysphagia
– Rapid resolution
– Position / Sitting
GLANDULAR FEVER – Acute sore throat and fever
– Cervical lymphadenopathy
– Grossly enlarged tonsils with grey slough
– Rash with ampicillin
Stridor Inspiratory : supraglottis and glottis Oxygen
Biphasic : subglottis Adrenaline Nebulisers
Expiratory : trachea and bronchi Heliox
Steroids
Antibiotics
Nasal Fracture Rule out Septal Haematoma Analgesia
(URGENT) Exclude other max-fax fractures
Exclude CSF rhinorrhoea
Epistaxis Post bleeds are more severe RESUSCITATE
Risk factors : URTIs, digital trauma o FBC, G&X match, Plts
Anterior bleedLittle’s o BP, IV Line
area(sphenopalatine) o (Cautery)
o Nasal Packing
Middle Ear: ET 1. Tympanic membrane retraction
Dysfunction 2. Acute otitis media
3. Otitis media with effusion (glue ear)
4. Chronic suppurative otitis media
5. Cholesteatoma
Foreign Body in one attempt at removal only.
Nose Do not use forceps for round objects
Urgent ENT referral
PROMINENT EARS • Pinnaplasty/Otoplasty
Orbital Cellulitis Assess with chandlers criteria 1. Systemic antibiotics
2. Decongestants
3. Analgesia
Acute Otitis Media Discharge, pain, hearing loss, 1. Systemic antibiotics
2. Decongestants
• S. pneumonia, H. 3. Analgesia
influenza,
• Marecella. catarrhalis • 1st line: amoxicillin 80-90mg/kg/day
• 2nd line (worsening symptoms after 2-3
days): co-amoxiclav
• PCN allergy: clarithromycin, erythromycin

• Surgical:
– for recurrent acute otitis media,
consider grommet placement
• 3 or more in 6 months
• 4 or more in 12 months
Acute Otitis Media : – Tympanosclerosis 4.
Complications – TM perforation
– Hearing Loss
– Mastoiditis & subperiosteal
abscess
– Facial nerve paralysis 1%
– Petrositis (Gradenigo’s
syndrome)
– Labyrinthitis
– Meningitis
– Extradural abscess
– Subdural abscess
– Brain abscess
Mastoiditis • Empyema in mastoid, sub-periostial • Dx: Contrasted CT of temporal
abscess bone may indicate abscess
• Fluid in the mastoid • Initially IV antibiotics, then
bone air cells possible mastoidectomy and
becomes infected and grommet
invades bony •
structures – IV antibiotics, mastoidectomy, grommet

Fever, ear pain, protruding pinna

Erythema of skin, tenderness
Otitis Media with • Commonest cause of hearing loss in • Antibiotics are not indicated
Effusion (Glue ear)] children Conservative
• : dull TM, fluid level, immobile • Hearing aid
Retracted and dull • Down Syndrome, cleft palate
tympanic Medical
membrane • Auto inflation(pop their ear by
blowing)
 Surgical
• Grommets

Chronic • Discharging ear >3month/12 in the • Topical Non ototoxic

Suppurative Otitis presence of tympanic membrane antiobiotics – steroids drops
Media(CSOM) perforation • Surgical repair of tympanic
membrane
•
• Otitis media with perforation
mucoiddischarge

Otitis externa • Predisposing factors: – Topical antibiotics

– /scratching/Water/Cotton – Aural toilet
buds/ Eczema – Analgesia
Discharge, pain on moving the pinna – Wick
, hearing loss, itching

Complications
1. Ear canal stenosis
2. Perichondritis
3. Necrotizing otitis externa

• Necrotizing • Osteomyelitis and spread of with high dose antibiotics

otitis externa infection along lateral skull base in
pts with DM / Immunocompromised

1. Severe Otalgia( sore ears )

2. Granulation tissue in EAC
3. Cranial nerve palsies
Perichondrial Systemic antibiotics
Haematoma Analgesia
URGENT REFERRAL for incision & drainage

Facial Nerve Palsy Fascial nerve palsy immediately after Prednisolone 30mg
(Bell’s). trauma  tx:Nerve decompression Acyclovir 200mg 5x/day
Hypermellose eye drops
Causes Lacrilube ointment
. AOM, Cholesteatoma, Necrotizing OE,
• Tumours – Eye protection
– Parotid/parotid surgery – Analgesia
– Facial Neuroma
 – Acoustic neuroma
Trauma : temporal bone fractures House Brack/mann Scale

Bells palsy • IdiopathiSteroids

• Infection=Steroids + antivirals
• TraumaSteroids +/- exploratory
surgery
Melkersson swelling of face / lips + facial nerve palsy
Rosenthal
Syndrome

RAMSAY HUNT LMN facial nerve palsy Early steroids, analgesia, antivirals
SYNDROME severe pain and vesicles in the external ear
sensorineural hearing loss

Outer ear: Trauma ct scan of temporal bone – Most of these injuries are
Battle sign • Possible facial weakness contusions that can be followed
• Battle’s sign expectantly. 
– Transection can be repaired
with either direct re-
anastomosis or a graft

Right temporal  Senerinueral hearing loss andf vertigo

bone fracture 
Erysipelas: Group A β-hemolytic Streptococci

Relapsing • Autoimmune disease, treated with steroids

polychondritis: steroids

Cholesteatoma • Foul-smelling chronic ear drainage • Mastoidectomy

• remove disease in mastoid
• remove disease in middle ear
• repair ear drum

Ear wax • Syringing – Contra Indications

• Micro-suction
Chronic sialadenitis • due to stones or duct stenosis can • Medical management - Hydration,
result in gland hypertrophy and compression and massage, antibiotics
fibrosis for the infected gland.
• Surgical management – Endoscopic :
Duct cannulation with stone removal or
gland excision in recurrent case.

Benign neck masses Lipoma /neuroma / Hemangiomas/Fibroma

Malignant • Lymphoma/scc/ Papillary thyroid cancer/ Skin cancer lymphatic metastases/Renal
cell carcinoma
Branchial Lateral neck mass
Anomalies
Thyroglossal Duct Ultrasound to ensure normal thyroid gland • Sistrunk operation (includes excision of
Cysts central portion hyoid) to completely
excise tract and cyst

DERMOID CYST • Surgical excision

•
Infectious causes • HIV- Especially adults/Cat Scratch – Bartonella Henselae/ Toxoplasmosis/Infectious
for neck mass Mononucleosis EBV Mono test/ Fungal- Actinomycosis
Otosclerosis is congenital bone disease with AD bone anchored hearing aid or
incomplete penetrance inheritance stapedotomy (prosthetic replacement)

Fixation of stapes footplate by immature • Conservative – Hearing Aid

new bone • Surgical – Stapedotomy / BAHA
• Risk of surgery = dead ear
fixation of stapes footplate onto oval
window by immature new bone

early :conductive hearing loss, tinnitus and

vertigo
Late presents with: SN hearing loss
White cottage cheese otorrhea = otitis externa
Types of ear Mucoid otorrhea = OM with perf 
discharge Blood stained otorrhea = cancer, trauma, granulation
tissue
foul smelling otorrhea = cholesteatoma 

mastoiditis Must do Contrast CT  IV Abx, ± mastoidectomy

and grommet placement
glue ear Conservative is hearing aid
Medical treatment is auto inflation
Surgical treatment is grommets
Relapsing is autoimmune in nature and is managed with steroids 
polychondritis
Warthin tumors- ‘ = Papillary cystadenoma lymphomatosum’.
Salivary calculi • Treat with :Hydration • Medical management - Hydration,
• Antibiotics Clindamycin compression and massage,
• Warm compresses and massage +antibiotics for the infected gland.
• Sialogogues • Surgical management – Endoscopic :
• Stop smoking Duct cannulation with stone removal
or gland excision in recurrent case.

Labyrinthitis severe persistent vertigo in a previously • Spontaneous recovery over 1-2 week
well pt with nausea, vomiting, ataxia due to central compensation occurs
• Vestibular rehabilitation to promote
+ Romberg test + & Unterberger’s test. compensation.
 • Prochlorperazine for a few days
• prochlorperazine
•

Ménierè Disease = Endolymphatic hydrops • MedicalLoop diuretics

Episodical (20min – 12h) • Surgical:
• Aural Fullness+ Horizontal • Intratympanic steroids injection
nystagmus • Intratympanic gentamycin injection
• Vertigo/Tinnitus • Endolymphatic sac surgery:
• Hearing loss • Endolymphatic sac decompression
• Nausea/Vomiting
– prochlorperazine

Benign Paroxysmal • + Dix Hallpike test Eply

Positional Vertigo • ue to presence of debris in the
(BPPV) posterior SCCs

ACUTE VIRAL Low-grade fever, facial discomfort, purulent Antipyretics, hydration, analgesics,
RHINOSINUSITIS nasal discharge decongestants

resolution in 7-10 days

ACUTE BACTERIAL CAUSES OF SINUSITIS: 1st line: 10-14 days of

SINUSITIS: ■ Polyps Amoxicillin/Clarithromycin/Azithromycin
■ Septal deviation 2nd line: Augmentin/Macrolides/Quinolones
■ Nasal tumour Adjunctive measures:
◻ Mucociliary clearance Short-term topical decongestants, oral
abnormality decongestants, antipyretics, hydration,
■ Cystic fibrosis analgesics, mucolytics, humidification, warm
■ Immotile cilia compresses
■ Streptococcus pneumoniae, For severe or recurrent cases: systemic
Haemophilus influenzae, and steroids
Moraxella catarrhalis If concomitant allergy: nasal steroids,
antihistamines

CHRONIC SINUSITIS ◻ Facial pain ■ Eradicate infection

◻ Facial congestion ◻ Antibiotics
◻ Postnasal drip ■ Treat underlying cause
◻ Nasal obstruction ◻ Correct septal deviation
◻ Olfactory disturbance ◻ Remove nasal polyps
◻ Treat nasal allergy
◻ Anaerobes, S. aureus ■ Reduce inflammation to improve sinus
drainage
◻ Long term topical steroids/ oral
steroids

COMPLICATIONS OF 1. Lower respiratory tract infection ■

SINUSITIS 2. Ear – AOM(
3. Osteomyelitis –"Potts puffy tumour"
4. Orbital – preseptal cellulitis, orbital
cellulitis, subperiosteal abcess,
orbital abcess, cavernous sinus
thrimbosis
5. Intracranial – meningitis, extra-dural
abscess, sub dural abscess, intra-
cerebral abscess

ACUTE FRONTAL • Frontal sinus lining contains veins – Aggressive antibiotic therapy to
SINUSITIS that penetrate posterior table of cover S. pneumoniae and H.
sinus, allowing organisms or infected influenzae with CSF penetration
clot to reach dura – Topical vasoconstriction to
improve drainage
Surgical drainage may be required to prevent
sequelae
septal deviation – SEPTOPLASTY
Nasal polyps – Nasal obstruction – Steroids
– Rhinorrhoea – Polypectomy (surgery)
– Sneezing
– Anosmia
CHOANAL ATRESIA • Cyclical crying / cyanosis • Test with catheter, observe mucus /
• Inability to feed fogging
• (e.g CHARGE syndrome) • Require secure oral airway / feeding /
• Failure of • CHARGE definitive procedure
canalisation • Coloboma, Heart anomalies, Atresia,
of the Retardation, Genito-urinary
bucco-nasal anomalies, Ear abnormalities
membrane
• is a congenital disorder where the
back of the nasal passage (choana) is
blocked,

UNILATERAL POLYP • Suspicious for tumour or fungal –

sinusitis
“inverted papilloma
– Olfactory neuroblastoma
– SCC
Allergic Rhinitis • Frequent sneezing 1. Avoidance
(AR) • Itching 2. Antinhistamines
• Nasal obstruction 3. Steroids
• whatery rhinorrhea 4. Antileukotrienes
5. Immunotherapy
 test serum-specific IgE
-skin prick testing
Dx:or RAST (Radioallergosorbent test to
check IgE levels)

VASOMOTOR/NON- • Hyperactive nasal mucosa • Treat

ALLERGIC RHINITIS • Non–specific stimulus – medical (empiric)
– surgical (make more space)

osa Conservative :
ü Lifestyle changes:
ü Weight reduction
ü Stop smoking
ü Stop alcohol
ü Avoid sedatives
+Mandibular advancement device:
CPAP/ BIPAP
Steroids

ü Surgery “glossectomy
ü Adenoidectomy & adenotonsillectomy

Pediatric OSAS • Adenotonsillar hypertrophy – CPAP/ BIPAP

• Obesity – Useful prior to surgery if child
• Craniofacial abnormalities unfit or if there is a delay
• Night time sweats – Poor compliance the biggest
• Restless issue
• Enuresis – Oral and nasal steroids
– Only helpful if an acute
–  hyperactive kid+ Poor condition is causing the OSAS eg
attention EBV
+Adenotonsillectomy

VESTIBULAR • Unilateral sensorineural hearing loss, • Conservative

SCHWANNOMA unilateral tinnitus, vertigo • Stereotactic Radiosurgery
• Surgical

EPISTAXIS • causes: • Treat: silver nitrate cautery

• Nose picking/ digital trauma
• Allergic rhinitis

ADENOIDAL • Nasal obstruction • Surgical curettage

HYPERTROPHY • Snoring •
• Sleep apnoea
• Glue ear
PRESBYCUSIS • Reduction in the number of spiral • HEARING AID
ganglion cells and hair cells
 • affects high frequencies

OTOTOXICITY • Aminoglycosides •
• Gentamycin, streptomycin,
neomycin,tobramycin
• Loop diuretics
• furosemide – usually reversible
• Salicylates
• aspirin - reversible
• Quinine (malaria)
• Propranolol
• Cisplatinum (chemotherapy)
•
Leukoplakia: a condition where areas of keratosis •
appear as firmly attached white patches on
the mucous membranes of the oral cavity
• Sun exposure to the lips
• Oral cancer(although rare)
• HIV or AIDS

Oral Cancer 'Depth of Invasion’ key prognostic factor • PROPHYLACTIC NECK

DISSECTION LEVELS 1-4.
Paranasal Sinus • aggressive tumours that generally • SURGERY
Cancer are diagnosed in an advanced stage. • Total Ethmoidomaxillectomy
• Multimodality treatment with surgery
and postoperative radiation therapy is
the standard paradigm.

HODGKIN • Rx: Rt alone or Chemo +/- Rt

LYMPHOMA
Laryngeal Cancer • Most common cancer of the upper • ChemoRadiotherapy (Organ
aerodigestive tract Preservation)
• Smoking and drinking are risk • Laryngectomy (Organ Sacrifice) post op
factors get hoem by day 14
• Gottic cancer(Lesions limited to the •
true vocal cords) is more common
than supra glottic (often ignored+
Rich lymphatic drainage,)

Indications for • Edema-Infective /Trauma / Burns • Tracheostomy (tray-key-OS-tuh-me) is

tracheostomy • Airway obstruction a hole that surgeons make through the
• Pulmonary toilet- (inadequate front of the neck and into the windpipe
cough / aspiation) (trachea). A tracheostomy tube is
• Sleep apnea placed into the hole to keep it open for
• Prophylaxis*** breathing. 
• Complications:
• Death
 • Obstruction
• Displacement
• Bleeding
• Subcut emphysema
• Pneumothorax
• Fistula
• Tracheoesophageal
• Tracheoinnominate
• RLN damage

edd
Facial nerve palsy 1 ==\> normal…… 4 cant close eyes. …… 6 severe
 d

1normal
2 slights weakness 
4= can’t close eye 
5 = still bit of movement 
6 (severe)
 RHINOSINUSITIS: CLINICAL DEFINITION
• Either
– Endoscopic signs of:
• Nasal polyps and/or
• Mucopurulent discharge primarily from middle meatus
and/or
• Oedema/mucosal obstruction primarily in middle meatus
• And/or
– CT changes
• Mucosal changes within the osteomeatal complex and/or
sinuses

ORBITAL COMPLICATIONS

• Chandler’s classification
–1: Pre-septal cellulitis
–2: Orbital cellulitis
–3: Subperiosteal abscess
–4: Orbital abscess
–5: Cavernous sinus thrombosis
• Treatment:
–IV Antibiotics
–Nasal toilet (decongestants and
rinses)
–If abscess, FESS +/- open
approach to decompress eye

 Type A tympanogram is normal ear

 Type Ad tympanogram (high peak) is ossicle dislocation
 Type As tympanogram (low peak) is fixed ossicle or tympanosclerosis / scarring
 Type B tympanogram (flat) is fluid in middle ear or perforation
 Type C tympanogram (early peak) is ET dysfunction or retratction
HiNTs criteria differentiated peripheral and central vertigo

1. Hi = head impulse (if correcting saccades then peripheral) 

2. N =Nystagmus (if horizontal then peripheral) 
3. TS = test of scew (if no sign of vertical gaze corrections then peripheral)

Nasopharynx:
OROPHARYNC DOWN TO VALLECULA (BASE OF TONGUE AND TONSILS)

HPV
 lymphatic dissemination
Males
Lump in neck
Type of cancer basaloid non keratinizing squamous cell carcinoma
Better prognosis than head and neck
Less mutations in viral cancer
6/11  genital wort
Respiratory papillomatosis

16/18  oncogenic types

Imaging : PET SCAN ( radioactive glucose )

Thyroid
ANANPLASTIC thyroid cancer everyone dies
Medullary para follicular cells/ forms week 3 / calcitonin is the tumour marker
50 % DIE IN 10 YEARS THUS u need aggressive treatment

Thyroglobulin is the tumour marker for the other differentiated thyroid cancer
Post Thyroidectomy  hematoma  SURGICAL URGENT REFERAL
TRASEAU SIGN BECAUSE HYPOCALCIUM
CHVASTICKS SIGNS  FAC ESPASM
TX: CALCIUM DELUCANATE ? + REFER TO ENDOCRINHOLOGIST

RECURRENT LARANGEAL NERVE 

CHECK THE THYROID FUNCTION 6 WEEKS THEN. DECIDE ON DOSAGE OF THYROID
FUNCTION

GAMES (to tailor treatment of cancer

 Grade of tumour
 Age of patient under 55
 Metastasis
 Extra thyroidal extension (bursting out surface
 Size Less than 4 cm

Neck lump
1. Full history
2. Send to ultrasound
3. Needle test if they score above U3 + (assess THY score. Thy3f + )
4. MDT

==================================
v MEN SYNDROMES
ü MEN type 1:
• menin gene
• Parathyroid hyperplasia, pancreatic tumors, and pituitary tumors
ü MEN type 2a:
• RET gene
• medullary thyroid cancer & pheochromocytoma & parathyroid hyperplasia
ü MEN type 2b:
• RET gene
• medullary thyroid cancer & pheochromocytoma & marfanoid features & multiple
mucosal melanoma