DOHNS MAY 2004

MANNED STATIONS:

History:
anosmia
History:
6 month history of right tonsil enlargement. She has no PMH or CVD or DM. DDx
Examination:
Neck (stethoscope provided) – normal neck
Examination:
Examine this patients hearing. Write down your findings (auroscope, range of tuning forks and speculae provided). Normal
ears
Continuation:
Draw your otoscopic findings from the patient above. Write down your tuning fork test findings.
Explanation:
This mother’s 6 yo child has L SNHL. He has had a PTA and BAER. Explain the findings to the mother and the options
(audiogram showing L dead ear and schematic picture of ear are provided)

UNMANNED STATIONS:

Xray: left -what does this xray show

submandibular gland submandibular gland stone
stone
-whatSx may this patient present with
pain worse with eating
submandibular swelling
erythema around submandibular region
abscess formation

-Tx options
conservative – hydration, analgesia, sialogogues
lithotripsy
therapeuticsialoendoscopy
surgical – stone excision by widening duct or submandibular gland excision

-what determines which surgical approach is used

size, location of stone
history of recurrent stones

Pict: attic -Dx

cholesteatoma atticcholesteatoma

-Sx (not complications)

Hearing loss
Dizziness
Tinnitus
Chronic discharging ear

-what type of HL will this patient have

conductive hearing loss but if cholesteatoma has invaded inner ear will have mixed hearing loss

-Mx options if the patient was a 6 yo

conservative with regular microsuction
surgical: canal wall up mastoidectomy
 -what are the complications of surgery
bleeding
infection
recurrence
need for regular aural toilet
facial nerve palsy dizziness
hearing loss

intracranial – meningitis, brain abscess

Shah grommet in -what is this

specimen bottle shah grommet

-Indications for its use

OME
Recurrent AOM
Retracted TM

-complications
bleeding
infection
hearing loss
need for further grommet

Pict: left inferior -give 4 non-allergic causes of enlargement of this structure

turbinate oral contraceptive pill
Neoplasia
Congenital
Rhinitis medicamentosa

-name 3 groups of drugs used to treat this problem

antihistamine
steroids
Decongestants
Leukotriene antagonists

-give 3 surgical techniques used in the reduction of this structure

out-fracture of turbinates
submucous diathermy
turbinectomy/ turbinate trimming
FESS

Pict: normal TM Arrows to:

Umbo
Attic
Annulus fibrosis
Long process of incus

Pict: normal larynx Name the labeled structures (Arrows to):

Epiglottis
Aryepiglottic fold
Arytenoids
 Vestibular fold
Subglottis
Anterior commisure

Pict: exophytic ulcer -what is the most likely histological diagnosis of this lesion
right lateral border 90% SCC
tongue
-5 aetiological factors
smoking
betel nut chewing
alcohol
sharp teeth
spicy food

-maintx options
based on TNM classification
conservative
radiotherapy
surgical – glossectomy
palliative

PTA showing R SNHL -what is the symbol used for R AC

40dB 0.25-2kHz O
70dB 4-8kHz
10dB conductive loss -what is the symbol used for L AC
component X

-what is the symbol used for unmasked BC

triangle

-what does this audiogram show

-what is the DDx for this finding

presbyacusis
noise induced hearing loss

Pict: TM showing -Dx

fungal otitis externa
-name 2 possible causative organisms
aspergillusniger
candidiasis

-5 risk factors for this condition

immunosuppression
diabetic
prolonged use of broad spectrum antibiotic drops
humid climate
configuration of EAC
systemic steroids

-whattx would you give

topical antifungal such as canestan

2 picts of man’s face -what is the Dx

showing House- Ramsay Hunt Syndrome
Brackman Grade IV
facial nerve palsy and -causative factor
one pict showing his Herpes zoster virus
right pinna with a few
vesicular lesions -othersx this patient may have
hearing loss
otalgia
metallic taste
hyperacusis
tinnitus
dizziness

-treatment options
Prednisolone, acyclovir for 1 week
Eye protection with regular artificial tears and eye patch at night

Video: L VC palsy -what are the causes of this x3

Viral
neoplastic (invasion RLN)
iatrogenic (surgical division)
idiopathic

-what is the sensory nerve supply of epiglottis

glossopharyngeal nerve (CN IX) sends fibers to the upper epiglottis that contribute to
the afferent limb of the gag reflex

superior laryngeal branch of the vagus nerve (CN X) sends fibers to the lower epiglottis
that contribute to the efferent limb of the cough reflex

-Ix
CXR-pancoast’stumour
Stroboscopy
viraltitres
CT skull base to aortic arch

-Tx
collagen injections
thyroplasty

-after what length of time would you offer treatment

?6 months to allow any viral cause to resolve

Temporal bone with -name the following:

labels Petrous temporal bone
Squamous temporal bone
Mastoid process
Styloid process

-what structures pass through here (stylomastoid foramen)

facial nerve
-what is this called and what is its purpose (fossa of TMJ)
 articulation with mandible

Pict: nasal polyp -what is labeled in this pic

nasal polyp

-1st line medical management

topical nasal steroid with nasal decongestants

-surgicaltx options
FESS with polypectomy

-complications of surgical removal

bleeding
infection
recurrence
diplopia
Orbital heamatoma
Loss of vision
CSF rhinorrhoea
Meningitis
Brain abscess

Pict of right -3 terms to describe this mass

exophyticsupraglottic irregular
mass exophytic
locally invasive

-2 presenting Sx
Hoarse voice
Sore throat
Dysphagia
Stridor
Referred otalgia

-3 aetiological factors
Smoking
Alcohol
?HPV infection

Pict: -what is (a)

End of (a) bronchoscope
bronchoscope (b)
oesophagoscope -Why are there holes in the instrument
to allow ventilation of patient

-what is (b)
oesophagoscope

-what are the adv of using this over a flexible instrument

Allows direct visualization of any abnormality or foreign body for removal

-what major complications does it cause

perforation
mediastinitis
Pict: TM with OME -Dx
and normal TM OME and normal TM

-expectedtympanograms
Flat, normal tympanogram

-main symptom this patient would complain of

hearing loss

-aetiology
Eustachian tube dysfunction causing negative pressure in middle ear due to middle ear mucosa
absorption of oxygen. This negative pressure over time causes transudate from mucosa leading to
accumulation of sereous effusion.

Pict: tonsillitis with -DDx

exudates tonsillitis
glandular fever

-what 2 local signs might be found

Cervical lymphadenopathy
Palatal petechiae

-name 3 associated systemic symptoms/ signs that may be associated

General malaise
myalgia
hepatosplenomegaly

Pict: thyroglossal cyst -whichtriange is lesion in

in child anterior triangle
-2 specific signs that might be present
moves with swallowing
moves with protrusion of tongue

-what structures are removed in surgical excision

Medial third of hyoid bone

-what is the embryological origin

Remnant of duct following migration of thyroid gland from foramen ceacum at tongue base to the
trachea. The duct then forms a cyst.

Barious swallow: -what is this Ix

pharyngeal pouch Barium swallow

-Dx
Phagyngeal pouch

-anatomical origin of this abnormality

Weakness at Killian’s dehiscence at the inferior constrictors between cricopharyngeus and
thyropharyngeus and increased muscle spasm of cricopharyngeus causes herniation forming a
pouch
 -3 treatment options
conservative
surgical – endoscopic stapling
- open excision of pouch with cricopharyngeusmyotomy

Discharge summary
to GP: FESS