Master ENT
for DHA

Core Concepts

Otolaryngology (ENT) encompasses the medical and surgical management of conditions affecting the ear, nose, throat, and related head and neck structures. Key anatomical areas include:

• **Ear:** External (pinna, ear canal), Middle (tympanic membrane, ossicles), Inner (cochlea for hearing, vestibular system for balance). Functions include hearing and balance.
• **Nose & Paranasal Sinuses:** Nasal cavity, septum, turbinates, and sinuses (frontal, ethmoid, maxillary, sphenoid). Functions include olfaction, respiration, humidification, and filtration.
• **Throat & Larynx:** Oral cavity, pharynx (naso-, oro-, laryngo-), tonsils, larynx (vocal cords, epiglottis). Functions include speech, swallowing, and airway protection.
• **Head & Neck:** Salivary glands, thyroid gland, lymphatic system, cranial nerves.

Common pathologies involve inflammatory/infectious processes, neoplastic growths (benign and malignant), congenital anomalies, and trauma.

Clinical Presentation

• **Ear:** Otalgia (earache), hearing loss (conductive or sensorineural), tinnitus (ringing), vertigo (spinning sensation), otorrhea (ear discharge), aural fullness, facial weakness.
• **Nose:** Rhinorrhea (runny nose), nasal obstruction, epistaxis (nosebleed), anosmia/hyposmia (loss/reduced smell), facial pain/pressure, post-nasal drip.
• **Throat/Oral Cavity:** Sore throat, dysphagia (difficulty swallowing), odynophagia (painful swallowing), hoarseness (dysphonia), globus sensation (lump in throat), oral lesions, neck mass, trismus (difficulty opening mouth).
• **General:** Fever, fatigue, weight loss, night sweats (especially concerning for malignancy or systemic illness).

Diagnosis (Gold Standard)

A thorough history and physical examination are paramount for all ENT complaints, including otoscopy, anterior rhinoscopy, oral/oropharyngeal inspection, and palpation of neck nodes and salivary glands.

• **Ear:**
  • Hearing Loss: Pure Tone Audiometry (PTA) with speech audiometry, tympanometry.
  • Vertigo: Dix-Hallpike maneuver (for BPPV), Videonystagmography (VNG).
  • Facial Nerve Palsy: House-Brackmann scale.
• **Nose & Sinuses:**
  • Chronic Sinusitis/Polyps: Nasal Endoscopy, CT Paranasal Sinuses.
  • Allergy: Skin Prick Test or RAST (blood test).
• **Throat & Larynx:**
  • Hoarseness/Dysphagia: Flexible Laryngoscopy.
  • Neck Mass: Fine Needle Aspiration (FNA) biopsy.
  • Suspected Foreign Body: CT Neck/Chest.
• **Infections:** Culture & Sensitivity (e.g., ear discharge, throat swab) to guide antibiotic choice.

Management (First Line)

• **Otitis Externa:** Topical antibiotic/steroid ear drops (e.g., ciprofloxacin-dexamethasone). Maintain ear dryness.
• **Acute Otitis Media (AOM):** Analgesia (Paracetamol/Ibuprofen). Watchful waiting for mild cases; Oral Amoxicillin for severe symptoms or non-resolution after 48-72h.
• **Chronic Suppurative Otitis Media (CSOM):** Aural toilet, topical antibiotics (e.g., quinolone drops), surgical repair (tympanoplasty) for persistent perforations.
• **Benign Paroxysmal Positional Vertigo (BPPV):** Epley maneuver.
• **Sudden Sensorineural Hearing Loss (SSNHL):** Oral corticosteroids (e.g., Prednisolone) – urgent referral to ENT.
• **Allergic Rhinitis:** Intranasal corticosteroids (e.g., Fluticasone), oral antihistamines.
• **Acute Rhinosinusitis:** Analgesia, saline nasal irrigation. Oral Amoxicillin-Clavulanate for severe/persistent bacterial infection (>10 days).
• **Epistaxis (Anterior):** Direct pressure, anterior nasal packing (e.g., Merocel, Vaseline gauze), chemical cautery (silver nitrate).
• **Acute Pharyngitis/Tonsillitis:** Viral: symptomatic relief. Bacterial (Group A Strep): Penicillin V.
• **Acute Laryngitis:** Voice rest, hydration.
• **Peritonsillar Abscess (Quinsy):** Needle aspiration or Incision & Drainage (I&D), oral antibiotics (e.g., Amoxicillin-Clavulanate).
• **Head & Neck Masses:** Investigations (FNA) to rule out malignancy. Surgical excision for suspicious or symptomatic benign masses.