WACS ORL Membership cheat sheet

Rinne test: air conduction > bone conduction = positive (normal or sensorineural loss); bone > air = negative (conductive loss).

Weber test: lateralizes to the affected ear in conductive hearing loss; to the better ear in sensorineural hearing loss.

Sudden sensorineural hearing loss: ≥30 dB across 3 consecutive frequencies within 72 hours; treat with high-dose corticosteroids (oral or intratympanic) within 2 weeks of onset.

Acoustic neuroma (vestibular schwannoma): MRI with gadolinium is gold standard; small tumors may be observed or treated with stereotactic radiosurgery; larger tumors require microsurgery.

Cholesteatoma: keratinizing squamous epithelium in middle ear; presents with foul-smelling otorrhea and conductive hearing loss; treatment is surgical (tympanomastoidectomy).

Benign paroxysmal positional vertigo: Dix-Hallpike maneuver for posterior canal; Epley canalith repositioning is first-line treatment.

Meniere disease: episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness; low-salt diet, diuretics, and intratympanic steroids or gentamicin for refractory cases.

Otosclerosis: conductive hearing loss with normal tympanic membrane; stapes fixation; treatment is stapedotomy or hearing aid.

Acute bacterial rhinosinusitis: symptoms >10 days or worsening after initial improvement; first-line antibiotics are amoxicillin-clavulanate or doxycycline.

Chronic rhinosinusitis: ≥12 weeks of symptoms; diagnose with nasal endoscopy and CT scan; treat with saline irrigation, intranasal corticosteroids, and antibiotics for acute exacerbations.

Nasal polyps: bilateral, associated with asthma and aspirin sensitivity (Samter triad); treat with intranasal or systemic corticosteroids; surgery for refractory cases.

Epistaxis: most common from Kiesselbach's plexus (anterior); posterior bleeding from sphenopalatine artery; initial treatment is pressure, topical vasoconstrictors, and cautery; posterior packing or embolization for severe cases.

Functional endoscopic sinus surgery (FESS): indicated for chronic rhinosinusitis refractory to medical therapy; complications include CSF leak, orbital injury, and hemorrhage.

Allergic rhinitis: first-line treatment is intranasal corticosteroids and oral antihistamines; immunotherapy for refractory cases.

Cerebrospinal fluid rhinorrhea: confirm with beta-2 transferrin; treat with bed rest, lumbar drain, or endoscopic repair.

Hoarseness >3 weeks requires laryngoscopy to rule out malignancy.

Vocal fold nodules: bilateral, symmetric, at junction of anterior and middle thirds; caused by voice abuse; treatment is voice therapy.

Vocal fold polyps: unilateral, often due to smoking or trauma; treatment is surgical excision and voice therapy.

Recurrent laryngeal nerve injury: causes vocal fold paralysis; presents with breathy dysphonia and aspiration risk; treatment includes voice therapy, injection laryngoplasty, or medialization thyroplasty.

Laryngopharyngeal reflux: symptoms include globus, throat clearing, and hoarseness; treat with lifestyle modifications and proton pump inhibitors.

Spasmodic dysphonia: focal dystonia; adductor type causes strained-strangled voice; treatment is botulinum toxin injection into vocal folds.

Laryngeal cancer: squamous cell carcinoma most common; risk factors include smoking and alcohol; presents with persistent hoarseness, odynophagia, or neck mass; diagnosis by biopsy.

Head and neck squamous cell carcinoma: most common malignancy; risk factors include tobacco, alcohol, and HPV (especially oropharyngeal).

Neck mass in adult: rule out malignancy until proven otherwise; fine-needle aspiration is first-line diagnostic test.

Oral cavity cancer: presents as non-healing ulcer or leukoplakia; treatment is surgical resection with neck dissection if indicated.

Laryngeal cancer: glottic cancer presents early with hoarseness; supraglottic cancer presents with neck mass and dysphagia; treatment options include surgery, radiation, and chemoradiation.

Thyroid cancer: papillary carcinoma most common; treat with total thyroidectomy and radioactive iodine for high-risk features.

Parotid tumors: pleomorphic adenoma most common benign; mucoepidermoid carcinoma most common malignant; superficial parotidectomy with facial nerve preservation.

HPV-positive oropharyngeal cancer: better prognosis than HPV-negative; treatment de-escalation trials ongoing.

Acute otitis media: treat with amoxicillin (high dose) for 10 days in children <2 years or severe symptoms; observation for 48-72 hours in older children with mild symptoms.

Otitis media with effusion: persistent middle ear fluid >3 months; hearing test required; tympanostomy tubes if hearing loss or speech delay.

Tonsillectomy indications: recurrent throat infections (7 in 1 year, 5 per year for 2 years, or 3 per year for 3 years) or obstructive sleep apnea.

Croup: barking cough, inspiratory stridor; treat with dexamethasone and nebulized epinephrine for severe cases.

Epiglottitis: medical emergency; presents with drooling, tripod position, and high fever; do not examine throat; secure airway in operating room.

Foreign body aspiration: common in children <3 years; presents with choking and unilateral wheeze; diagnosis by bronchoscopy.

Congenital hearing loss: universal newborn hearing screening; if failed, refer for audiologic evaluation by 3 months and intervention by 6 months.

Rhinoplasty: open approach for complex deformities; closed approach for simple dorsal hump; complications include bleeding, infection, and nasal obstruction.

Facial nerve paralysis: House-Brackmann scale for grading; treat with corticosteroids for Bell's palsy; surgical decompression for traumatic paralysis.

Skin cancer reconstruction: Mohs micrographic surgery for basal cell and squamous cell carcinomas; reconstruction with local flaps or grafts.

Cleft lip and palate: repair lip at 3-6 months, palate at 9-12 months; multidisciplinary team care.

Otoplasty: for prominent ears; techniques include suture or scoring to create antihelical fold.

Blepharoplasty: upper lid for visual field obstruction; lower lid for cosmetic; complications include ectropion and hematoma.

Facial fractures: mandible most common; treat with closed reduction or open reduction internal fixation; Le Fort fractures classified I, II, III.

Obstructive sleep apnea (OSA): diagnose with polysomnography; apnea-hypopnea index (AHI) ≥5 with symptoms or ≥15 alone.

OSA treatment: CPAP first-line; alternatives include oral appliances, weight loss, and surgery (uvulopalatopharyngoplasty, maxillomandibular advancement).

Pediatric OSA: most common cause is adenotonsillar hypertrophy; adenotonsillectomy is first-line treatment.

Central sleep apnea: caused by lack of respiratory effort; treat underlying cause (e.g., heart failure, opioids); adaptive servo-ventilation may be used.

Tracheostomy: indicated for upper airway obstruction, prolonged ventilation, or pulmonary toilet; complications include bleeding, infection, and tracheal stenosis.

Difficult airway management: anticipate with history and physical exam; have backup plan including fiberoptic intubation and surgical airway.

Pure tone audiometry: air and bone conduction thresholds; sensorineural loss = air-bone gap <10 dB; conductive loss = air-bone gap >10 dB.

Tympanometry: type A normal; type B flat (effusion or perforation); type C negative pressure (Eustachian tube dysfunction).

Otoacoustic emissions: screening test for cochlear function; absent in sensorineural hearing loss >30 dB.

Auditory brainstem response (ABR): used for newborn hearing screening and retrocochlear pathology.

Vestibular testing: caloric testing for lateral semicircular canal; video head impulse test (vHIT) for all canals; Dix-Hallpike for BPPV.

Vestibular neuritis: acute vertigo without hearing loss; treat with corticosteroids and vestibular rehabilitation.

Labyrinthitis: vertigo with hearing loss; treat with corticosteroids and supportive care.

Informed consent: must include diagnosis, proposed treatment, risks, benefits, alternatives, and consequences of no treatment.

Confidentiality: protected by HIPAA; exceptions include danger to self or others, and reportable communicable diseases.

Surgical safety checklist: verify patient identity, procedure, site, and allergies; use time-out before incision.

Medical errors: disclose to patient and family; root cause analysis for system improvements.

Conflict of interest: disclose financial relationships; avoid influencing patient care.

Research ethics: institutional review board (IRB) approval; informed consent; protect vulnerable populations.

End-of-life care: advance directives; palliative care; respect patient autonomy.