Otolaryngology (ENT): Airway, Hearing, Voice, and Neck Red Flags
Overview
Otolaryngology (ENT) in the OMSB exam tests pattern recognition across airway obstruction, ear disease, hearing loss, voice change, and neck masses. Most items turn on one discriminating sign or one escalation step, so learn the decision points rather than exhaustive lists.
Core rules
- Stridor timing: inspiratory stridor points to extrathoracic/upper airway narrowing; expiratory stridor to intrathoracic disease; biphasic stridor suggests a fixed glottic or subglottic lesion.
- Epistaxis: anterior bleeding from Kiesselbach's plexus responds to pressure, topical vasoconstrictor, and cautery; posterior bleeding is heavier, may run down the pharynx, and often requires sphenopalatine artery control or posterior packing by ENT.
- Ear disease: acute otitis media shows otalgia with a bulging, erythematous tympanic membrane; otitis media with effusion shows a retracted, non-bulging membrane with fluid and no acute inflammation, and is observed for about 3 months before surgical referral.
- Vertigo: posterior canal benign paroxysmal positional vertigo is confirmed by Dix-Hallpike and treated with Epley repositioning, not long-term vestibular sedatives.
- Sudden sensorineural hearing loss: treat as an emergency within 72 hours, typically with systemic corticosteroids.
- Hoarseness: any voice change lasting more than 3 weeks, especially in a smoker or with dysphagia, weight loss, or a unilateral neck mass, needs laryngoscopy to exclude malignancy.
Worked example
A 4-year-old has fever, drooling, a muffled voice, and sits tripod-positioned with neck extension; there is no barking cough. The discriminator is the absence of a cough plus toxic posture and drooling, which favours epiglottitis over croup. Do not inspect the throat or lie the child flat. Keep the child calm, call anaesthesia and ENT for controlled airway assessment, and start intravenous ceftriaxone.
Traps
- Calling otitis media with effusion acute otitis media and prescribing antibiotics unnecessarily.
- Missing posterior epistaxis because bleeding appears only in the pharynx.
- Treating benign paroxysmal positional vertigo with sedatives instead of repositioning.
- Attributing persistent hoarseness to laryngitis without laryngoscopy.
- Assuming an adult lateral neck mass is benign; it is malignancy until proven otherwise.