Comprehensive Otolaryngology: Ear, Nose, and Sinus Disorders

Otitis Externa (Swimmer's Ear)

Severe ear pain (worse with tragus/pinna movement), itching, ear fullness, clear/purulent discharge. Exam shows an inflamed, red, swollen EAC (edema narrows canal so TM is not visualized). Triggers include swimming and Q-tip use. Treatment: clean out pus, place ear wick, and apply topical antibiotic ear drops.

Cerumen Impaction

Earwax blockage in the EAC. Slide highlight for treatment: peroxide + warm water sit for 10 minutes, then irrigate. Otoscope speculum advances past or around cerumen.

Mastoiditis

Infection of mastoid bone air cells, usually a complication of chronic or untreated acute otitis media or cholesteatoma. Key features: severe ear pain, fever, posterior ear redness/swelling/tenderness, ear pushed forward, purulent otorrhea. CT scan confirms diagnosis. Treatment: IV antibiotics +/- OR incision & drainage.

Otitis Media (Acute / Serous)

Middle ear infection/effusion characterized on exam by TM bulging and erythema. Effusion may be serous or purulent. Highlighted note: only use ear drops in otitis media if a tympanostomy tube is present; requires ENT follow-up.

Tympanic Membrane Perforation

Hole in the eardrum caused by trauma (Q-tips, slap, blast, barotrauma) or infection. Key history: sudden ear pain followed by sudden relief, sudden hearing loss, ear discharge (bloody/clear/purulent), and tinnitus. Exam shows no normal landmarks, a 'flap' perforation, and diagnosis confirmed via pneumatic insufflation.

Cholesteatoma

Abnormal, non-cancerous growth of keratinizing squamous epithelium (trapped desquamating skin) in middle ear/mastoid that erodes local bone and ossicles. Key symptoms: persistent/recurrent foul-smelling otorrhea, progressive hearing loss, ear fullness.

Otosclerosis

Progressive conductive hearing loss, tinnitus, and paracusis willisii (hearing better in noisy environments); often triggered/worsened during pregnancy. Key exam finding: otoscopy is usually NORMAL.

Acoustic Neuroma (Vestibular Schwannoma)

Noncancerous, slow-growing tumor arising from Schwann cells on the vestibulocochlear nerve (CN VIII) within the internal auditory canal.

Eustachian Tube Dysfunction

Failure of Eustachian tube to open/close properly -> trapped air pressure & fluid buildup. Key symptoms: ear fullness/pressure, muffled hearing, popping/clicking, autophony.

Meniere's Disease

Hearing loss + Tinnitus + Vertigo (along with episodic ear fullness)

Barotrauma of Ear

Pressure injury from rapid altitude change (flying, diving). Symptoms: ear pain/pressure, muffled hearing, popping, tinnitus. Bloody or clear drainage indicates TM rupture.

Nasal Polyps

Pale, sac-like structures obstructing nasal passage or sinuses, causing congestion, anosmia, and postnasal drip.

Samter's Triad

= Nasal Polyps + Asthma + Aspirin/NSAID Allergy.

Sinusitis

Inflammation of sinuses Key symptoms: facial pain/pressure, purulent discharge, hyposmia. Highlighted pattern: 'Double-worsening' (getting better, then getting worse = bacterial superinfection). ENT guidelines require symptoms >=10 days before considering antibiotics.

Rhinitis (Allergic / Non-Allergic)

Nasal inflammation (seasonal, perennial, or intermittent). Features allergic facies (allergic shiners, Dennie-Morgan lines, nasal crease), postnasal drip, and cobblestoning of posterior pharynx/mucosa (indicates allergic process). Anterior rhinoscopy: pale, boggy, edematous mucosa (allergic) vs red, inflamed mucosa (infective/non-allergic).