ENT, Speech and Hearing

ENT presentations are common in general practice and well represented in the AKT. The main areas are ear infections and hearing loss, throat infections, nasal conditions, and vertigo.

Acute otitis media is one of the most common childhood presentations. NICE recommends a delayed prescribing strategy for most cases: reassurance, analgesia, and a prescription to use if symptoms do not improve within 48-72 hours. Immediate antibiotics are recommended for systemically unwell children, children under 2 with bilateral otitis media, and those with otorrhoea. First-line antibiotic is amoxicillin.

Hearing loss types: conductive (outer or middle ear problem, e.g. wax, otitis media with effusion, otosclerosis) vs sensorineural (inner ear or nerve, e.g. presbyacusis, noise-induced, acoustic neuroma). Sudden sensorineural hearing loss is a red flag requiring urgent ENT referral. Rinne and Weber tuning fork tests distinguish the types: Rinne is normal (air > bone) in sensorineural loss but abnormal (bone > air) in conductive loss. Weber lateralises to the affected ear in conductive loss and to the unaffected ear in sensorineural loss.

Tonsillitis management uses the FeverPAIN or Centor criteria to determine likelihood of bacterial infection and need for antibiotics. FeverPAIN scores of 4-5 suggest antibiotic treatment is likely beneficial. First-line is phenoxymethylpenicillin for 10 days. Avoid amoxicillin if glandular fever is suspected (causes a rash). Recurrent tonsillitis (7 episodes in 1 year, 5 per year for 2 years, or 3 per year for 3 years) may warrant tonsillectomy referral.

Sinusitis is usually viral and self-limiting. NICE recommends no antibiotic for acute sinusitis unless symptoms persist beyond 10 days without improvement. If antibiotics are needed, first-line is phenoxymethylpenicillin. Refer urgently if periorbital cellulitis, visual changes, or severe frontal headache are present.

Vertigo has three main primary care diagnoses. BPPV causes brief episodes triggered by head position changes and is diagnosed with the Dix-Hallpike test. Treatment is the Epley manoeuvre. Vestibular neuritis causes prolonged vertigo lasting days with nausea but no hearing loss. Meniere's disease causes episodic vertigo with hearing loss, tinnitus, and aural fullness.

Epistaxis is usually anterior (from Little's area) and managed with firm pressure for 15-20 minutes. Posterior bleeds require nasal packing and ENT referral.