EN1.2 | Pathophysiology of Common ENT Disorders — Summary & Reflection

KEY TAKEAWAYS

Four EN1.2 diseases, four pathophysiological mechanisms. Chronic Otitis Media (COM): two types: tubotympanic (mucosal/'safe' — central perforation pars tensa, mucoid discharge, no cholesteatoma, conductive hearing loss, complications rare, medical treatment + myringoplasty) vs atticoantral (squamosal/'unsafe' — attic/marginal perforation, foul discharge, cholesteatoma formed from keratin-accumulating squamous retraction pocket, bone erosion → ossicles, facial nerve, tegmen, sigmoid sinus → ALWAYS surgical, mastoidectomy). Never call an attic/marginal perforation 'safe.' Otosclerosis: abnormal bony remodelling at fissula ante fenestram → stapes footplate fixation → progressive bilateral conductive hearing loss; normal TM on otoscopy; Carhart notch at 2000 Hz (mechanical artefact); Type As tympanogram; autosomal dominant, Caucasians, women > men, worsens in pregnancy; treatment: hearing aid or stapedectomy. Adenotonsillitis: acute = 70% viral (EBV — DO NOT give amoxicillin) + 30% GABHS (penicillin; risk of ARF/PSGN if untreated); progression → peritonsillar abscess (quinsy — incise/drain); tonsillectomy for recurrent disease (Paradise criteria). Adenoid hypertrophy → Eustachian tube obstruction → OME (glue ear, conductive hearing loss) + nasopharyngeal obstruction → mouth breathing, OSA → adenoidectomy ± grommets. Nasal polyposis: ethmoidal (bilateral, multiple, adults, eosinophilic/allergic, asthma, Samter's triad = aspirin sensitivity + asthma + polyps — avoid NSAIDs; treat with topical steroids/FESS; RECUR) vs antrochoanal/Killian's (unilateral, single, from maxillary antrum, young patients; treat with endoscopic polypectomy including antral base; does NOT recur when completely removed). For any unilateral nasopharyngeal mass in an adolescent male — DO NOT BIOPSY; exclude JNA with imaging first.

REFLECT

The safe/unsafe classification of CSOM is a teaching tool intended to prevent dangerous errors — but it carries a risk of its own. A student who has memorised 'tubotympanic = safe' may unconsciously stop looking for danger once they see a central perforation. Reflect: what clinical features BEYOND the perforation site would make you request a CT scan even in a patient with what appears to be a central perforation? (Hint: consider the presence of granulation tissue, unexplained facial weakness, persistent vertigo, or a very foul smell.) Write in your reflective journal: what is the one habit you will build during your ENT clinical posting to ensure you never miss a cholesteatoma — and how does pathophysiology, rather than just pattern-recognition, support that habit?