Normal ENT Values & Tests
Pure Tone Audiometry (PTA)
- Normal Hearing: 0–25 dB
- Mild Hearing Loss: 26–40 dB
- Moderate Hearing Loss: 41–55 dB
- Moderately Severe: 56–70 dB
- Severe: 71–90 dB
- Profound Hearing Loss: >90 dB
Rinne Test
- Normal: Air Conduction (AC) > Bone Conduction (BC)
- Positive Rinne = Normal or Sensorineural Hearing Loss
- Negative Rinne = Conductive Hearing Loss
- Conductive Loss: BC > AC
- Sensorineural Loss: AC > BC
Weber Test
- Normal: Sound heard equally in both ears
- Conductive Hearing Loss: Sound lateralizes to affected ear
- Sensorineural Hearing Loss: Sound lateralizes to normal ear
Schwabach Test
- Normal: Patient and examiner hear equally
- Conductive Hearing Loss: Prolonged hearing
- Sensorineural Hearing Loss: Reduced hearing duration
Absolute Bone Conduction (ABC) Test
- Normal: Same duration as examiner
- Sensorineural Hearing Loss: Shortened duration
Tympanometry
- Type A: Normal middle ear function
- Type As: Otosclerosis
- Type Ad: Ossicular discontinuity
- Type B: Middle ear effusion
- Type C: Eustachian tube dysfunction
Speech Audiometry
- Speech Reception Threshold (SRT): Within 10 dB of PTA
- Speech Discrimination Score (SDS): 90–100%
- Poor SDS suggests retrocochlear pathology
Dix-Hallpike Test
- Positive Test: Vertigo with rotary nystagmus
- Suggestive of Benign Paroxysmal Positional Vertigo (BPPV)
Caloric Test
- COWS Rule
- Cold Water → Fast phase to Opposite side
- Warm Water → Fast phase to Same side
- Used to assess vestibular function
Tuning Fork Frequencies
- 256 Hz – Vibration sense
- 512 Hz – Standard ENT hearing examination
- 1024 Hz – Supplementary hearing assessment
Common ENT OPD Cases
Allergic Rhinitis
Clinical Features
- Repeated sneezing
- Nasal itching
- Watery rhinorrhea
- Nasal blockage
- Postnasal drip
- Allergic salute and allergic shiners
Treatment
- Cetirizine 10 mg orally once daily at night × 2–4 weeks
- OR Levocetirizine 5 mg orally once daily × 2–4 weeks
- Fluticasone nasal spray: 2 sprays/nostril once daily
- Saline nasal irrigation 2–3 times daily
Advice
- Avoid dust, smoke and allergens
- Use mask during exposure
- Regular nasal saline wash
Acute Rhinitis (Common Cold)
Clinical Features
- Sneezing
- Rhinorrhea
- Nasal congestion
- Mild fever
- Sore throat
Treatment
- Paracetamol 500–650 mg every 6–8 hours as required
- Cetirizine 10 mg once daily × 5–7 days
- Steam inhalation 3–4 times daily
- Adequate oral fluids
Advice
- Rest adequately
- Maintain hydration
- Avoid unnecessary antibiotics
Acute Sinusitis
Clinical Features
- Facial pain
- Purulent nasal discharge
- Headache
- Nasal obstruction
- Fever
- Maxillary tenderness
Treatment
- Amoxicillin-Clavulanate 625 mg orally three times daily × 5–7 days
- Paracetamol 650 mg every 6–8 hours if pain/fever
- Xylometazoline 0.1% nasal drops 2–3 drops TDS × maximum 5 days
- Steam inhalation 3–4 times/day
Advice
- Maintain hydration
- Complete antibiotic course
- Avoid prolonged decongestant use
Deviated Nasal Septum (DNS)
Clinical Features
- Unilateral or bilateral nasal obstruction
- Snoring
- Headache
- Recurrent sinusitis
- Mouth breathing
- Epistaxis
Treatment
- Saline nasal spray 2–3 times daily
- Fluticasone nasal spray 2 sprays/nostril once daily if associated rhinitis
- Antihistamines if allergy present
- Definitive treatment: Septoplasty
Advice
- Avoid nasal trauma
- Seek surgical correction if symptoms persist
Nasal Polyp
Clinical Features
- Progressive nasal obstruction
- Reduced sense of smell (Hyposmia)
- Mouth breathing
- Nasal discharge
- Snoring
Treatment
- Fluticasone nasal spray: 2 sprays each nostril once daily
- Prednisolone 30–40 mg orally once daily × 5–7 days (selected patients)
- Saline nasal irrigation
- Definitive treatment: Functional Endoscopic Sinus Surgery (FESS)
Advice
- Control allergy triggers
- Regular follow-up for recurrence
Acute Otitis Media
Clinical Features
- Ear pain
- Fever
- Reduced hearing
- Irritability in children
- Bulging tympanic membrane
- Ear fullness
Treatment
- Amoxicillin 500 mg orally three times daily × 5–7 days
- Paracetamol 650 mg every 6–8 hours for pain/fever
- Nasal decongestants if required
Advice
- Complete antibiotic course
- Avoid self-cleaning of ears
- Follow-up if discharge develops
Otitis Externa
Clinical Features
- Severe ear pain
- Ear discharge
- Tragal tenderness
- Ear canal swelling
- Pruritus
Treatment
- Ciprofloxacin ear drops: 3–4 drops twice daily × 7–10 days
- Analgesics as needed
- Aural toilet by ENT specialist
Advice
- Keep ear dry
- Avoid swimming until cured
- Do not use cotton buds
Impacted Ear Wax
Clinical Features
- Hearing loss
- Ear fullness
- Tinnitus
- Occasional vertigo
- Blocked ear sensation
Treatment
- Glycerin ear drops: 2–3 drops three times daily × 5 days
- OR Sodium Bicarbonate ear drops 2–3 drops TDS × 5 days
- Syringing or suction clearance if required
Advice
- Avoid inserting objects into ears
- Routine cleaning is unnecessary
Chronic Suppurative Otitis Media (CSOM)
Clinical Features
- Persistent ear discharge
- Hearing loss
- Perforated tympanic membrane
- Intermittent foul smell
Treatment
- Aural toilet (ear cleaning)
- Ciprofloxacin ear drops 3–4 drops twice daily × 7–14 days
- Systemic antibiotics if severe infection present
- Definitive treatment: Tympanoplasty
Advice
- Keep ear dry at all times
- Use ear plugs while bathing
- Regular ENT follow-up
Tinnitus
Clinical Features
- Ringing in ears
- Buzzing sensation
- Whistling sounds
- May be associated with hearing loss
Treatment
- Identify and treat underlying cause
- Hearing aid if hearing loss present
- Tinnitus retraining therapy
- Noise masking devices if needed
Advice
- Avoid loud noise exposure
- Reduce caffeine and nicotine intake
- Manage stress levels
Benign Paroxysmal Positional Vertigo (BPPV)
Clinical Features
- Brief episodes of vertigo
- Triggered by head movements
- Nausea and vomiting
- Positive Dix-Hallpike test
- No hearing loss
Treatment
- Betahistine 16 mg orally three times daily × 2–4 weeks
- Epley repositioning maneuver
- Vestibular rehabilitation exercises
Advice
- Avoid sudden head movements
- Sleep with head elevated
- Perform vestibular exercises regularly
Meniere Disease
Clinical Features
- Recurrent vertigo
- Tinnitus
- Fluctuating hearing loss
- Aural fullness
- Nausea and vomiting
Treatment
- Betahistine 16 mg orally three times daily
- Low-salt diet
- Vestibular suppressants during acute attacks
- Diuretics in selected patients
Advice
- Restrict salt intake
- Avoid caffeine and alcohol
- Maintain adequate hydration
Acute Pharyngitis
Clinical Features
- Sore throat
- Pain while swallowing
- Fever
- Pharyngeal congestion
- Malaise
Treatment
- Amoxicillin 500 mg orally three times daily × 5–7 days (if bacterial)
- Paracetamol 650 mg every 6–8 hours as required
- Warm saline gargles 3–4 times daily
- Adequate fluid intake
Advice
- Maintain hydration
- Avoid smoking
- Complete antibiotic course if prescribed
Acute Tonsillitis
Clinical Features
- Fever
- Severe throat pain
- Dysphagia
- Enlarged tonsils
- Tonsillar exudates
- Tender cervical lymph nodes
Treatment
- Amoxicillin-Clavulanate 625 mg orally three times daily × 5–7 days
- Paracetamol 650 mg every 6–8 hours
- Warm saline gargles
- Oral hydration
Advice
- Complete treatment course
- Maintain oral hygiene
- Seek review if recurrent attacks occur
Peritonsillar Abscess (Quinsy)
Clinical Features
- Severe unilateral throat pain
- Muffled "hot potato" voice
- Difficulty swallowing
- Trismus
- Uvula deviation
- Fever
Treatment
- Urgent ENT referral
- Incision and drainage
- Amoxicillin-Clavulanate 625 mg orally three times daily
- Analgesics and hydration
Advice
- Do not delay treatment
- Maintain hydration
- Follow-up after drainage
Laryngopharyngeal Reflux (LPR)
Clinical Features
- Chronic throat clearing
- Hoarseness of voice
- Foreign body sensation in throat
- Chronic cough
- Globus sensation
Treatment
- Pantoprazole 40 mg orally once daily before breakfast × 4–8 weeks
- Dietary modifications
- Avoid late-night meals
Advice
- Avoid spicy foods
- Avoid lying down immediately after meals
- Weight reduction if overweight
Vocal Cord Nodules
Clinical Features
- Hoarseness of voice
- Voice fatigue
- Difficulty speaking loudly
- History of voice abuse
Treatment
- Voice rest
- Speech therapy
- Treatment of associated reflux if present
- Microlaryngeal surgery in selected cases
Advice
- Avoid shouting
- Maintain hydration
- Follow speech therapy recommendations
Cervical Lymphadenitis
Clinical Features
- Neck swelling
- Tender lymph nodes
- Fever
- Throat infection history
Treatment
- Amoxicillin-Clavulanate 625 mg orally three times daily × 7 days
- Paracetamol 650 mg as required
- Treat primary source of infection
Advice
- Follow-up if swelling persists
- Evaluate for tuberculosis if chronic
Epistaxis
Clinical Features
- Nasal bleeding
- May be spontaneous or traumatic
- Commonly from Little's area
Treatment
- Pinch nostrils firmly for 10–15 minutes
- Apply ice packs
- Oxymetazoline nasal spray: 2 sprays in affected nostril
- Nasal packing if bleeding persists
Advice
- Avoid nose picking
- Control hypertension
- Keep nasal mucosa moist
Foreign Body Ear / Nose / Throat
Clinical Features
- Sudden discomfort
- Ear pain or nasal blockage
- Foul smelling discharge
- Coughing or choking episodes
Treatment
- Removal under direct visualization
- ENT referral when required
- Urgent removal if button battery present
Advice
- Do not attempt repeated home removal
- Seek immediate medical attention for batteries
Presbycusis
Clinical Features
- Age-related hearing loss
- Difficulty hearing conversations
- Poor speech discrimination
- Bilateral sensorineural hearing loss
Treatment
- Hearing assessment with PTA
- Hearing aid fitting
- Auditory rehabilitation
Advice
- Avoid excessive noise exposure
- Regular hearing evaluations
Otosclerosis
Clinical Features
- Progressive conductive hearing loss
- Tinnitus
- Usually young adults
- Normal tympanic membrane
Treatment
- Hearing aid
- Stapedotomy / Stapedectomy (definitive treatment)
- Regular audiometric follow-up
Advice
- Regular hearing assessment
- Discuss surgical options when appropriate
