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Open in new tab Unit 525 March 2016
Ear, nose and
throat (ENT)
Independent learning program for GPsIndependent learning program for GPswww.racgp.org.au/check DisclaimerThe information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.While the text is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices. Accordingly, The Royal Australian College of General Practitioners and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the information.SubscriptionsFor subscriptions and enquiries please call 1800 331 626 or email check@racgp.org.auPublished byThe Royal Australian College of General Practitioners 100 Wellington Parade East Melbourne, Victoria 3002, Australia Telephone 03 8699 0414 Facsimile 03 8699 0400 www.racgp.org.auABN 34 000 223 807 ISSN 0812-9630© The Royal Australian College of General Practitioners 2016. Ear, nose and throat (ENT)
Unit 525 March 2016
About this activity
Acronyms
Case 1 Paul has a sore throat
Case 2 Casey has ear trouble
Case 3 Janine’s voice is hoarse
Case 4 Dilan has a runny nose
Case 5 Lynne feels dizzy
Case 6 Ralph has hearing loss
Multiple choice questions
The five domains of general practice
Communication skills and the patient–doctor relationship
Applied professional knowledge and skills
Population health and the context of general practice
Professional and ethical role
Organisational and legal dimensions
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Independent learning program for GPsIndependent learning program for GPs ABOUT THIS ACTIVITY
ABOUT THIS ACTIVITY
Patients often present to general practice with various ear, nose
and throat (ENT) conditions. These conditions are often referred to
specialist care, and general practitioners (GPs) could benefit from
further education in the management of these conditions, particularly
in rural and remote communities where specialist services are often
scarce.
Viral sore throat is common in children and 15–30% of children and
10% of adults will have Group A streptococcal (GAS) pharyngitis/
tonsillitis.1 Acute tonsillitis was encountered at 2.7 per 100
encounters for children under the age of five years and has one of
the highest prevalences of antibiotics prescription.2 Acute otitis media
is a common childhood problem and 90% of children will have at
least one episode by the time they reach school age.3 In particular,
acute otitis media is a serious problem in Aboriginal and Torres Strait
Islander children.4
Viral infections of the upper respiratory tract are the most common
causes of acute hoarseness and persistent hoarseness, and could
be indicative of a more serious underlying problem.5 More than
three million Australian are known to have allergic rhinitis and it
can severely disrupt a patient’s daily activities and cause irritation.6
Vertigo is described as a ‘false sense of motion’ and is one of the
sensations of dizziness,7 accounting for 32% of all dizziness cases,8
up to 56.4% in older Australians.9 The management of hearing
problems is 3.5 and 2.6 per 1000 encounters for men and women
respectively who are 50 years of age and older.10
This edition of check considers the management and treatment of
various ear, nose and throat problems that may present in general
practice.
LEARNING OUTCOMES
At the end of this activity, participants will be able to:
• outline the differential diagnoses for a patient presenting with a
• discuss the assessment and management of a child with acute
• describe strategies for managing hoarseness
• summarise the recommendations for treating children with allergic
• discuss the causes and management of vertigo
• describe investigations for hearing loss.
sore throat
otitis media
rhinitis
AUTHORS
Lalith Baduraliya (Case 4) MBBS, FRACGP, is a general practitioner
in the south-eastern suburbs in Melbourne. He has been involved
in teaching and training general practice registrars and medical
students, as well as FRACGP examinations.
Andrew Chang (Case 6) MBBS (Hons), FRACS (OHN), is an Ear Nose
and Throat Surgeon at the Mater Adults Hospital and Lady Cilento
Children’s Hospital. He has special interests in paediatric hearing loss
and implantable hearing devices.
Matthew Cronin (Case 5) BSc, MBBS, FRACS (Otolaryngology, Head
and Neck Surgery). is a specialist otolaryngologist providing expert
care in all areas of the ear, nose and throat. Dr Cronin is based at the
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Gold Coast University Hospital, Ipswich Hospital and Pindara Private
Hospital.
Kenneth De Jong (Case 2) MBBS (Hons), graduated from Monash
University and will be starting his internship at Eastern Health in
Melbourne in 2016.
Liz Harrison (Case 5) BSc, MBBS, is a non-accredited ear nose and
throat registrar at the Gold Coast University Hospital.
Grace Kirkby Strachan (Case 6) MBBS, is an ENT registrar (non-
training) at Mater Adults Hospital Brisbane.
Carol Lawson (Case 3) MBBS, FRACGP, is a general practitioner
in Brunswick, Victoria. She previously worked in the Department of
General Practice at Monash University and has an interest in medical
education.
Rachel Oommen (Case 2) BSc (Hons), MSc, MD, is a CCFP
candidate. Dr Oommen has a particular interest in people and their
stories and aspires to convey that in her daily practice.
Fabian Schwarz (Case 2) BSc, MBBS, FRACGP, FARGP, CCFP, is a
rural generalist working for the Department of Health in the Northern
Territory. Dr Schwarz also has a special interest in people and their
stories and bringing personal aspects into contemporary medical
education – going beyond mere medical facts.
Sara Whitburn (Case 1) BMBS, FRACGP, DRANZCOG, DCH (UK),
FSRH (UK), is a general practitioner and family planning doctor who
works at Belmore Road Medical Centre in Balwyn, Victoria. She has
a special interest in women’s and children’s health, especially early
childhood.
PEER REVIEWERS
Sylvia Leung MBBS (Hon), FRACGP, trained at various hospitals
around Victoria, including the Royal Children’s Hospital and the Royal
Victorian Eye and Ear Hospital in Melbourne. She currently works as
a general practitioner in Rowville, Victoria, and enjoys teaching and
supervising general practice registrars. Dr Leung has been actively
involved with The Royal Australian College of General Practitioners as
an examiner since 2008.
Sam Morcom BSc, MBBS, is currently studying a Master of Surgical
Sciences at the University of Sydney. Dr Morcom has previously
worked as a resident at the Royal Brisbane and Women’s Hospital in
2013 and 2014. For the past 12 months, he has been employed at
Nambour General Hospital as a principal house officer in ear, nose
and throat surgery and has been appointed to remain in that position
for another 12 months. Dr Morcom is also involved with tutoring
third-year medical students from the University of Queensland during
their surgical rotation.
REFERENCES
1. The Royal Australian College of General Practitioners. National guide to
preventive health assessment for Aboriginal and Torres Strait Islander
people. 2nd edn. Melbourne: RACGP, 2012. Available at www.racgp.
org.au/your-practice/guidelines/national-guide/rheumatic-heart-disease
[Accessed 25 October 2015].
2. Blezen R, Pollack A, Harrison C, et al. Respiratory tract infections among
children younger than 5 years: Current management in Australian general
practice. Med J Aust 2015;202(5):262–66.
check Ear, nose and throat (ENT) ABOUT THIS ACTIVITY
3. Nyquist A-C, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing
for children with colds, upper respiratory tract infections, and bronchitis.
JAMA 1998;279:875–77.
4. Leach AJ, Boswell JB, Asche V, et al. Bacterial colonization of the
nasopharynx predicts very early onset and persistence of otitis media in
Australian Aboriginal infants. Pediatr Infect Dis J 1994;13:239–47.
5. Murtagh JE. General practice. 4th edn. Sydney: McGraw Hill, 2007.
6. Australian Institute of Health and Welfare. Allergic rhinitis (‘hay fever’)
in Australia. Bruce, ACT: AIHW, 2011. Available at www.aihw.gov.au/
publication-detail/?id=10737420595 [Accessed 4 January 2016].
7. Kuo CH, Pang L, Chang R. Vertigo: Part 1 – Assessment in general
practice. Aust Fam Physician 2008;37(5):341–45.
8. Hanley K, O’Dowd T, Considine N. A systematic review of vertigo in
primary care. Br J Gen Pract 2001;51:666–71.
9. Bird JC, Beynon GJ, Prevost AT, Baguley DM. An analysis of referral
patterns for dizziness in the primary care setting. Br J Gen Pract
1998;48:1928–32.
10. Schneider JM, Gopinath B, McMahon CM, et al. Role of general
practitioners in managing age-related hearing loss. Med J Aust
2010;192(1):20–23.
ACRONYMS
air conduction
AC
acute rheumatic fever
ARF
ASCIA Australasian Society of Clinical
Immunology and Allergy
bone conduction
benign paroxysmal positional vertigo
BC
BPPV
CSOM chronic suppurative otitis media
computed tomography
CT
Epstein–Barr virus
EBV
electrocardiogram
ECG
electronystagmogram
ENG
ear, nose and throat
full blood evaluation
Group A streptococcal
ENT
FBE
GAS
GORD gastro-oesophageal reflux disease
general practitioner
GP
immunoglobulin E
IgE
intramuscular
IM
liver function test
LFT
MBS Medicare Benefits Schedule
MC&S microbiology, culture and sensitivity
MRI magnetic resonance imaging
MS
NICE
multiple sclerosis
National Institute for Health
and Care Excellence
pure tone audiometry
quality of life
radioallergosorbent test
PTA
QoL
RAST
SNHL sensorineural hearing loss
tympanic membrane
TM
upper respiratory tract infection
URTI
vestibular-evoked myogenic
VEMP
potential
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check Ear, nose and throat (ENT)