ENT contitions

Cerumen (wax) impaction, often from cotton bud use, causes reduced hearing, fullness, itching, pain and tinnitus. Soften the wax with hydrogen peroxide 3% drops for 7 days and remove it with a cerumen hook or suction under direct vision.

Ear foreign bodies are common in children (beads, stones, seeds) and adults (cotton buds, insects). Remove them under direct vision with proper instruments, kill an insect first with saline or spirit, and do not attempt removal without the right equipment and skill.

Chronic rhinosinusitis is bacterial or fungal sinus inflammation lasting more than 12 weeks, with discharge, blockage, facial pressure and loss of smell. Treat as acute rhinosinusitis but for 4–6 weeks, with saline washes and steaming, and refer for CT and sinus surgery if it fails.

Non-infectious chronic laryngitis, usually reflux with vocal cord nodules or polyps, causes hoarseness, dry cough, globus and throat clearing. Treat with diet and lifestyle change, voice rest, 8–12 weeks of a PPI, short steroids and antihistamines, and microlaryngeal surgery for nodules or polyps.

Choanal atresia is congenital blockage of the back of the nose; bilateral atresia is an emergency because neonates breathe through the nose, with distress relieved by crying and failure to pass a nasogastric tube. Secure an oral airway, refer urgently, and repair endoscopically.