ENT Nursing Guide — GCC Edition

👁 Otoscopy Technique & Tympanic Membrane

Straighten the ear canal: adults — pull pinna up and back; children <3 yr — pull down and back. Use largest speculum that fits comfortably. Brace hand against patient's face. Advance under direct vision.

Normal TM Appearance

Pearly grey, translucent, cone of light (light reflex) at 5 o'clock (right) / 7 o'clock (left)
Landmarks visible: handle of malleus, pars flaccida, annulus

Pathological Findings

Condition	TM Appearance	Key Features
AOM (Acute Otitis Media)	Red, bulging, opacified, loss of light reflex	Fever, severe otalgia, +/− perforation with purulent discharge
OME (Glue Ear)	Amber/yellow, retracted, air-fluid levels or bubbles	Painless, conductive hearing loss, common in children
Perforation	Visible hole — central (safe) vs marginal/attic (unsafe)	Marginal/attic perforations carry cholesteatoma risk
Cholesteatoma	Attic crust/retraction pocket with keratinous debris	Foul-smelling discharge, erosion of ossicles, facial nerve risk

Attic/marginal perforations or retraction pockets with debris — refer urgently. Do NOT irrigate ears with suspected perforation or mastoid surgery history.

🎵 Rinne & Weber Tuning Fork Tests (512 Hz)

Rinne Test (per ear)

Method: Strike fork → mastoid (bone conduction) until not heard → move to external meatus (air conduction).

Rinne Positive (AC > BC) — Normal or sensorineural loss

Rinne Negative (BC > AC) — Conductive hearing loss (>20 dB)

False-negative Rinne: profound unilateral SNHL — sound crosses to better ear. Always do Weber first.

Weber Test (lateralisation)

Method: Place vibrating fork on vertex/forehead midline.

Lateralises to DEAF ear — Conductive hearing loss (noise masked out)

Lateralises to BETTER ear — Sensorineural hearing loss

No lateralisation — Normal bilateral or symmetrical loss

Interpretation Summary

Weber	Rinne (affected side)	Diagnosis
Lateralises LEFT	Negative LEFT	Left conductive hearing loss
Lateralises RIGHT	Positive RIGHT (falsely)	Left SNHL (false-negative Rinne left)
Central / No lateral.	Positive bilaterally	Normal or symmetrical SNHL

👃 Anterior Rhinoscopy

Use Thudichum nasal speculum or otoscope with large speculum. Tilt head back slightly. Inspect: turbinates (inferior most visible), nasal septum, mucosa colour, discharge, polyps, septal deviation.

Normal Findings

Pink, moist mucosa
Inferior turbinate pink, not obstructing
Clear mucous, midline septum

Pathological Findings

Pale/blue boggy turbinates — allergic rhinitis
Grey grape-like polyps — nasal polyposis
Septal deviation or spur
Purulent discharge — sinusitis
Bleeding point — epistaxis (Little's area)

👀 Throat & Pharynx Inspection

Tonsil Grading (Brodsky Scale 0–4)

Grade	Description
0	Tonsils within tonsillar fossa (post-tonsillectomy)
1+	Tonsils occupy <25% of oropharyngeal width
2+	25–50% — mild enlargement, visible beyond pillars
3+	50–75% — moderate, approaching midline
4+	>75% — "kissing tonsils", obstructing airway — OSA risk

Mallampati Score (Airway Assessment)

Class	Visible Structures	Implication
I	Soft palate, uvula, fauces, tonsils	Easy intubation
II	Soft palate, uvula, fauces	Moderate
III	Soft palate, base of uvula only	Difficult
IV	Hard palate only	Very difficult intubation

🕻 Neck Palpation — Lymphadenopathy & Thyroid

Examine from behind. Systematically palpate all cervical node groups: submental → submandibular → pre-auricular → post-auricular → anterior cervical chain → posterior cervical → supraclavicular (Virchow's node — GI malignancy).

Lymph Node Characteristics

Reactive: soft, tender, mobile, <1 cm
Infective (abscess): fluctuant, tender, erythema
Malignant: hard, non-tender, fixed, >2 cm, rubbery (lymphoma)

Supraclavicular node, non-tender >2 cm lasting >6 weeks → urgent 2-week-wait cancer referral

Thyroid Palpation

Examine from behind, fingers over thyroid isthmus
Ask patient to swallow — thyroid rises with deglutition
Note: size, consistency, nodules, tenderness, bruit (Graves')
Pemberton's sign: arms raised → facial congestion = retrosternal goitre

🔊 Otitis Media

Acute Otitis Media (AOM)

Most common in children 6 months–3 years
Pathogens: S. pneumoniae, H. influenzae, M. catarrhalis
Symptoms: rapid onset otalgia, fever, irritability, reduced hearing
TM: red, bulging, opacified, absent light reflex

Nursing Management AOM

Analgesia (paracetamol/ibuprofen) — first line
Antibiotics: amoxicillin if severe/<2 yr/no improvement 48 h
Educate: fever management, return if worsening
Complications: mastoiditis (post-auricular swelling/tenderness, pinna displaced forward) — URGENT ENT

Otitis Media with Effusion (Glue Ear / OME)

Commonest cause of childhood conductive hearing loss
TM: retracted, amber/dull, possible fluid level
Often asymptomatic; detected on school hearing screen

Grommets (Ventilation Tubes)

Indication: bilateral OME >3 months with significant hearing loss
Inserted under GA through myringotomy
Nursing: keep ears dry — ear plugs for swimming; no diving
Advise: grommets extrude spontaneously (6–18 months for short-term)
Hearing checked 4–6 weeks post-op; school notification

🔉 Otitis Externa

Diffuse inflammation of EAC — "swimmer's ear"
Organisms: Pseudomonas aeruginosa (most common), S. aureus, Candida
Symptoms: otalgia (worse with tragus pressure), otorrhoea, itch, blocked ear
Treatment: topical acetic acid or antibiotic/steroid drops (ciprofloxacin); aural toilet (microsuction); keep dry

Malignant (Necrotising) Otitis Externa — EMERGENCY
Seen in elderly diabetics and immunocompromised. Pseudomonas spreads to skull base. Signs: severe otalgia disproportionate to exam, granulation tissue at bony-cartilaginous junction of floor EAC, facial nerve palsy (late). Requires urgent ENT + IV anti-pseudomonal antibiotics (ciprofloxacin/piperacillin-tazobactam) + CT/MRI skull base + diabetes optimisation. Mortality significant if delayed.

🔍 BPPV — Benign Paroxysmal Positional Vertigo

Commonest cause of vertigo. Free-floating otoconia in posterior semicircular canal (usually).

Dix-Hallpike Test (Diagnosis)

Patient seated, turn head 45° to side being tested
Rapidly lower to supine with head hanging 20–30° below horizontal
Observe for nystagmus (upbeat, torsional toward affected ear)
Onset 1–5 s, duration <60 s, fatigable — characteristic of BPPV

Epley Manoeuvre (Treatment)

Dix-Hallpike position (affected side)
Rotate head 90° to opposite side (wait 30 s)
Roll body/head further 90° face-down (wait 30 s)
Sit up slowly

Success rate ~80% single treatment. Teach patient to self-manage. Avoid vigorous head movements for 24 h post-Epley.

🌍 Ménière's Disease

Endolymphatic hydrops — excess endolymph pressure. Classic triad: episodic vertigo (20 min–12 h), fluctuating SNHL (low frequency), tinnitus ± aural fullness.

Nursing Management

Low-sodium diet (<1500–2000 mg/day) — cornerstone lifestyle change; educate re: hidden salt in GCC foods (canned/processed)
Betahistine 16 mg TDS (vestibular microperfusion) — long-term, compliance key
Acute attack: prochlorperazine buccal/IM for nausea/vertigo; bed rest
Vestibular rehabilitation exercises (Cawthorne-Cooksey) — between attacks
Avoid caffeine, alcohol, stress, fatigue
Driving advice: must not drive during acute attacks; discuss DVLA/transport authority regulations
Surgical options (if refractory): endolymphatic sac decompression, intratympanic gentamicin

🚨 Sudden Sensorineural Hearing Loss (SSNHL)

EMERGENCY — Do NOT delay referral. Defined as >30 dB SNHL across 3 consecutive frequencies occurring within 72 hours. Treatment window: ideally within 2 weeks (some benefit up to 4 weeks).

Aetiology: viral (most common), vascular, autoimmune, perilymph fistula, acoustic neuroma
Treatment: oral high-dose prednisolone (1 mg/kg/day up to 60 mg × 10–14 days, taper) ± intratympanic steroid injection
MRI internal auditory meati to exclude acoustic neuroma
Nursing: reassure, document time of onset precisely, expedite ENT same-day, audiogram urgently
Prognosis: ~65% partial/complete recovery; worse prognosis if profound loss, elderly, delayed treatment

🔧 Tympanoplasty — Post-Op Nursing Care

Keep ear dry for 4–6 weeks; no swimming; shower with cotton wool + Vaseline in ear
Avoid nose-blowing — Valsalva causes graft displacement; sneeze with mouth open
Analgesia: paracetamol/ibuprofen; ear may feel blocked — reassure
Dressing: mastoid bandage removed at 24–48 h
Ear pack/wick dissolves or removed at 2–4 weeks outpatient
Hearing improvement may not be apparent for 6–8 weeks until pack absorbs
Red flags: increasing pain, fever, facial droop — urgent review
Return to work: office 1–2 weeks; avoid heavy lifting/straining 3 weeks

🔴 Epistaxis Management

Little's area (anterior nasal septum) = Kiesselbach's plexus — anastomosis of 4 arteries: sphenopalatine, anterior ethmoidal, superior labial, greater palatine. Source of ~90% of anterior bleeds.

ABCDE Initial Assessment

A: Airway — check patency; sit patient forward, breathe through mouth
B: Estimate blood loss, SpO2
C: IV access if significant bleed, HR/BP, FBC/coagulation/G&S if severe
D: Anticoagulants? Hypertension? Haematological disorder? Medications (warfarin, clopidogrel, NSAIDs)
E: Examine: anterior vs posterior source; apply gloves & eye protection

Step-by-Step Management

Pinch entire soft lower third of nose for 10–20 minutes continuous — patient forward, breathing through mouth
Cold compress over nasal bridge
If continues: inspect with light — visualise bleeding point
Cauterisation: silver nitrate stick to visible bleeding point — one side only, unilateral
Anterior nasal pack: Merocel sponge lubricated with BIPP/lidocaine gel, or RAPID RHINO balloon. Document pack in, time, side
Posterior packing: Foley catheter (12–14 Fr, inflate 10–15 mL saline balloon, traction to choanae) OR Brighton balloon. Requires HDU/admission for monitoring — hypoxia risk
Persistent/arterial bleeding: surgical sphenopalatine artery ligation or IR embolisation

Anterior pack: prescribe prophylactic antibiotics (co-amoxiclav) for >24 h packing. Remove pack at 24–48 h unless surgeon advises otherwise. Document pack removal with pack check.

⚙ Interactive Epistaxis Decision Pathway

Step 1: Where is the bleeding source?

👃 Sinusitis

Acute Bacterial Rhinosinusitis

Symptoms >10 days or "double sickening" pattern
Unilateral facial pain, purulent discharge, loss of smell
Pathogens: S. pneumoniae, H. influenzae
Treatment: amoxicillin/co-amoxiclav 5–7 days; saline irrigation; decongestants short-term (<5 days)

Complications (Rare but Serious)

Orbital cellulitis/abscess — periorbital oedema, proptosis, ophthalmoplegia → URGENT CT + surgery
Intracranial extension: meningitis, subdural empyema — neurosurgical emergency

Chronic Rhinosinusitis (CRS)

Symptoms >12 weeks: nasal obstruction, discharge, facial pressure, hyposmia
CRS with polyps (CRSwNP): bilateral polyps, loss of smell, +/− asthma, NSAID sensitivity (Samter's triad)
CRS without polyps (CRSsNP): anatomical obstruction, recurrent infections

FESS Post-Op Care

Saline nasal irrigation (high-volume, low-pressure) from Day 1 — BudesonideL irrigation if prescribed
Do NOT blow nose for 2 weeks — risk of orbital emphysema
Sneeze with mouth open
Nasal pack removal (if used) at 24–48 h
Crusting, blood-stained mucus normal for 2–4 weeks
Avoid heavy lifting, flying, strenuous exercise for 2 weeks
Follow-up debridement at 1–2 weeks essential for scar prevention

🕇 Nasal Fracture

Most common facial fracture. Clinical diagnosis: deformity, epistaxis, periorbital bruising
Immediate: control epistaxis; assess for septal haematoma — boggy, purple swelling on septum → URGENT drainage (abscess/necrosis risk)
X-ray rarely changes management; CT if complex facial fracture
Manipulation under anaesthesia (MUA): 7–10 days post-injury (once swelling subsided, before union)
Reassure: bruising, swelling resolve in 1–2 weeks

Septal haematoma = emergency. Untreated → septal abscess → saddle-nose deformity (cartilage necrosis). Drain and pack.

🍀 Allergic Rhinitis — Treatment Ladder

Step	Intervention
1	Allergen avoidance (house dust mite covers, pet dander, pollen — relevant to GCC: date palm, grass pollen season Feb–May)
2	Intranasal corticosteroid spray (mometasone, fluticasone) — first-line pharmacotherapy; onset 2 weeks
3	Add non-sedating antihistamine (cetirizine/loratadine) for breakthrough symptoms
4	Saline nasal irrigation BID; consider leukotriene antagonist (montelukast) if co-existing asthma
5	Short course oral steroids for severe acute exacerbation
6	Allergen immunotherapy (subcutaneous or sublingual) for refractory cases

Nasal polyps: intranasal steroid drops (head-down/Moffatt's position) in addition to spray; biologics (dupilumab) for severe refractory CRSwNP.

🩕 Tonsillitis & Centor/McIsaac Score

Viral vs Bacterial

	Viral	Bacterial (GAS)
Onset	Gradual	Sudden
Cough	Present	Absent
Exudate	Absent/minimal	White/yellow exudate
Lymph nodes	Mild	Tender cervical LAD
Fever	Low-grade	>38°C
Treatment	Supportive	Penicillin V/amoxicillin

⚙ Centor/McIsaac Calculator

Tonsillar exudate (+1) Tender anterior cervical lymphadenopathy (+1) Fever >38°C (history or current) (+1) Absence of cough (+1) Age 3–14 yr (+1) / Age 15–44 yr (0) / Age ≥45 yr (−1)

Infectious mononucleosis (EBV): severe tonsillitis, splenomegaly, cervical LAD, atypical lymphocytes. Do NOT give amoxicillin/ampicillin — causes maculopapular rash in ~95% of cases.

🚨 Quinsy (Peritonsillar Abscess) — EMERGENCY

Airway emergency risk. Commonest deep space neck infection in adults. Streptococcus pyogenes, mixed oral flora.

Features: unilateral throat pain, trismus (difficulty opening mouth), "hot potato" voice, uvular deviation away from abscess, drooling, dysphagia, dehydration
Management:
1. IV access, fluid resuscitation if dehydrated
2. IV antibiotics: benzylpenicillin + metronidazole (or co-amoxiclav)
3. IV dexamethasone (reduces oedema, trismus)
4. Needle aspiration or incision and drainage under LA — 1.5 cm above upper pole of tonsil, lateral to uvula
5. Airway monitoring — have difficult airway trolley available; anaesthetist aware
6. Oral intake monitoring post-drainage
Interval tonsillectomy ("quinsy tonsillectomy") considered after 2nd episode

🚨 Epiglottitis — Airway Emergency

Do NOT examine throat / use tongue depressor. Do NOT lay patient flat. Keep calm, minimise disturbance. Call anaesthetist IMMEDIATELY for controlled intubation in theatre.

Cause: Haemophilus influenzae type b (Hib) — now rare in vaccinated children; adults (Hib, Strep, Staph, viral)
GCC relevance: verify Hib vaccination status — immigrant workers may be unvaccinated; paediatric Hib immunisation programme varies by country of origin
Features: sudden high fever, toxic appearance, stridor, drooling, tripod posturing, dysphonia, odynophagia
"Thumbprint sign" on lateral neck X-ray (if patient stable and cooperative — not mandatory)
Management: controlled intubation in theatre, IV ceftriaxone, humidified oxygen, HDU/ICU

🚨 Ludwig's Angina

Rapidly spreading cellulitis of submandibular space. Life-threatening airway emergency.

Source: usually dental (lower molar infection); diabetics at high risk
Features: bilateral submandibular swelling, elevated/displaced tongue, stridor, drooling, brawny (board-like) induration
Management: urgent airway (awake fibreoptic intubation preferred), IV broad-spectrum antibiotics (ampicillin-sulbactam + metronidazole), surgical drainage, ITU

🔊 Hoarse Voice — Red Flags

Hoarseness >3 weeks in adult smoker/drinker → urgent 2-week-wait laryngoscopy to exclude laryngeal carcinoma.

Cause	Features	Action
Laryngitis (acute viral)	<3 weeks, URTI, self-limiting	Voice rest, steam, hydration
Vocal cord nodules	Bilateral, "teacher's nodules", breathy voice	Voice therapy first line
Laryngeal carcinoma	>3 weeks, smoker, progressive	Urgent ENT, laryngoscopy, CT
Recurrent laryngeal nerve palsy	Bovine cough, breathy, aspiration risk	CT chest/neck (apical lung/mediastinum)
Reinke's oedema	Female smoker, low-pitched voice	Stop smoking; surgical stripping

🔴 Post-Tonsillectomy Haemorrhage

Surgical emergency — return to theatre. Any haemorrhage post-tonsillectomy requires urgent ENT review.

Primary Haemorrhage (<24 hours)

Intra-operative or within 24 h of surgery
Cause: inadequate haemostasis, slipped ligature
Action: return to theatre, adrenaline-soaked gauze pressure, general anaesthetic, suture or diathermy
Rapid IV access, cross-match, senior anaesthetist (full stomach risk — aspiration)

Secondary Haemorrhage (Day 5–10)

Most common type (2–3% incidence)
Cause: sloughing of fibrinous eschar, local infection
Clot in socket may conceal significant bleeding — do NOT remove
Management: IV access, FBC/G&S/coagulation, IV antibiotics, theatre standby
Nursing: nil by mouth until senior review, monitor HR/BP, measure vomited blood

🔧 Post-Tonsillectomy Nursing Care

Diet Progression

Day 0–1: Cold fluids, ice lollies, cool water — soothe raw surface
Day 2–3: Soft cool foods (yoghurt, ice cream, mashed foods)
Day 4–7: Progress to normal diet — important for debridement of socket, healing
Encourage adequate oral intake; dehydration increases secondary bleed risk
Avoid hard, sharp, scratchy foods (crisps, toast) for 2 weeks

Analgesia

Regular paracetamol ± ibuprofen (if no haemostatic concern)
Avoid NSAIDs if bleeding risk — diclofenac/aspirin increase haemorrhage
Consider co-dydramol or low-dose codeine short-term (adults)

Bleeding Surveillance

Observe tonsillar fossae at each nursing assessment
Alert signs: frequent swallowing, tachycardia, pallor, anxiety, haematemesis
Normal: slight blood-tinged saliva on Day 1 only
White slough in fossae (Days 2–10) — NORMAL healing, not infection

Return to Normal Activities

Off school/work: minimum 2 weeks
No strenuous exercise for 2 weeks
Avoid crowded places (infection risk during healing)
No swimming for 2 weeks
24-hour emergency contact number must be given at discharge

🕇 Septoplasty / Rhinoplasty Post-Op Care

Nasal packs: removed at 24–48 h (or as surgeon instructs); warn patient of discomfort and possible bleeding on removal; have suction available
External splint (rhinoplasty): kept on 1–2 weeks; keep dry; no spectacles on nose for 6 weeks
Bruising and oedema: periorbital bruising peaks Day 2–3, resolves over 2–3 weeks; head elevation 30–45°; cold compress (not on nose directly) reduces oedema
Do NOT blow nose for 2–3 weeks; sneeze with mouth open
Saline sprays from Day 2 to humidify and reduce crusting
Avoid contact sport for 6 weeks (septoplasty) / 3 months (rhinoplasty with osteotomies)
Avoid swimming, sunbathing for 3–4 weeks
Final cosmetic result: 6–12 months after oedema fully resolves
Return to work: office-based 1–2 weeks; manual labour 3–4 weeks

👁 FESS Post-Op Nursing (Functional Endoscopic Sinus Surgery)

Saline nasal douching: high-volume (240 mL) isotonic or hypertonic saline BID from Day 1 — flushes blood clot, crusts, prevents adhesion formation
Technique: head tilted 45°, pour into upper nostril, drain from lower nostril, do not forcibly sniff in
Do NOT blow nose for 2 weeks; no air travel for 2 weeks
Crusting: normal for 4–6 weeks; endoscopic debridement at 1–2 weeks clears this
Nasal steroid spray: restart as directed 1 week post-op to maintain sinus patency
Watch for: orbital haematoma (proptosis, loss of vision — urgent ophthalmology/neurosurgery), CSF leak (clear watery drip, salty taste, increases when leaning forward — β-2 transferrin), intracranial haemorrhage

CSF rhinorrhoea post-FESS: patient must not blow nose, sit upright, urgent CT head, neurosurgical consultation, prophylactic antibiotics debated.

🔨 Tracheostomy Nursing Care

Inner Cannula Care

Remove inner cannula every 4–8 hours (or as per secretion load)
Clean with tracheostomy brush and sterile water/sodium bicarbonate solution; rinse with sterile water; reinsert
Never leave inner cannula out >30 minutes
Disposable inner cannulas: replace every 8 h

Humidification

Bypass of nasal humidification → secretion desiccation → mucus plugging
Heated humidifier via ventilator circuit (ventilated patients)
HME (Heat and Moisture Exchanger) filter for spontaneously breathing patients
Swedish nose (in GCC desert climate — especially important due to low ambient humidity)
Minimum fluid intake 2–2.5 L/day

Emergency Tube Change Protocol

Bedside: spare same-size tube, one size smaller, 10 mL syringe, tracheal dilators, suction
Routine change: every 7–30 days (manufacturer guidance)
Emergency: tube displacement/obstruction — call for help, attempt suction of inner cannula first, then tube change, BVM for apnoeic patient, never leave patient
If unable to reinsert: bag-mask via stoma, intubate orally if possible

🏭 GCC-Specific ENT Epidemiology

High Sinusitis Prevalence

Air conditioning (rapid temperature changes, dry air) → mucosal dehydration, impaired mucociliary clearance
Desert dust (PM10/PM2.5), haboob season → upper airway inflammatory load
Occupational exposure: construction dust (silica), petrochemical fumes
Advise: humidifiers at home/workplace, regular saline sprays, minimise time outdoors during sandstorms

Sandstorm-Related Epistaxis

Nasal mucosa desiccation during haboob → mucosal cracking → epistaxis
Preventive measures: vaseline/aqueous cream to anterior septum, nasal saline spray before/after outdoor exposure
Public health messaging needed during sandstorm seasons (March–June, UAE/Saudi/Qatar)

Paediatric Foreign Body Aspiration

Date seeds (major GCC risk) — smooth, slippery, can pass glottis easily
Nuts, watermelon seeds common during Ramadan gatherings
Presentation: witnessed choking episode, sudden wheeze, unilateral reduced air entry, recurrent pneumonia
Management: rigid bronchoscopy under GA; DO NOT perform blind finger sweeps
Parent education at well-baby visits; no whole dates/nuts <5 years

High OSA Prevalence → Adenotonsillectomy Demand

High rates of childhood obesity in GCC + large adenotonsillar hypertrophy
OSA screening: snoring, apnoeic pauses, night sweats, daytime somnolence, poor school performance, enuresis
Polysomnography gold standard; adenotonsillectomy highly effective in children
Post-op: observe overnight for respiratory compromise (obese/severe OSA); SpO2 monitoring

Neonatal Hearing Screening

Universal neonatal hearing screening established in UAE, Saudi Arabia, Qatar
Method: TEOAE (Transient Evoked Otoacoustic Emissions) + AABR (Automated ABR) in NICU
Target: identify bilateral SNHL >40 dB by 3 months; amplification by 6 months
Nurse role: screen completion, parental counselling, referral pathway

Occupational Noise-Induced Hearing Loss

Large migrant construction workforce in GCC — high decibel exposure (drilling, heavy machinery >85 dB)
Noise-induced HL: bilateral symmetrical high-frequency SNHL (notch at 4 kHz)
Prevention: mandatory hearing protection above 85 dB; audiometric surveillance annually
GCC labour laws (UAE Federal Law No. 8/1980, KSA Labour Law) — employer duty to provide PPE

🏥 Leading GCC ENT Centres

Centre	Country	Speciality / Notes
Zayed Military Hospital ENT	UAE (Abu Dhabi)	Tertiary ENT/skull base surgery, cochlear implant programme
Al Baraha Hospital	UAE (Dubai)	Major public ENT referral centre, Dubai Health Authority
King Fahad Medical City	KSA (Riyadh)	National cochlear implant centre, complex head & neck oncology
Hamad Medical Corporation	Qatar (Doha)	ENT + hearing & balance centre, neonatal hearing programme
King Abdulaziz University Hospital	KSA (Jeddah)	Academic ENT, rhinology and sleep surgery
Royal Hospital Oman	Oman (Muscat)	Tertiary ENT, temporal bone surgery

🌎 GCC Pollen Seasons & Allergens

Date palm (Phoenix dactylifera): major aeroallergen, Feb–April; cross-reactive with other palm pollens
Grass pollens: March–May in coastal regions (UAE, Kuwait, Bahrain)
Dust mites: perennial; high humidity coastal areas (Dubai, Manama); AC systems harbour dust
Camel and horse dander: occupational exposure, camel racing communities
Prescribe intranasal steroids prophylactically 2 weeks before pollen season for known hay fever sufferers

🎓 Practice MCQs — ENT Nursing (10 Questions)

Click an answer to reveal instant feedback.

1. A 55-year-old diabetic patient presents with severe right otalgia, granulation tissue on the floor of the external auditory canal, and new-onset right-sided facial droop. What is the most likely diagnosis?

Acute otitis media

Cholesteatoma

Malignant (necrotising) otitis externa

Ramsay Hunt syndrome

2. During Weber test, the sound lateralises to the right ear. Rinne test shows bone conduction greater than air conduction on the right side. What does this indicate?

Right sensorineural hearing loss

Right conductive hearing loss

Left conductive hearing loss

Bilateral symmetrical SNHL

3. A 3-year-old child is brought to ED with sudden onset wheeze and reduced air entry on the left. No fever. Mother reports the child was eating dates 2 hours ago. What is the priority nursing action?

Administer nebulised salbutamol

Start chest physiotherapy

Keep child calm, call senior team urgently, prepare for rigid bronchoscopy

Give IV antibiotics for pneumonia

4. A patient presents on Day 7 post-tonsillectomy with bleeding from the mouth. Heart rate is 110 bpm. Which of the following is the MOST appropriate immediate action?

Remove the blood clot from the tonsillar fossa

IV access, NBM, urgent bloods, call ENT and anaesthetics — prepare for theatre

Prescribe oral antibiotics and observe

Give ibuprofen for pain and reassess in 1 hour

5. A patient with known chronic rhinosinusitis returns 3 weeks after FESS complaining of clear, watery nasal discharge that increases when leaning forward and has a salty taste. What complication should you suspect?

Normal post-operative discharge

Acute bacterial rhinosinusitis

CSF rhinorrhoea

Allergic rhinitis exacerbation

6. Which position should a patient adopt during an acute nosebleed while awaiting assessment?

Lying flat, head on pillow

Sitting upright with head tilted backward

Sitting forward, pinching lower soft part of nose

Left lateral (recovery position)

7. A 4-year-old presents with sudden high fever, drooling, stridor, and is sitting in tripod position. The parents are anxious. Which of the following actions is CONTRAINDICATED?

Call anaesthetist immediately

Allow child to remain in parent's arms in sitting position

Use a tongue depressor to examine the throat

Give humidified oxygen via face mask if tolerated

8. A McIsaac score of 4 is calculated for a 25-year-old patient with sore throat. What does this indicate and what is the recommended management?

Low risk of Group A Strep; supportive care only

Send monospot test only, withhold antibiotics

High risk Group A Strep; prescribe antibiotics (penicillin V or amoxicillin)

Admit for IV antibiotics

9. A construction worker in Dubai presents with progressive bilateral hearing loss, particularly for high-pitched sounds. Audiometry shows a bilateral notch at 4 kHz. What is the likely cause and what is the most important preventive measure?

Presbycusis; no preventive measure possible

Noise-induced hearing loss; mandatory hearing protection above 85 dB

Ototoxicity; review medications

Otosclerosis; stapedectomy

10. After a Dix-Hallpike manoeuvre, the patient develops upbeat-torsional nystagmus with a 3-second latency, lasting 15 seconds, which fatigues on repeat testing. What is the appropriate treatment?

Prescribe betahistine and low-sodium diet

Urgent MRI brain to exclude posterior fossa lesion

Perform Epley canalith repositioning manoeuvre

Give prochlorperazine IM and admit for observation