Master ENT
for DHA

What the DHA Tests in ENT

The DHA ENT exam tests the ability to recognise and manage common otorhinolaryngological presentations in primary care and emergency settings. Candidates must demonstrate knowledge of red-flag symptoms (e.g., stridor, unilateral nasal obstruction, sudden sensorineural hearing loss), appropriate use of nasendoscopy, interpretation of audiometry, and indications for urgent referral. Questions focus on acute infections (otitis media, sinusitis, tonsillitis), hearing loss types, vertigo syndromes, and paediatric airway emergencies. Drug choices (e.g., amoxicillin for acute otitis media, topical nasal steroids for allergic rhinitis) and surgical thresholds (e.g., tympanostomy tubes for recurrent otitis media, tonsillectomy criteria) are frequently tested. Guidelines from NICE and SIGN are referenced, including the Centor criteria for streptococcal pharyngitis and the House-Brackmann scale for facial nerve palsy. Clinical decision-making around complications (mastoiditis, peritonsillar abscess, epiglottitis) is emphasised.

High-Yield Concepts

• Centor criteria for streptococcal pharyngitis: Four criteria: fever >38°C, tonsillar exudate, tender anterior cervical lymphadenopathy, absence of cough. Score 0-1: no antibiotic; 2-3: consider rapid antigen test or throat swab; 4: treat with penicillin V 500 mg TDS for 10 days (or clarithromycin if allergic).
• Acute otitis media (AOM) management: Diagnose with acute onset, otalgia, and bulging tympanic membrane. First-line: amoxicillin 80 mg/kg/day for 5 days (or 7 days if <2 years). Watchful waiting for 48-72 hours if non-severe and >6 months. Refer for myringotomy if mastoiditis or intracranial complication suspected.
• Sudden sensorineural hearing loss (SSNHL): Defined as >30 dB loss over 3 contiguous frequencies within 72 hours. Urgent audiometry confirms. Treat with high-dose oral prednisolone (1 mg/kg/day, max 60 mg) for 7-14 days, with taper. Intratympanic steroids as salvage. Refer to ENT within 24 hours.
• Meniere's disease diagnostic criteria: Definite: ≥2 spontaneous episodes of vertigo lasting 20 min to 12 hours, with audiometrically documented low- to mid-frequency sensorineural hearing loss in the affected ear, and fluctuating aural symptoms (fullness, tinnitus). First-line: betahistine 16 mg TDS, dietary salt restriction, and diuretics (e.g., bendroflumethiazide).
• Tonsillectomy indications (SIGN 117): Consider if ≥7 episodes of acute tonsillitis in the preceding year, or ≥5 episodes per year for 2 years, or ≥3 episodes per year for 3 years. Each episode must be disabling (fever, dysphagia, absence from school/work). Also indicated for obstructive sleep apnoea, peritonsillar abscess recurrence, or suspected malignancy.
• Epiglottitis recognition and management: Presents with acute stridor, drooling, tripod positioning, and muffled voice. Do not examine the throat; do not lie patient flat. Immediate senior ENT and anaesthesia involvement. Secure airway (intubation or tracheostomy). Give IV ceftriaxone 50 mg/kg and dexamethasone 0.15 mg/kg.
• Chronic rhinosinusitis (CRS) with nasal polyps: Diagnosis: symptoms >12 weeks (nasal obstruction, discharge, facial pain, hyposmia) plus endoscopic or CT evidence. First-line: intranasal corticosteroid spray (e.g., mometasone furoate 200 mcg daily). Add saline irrigation. If severe, consider oral prednisolone 30 mg for 7 days and refer for functional endoscopic sinus surgery (FESS). Biologics (dupilumab) for refractory cases.
• Facial nerve palsy (Bell's palsy vs Ramsay Hunt): Bell's palsy: idiopathic, unilateral lower motor neuron, onset <72 hours. Treat with prednisolone 50 mg daily for 10 days (start within 72 hours). Ramsay Hunt: varicella-zoster reactivation with vesicular rash in ear canal or pinna. Treat with acyclovir 800 mg five times daily for 7 days plus prednisolone. House-Brackmann grade III or worse at 3 months warrants referral.

Common Traps in ENT Questions

• Using antibiotics for acute otitis media in children >6 months with mild symptoms and no red flags — watchful waiting is appropriate.
• Ordering a CT scan for uncomplicated chronic rhinosinusitis before a trial of medical therapy — NICE recommends 12 weeks of intranasal steroids first.
• Diagnosing Meniere's disease after a single vertigo episode — requires ≥2 episodes and audiometric confirmation.
• Prescribing oral antibiotics for acute bacterial rhinosinusitis unless symptoms persist >10 days or worsen after 5 days — most cases are viral.
• Assuming a child with stridor has croup without considering epiglottitis or foreign body — always assess for drooling and toxic appearance.
• Giving antivirals for Bell's palsy without vesicles — acyclovir is only indicated for Ramsay Hunt syndrome, not idiopathic Bell's palsy.

How to Revise ENT for the DHA

Focus on acute presentations: stridor, otalgia, sore throat, vertigo, and facial palsy. Questions often present a clinical scenario with a single best answer or next step in management. Memorise Centor criteria, AOM antibiotic durations, and SSNHL steroid dosing. Practice interpreting audiograms (conductive vs sensorineural) and tympanograms (type B for effusion, type C for Eustachian tube dysfunction). Know when to refer urgently: stridor, unilateral nasal mass, sudden hearing loss, peritonsillar abscess. Review NICE guidance on tonsillectomy and SIGN on rhinosinusitis. Use mnemonics for red flags (e.g., 'SORE THROAT' for peritonsillar abscess: Severe pain, Odynophagia, Referred ear pain, Erythema, Trismus). Do not over-investigate benign positional vertigo — the Dix-Hallpike test and Epley manoeuvre are key.

Practise it: MedLumen has 85 ENT questions for the DHA, each with a full explanation and references.