Diagnostic and daily engine
Use all 360 reviewed SBAs to identify weaker domains and build a device-private “due today” queue.
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ENT exam
practice hub.
An independent preparation hub for Section 1 SBA practice and Section 2 clinical, communication and oral rehearsal. It is not official JCIE material.
Start the complete 240-question examinationEXAM MAPTwo different
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Two-paper examination mode
Attempt all 240 questions with two separate 135-minute timers and one combined report.
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Attempt 120 questions in 2 hours 15 minutes with answers hidden until submission.
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Attempt a second 120-question paper with full post-submission explanations.
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A further 135-minute rehearsal with a separate score report. This is not an official third examination paper.
Start Practice Form 1Clinical and oral
Eighty-seven clinically reviewed stations plus an interactive timed rehearsal mode.
Start timed Section 2 circuitSECTION 1 · PAPER 1 BANKFRCS-level
FRCS-level
SBAs.
Each advanced item explains the best answer, every distractor and a scenario-changing “what if?”.
Otology and neuro-otologyREVIEWED
Cholesteatoma with labyrinthine fistula
A 42-year-old with a long-standing attic cholesteatoma develops disequilibrium when the ear is suctioned. CT shows erosion of the lateral semicircular canal, while hearing remains serviceable. There is no facial weakness or intracranial complication. What is the most appropriate management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Acute otitis media with facial palsy
A 63-year-old with diabetes presents with severe otalgia, fever, a bulging tympanic membrane and a new complete lower-motor-neurone facial palsy. CT shows opacified mastoid air cells but no abscess. What is the best next management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Asymmetric sensorineural hearing loss
A 56-year-old has progressive left-sided hearing difficulty and tinnitus. Audiometry shows a 20 dB asymmetry at two adjacent frequencies; there is no facial weakness. Which investigation is most appropriate?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Acute vestibular syndrome
A 68-year-old with hypertension develops continuous vertigo, vomiting and inability to walk without support. Head-impulse testing is normal, direction-changing gaze-evoked nystagmus is present and there is skew deviation. What is the most appropriate action?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Refractory posterior epistaxis
A 74-year-old taking apixaban has ongoing posterior epistaxis despite resuscitation, correction of reversible factors and correctly placed packing. They are now haemodynamically stable. What is the most appropriate definitive next step in a centre with expertise?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Suspected acute invasive fungal rhinosinusitis
A neutropenic patient on chemotherapy develops rapidly progressive facial pain, ophthalmoplegia and a pale-to-black nasal turbinate. CT shows unilateral sinus opacification; there is no intracranial collection. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Adult cystic lateral neck mass
A 51-year-old non-smoker has a 3 cm cystic level II neck mass. Fine-needle aspiration demonstrates p16-positive squamous carcinoma; flexible endoscopy is unrevealing. What is the best staging principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Early oral cavity cancer
A fit patient has a 12 mm lateral-tongue squamous carcinoma staged T1 N0 clinically, with no need for cervical access for reconstruction. Which neck strategy is recommended by NICE?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Threatened airway from laryngeal cancer
A patient with a bulky supraglottic tumour has increasing stridor, cannot lie flat and has had two minor haemoptysis episodes. Oxygen saturation is 97% while sitting. What is the most appropriate immediate principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Parotid mass with facial weakness
A 70-year-old has a rapidly enlarging parotid mass, new lower facial weakness and a suspicious core biopsy. CT shows deep-lobe extension but no distant metastases. Which statement best guides counselling?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Impending upper-airway obstruction
A febrile 4-year-old is drooling, sitting forward, has a muffled voice and becomes distressed when examined. There is soft inspiratory stridor. What is the single best next action?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Paediatric obstructive sleep apnoea
A 9-year-old with trisomy 21 has severe obstructive sleep apnoea and adenotonsillar hypertrophy. Parents ask whether adenotonsillectomy will cure the condition. What is the best answer?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Nasal septal haematoma
Two days after a football injury, a teenager has bilateral nasal obstruction and a fluctuant boggy septal swelling. The nasal bridge is only minimally displaced. What is the best management?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Paediatric orbital-floor trapdoor fracture
A child has nausea, bradycardia and marked restriction of upward gaze after facial trauma. CT shows a small orbital-floor defect with little external bruising. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Bilateral vocal-fold immobility after thyroid surgery
Immediately after total thyroidectomy, a patient develops biphasic stridor and flexible endoscopy shows both vocal folds near the midline. They are alert with normal oxygen saturation. What is the best next management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Deep neck space infectionREVIEWED
Parapharyngeal abscess with airway risk
A 35-year-old with odynophagia, trismus and muffled voice has a CT-confirmed parapharyngeal collection displacing the airway. They become more breathless when supine. What is the key initial management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Silent aspiration after chemoradiotherapy
A patient treated with chemoradiotherapy for oropharyngeal cancer has weight loss and recurrent chest infections but reports no cough during meals. Which test most directly evaluates pharyngeal secretions, residue and laryngeal penetration at bedside?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Immediate facial palsy after temporal-bone fracture
A patient has immediate complete facial paralysis after temporal-bone trauma. CT suggests fallopian-canal disruption and the cornea is exposed. What is the best management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Diagnostic threshold after an imperfect test
A patient with a clinically suspicious neck mass has a negative imaging test with a negative likelihood ratio of 0.2. Their pre-test probability of malignancy is sufficiently high that the post-test probability remains 12%. What is the best next principle?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Material-risk consent
A professional singer is considering thyroid surgery for a compressive benign goitre. She asks specifically about the chance of a permanent voice change and whether non-operative management remains possible. What is the best response?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Recurrent cholesteatoma after canal-wall-up surgery
A 34-year-old has progressive conductive hearing loss three years after canal-wall-up cholesteatoma surgery. Otoscopy shows a reconstructed intact tympanic membrane. Diffusion-weighted MRI shows a 7 mm focus of restricted diffusion in the epitympanum. What is the most appropriate interpretation?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Sudden sensorineural hearing loss
A 47-year-old develops unilateral sensorineural hearing loss over twelve hours, 8 days ago. Otoscopy is normal and there is no focal neurology. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Vestibular schwannoma surveillance decision
A 59-year-old has a 14 mm intracanalicular vestibular schwannoma, serviceable hearing and two MRI scans showing 1 mm apparent change over one year. What is the most defensible next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Third-window syndrome versus otosclerosis
A patient has autophony, pressure-induced vertigo, a low-frequency air–bone gap and preserved acoustic reflexes. CT appears to show superior canal dehiscence. Which additional finding most strengthens the diagnosis before offering surgery?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Necrotising otitis externa
An 81-year-old with diabetes has severe nocturnal otalgia, granulation at the bony-cartilaginous canal junction and new House–Brackmann IV facial weakness despite topical treatment. What is the best management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Post-stapedotomy vertigo
Two days after stapedotomy, a patient develops severe vertigo, new profound sensorineural hearing loss and a positive fistula sign. What is the most appropriate response?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Cochlear implantation after meningitis
A child who became profoundly deaf after pneumococcal meningitis is referred six weeks later. MRI suggests early cochlear fibrosis. What is the best planning principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Pulsatile tinnitus with venous signs
A patient reports unilateral pulse-synchronous tinnitus that decreases with ipsilateral jugular compression. Otoscopy is normal and there are no focal neurological signs. What is the best next principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Occult primary after cervical metastasis
A patient has HPV-negative metastatic squamous carcinoma in a level II node. PET-CT identifies no primary; examination under anaesthesia is planned. Which additional step most improves the chance of detecting a small mucosal primary?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
MEN2 operative sequence
A patient with medullary thyroid carcinoma has a pathogenic RET variant and raised plasma metanephrines. They are clinically well. What must happen before thyroidectomy?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Adenoid cystic carcinoma and perineural spread
A patient has adenoid cystic carcinoma of the submandibular gland with numbness in the lower lip. MRI shows enhancement tracking along a named nerve toward the skull base. What is the critical treatment-planning implication?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Oral cancer depth of invasion
A 9 mm lateral-tongue squamous carcinoma has a depth of invasion of 7 mm and no clinical nodes. What feature most strongly drives elective neck management?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Laryngeal organ preservation
A patient with T4a laryngeal cancer has cartilage penetration, a non-functioning aspirating larynx and repeated pneumonias. What is the most defensible curative strategy to discuss?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Recurrent cancer with threatened carotid
A previously irradiated patient has recurrent nodal disease abutting the carotid artery and reports a small self-limiting oral bleed. What is the best next action?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Equivocal post-chemoradiotherapy PET-CT
Twelve weeks after chemoradiotherapy for oropharyngeal cancer, PET-CT shows low-grade residual uptake in one neck node but no progressive mass. The patient is clinically well. What is the best next principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Salivary duct carcinoma systemic options
A patient has recurrent metastatic salivary duct carcinoma after local treatment. Pathology demonstrates strong androgen-receptor expression and HER2 amplification. What is the most appropriate principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Aspirin-exacerbated respiratory disease
A patient with severe eosinophilic asthma, recurrent nasal polyps and bronchospasm after ibuprofen remains symptomatic after surgery and topical treatment. What is the best overarching management?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Unilateral sinonasal mass with orbital symptoms
An adult has unilateral obstruction, blood-stained discharge and new diplopia. Endoscopy shows a friable nasal mass; CT demonstrates bone erosion. What is the best next management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Spontaneous CSF rhinorrhoea
An obese middle-aged patient has intermittent unilateral watery rhinorrhoea, an empty sella and a small lateral sphenoid encephalocele. What additional issue must be addressed when repairing the leak?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Acute invasive fungal rhinosinusitis
A neutropenic patient has facial numbness, a pale insensate middle turbinate and rapidly progressive ophthalmoplegia. Frozen section confirms broad non-septate hyphae. What is the best immediate strategy?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Frontal sinus mucocele
A patient with previous frontal surgery has progressive proptosis. CT shows an expansile frontal lesion with bony remodelling extending far lateral to the orbit. What most determines surgical access?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Postoperative CSF rhinorrhoea
On day 3 after extended endoscopic skull-base surgery, a patient develops a constant clear unilateral nasal discharge that increases on leaning forward. There is no meningism. What is the best next principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Nasal button battery
A 3-year-old has unilateral offensive discharge; a button battery is visible against the septum and removal in clinic has failed. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Paediatric deep-neck infection
A 5-year-old has fever, torticollis, limited neck extension and refusal to swallow. CT demonstrates a retropharyngeal collection with early airway narrowing. What is the key first management priority?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Recurrent atypical croup
A 2-year-old has had six episodes labelled croup, including symptoms between infections and two previous intubations. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Bilateral choanal atresia
A term neonate becomes cyanotic while feeding and settles when crying. Passing a nasal catheter fails bilaterally. What is the best immediate action?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Paediatric lateral neck mass
A 6-year-old has a painless lateral neck cyst that becomes infected repeatedly. Ultrasound suggests a second branchial cleft anomaly. When is definitive excision best performed?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Secondary post-tonsillectomy haemorrhage
A 10-year-old presents on day 6 after tonsillectomy after vomiting blood. They are pale and repeatedly swallowing, but the tonsillar fossae appear dry. What is the best response?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Unilateral vocal-fold paralysis
A professional singer has symptomatic unilateral vocal-fold paralysis two weeks after thyroid surgery. The nerve appeared intact and recovery is possible, but aspiration and severe breathy dysphonia persist. What is the best intervention to discuss?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Adductor laryngeal dystonia
A 45-year-old has task-specific strained, strangled speech with intermittent breaks on voiced sentences; whispering and singing are relatively preserved. What is first-line treatment?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Oropharyngeal dysphagia after lateral medullary stroke
A patient with a lateral medullary infarct has wet voice, poor cough and recurrent aspiration after small sips. Which immediate nutrition decision is most appropriate?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Adult subglottic stenosis
A patient with prior prolonged intubation has Cotton–Myer grade III subglottic stenosis and exertional stridor. Which factor most determines endoscopic versus open reconstruction?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Blunt laryngeal trauma
After a road collision, a patient has hoarseness, neck tenderness and increasing stridor. CT shows a displaced thyroid-cartilage fracture. What is the priority?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Naso-orbito-ethmoid fracture planning
After central facial trauma, a patient has telecanthus and the medial canthus moves with gentle traction. CT shows a comminuted central fragment. Which operative objective is most important?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Zygomaticomaxillary-complex fracture
A patient has trismus, flattening of the malar prominence and infraorbital numbness after trauma. CT confirms a displaced zygomaticomaxillary-complex fracture without muscle entrapment. What most determines the indication for operative reduction?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Naso-orbito-ethmoid fracture
After central facial trauma, the intercanthal distance is increased and the medial canthus moves with gentle traction. Which structure is most likely disrupted?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Facial reanimation after delayed presentation
A 32-year-old has complete irreversible facial palsy 18 months after vestibular-schwannoma surgery. There is no usable proximal facial-nerve stump and the target muscles show poor spontaneous movement. What is the central reconstructive principle?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Number needed to treat
A trial reports postoperative haemorrhage in 10% of controls and 6% with an intervention. What is the number needed to treat to prevent one haemorrhage?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Material-risk consent
A competent patient declines discussion of recurrent-laryngeal-nerve injury before thyroidectomy, saying it will increase anxiety. What is the best response?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Non-inferiority trial interpretation
A trial finds a new surgical device has a complication rate 1.5% higher than standard treatment; its prespecified non-inferiority margin was 3%, but the upper confidence-limit is 3.4%. What is the correct conclusion?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Refractory unilateral Ménière's disease
A 52-year-old with definite unilateral Ménière's disease has disabling vertigo despite education, salt moderation and maintenance treatment. Hearing remains aidable and the contralateral ear is normal. Which escalation best balances vertigo control and hearing preservation?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Cochlear implant wound infection with extrusion
Six months after cochlear implantation, a patient has recurrent post-auricular infection, exposed receiver-stimulator and a draining biofilm-associated wound despite culture-directed antibiotics. The electrode still provides benefit. What is the most defensible management?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Bilateral vestibulopathy interpretation
A patient reports oscillopsia while walking and imbalance worse in darkness. Video head-impulse testing shows bilaterally reduced horizontal canal gain; calorics are bilaterally weak. MRI is normal. What is the best management principle after excluding a remediable cause?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Petrous apicitis with abducens palsy
A diabetic adult with inadequately treated otitis media develops deep retro-orbital pain and diplopia. Examination shows persistent otorrhoea and a sixth-nerve palsy; CT demonstrates opacification and erosion around a pneumatized petrous apex. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Revision ossiculoplasty decision
After eradication of cholesteatoma, a dry ear has an intact mobile tympanic graft, absent malleus and stapes superstructure, a mobile stapes footplate, an aerated middle ear and a 35 dB conductive gap. Which reconstruction is anatomically appropriate?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Intratemporal facial nerve schwannoma
MRI shows an enhancing geniculate-ganglion facial-nerve tumour extending into the labyrinthine segment. Facial function is House–Brackmann II and serial scans show no growth. Hearing is serviceable. What is the preferred strategy?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Post-thyroidectomy rising thyroglobulin
A patient treated with total thyroidectomy and radioiodine for papillary thyroid carcinoma has a rising stimulated thyroglobulin, confirmed on repeat testing with the same assay; anti-thyroglobulin antibodies are absent. Neck ultrasound is negative and diagnostic radioiodine imaging shows no avid disease. What is the best next investigation principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Adjuvant therapy after oral cancer resection
A fit 58-year-old undergoes clear-margin resection of a pT3 oral-tongue squamous cell carcinoma with neck dissection. One metastatic cervical node shows extranodal extension. What is the most appropriate adjuvant recommendation?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Parotid metastasis from cutaneous SCC
An immunosuppressed patient has a resectable parotid-tail metastasis from temple cutaneous squamous carcinoma. Imaging shows no clinically involved neck nodes. What is the best oncological principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Nasopharyngeal carcinoma response assessment
A patient completes chemoradiotherapy for EBV-associated nasopharyngeal carcinoma. At 12 weeks, MRI shows post-treatment thickening without a discrete mass, examination is unremarkable and plasma EBV DNA is undetectable. What is the best approach?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Carotid blowout syndrome
A previously irradiated laryngectomy patient has a small self-limiting bleed from a fungating neck wound. CT angiography shows carotid exposure and a pseudoaneurysm. The patient is currently stable. What is the priority?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Salvage laryngectomy after radiotherapy
A fit patient has biopsy-proven isolated recurrent T3 glottic carcinoma two years after definitive radiotherapy, with a functional but threatened larynx and no metastases. What offers the best chance of cure?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Orbital haematoma during endoscopic sinus surgery
During ethmoidectomy under general anaesthesia, the orbit suddenly becomes tense with proptosis and a fixed dilated pupil. What is the immediate operative response?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Frontal sinus posterior-table fracture
CT after high-energy trauma shows a comminuted displaced posterior-table frontal sinus fracture, dural breach and persistent CSF leak. The nasofrontal outflow tract is disrupted. What is the best definitive principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Internal carotid injury during transsphenoidal surgery
Brisk arterial haemorrhage erupts from the cavernous carotid during endoscopic transsphenoidal surgery. What is the best immediate strategy?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Allergic fungal rhinosinusitis
An immunocompetent young adult has chronic unilateral proptosis. CT shows expansile heterogeneously hyperdense sinus opacification with smooth bony remodelling; MRI shows central T2 signal loss. There is nasal polyposis and eosinophilic mucin but no tissue invasion. What is the best management?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Revision frontal sinus surgery
A patient has persistent frontal sinusitis after two operations. CT shows a narrow scarred frontal recess with retained partitions; the frontal sinus remains aerated laterally and there is no tumour. What most strongly determines whether a Draf IIb or Draf III approach is chosen?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Neonatal bilateral vocal-fold immobility
A term neonate has biphasic stridor, recurrent desaturation and endoscopy showing both vocal folds near the midline. The airway worsens despite non-invasive support. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Radiolucent bronchial foreign body
A 2-year-old had a witnessed choking episode and now has unilateral wheeze and reduced air entry. Inspiratory chest radiography is reported normal. What is the best action?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Juvenile nasopharyngeal angiofibroma
A 15-year-old boy has recurrent severe epistaxis and nasal obstruction. Contrast CT shows an avidly enhancing mass centred at the sphenopalatine foramen with anterior bowing of the posterior maxillary wall. What is the next best step?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Recurrent suppurative thyroiditis and pyriform sinus fistula
A child has a third episode of left-sided acute suppurative thyroiditis. Ultrasound shows a perithyroid abscess. After drainage and antibiotics, what is the most important definitive investigation and management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Zenker diverticulum treatment selection
A frail 79-year-old has regurgitation of undigested food, halitosis, aspiration and a 3 cm Zenker diverticulum on contrast study. Neck extension is limited, making rigid exposure poor. What is the preferred treatment principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Leakage through a tracheoesophageal voice prosthesis
A total-laryngectomy patient coughs immediately after swallowing liquids. Blue-dye assessment shows fluid passing through the lumen of the indwelling voice prosthesis, not around it. What is the best first intervention?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Laryngeal electromyography in vocal-fold paralysis
Three months after thyroid surgery, a patient has unilateral vocal-fold immobility and aspiration. Laryngeal EMG shows no voluntary motor-unit recruitment in the thyroarytenoid muscle. How should this finding be used?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Cricopharyngeal dysfunction on videofluoroscopy
After a lateral medullary stroke, videofluoroscopy shows preserved oral control and pharyngeal propulsion but marked upper oesophageal sphincter non-opening with pyriform residue and aspiration after the swallow. What is the best treatment principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Frontal branch facial-nerve transection
During excision of a temple lesion, the frontal branch of the facial nerve is sharply divided and recognised immediately. The ends approximate without tension. What is the best repair?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Mandibular condylar fracture with malocclusion
An adult has a displaced unilateral condylar-neck fracture, persistent malocclusion and ramus shortening despite an attempted closed reduction. What is the best management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Auricular avulsion
A patient presents within two hours of complete clean auricular avulsion; the amputated pinna has been kept cool and moist. Microsurgical expertise is available. What offers the best reconstructive prospect?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Interpreting a non-inferiority trial
A trial compares a shorter antibiotic course with standard treatment after contaminated head-and-neck surgery. The risk-difference non-inferiority margin is 5%. The observed difference in infection risk is 2% higher with the short course, with a 95% confidence interval from −1% to +6%. What is the correct conclusion?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Professional and statutory candour
A surgeon discovers that a planned unilateral grommet was inserted in the wrong ear. It was removed and the correct ear treated during the same anaesthetic; no lasting injury is apparent. What is the most appropriate response?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Cochlear implant soft failure
A 9-year-old cochlear-implant user develops intermittent painful stimulation, declining speech scores and aversion to the device. Integrity testing is repeatedly normal; mapping changes and replacement external equipment have failed. Imaging shows no migration. What is the most appropriate conclusion and next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Otogenic sigmoid sinus thrombosis
A 17-year-old with acute mastoiditis remains septic with headache and papilloedema. Contrast CT shows an empty-delta appearance in the sigmoid sinus and a perisinus abscess. What is the best management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Cholesteatoma with labyrinthine fistula
A 43-year-old with cholesteatoma has pressure-induced vertigo and a 6 mm lateral semicircular-canal fistula on CT. Bone-conduction thresholds are serviceable. At surgery, matrix is densely adherent over the fistula but there is no purulence. What is the best operative strategy?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Active middle-ear implant selection
A 58-year-old with a stable canal-wall-down cavity has severe mixed hearing loss, recurrent otorrhoea with conventional aids and adequate cochlear reserve. The ear is dry after revision cavity surgery but the air–bone gap remains large. Which rehabilitation principle is best?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Autoimmune inner-ear disease
A 46-year-old has rapidly progressive, fluctuating bilateral sensorineural hearing loss over 10 weeks with episodic imbalance. MRI excludes retrocochlear disease; infection and ototoxicity have been excluded. ESR is raised, but a commercial inner-ear antibody panel is negative. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Otology and neuro-otologyREVIEWED
Otosclerosis with poor speech discrimination
A 66-year-old has a substantial air–bone gap and severe high-frequency sensorineural loss. Repeated validated aided word testing shows very poor recognition disproportionate to audibility. CT is compatible with fenestral otosclerosis. What is the best counselling?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Anaplastic thyroid cancer airway strategy
A 74-year-old has rapidly enlarging anaplastic thyroid carcinoma, stridor and CT evidence of long-segment tracheal encasement below the thoracic inlet. Flexible endoscopy shows bilateral vocal-fold immobility. What is the best immediate approach?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Carotid body paraganglioma
A 49-year-old has a hypervascular mass splaying the internal and external carotid arteries. MRI suggests a Shamblin III carotid body tumour and plasma metanephrines are elevated. What should happen before any operation?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Oral cavity SCC with mandibular medullary invasion
A fit 63-year-old has a floor-of-mouth squamous cell carcinoma. CT and MRI show definite invasion through the lingual cortex into mandibular medullary bone over 2 cm, without distant disease. Which mandibular resection principle is most appropriate?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Nasopharyngeal carcinoma skull-base spread
A patient with EBV-associated nasopharyngeal carcinoma develops diplopia. MRI shows cavernous-sinus extension encasing the internal carotid artery without distant metastasis. Which treatment principle is best?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
Mandibular osteoradionecrosis
Five years after 66 Gy oropharyngeal radiotherapy, a patient has exposed mandibular bone, a pathological fracture and an orocutaneous fistula despite conservative care. What is the best definitive management?
- FORMAT
- SBA
- STATUS
- Reviewed
Head and neck oncologyREVIEWED
High-output chyle leak after neck dissection
On day 2 after left neck dissection, the drain produces 1.4 litres of milky fluid in 24 hours, rising after enteral feeding. The patient is becoming hypocalcaemic. What is the best response?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Isolated sphenoid disease with optic neuropathy
A 63-year-old has deep retro-orbital headache, rapidly falling visual acuity and a relative afferent pupillary defect. CT/MRI shows an isolated opacified sphenoid sinus with inflammatory tissue abutting the optic canal and no intracranial mass. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Subperiosteal orbital abscess
A 12-year-old with acute ethmoiditis has proptosis, reduced colour vision, ophthalmoplegia and a medial subperiosteal orbital collection on CT. Visual acuity is deteriorating despite IV antibiotics. What is the next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Juvenile nasopharyngeal angiofibroma
A 16-year-old boy has recurrent unilateral epistaxis and obstruction. Imaging shows an avidly enhancing posterior nasal mass extending to the pterygopalatine fossa. What is the safest diagnostic principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Rhinology and skull baseREVIEWED
Olfactory neuroblastoma staging and treatment
A superior nasal-vault tumour crosses the cribriform plate with limited dural involvement but no brain invasion or distant disease. Histology confirms olfactory neuroblastoma. What is the best treatment principle?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Severe laryngomalacia
A 6-week-old has inspiratory stridor, suprasternal recession, oxygen desaturations and faltering growth. Flexible laryngoscopy shows shortened aryepiglottic folds and inspiratory supraglottic collapse. What is the best management?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Retropharyngeal abscess with threatened airway
A 3-year-old is toxic, drooling and holding the neck extended. There is inspiratory stridor and increasing recession. Contrast CT, obtained while stable, shows a 3.5 cm retropharyngeal collection compressing the airway. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Bilateral neonatal choanal atresia
A term neonate becomes cyanosed at rest but improves when crying. A suction catheter cannot pass through either nostril; endoscopy and thin-slice CT confirm bilateral bony-membranous choanal atresia. What is the best initial management?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Congenital CMV hearing loss
A neonate fails hearing screening and urine PCR taken at 10 days is positive for CMV. Auditory brainstem responses show unilateral severe sensorineural loss; examination is otherwise normal. What is the best next step?
- FORMAT
- SBA
- STATUS
- Reviewed
Paediatric ENT and airwayREVIEWED
Recurrent respiratory papillomatosis
A 4-year-old with juvenile-onset recurrent respiratory papillomatosis needs debulking every 4 weeks and has early subglottic spread. What is the best strategy?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Posterior glottic stenosis versus bilateral neurogenic immobility
Six weeks after prolonged intubation, a patient has stridor and both vocal folds appear immobile near the midline. CT shows no compressive lesion along either recurrent laryngeal nerve. Which assessment best distinguishes posterior glottic stenosis from bilateral neurogenic paralysis?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Post-radiotherapy pharyngoesophageal stricture
A patient treated with chemoradiotherapy for hypopharyngeal cancer has progressive dysphagia and weight loss. Endoscopy and biopsies show no recurrence; contrast swallow shows a short, tight pharyngoesophageal stricture with a thread of contrast passing into the oesophagus. What is the best next intervention?
- FORMAT
- SBA
- STATUS
- Reviewed
Laryngology and swallowingREVIEWED
Inducible laryngeal obstruction
A competitive athlete has abrupt inspiratory difficulty and throat tightness at peak exercise. Spirometry is normal between attacks and asthma therapy has failed. Which test best establishes the diagnosis?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Delayed facial reanimation
A 38-year-old has complete facial paralysis 16 months after proximal facial-nerve sacrifice. There is no recoverable proximal stump, but needle EMG shows viable facial musculature. What is the best dynamic option?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Auricular haematoma
A rugby player presents 5 days after trauma with a large fluctuant anterior auricular haematoma. Aspiration performed elsewhere twice has recurred. What is the best management?
- FORMAT
- SBA
- STATUS
- Reviewed
Facial plastics and traumaREVIEWED
Zygomaticomaxillary complex fracture
A patient has malar flattening, infraorbital numbness, trismus and diplopia after assault. CT shows a displaced zygomaticomaxillary complex fracture with increased orbital volume, but no muscle entrapment. What is the best management principle?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Spectrum bias in diagnostic studies
A new office test for laryngeal malignancy is evaluated in 100 patients with obvious advanced cancers and 100 healthy volunteers. It reports 98% sensitivity and 97% specificity. Why may these figures overestimate performance in a rapid-access clinic?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Human factors and recurrent near misses
Three near misses occur in two months in which two patients with similar names are almost taken to ENT theatre under the wrong consent form. Each is caught at the team brief; no patient is harmed. What is the best governance response?
- FORMAT
- SBA
- STATUS
- Reviewed
General ENT, evidence and governanceREVIEWED
Cluster-randomised trials and intracluster correlation
Twenty hospitals are randomised to a surgical checklist intervention or usual care. The sample-size calculation treats 2,000 operations as independent observations and ignores clustering. What is the main consequence?
- FORMAT
- SBA
- STATUS
- Reviewed