Clinical decision support that reasons like an otolaryngologist: separate viral from bacterial rhinosinusitis, decide antibiotics or observation in otitis media, treat sudden sensorineural hearing loss before the window closes, and manage the nosebleed — with the decision rule and exactly what would change it. Built for verified physicians.
Two real ENT questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Unilateral hearing loss over hours to days with aural fullness and a normal otoscopy — the move?
Treat this as sudden sensorineural hearing loss, an emergency with a closing window. A bedside Weber and Rinne separating sensorineural from conductive supports it; confirm with pure-tone audiometry showing a loss of at least 30 decibels over three contiguous frequencies within 72 hours. Start systemic corticosteroids urgently, offering intratympanic steroids as salvage, and obtain an MRI to exclude a vestibular schwannoma. Do not dismiss it as wax or a cold.
Decision ruleSudden unilateral SNHL (loss 30 dB+ over 3 contiguous frequencies within 72 h) → audiometry to confirm; start corticosteroids urgently (with intratympanic salvage); MRI to exclude vestibular schwannoma.
Not established from this alone — the audiogram, the tuning-fork exam and the time course change the certainty and the urgency.
A brisk anterior nosebleed in a hemodynamically stable patient — the stepwise plan?
Start with first aid: firm, sustained pressure on the cartilaginous part of the nose, sitting forward, for ten to fifteen minutes, with a topical vasoconstrictor. If it continues, find the anterior bleeding point on the nasal septum and cauterize with silver nitrate, or place an anterior pack. A bleed that persists from behind suggests a posterior source needing a posterior pack or balloon and admission. Check the blood pressure and correct any coagulopathy or anticoagulation.
Decision ruleEpistaxis → first aid (sustained anterior pressure + vasoconstrictor 10–15 min); if persists, cautery or anterior pack; posterior source → posterior pack or balloon + admit; correct BP and coagulopathy.
Not established from this alone — the bleeding site, the hemodynamics and the coagulation status change the escalation.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Most acute rhinosinusitis is viral and resolves without antibiotics. Suspect a bacterial cause when symptoms persist beyond ten days without improvement, are severe from the outset with fever and purulent discharge, or double-worsen after an initial improvement. When antibiotics are warranted, amoxicillin with or without clavulanate is first-line; otherwise treat symptoms with analgesia, saline irrigation and intranasal steroids, and reserve imaging for complications or a surgical question.AAO-HNS · IDSA
Decision ruleBacterial rhinosinusitis if symptoms beyond 10 days without improvement, severe onset (fever + purulence), or double-worsening → amoxicillin with or without clavulanate; else viral → symptomatic (saline, intranasal steroid, analgesia); imaging only for complications.
Missing data: the symptom duration and pattern, and complication signs, change the need for antibiotics.
Diagnose acute otitis media by a bulging tympanic membrane or new otorrhea with a middle-ear effusion, not redness alone. Treat with antibiotics when the child is under six months, has severe symptoms, or has bilateral disease under two years; otherwise, observation with analgesia for 48 to 72 hours is a shared option. When treating, high-dose amoxicillin is first-line, moving to amoxicillin-clavulanate for recent antibiotics or failure. Always control the pain.AAP
Decision ruleAOM = bulging TM or otorrhea + effusion; antibiotics if under 6 months, severe, or bilateral under 2 years; else observe 48–72 h with analgesia; first-line high-dose amoxicillin (clavulanate if recent antibiotics or failure).
Missing data: the age, the severity and the laterality change antibiotics versus observation.
Sudden sensorineural hearing loss is an otologic emergency. Confirm it with audiometry — a drop of at least 30 decibels across three contiguous frequencies within 72 hours — after distinguishing it from conductive loss by otoscopy and tuning forks. Start corticosteroids as early as possible, systemic first with intratympanic injection as an option or salvage, and obtain MRI to rule out a retrocochlear lesion such as vestibular schwannoma. Time to treatment drives recovery.AAO-HNS
Decision ruleSSNHL = 30 dB+ loss over 3 contiguous frequencies within 72 h; distinguish from conductive; start corticosteroids early (systemic with intratympanic salvage); MRI for a retrocochlear lesion.
Missing data: the audiogram, the onset timing and the neurologic exam change the plan.
Manage a nosebleed in steps. Begin with first aid — sustained firm pressure over the cartilaginous nose, leaning forward, with a topical decongestant — for ten to fifteen minutes. If it persists, identify an anterior bleeding point and cauterize with silver nitrate, or place an anterior pack. A brisk bleed that continues despite an anterior pack points to a posterior source, which needs a posterior pack or balloon and admission. Control blood pressure and reverse a coagulopathy.AAO-HNS · epistaxis
Decision ruleFirst aid (sustained anterior pressure + decongestant 10–15 min) → anterior cautery or pack → posterior pack or balloon + admit if posterior; manage BP and coagulopathy throughout.
Missing data: the bleeding location, the volume and the coagulation status change the step.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist ENT colleague across the ear, nose and sinus, throat and airway, head-and-neck oncology, and balance — cited, non-directive, always with the decision rule.
Deep specialist agents for otology and neurotology, rhinology, head-and-neck oncology and laryngology — each its own soul and knowledge base — plus your own uploaded materials.
From the sinusitis antibiotic to the sudden-hearing-loss clock the margin is thin. Only one of these reasons like an ENT colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the otolaryngology build, get in before anyone else, and lock the founding price for good.
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It reasons in the frameworks you use — the rhinosinusitis criteria, the AAP otitis-media pathway, the sudden-hearing-loss workup and the epistaxis steps — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and on call. Access is gated to verified physicians.
Otology and neurotology, rhinology, head-and-neck oncology and laryngology each have their own deep specialist agent on the Pro plan, on top of the full otolaryngology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited otolaryngology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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