ENT MCQs
1.Ranula: cystic swelling ofsublingual gland .Rx. Marsupialisation
1.Ranula: cystic swelling ofsublingual gland .Rx. Marsupialisation
2.Vincet’s angina /trench mouth /necrotizing gingio-tonsillitis :
Etiology : Borellia vincentiFusobacillus
DOC: metronidazole + penicillin
Etiology : Borellia vincentiFusobacillus
DOC: metronidazole + penicillin
3.MC cause of membrane formation in throat : streptococcal tonsillitis
2nd MC is Diptheria.
2nd MC is Diptheria.
4.Interval tonsillectomy: done for Quincy.
5.Quincy : peritonsillar abbesses. Pus between capsule of tonsil , superior Constrictor muscle.Also known as Hot potato condition. Tonsil is pushed anteromedially.Uvula is pushed on opposite side
Rx. 1. Short antibiotics
2. after 24-48 hrs – dranaige
3. after 6 wks – tonsillectomy
5.Quincy : peritonsillar abbesses. Pus between capsule of tonsil , superior Constrictor muscle.Also known as Hot potato condition. Tonsil is pushed anteromedially.Uvula is pushed on opposite side
Rx. 1. Short antibiotics
2. after 24-48 hrs – dranaige
3. after 6 wks – tonsillectomy
6.MC indication of tonsillectomy : Recurrent tonsillitis
7.Position during tonsillectomy : Rose position
8.Main complication of tonsillectomy : Bleeding
9.Primary bleeding is: bleeding during Sx.Most common source of primary bleeding is : paratonsillar vein or
tonsillar plexus. Second most common : Tonsillar branch of facial never.
tonsillar plexus. Second most common : Tonsillar branch of facial never.
10.Reactionary bleeding : bleeding within first and second hour after Sx.
11.Secondary bleeding : due to infection after 24 hrs .MC : 5-8 days after Sx.
12.Bleeding : immediate ligation under GA.
13.Main artery of tonsil : tonisllar branch of facial nerve.
14. MC indication for traceostomy is : Ca. larynx
15. MC site for tracheostomy is : T2,T3
15. MC site for tracheostomy is : T2,T3
16. Tracjeostomy damages :
a) ishmus of thyroid
b)Ant. Thyroid vein
c)Inf. Thyroid vein
d)Thyroida ima Artery
a) ishmus of thyroid
b)Ant. Thyroid vein
c)Inf. Thyroid vein
d)Thyroida ima Artery
17. MC source of bleeding during tracheostomy : Ant. Throid vein
18. MC complication of tracheostomy : tracheal stenosis
19. Gold statndard t/t for Tracheal stenosis is : Removal of stenosed part of trachea +end to end anastomosis.
20. MC site for laryngeal Ca. : Glottis
21. MC type of laryngeal CA: sq. cell ca
22. First symptom of laryngeal ca. : hoarseness of voice
23. T/t of laryngeal Ca. : stage 1st+2nd is : radiotheraoy (Excellent result)If it is a Glottis Ca as Glottis doesn't have any lymphatics
Stage 3rd +4th : Sx. + radiotherapy
Stage 3rd +4th : Sx. + radiotherapy
24. Disadvantages of total laryngectomy:
a)Complete loss of voice
b)Permanent tracheostomy
c)Thyroidectomy + parathyroidectomy
d)Hormonal supplementation for whole life.
a)Complete loss of voice
b)Permanent tracheostomy
c)Thyroidectomy + parathyroidectomy
d)Hormonal supplementation for whole life.
25. MC laryngeal tumor in children : juvenile papilloma of larynx.
26. MC laryngeal tumor in adults: Laryngeal Ca.
27. Mandatory Dx. Of laryngeal papilloma by : brochoscopic examination / microlaryngoscopic
examination.
28. Laryngeal papilloma: premalignant condition. t/t : CO2 laser excision.
30. Vocal cord nodule/ singer’s nodule: junction of ant 1/3 and post. 2/3rd fibrotic , due to chronic misuse of voice , B/L . T/t: voice rest followed by speech therapy (sometimes Sx)
Vocal cord polyp: anywhere in ant. 2/3rd of vocal cord U/L.
T/t. of choice is microlaryngeal Sx.
Followed by S. therapy
27. Mandatory Dx. Of laryngeal papilloma by : brochoscopic examination / microlaryngoscopic
examination.
28. Laryngeal papilloma: premalignant condition. t/t : CO2 laser excision.
30. Vocal cord nodule/ singer’s nodule: junction of ant 1/3 and post. 2/3rd fibrotic , due to chronic misuse of voice , B/L . T/t: voice rest followed by speech therapy (sometimes Sx)
Vocal cord polyp: anywhere in ant. 2/3rd of vocal cord U/L.
T/t. of choice is microlaryngeal Sx.
Followed by S. therapy
31. Causes of hypernasality :
a)Cleft palate
b)Soft plalate palsy
c)Oro antral fistula
d)After adenoidectomy
e)Velo-phyryngeal insufficiency
a)Cleft palate
b)Soft plalate palsy
c)Oro antral fistula
d)After adenoidectomy
e)Velo-phyryngeal insufficiency
32. Phonaesthenia: laryngeal muscles get tired faster . inter arytenoids thyroarytenoid
Laryngoscopic findings: key hole glottis
Laryngoscopic findings: key hole glottis
33. Puberphonia: fast voice.Male having female like voice T/t. type 3rd thyroplasty (shortening)
34. Androphonia: female having malelike voice
T/t. type 4th thyroplasty(lengthening)
T/t. type 4th thyroplasty(lengthening)
35. Spasmodic dyphonia: neurologic disease
Destortion of voice
T/. botox injection into laryngeal
muscles
Recurrent laryngeal nerve resection
Destortion of voice
T/. botox injection into laryngeal
muscles
Recurrent laryngeal nerve resection
36. Dysphonia plica ventrivularis: voice production by false vocal cord
T/t. speech therapy
T/t. speech therapy
37. Rhinolalia Aperta: hyper nasality
38. Rhinolalia clausa: hypo nasality
39. Type 1st thyroplasty : medialisation for adductor palsy
40. Type 2nd thyroplasty :lateralization for abductor palsy
40. Type 2nd thyroplasty :lateralization for abductor palsy
41. MC nerve damaged during thyroidectomy: external laryngeal n.branch of sup. Laryngeal n.
42. Mc cause of vocal cord palsy : idiopathic
2nd mc cause : thyroidectomy
2nd mc cause : thyroidectomy
43. MC cause of recurrent laryngeal N palsy : Bronchial ca. (smoking)
44. External laryngeal N palsy: cricothyroid affected . unable to raise pitch of voice
45. RLNP : all muscles affected except cricothyroid so no abduction and adduction
Position of vocal cord: aramedical /cadaveric
46. Adductor palsy: No respiration obstruction
Voice disorder : severe in B/L
Severe complication is : Aspiration
Position of vocal cord: aramedical /cadaveric
46. Adductor palsy: No respiration obstruction
Voice disorder : severe in B/L
Severe complication is : Aspiration
47.Adductor palsy: respiration difficulty.More severe respiration stidor in B/L palsy
48. TB larynx : affects post. 1/3rd of larynx.Turban epiglottis
Mouse nibble appearance.Cobble stone
Mouse nibble appearance.Cobble stone
49. Acute epiglottitis : cherry red epiglottis
MC presentation: high grade fever
Etiology: H. infuenzae (2-7days)
Stridor +dysphagia + hoarseness
Child prefers to sitdown in tripod position
X-ray : thumb sign
DOC: ampicillin or cephalosporins
MC presentation: high grade fever
Etiology: H. infuenzae (2-7days)
Stridor +dysphagia + hoarseness
Child prefers to sitdown in tripod position
X-ray : thumb sign
DOC: ampicillin or cephalosporins
50.MC congenital disorder of larynx : laryngomalacia
Very soft cartilage.Stridor only during inspiration.Increased loudness of stidor : feeding ,crying. Decreased in : pronation
Laryngposcope findings : omega shaped epiglottic
T/t. reassurance by 2 yrs childbecome normal
Very soft cartilage.Stridor only during inspiration.Increased loudness of stidor : feeding ,crying. Decreased in : pronation
Laryngposcope findings : omega shaped epiglottic
T/t. reassurance by 2 yrs childbecome normal
51. Males: low pitched voice , length of vocal cord 24-25mm
52. Females: high pitch voice
Length of vocal cord is : 16-17mm
Length of vocal cord is : 16-17mm
53. Tensor of larynx : cricothyroid (Ext. LN )
To raise pitch of voice
To raise pitch of voice
54. Only abductor of vocal cord : post. Cricoarytenoid
55. Adduction of VC: lat.Cricoarytenoid , inter arytenoids, thyro-arytenoid , cricothyroid (weak
adductor)
55. Adduction of VC: lat.Cricoarytenoid , inter arytenoids, thyro-arytenoid , cricothyroid (weak
adductor)
56. Nerve for voice production : recurrent laryngeal N (Adduction +abduction)
57. Laryngeal cartilage : unpaired : cricoids , throid, and epiglottis
Paired : arytenoid, cuneiform, corniculate
Paired : arytenoid, cuneiform, corniculate
58. Adult larynx: C3-C6 narrowest part : Glottis
Infantile : C2-C3: subglottis
Infantile : C2-C3: subglottis
59. Glottis: can produce voice . No lymphatics , lined by sq. epi , rest of larynx dosent have Sq. epithelium.
Deep to glottis: Reinke’s space
Deep to glottis: Reinke’s space
61. MC site for nasopharyngeal Ca.: EBV
Fossa of Rosenmuller
MC type: undifferentiated Sq. cell ca
MC presentation: cervical lymphodenopathy
Trotter’s triad: soft palate palsy, facial pain , hearing loss
T/t Radiotherapy
Fossa of Rosenmuller
MC type: undifferentiated Sq. cell ca
MC presentation: cervical lymphodenopathy
Trotter’s triad: soft palate palsy, facial pain , hearing loss
T/t Radiotherapy
62. Angiofibroma: Benign tumor (juvenile age group)
MC site: sphenopalatine foramen/ nasopharyngeal
MC C/F : Recurrent nasal bleeding.
63. CT scan findings of angiofibroma : antral sign / Halmann miller sign
Hondurus sign
64. Ringertz tumor: inverted papilloma
From lateral wall of nose.
Sx. Medical maxillectomy
65. Myiasis / maggot’s: larva of chrysomia
T/t. 10% diluted chroloform
66. MC site for madibular block : Subcondylar / neck of condyle
67. Block of floor of orbit: Blow out block
Floor+ medical wall of orbit
X-ray findings : Tear drop sign
68. Maxillary block: Le forte 1st : Transverse
Le forte 2nd : pyramidal
Le forte 3rd : craniofacial
69. Block of zygoma : tripod block
70. Septal block :
a)cherellet : vertical
b)Jarjaway: horizontal
71. MC block of bone : nasal bone
72. Rhinosporidiosis: due to seeberi
MC presentation : strawberry/
mulberry polyp
Bleeding polyp
DOC : Depsone
T/t. : cautery excision
73. Rhinoscleroma : klebsiealla rhinoscleromatis
Also known as woody nose (seen in north india)
Dx. Biopsy findings : Milulitz cells
Russel bodies
DOC: streptomycin _+ tetracyclin
T/t. of choice : Excision
74. Rhinophyma: potato NOSE Sebaceous gland hypertrophy
75. Rhinolith : old calcified FB in nose
FB of nose mc present as : U/L discharge in a child and bleeding and faul smell.
76. Maxillary polyps: antrochoanal polyp, unilateral , due to infection NL recurrent
77. Ethomoidal polyp : B/L, due to allergy, A bunch of grapes .
78. MC cause of spur: trauma during birth
79. Main complication of DNS : sinusitis
80. DNS : compensatory hypertrophy of inf. Turbinate , obstruction on opposite side
Due to ant. Ethomidal N involvement
T/t. SMR / septoplasty (most commonly done) done after 16 years of age
81. MC complication of SMR: septal perforation / Saddle nose
82. Atrophic rhinitis : Klebsiealla ozaena
MC in young females : decreased estrogen
Merciful Anosmia
Rx. 1) Alakaline nasal douche
a)Sodium bicarbonate
B)Sodium barborate
c)Sodium chloride
These are component of nasal solution.
2) Young’s operation .
83. MC X-ray from sinusitis : water’s view. Also known as submento occipital with mouth opening
84. Sinusitis Sx. : antral wash : puncture /fistula in inf. Meatus
FESS
Codwell
85. MC viral rhinitis :Due to rhino virus.
86. Vasomotor Rhinitis : parasympatic activity> sym.
Boggy turbinates due to pooling of blood.
87. MC allergen for Allergic Rhinitis: House dust / Dermatophycocyte
88. MC site for nasal bleed in HTN patients: Little’s area (Kissel banch’s plexus)
89. MC site for nose bleeding in elderly : HTN
90. Mc site for nose bleed : pricking / Digital trauma
91. MC cause of oroantral fistula : removal of 1st molar
92. Largest sinus: maxillary /antrum of hignmoon
Volume : 15 CC
93. 1st sinus to develop : maxillary sinus
Starts at 10th wks of IUL.
94. Last sinus to develop : frontal , after birth
95. 2 openings in nasolacrimal duct:
a) ET( small opening)
b) Sphenopalatine foramen
(sphenopalatine arch)
96. Inf. Meatus : nasolacrimal duct opening
97. Middle meatus :
a) Ant. Ethomoidal sinus
b)Maxiallary sinus
c) Frontal sinus
98. Supreme meatus / sphenoethimoidal recess: sphenoid sinus
99. Kiessel bach’s plexus:
1.sphonopalatine
2.greater palatine A
3.sup. labial A: from external carotid artery
4. Ant. Ethmoidal A: from int. carotid A
100. Bones of nasal septum :
1) vomer
2) Plate of ethmoid
3)Crest of maxilla
4) Crest of palate
5) Rostrum of sphenoid
101. Middle layer of septum : most important Bones+ cartilage : mucoperichondri
um on either sides
102. Choanal atresia : persisting bucconasal memb/ emergency situation
T/t. intubation : tailed
MC Groven’s technique
103. Accoustic neuroma /vestibular schwannoma: Schwann cell tumor of sup. Vestibular N.
MC site : cerebello –pontine N.
MC involved N : trigeminal /5th N.
2nd MC facial N
Capsulated , slow growing , benign U/ L
MC in neurofibromatosis : B/L Earlest symptom : hearling loss (8th N )
Mc presentation : loss of corneal
reflex (5th N)
7th N : histex berger’s sign: anesthesia in canal
Dx: Gadolinium MRI
Reterocochlear : BERA
T/t. Gamma –knife radio Sx.
104. Meniere’s disease: inner ear disease
Membranous labrynth / saccus endolyphaticus
Increased endolymph
In middle aged males , U/L
Autosomal dominant
C/F: fluctuating tinnitus
Fluctuation hearling loss
Episodic vertigo
Diplacussis : pts hears two sounds in one ear at the same time
Glycerol test: diagnostic
Osmotic dieresis : symptoms decreases pts feel better or normal
Most sensitive test : electrochochleography
T/t. no tea . coffee . tobacco , less salt , less fluid
Anti vertigo : beta histidine , antiemetics ,
Steroids + diuretics :HL , tinnitus
Sx. Intra tympanic gentamycin
Through round window of inner ear
Chemical vestibulectomy
Vestibular N. resection
Part mann’s , Cody n Fick labrynthectomy
105. MC site for Glomus tumor : Nail bed
106. MC tumor of middle ear : Glomus tumor
Glomus tumor : juglar V Glomus
jugulave : noncapsulated , slow growing , benign, U/L
C/F : pulsatile tinnitus +CHL
Rising sun sign
Brown sings
Phlep’s sign
Dx. Of choice : contrast enhanced CT T/t. Sx.
107. MC cause of rejection of conventional hearing aids: Noise intolerance
108. Bone anchoring hearing aids (BAHA): for small child
109. Contralateral routing of singnals (CROS): sever SNHL of one side
110. Cochlear implant : speech processor
Transduction vibration to electrical energy . electrodes are inserted into scala tympani of chochlea through
round window.
111. Stapedectomy: for passive otosclerosis
112. Otosclerosis : fibrosis of ear (Disaease of bony labyrinth)
MC site : fistula ante fenestrum (Ant to oval window)
Main presentation : CHL
Young female : 30 yrs
During preg . severity increased
1. Schwartz sign : TM fleminmgo pink : only active side
2. Paracusis willi’s sign : pts hear better in noisy environment.
3. Cohart’s notch : sudden deep at 2000 Hz in audiogram . seen in only B, C audiogram . disappear after Sx.
DX. of choice : tympanometry : As
T/t. NaF : only in active stage
C/I in passive stage
Stapedectomy : passive stage , hearing Aids
113. Vestibular fun test / caloric test / Bithermal caloric test :
Warm: 44*c , cold 30*c
Tep. Of water used : 37 plus minus 4*C
Lateral semicircular canal / horizontal canal is stimulated
Cold water : opposite side nystagmus
Hot water : same side nystagmus
114. Brain stem evoked response audiometgry (BERA):
1. Hearing loss in a newborn : best investigation
2. Differentiates cochlear diseases from retrocochlear disease.
115. Tympanometry/ Impidance audiometry:
Compliance of middle ear
1. A : normal
2. As : otosclerosis
3. Ad : dissrupton of ossicles
4. B: ASOM + glue ear
5. C: glue ear
116. Pure tone audiometry : (PTO) threshold of hearing
Normal threshold of human ear : 0-20 dB
225 dB : Hearing loss
False (-)Rinne’s : Dead ear
117. Right : left
AC> BC BC>AC
-----------------------------------
Sever lateral SNHL (Dead ear )
118. Right : left
AC< BC BC>AC
-------------------------------
Lateral CHL
119. Rienne’s test :
AC> BC -> +ve normal , SNHL
BC> AC -> -ve CHL
120. Weber’s test :
Centralised normal
Lateralised abnormal
CHL weber’s goes to CHL
SNHL always lateralised to opposite side which is normal Ear
MC tuning fork frequency : 512 HZ.
121. Main indications for simple mastoidectomy : mastoiditis
122. Landmark of mastoid antrum : Mc Even’s triangle / suprameatal triangle
123. Radial mastoidectomy: Exteriorisation: middle ear cleft+ ext. auditory canal converted into single
cavity. Only structure which Not removed : footplate of stapes
124. Tympanoplasty : myringoplasty + ossiculoplasty
Type 3rd : columella
Only one ossicle left behind in middle ear : stapes (MC)
125.Type 4th : fenestration
A whole or fistula is made on lateral sac canal.
126. Myringoplasty: MC used graft Temporalis fasica . its done for central perforation.
127. Myryingotomy plus minus Grommet : Main complication is permanent fistula / perforation
128. 3 perforations in TM: central ,attic and marginal
129.Steroid resistant facial N palsy: never decompression / Electoneuronography
130.MC cause of facial N palsy: idiopathic (Bell’s palsy)
131. Petrositis : extracranial complication of CSOM
Gradeningo’s syndrome : 3 Ds
1. Ear discharge
2. Retro orbital / deep seated pain
due to 5th N
3. Diolopia : due to 6th N
132. MC damaged ossicle by CSOM : Incus
133. Labrinthine fistula : seen in lateral SCC
Vertigo , fistula sign +ve
134. MC intracranial complication of CSOM: tempral lobe /cerebral abscess
135. Mc cause of brain abscess : CSOM
136. Cholesteotoma : a sac of keratinized Sq. epithelium
MC site: prussic’s space in attic postero sup. Quadrant of TM.
137. CSOM: pseudomonas Middle ear cleft infection > 3 months
1. Tubotympanic
Safe CSOM
Increased Discharge
No smell
Peforation central
Pale polyp
No cholesteotoma
Less complications
2. Attico-antral
Unsafe
Less discharge
Foul smelling
Marginal /attic
Red polyp
+ve cholesteotoma
More complication
Spread through blood vessles infects bones
138. Glue ear/ serous ottis media: Mc in children
Mc cause of hearling loss in child is glue ear
Child with glue ear : adenoid hypertrophy
Adult with glue ear : Ca of nasopharynx
MC complication: hearling loss
Findings : Retracted TM
Dull/ Bluish TM
Reduced mobility of TM
Fluid and air bubble are seen
T/t.
Myringotomy +grommet+adenoidectomy
Done on antero-inf. Quadrant
139.ASOM: myringotomy is T/t of choice
Done in post. Inf. Quadrant of TM
140. ASOM: suppuration : rupture of TM
Discharge is always pulsatile. Perforation of TM: antero- inf. Quadrant
141. ASOM: pre suppuration
Bulging TM
Red or congested
Cart wheel appearance
Fluid lever is seen
142. ET in children : smaller wider straight
Infection of middle ear more in children
143. Middle ear infection is primary to: Nasopharynx
144. Masoiditis : MC in children U/L
Group A and B hemolytic streptococci
Pain + hearing loss
Tragal sign(-ve)
Pinna pushed ant. Inferiorly
Cymba concha : tender point
Mastoid is ironed out : smooth warm
X-ray: clouded mastoid
T/t. of choice is simple
mastoidectomy
145. Tip of mastoid : muscles attached
1. SCM
2. Digatric
146. MC abscess : post aural abscess 2nd MC : Bezold’s in SCM
147. Diagastric abscess : citelli’s abscess
148. Post –aural : luc’s abscess
Symptoms : canal wall is sagging
149. Maliagnant otitis externa: pseudomonas infection of bony canal
Elderly DM pat.
Osteomyellitis of canal, fast spread
Multiple craninal N. palsy
MC involved N: facial N
Other N. 9,10,11,12
Dx. Of choice is CT scan
150. Furunculosis : follicullitis (Hair follicle )
Cartilage part of canal
S. aureus
Severe pain in canal
Most imp. Early feature:Tragul sign +ve
Pinna pushed laterally
Retro-auricular sulcus obliterated
T/t. icthymol glycerol
151. Bullous myringitis : H’gic bullae
Myringitis H’gic : influenza virus
152. Herpes otitis externa : pain +HL No facial N palsy
153. Ramsay hunt syndrome : Herpes otitis externa + facial N. palsy
T/t. Acyclovir 800 mg/ 5times a day
Steroids for palsy
154. Fungal otitis externa :
MC: Aspergillus niger
Main problem : itching
Multiple dark spots (spores ) in canal
155. Hematoma of pinna: cauliflower Ear
Due to trauma MC in boxers
156. Perchondritis :pseudomonas
157. Artery of labyrinth : labyrinth artery
A branch of ant inf. Cerebeller artery.
158. Vestibule: Balancing organ
Saccule : macula
Urticle : macula
Semicircular canal : crista ampullaris
ampulla
159. Linear Acceleration(unidirectional ) : saccule + utricle
160. Circular acceleration(multidimensional ): 3 semicircullar canals
161. SC canal: sup. , post, and lateral / horizontal
162. Cochlea: hearing
Snail shaped : 2 and half coils
Bony cochlea is longer than memb
cochlea
Scala vestibule : perilymph
Scala medica : endolymph
Scala tympani: perilymph
Base : higher freq.
Apex : lower freq.
Main sensory organ of hearing : organ
of corti (in scala media )
Normal human ear hearing freq. is 20
- 20000 Hz.
163. Inner hair cells : 3500, in single row , less delicate , less sensitive
164. Outer hair cells : 12000-13000 , multiple rows , more delicate .Noise induced hearling loss can damage
them.
165. Inner ear: labyrinth
M.L. : hearing + balancing :Endolymph
B.L.: otic capsule : perilymph
Perilymph : ECF/Na+
Endolymph: ICF/k+
Produced by stria vascullaris
166. Antrum in mastoid : depth
Newborn : 2 mm deep
Adult : 12-15 mm deep
167. Largest mastoid air cell : antrum
168. Nerves of middle ear: glossopharyngeal , supplies middle ear
Jacobson’s N : branch of 9th N enters in middle ear , spreads Tympanic plexus
169. Facial N dosent supply middle ear except : stapedius
170. Facial N : lacrimal +submandibular+sublingual
171. Chorda tympani: most imp branch of facial N
Ant. 2/3rd of tongue
Submadibular +sublingual gland
172. Stapedial reflex : Dampening
Afferent : 8th N : ear to brain
Efferent : 7th N brain to ear
Sound between 70-100 dB will produce in stapedial reflex.
173. Facial N trauma , proxiamal /before to geniculate ganglion : Dryness of eye
174. Facial N traum distal to geniculate ganglion : no dryness of eye
175.GPSN:
1st branch of facial N
Arises from geniculate ganglion
GPSN: vidien N. all glands above palate (Nose , sinuses and lacrimal gland )
176. Fallopian canal : facial N canal in middle ear
3 branches :
1. GPSN
2. Nerve to stapedius
3. Corda tympani
177. Main function of middle ear: amplification of sound / impedense matching (17-18 times)
178. Stapedius : origin : pyramid of post. Wall
Insertion : stapes
Nerve : branch from 7th nerve
Funtions: dampens sound (decrease loudness)
179. Middle ear: Roof: tegen tympani
MC site: sphenopalatine foramen/ nasopharyngeal
MC C/F : Recurrent nasal bleeding.
63. CT scan findings of angiofibroma : antral sign / Halmann miller sign
Hondurus sign
64. Ringertz tumor: inverted papilloma
From lateral wall of nose.
Sx. Medical maxillectomy
65. Myiasis / maggot’s: larva of chrysomia
T/t. 10% diluted chroloform
66. MC site for madibular block : Subcondylar / neck of condyle
67. Block of floor of orbit: Blow out block
Floor+ medical wall of orbit
X-ray findings : Tear drop sign
68. Maxillary block: Le forte 1st : Transverse
Le forte 2nd : pyramidal
Le forte 3rd : craniofacial
69. Block of zygoma : tripod block
70. Septal block :
a)cherellet : vertical
b)Jarjaway: horizontal
71. MC block of bone : nasal bone
72. Rhinosporidiosis: due to seeberi
MC presentation : strawberry/
mulberry polyp
Bleeding polyp
DOC : Depsone
T/t. : cautery excision
73. Rhinoscleroma : klebsiealla rhinoscleromatis
Also known as woody nose (seen in north india)
Dx. Biopsy findings : Milulitz cells
Russel bodies
DOC: streptomycin _+ tetracyclin
T/t. of choice : Excision
74. Rhinophyma: potato NOSE Sebaceous gland hypertrophy
75. Rhinolith : old calcified FB in nose
FB of nose mc present as : U/L discharge in a child and bleeding and faul smell.
76. Maxillary polyps: antrochoanal polyp, unilateral , due to infection NL recurrent
77. Ethomoidal polyp : B/L, due to allergy, A bunch of grapes .
78. MC cause of spur: trauma during birth
79. Main complication of DNS : sinusitis
80. DNS : compensatory hypertrophy of inf. Turbinate , obstruction on opposite side
Due to ant. Ethomidal N involvement
T/t. SMR / septoplasty (most commonly done) done after 16 years of age
81. MC complication of SMR: septal perforation / Saddle nose
82. Atrophic rhinitis : Klebsiealla ozaena
MC in young females : decreased estrogen
Merciful Anosmia
Rx. 1) Alakaline nasal douche
a)Sodium bicarbonate
B)Sodium barborate
c)Sodium chloride
These are component of nasal solution.
2) Young’s operation .
83. MC X-ray from sinusitis : water’s view. Also known as submento occipital with mouth opening
84. Sinusitis Sx. : antral wash : puncture /fistula in inf. Meatus
FESS
Codwell
85. MC viral rhinitis :Due to rhino virus.
86. Vasomotor Rhinitis : parasympatic activity> sym.
Boggy turbinates due to pooling of blood.
87. MC allergen for Allergic Rhinitis: House dust / Dermatophycocyte
88. MC site for nasal bleed in HTN patients: Little’s area (Kissel banch’s plexus)
89. MC site for nose bleeding in elderly : HTN
90. Mc site for nose bleed : pricking / Digital trauma
91. MC cause of oroantral fistula : removal of 1st molar
92. Largest sinus: maxillary /antrum of hignmoon
Volume : 15 CC
93. 1st sinus to develop : maxillary sinus
Starts at 10th wks of IUL.
94. Last sinus to develop : frontal , after birth
95. 2 openings in nasolacrimal duct:
a) ET( small opening)
b) Sphenopalatine foramen
(sphenopalatine arch)
96. Inf. Meatus : nasolacrimal duct opening
97. Middle meatus :
a) Ant. Ethomoidal sinus
b)Maxiallary sinus
c) Frontal sinus
98. Supreme meatus / sphenoethimoidal recess: sphenoid sinus
99. Kiessel bach’s plexus:
1.sphonopalatine
2.greater palatine A
3.sup. labial A: from external carotid artery
4. Ant. Ethmoidal A: from int. carotid A
100. Bones of nasal septum :
1) vomer
2) Plate of ethmoid
3)Crest of maxilla
4) Crest of palate
5) Rostrum of sphenoid
101. Middle layer of septum : most important Bones+ cartilage : mucoperichondri
um on either sides
102. Choanal atresia : persisting bucconasal memb/ emergency situation
T/t. intubation : tailed
MC Groven’s technique
103. Accoustic neuroma /vestibular schwannoma: Schwann cell tumor of sup. Vestibular N.
MC site : cerebello –pontine N.
MC involved N : trigeminal /5th N.
2nd MC facial N
Capsulated , slow growing , benign U/ L
MC in neurofibromatosis : B/L Earlest symptom : hearling loss (8th N )
Mc presentation : loss of corneal
reflex (5th N)
7th N : histex berger’s sign: anesthesia in canal
Dx: Gadolinium MRI
Reterocochlear : BERA
T/t. Gamma –knife radio Sx.
104. Meniere’s disease: inner ear disease
Membranous labrynth / saccus endolyphaticus
Increased endolymph
In middle aged males , U/L
Autosomal dominant
C/F: fluctuating tinnitus
Fluctuation hearling loss
Episodic vertigo
Diplacussis : pts hears two sounds in one ear at the same time
Glycerol test: diagnostic
Osmotic dieresis : symptoms decreases pts feel better or normal
Most sensitive test : electrochochleography
T/t. no tea . coffee . tobacco , less salt , less fluid
Anti vertigo : beta histidine , antiemetics ,
Steroids + diuretics :HL , tinnitus
Sx. Intra tympanic gentamycin
Through round window of inner ear
Chemical vestibulectomy
Vestibular N. resection
Part mann’s , Cody n Fick labrynthectomy
105. MC site for Glomus tumor : Nail bed
106. MC tumor of middle ear : Glomus tumor
Glomus tumor : juglar V Glomus
jugulave : noncapsulated , slow growing , benign, U/L
C/F : pulsatile tinnitus +CHL
Rising sun sign
Brown sings
Phlep’s sign
Dx. Of choice : contrast enhanced CT T/t. Sx.
107. MC cause of rejection of conventional hearing aids: Noise intolerance
108. Bone anchoring hearing aids (BAHA): for small child
109. Contralateral routing of singnals (CROS): sever SNHL of one side
110. Cochlear implant : speech processor
Transduction vibration to electrical energy . electrodes are inserted into scala tympani of chochlea through
round window.
111. Stapedectomy: for passive otosclerosis
112. Otosclerosis : fibrosis of ear (Disaease of bony labyrinth)
MC site : fistula ante fenestrum (Ant to oval window)
Main presentation : CHL
Young female : 30 yrs
During preg . severity increased
1. Schwartz sign : TM fleminmgo pink : only active side
2. Paracusis willi’s sign : pts hear better in noisy environment.
3. Cohart’s notch : sudden deep at 2000 Hz in audiogram . seen in only B, C audiogram . disappear after Sx.
DX. of choice : tympanometry : As
T/t. NaF : only in active stage
C/I in passive stage
Stapedectomy : passive stage , hearing Aids
113. Vestibular fun test / caloric test / Bithermal caloric test :
Warm: 44*c , cold 30*c
Tep. Of water used : 37 plus minus 4*C
Lateral semicircular canal / horizontal canal is stimulated
Cold water : opposite side nystagmus
Hot water : same side nystagmus
114. Brain stem evoked response audiometgry (BERA):
1. Hearing loss in a newborn : best investigation
2. Differentiates cochlear diseases from retrocochlear disease.
115. Tympanometry/ Impidance audiometry:
Compliance of middle ear
1. A : normal
2. As : otosclerosis
3. Ad : dissrupton of ossicles
4. B: ASOM + glue ear
5. C: glue ear
116. Pure tone audiometry : (PTO) threshold of hearing
Normal threshold of human ear : 0-20 dB
225 dB : Hearing loss
False (-)Rinne’s : Dead ear
117. Right : left
AC> BC BC>AC
-----------------------------------
Sever lateral SNHL (Dead ear )
118. Right : left
AC< BC BC>AC
-------------------------------
Lateral CHL
119. Rienne’s test :
AC> BC -> +ve normal , SNHL
BC> AC -> -ve CHL
120. Weber’s test :
Centralised normal
Lateralised abnormal
CHL weber’s goes to CHL
SNHL always lateralised to opposite side which is normal Ear
MC tuning fork frequency : 512 HZ.
121. Main indications for simple mastoidectomy : mastoiditis
122. Landmark of mastoid antrum : Mc Even’s triangle / suprameatal triangle
123. Radial mastoidectomy: Exteriorisation: middle ear cleft+ ext. auditory canal converted into single
cavity. Only structure which Not removed : footplate of stapes
124. Tympanoplasty : myringoplasty + ossiculoplasty
Type 3rd : columella
Only one ossicle left behind in middle ear : stapes (MC)
125.Type 4th : fenestration
A whole or fistula is made on lateral sac canal.
126. Myringoplasty: MC used graft Temporalis fasica . its done for central perforation.
127. Myryingotomy plus minus Grommet : Main complication is permanent fistula / perforation
128. 3 perforations in TM: central ,attic and marginal
129.Steroid resistant facial N palsy: never decompression / Electoneuronography
130.MC cause of facial N palsy: idiopathic (Bell’s palsy)
131. Petrositis : extracranial complication of CSOM
Gradeningo’s syndrome : 3 Ds
1. Ear discharge
2. Retro orbital / deep seated pain
due to 5th N
3. Diolopia : due to 6th N
132. MC damaged ossicle by CSOM : Incus
133. Labrinthine fistula : seen in lateral SCC
Vertigo , fistula sign +ve
134. MC intracranial complication of CSOM: tempral lobe /cerebral abscess
135. Mc cause of brain abscess : CSOM
136. Cholesteotoma : a sac of keratinized Sq. epithelium
MC site: prussic’s space in attic postero sup. Quadrant of TM.
137. CSOM: pseudomonas Middle ear cleft infection > 3 months
1. Tubotympanic
Safe CSOM
Increased Discharge
No smell
Peforation central
Pale polyp
No cholesteotoma
Less complications
2. Attico-antral
Unsafe
Less discharge
Foul smelling
Marginal /attic
Red polyp
+ve cholesteotoma
More complication
Spread through blood vessles infects bones
138. Glue ear/ serous ottis media: Mc in children
Mc cause of hearling loss in child is glue ear
Child with glue ear : adenoid hypertrophy
Adult with glue ear : Ca of nasopharynx
MC complication: hearling loss
Findings : Retracted TM
Dull/ Bluish TM
Reduced mobility of TM
Fluid and air bubble are seen
T/t.
Myringotomy +grommet+adenoidectomy
Done on antero-inf. Quadrant
139.ASOM: myringotomy is T/t of choice
Done in post. Inf. Quadrant of TM
140. ASOM: suppuration : rupture of TM
Discharge is always pulsatile. Perforation of TM: antero- inf. Quadrant
141. ASOM: pre suppuration
Bulging TM
Red or congested
Cart wheel appearance
Fluid lever is seen
142. ET in children : smaller wider straight
Infection of middle ear more in children
143. Middle ear infection is primary to: Nasopharynx
144. Masoiditis : MC in children U/L
Group A and B hemolytic streptococci
Pain + hearing loss
Tragal sign(-ve)
Pinna pushed ant. Inferiorly
Cymba concha : tender point
Mastoid is ironed out : smooth warm
X-ray: clouded mastoid
T/t. of choice is simple
mastoidectomy
145. Tip of mastoid : muscles attached
1. SCM
2. Digatric
146. MC abscess : post aural abscess 2nd MC : Bezold’s in SCM
147. Diagastric abscess : citelli’s abscess
148. Post –aural : luc’s abscess
Symptoms : canal wall is sagging
149. Maliagnant otitis externa: pseudomonas infection of bony canal
Elderly DM pat.
Osteomyellitis of canal, fast spread
Multiple craninal N. palsy
MC involved N: facial N
Other N. 9,10,11,12
Dx. Of choice is CT scan
150. Furunculosis : follicullitis (Hair follicle )
Cartilage part of canal
S. aureus
Severe pain in canal
Most imp. Early feature:Tragul sign +ve
Pinna pushed laterally
Retro-auricular sulcus obliterated
T/t. icthymol glycerol
151. Bullous myringitis : H’gic bullae
Myringitis H’gic : influenza virus
152. Herpes otitis externa : pain +HL No facial N palsy
153. Ramsay hunt syndrome : Herpes otitis externa + facial N. palsy
T/t. Acyclovir 800 mg/ 5times a day
Steroids for palsy
154. Fungal otitis externa :
MC: Aspergillus niger
Main problem : itching
Multiple dark spots (spores ) in canal
155. Hematoma of pinna: cauliflower Ear
Due to trauma MC in boxers
156. Perchondritis :pseudomonas
157. Artery of labyrinth : labyrinth artery
A branch of ant inf. Cerebeller artery.
158. Vestibule: Balancing organ
Saccule : macula
Urticle : macula
Semicircular canal : crista ampullaris
ampulla
159. Linear Acceleration(unidirectional ) : saccule + utricle
160. Circular acceleration(multidimensional ): 3 semicircullar canals
161. SC canal: sup. , post, and lateral / horizontal
162. Cochlea: hearing
Snail shaped : 2 and half coils
Bony cochlea is longer than memb
cochlea
Scala vestibule : perilymph
Scala medica : endolymph
Scala tympani: perilymph
Base : higher freq.
Apex : lower freq.
Main sensory organ of hearing : organ
of corti (in scala media )
Normal human ear hearing freq. is 20
- 20000 Hz.
163. Inner hair cells : 3500, in single row , less delicate , less sensitive
164. Outer hair cells : 12000-13000 , multiple rows , more delicate .Noise induced hearling loss can damage
them.
165. Inner ear: labyrinth
M.L. : hearing + balancing :Endolymph
B.L.: otic capsule : perilymph
Perilymph : ECF/Na+
Endolymph: ICF/k+
Produced by stria vascullaris
166. Antrum in mastoid : depth
Newborn : 2 mm deep
Adult : 12-15 mm deep
167. Largest mastoid air cell : antrum
168. Nerves of middle ear: glossopharyngeal , supplies middle ear
Jacobson’s N : branch of 9th N enters in middle ear , spreads Tympanic plexus
169. Facial N dosent supply middle ear except : stapedius
170. Facial N : lacrimal +submandibular+sublingual
171. Chorda tympani: most imp branch of facial N
Ant. 2/3rd of tongue
Submadibular +sublingual gland
172. Stapedial reflex : Dampening
Afferent : 8th N : ear to brain
Efferent : 7th N brain to ear
Sound between 70-100 dB will produce in stapedial reflex.
173. Facial N trauma , proxiamal /before to geniculate ganglion : Dryness of eye
174. Facial N traum distal to geniculate ganglion : no dryness of eye
175.GPSN:
1st branch of facial N
Arises from geniculate ganglion
GPSN: vidien N. all glands above palate (Nose , sinuses and lacrimal gland )
176. Fallopian canal : facial N canal in middle ear
3 branches :
1. GPSN
2. Nerve to stapedius
3. Corda tympani
177. Main function of middle ear: amplification of sound / impedense matching (17-18 times)
178. Stapedius : origin : pyramid of post. Wall
Insertion : stapes
Nerve : branch from 7th nerve
Funtions: dampens sound (decrease loudness)
179. Middle ear: Roof: tegen tympani
Juglar vein runs just below the floor of middle ear
Length of ET: 36 mm
Outher 1/3rd Bony
Inner 2/3rd carilagenous
Maintain the pressure of middle ear
Drain the secretion of middle ear
Barotrauma : deep sea diving
Tensor veli palatine
Levator palatti
These two muscles open ET during swallowing , yawning
180. Tensor tympanii: from ant. Wall of canal
Inserts on handle of maleus
Nerve : mandibular N
Tenses the TM
181. Medical wall of middle ear : promomtory : due to base of cochlea
182. Round window : covered by secondary TM
183. Facial N : comes out through stulomestoid foramen of post wall of middle ear.
Pinna : ATN, Greater auricular , lesser occipital
Meatus ATN, Arnold’s N, facial N
Tm: ATN, Arnold’s N , tympanic plexus
ATN: branch of mandibular : trigeminal N
Arnorld’s N : Branch of vagus , does not supply the pinna.
185. Biggest part of TM : cone of lioght (ant . inf . quadrant )
186. Umbo : positions : Rt side 5 o’clock
Lt side : 7 o’clock
187. Landmarks of TM: umbo/ handle of maleus
188. From outside in TM : MIS (maleus, incus, stapeus)
189. Pars flaccida (TM): Sharpnell’s memb.
190. Pars tensa (TM): vibrates more Effective area: 45-55mm
191. TM: thickness :0.1mm
Oval shaped , pearly white
Total area of TM : 80-90mm2
192. Ear wax: collection of cerumin in canal
Wax formation : mc after ear Sx
MC procedure to remove ear wax is : syringing of canal
Most dangerous method is : probe
193. Outer 1/3rd of canal : cartilaginous , hair follicles
Sebaceous gland : cerumin
194. Narrowest part of canal : Isthmus 6mm before TM
195. Inner 2/3rd of meatus : Bony Length of meatus :24mm in adults
Inner 2/3rd : bony: 16mm
Outer 1/3rd cartilaginous : 8mm
196. Pinna : elastic cartilage
Except : lobule , incicura terminalis.
197. Pinna / auricle : Develops from fusion of 1st and 2nd brachial arch
198. Incomplete fusion: preauricular sinus it’s a developmental anomaly Pus coming out of it
Dx. Sinogram
T/t. surgical excision
Length of ET: 36 mm
Outher 1/3rd Bony
Inner 2/3rd carilagenous
Maintain the pressure of middle ear
Drain the secretion of middle ear
Barotrauma : deep sea diving
Tensor veli palatine
Levator palatti
These two muscles open ET during swallowing , yawning
180. Tensor tympanii: from ant. Wall of canal
Inserts on handle of maleus
Nerve : mandibular N
Tenses the TM
181. Medical wall of middle ear : promomtory : due to base of cochlea
182. Round window : covered by secondary TM
183. Facial N : comes out through stulomestoid foramen of post wall of middle ear.
Pinna : ATN, Greater auricular , lesser occipital
Meatus ATN, Arnold’s N, facial N
Tm: ATN, Arnold’s N , tympanic plexus
ATN: branch of mandibular : trigeminal N
Arnorld’s N : Branch of vagus , does not supply the pinna.
185. Biggest part of TM : cone of lioght (ant . inf . quadrant )
186. Umbo : positions : Rt side 5 o’clock
Lt side : 7 o’clock
187. Landmarks of TM: umbo/ handle of maleus
188. From outside in TM : MIS (maleus, incus, stapeus)
189. Pars flaccida (TM): Sharpnell’s memb.
190. Pars tensa (TM): vibrates more Effective area: 45-55mm
191. TM: thickness :0.1mm
Oval shaped , pearly white
Total area of TM : 80-90mm2
192. Ear wax: collection of cerumin in canal
Wax formation : mc after ear Sx
MC procedure to remove ear wax is : syringing of canal
Most dangerous method is : probe
193. Outer 1/3rd of canal : cartilaginous , hair follicles
Sebaceous gland : cerumin
194. Narrowest part of canal : Isthmus 6mm before TM
195. Inner 2/3rd of meatus : Bony Length of meatus :24mm in adults
Inner 2/3rd : bony: 16mm
Outer 1/3rd cartilaginous : 8mm
196. Pinna : elastic cartilage
Except : lobule , incicura terminalis.
197. Pinna / auricle : Develops from fusion of 1st and 2nd brachial arch
198. Incomplete fusion: preauricular sinus it’s a developmental anomaly Pus coming out of it
Dx. Sinogram
T/t. surgical excision
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