ENT important points

CUSIS:

1. Hyperacusis – Bell’s palsy

2. Paracusis willisi – Otosclerosis

3. Diplacusis – Meniere’s disease

4. Presbyacusis – Age related SNHL

TRIADS:

1. Gradinego syndrome :

Ear discharge

Retroorbital pain

 Diplopia 

2. Trotter’s triad (NPC):

U/L CHL (glue ear)

Temporoparietal pain

Palatal palsy

3. Sampter’s triad

Allergy to Aspirin

Asthma 

Nasal polyps

SIGNS:

1. Heinnebert sign : Congenital Syphillus

2. Hitzelberger sign : Acoustic Neuroma

3. Rising sun/ brown sign/ Phelp sign : Glomus Juglare

4. Target/Halo sign : Traumatic CSF leak

5. Cart wheel sign : ASOM

6. Schwartz sign : Otosclerosis

7. Griessenger sign / Delta sign : Sigmoid Sinus Thrombosis

8. Reservoir Sign : Mastoiditis

9. Light House : ASOM

10. Tripod sign/ Thumb sign : Epiglotittis 

11. Steeple sign : ALTB / CROUP

12. Antral sign / Hollman miller sign : Angiofibroma CT

13. Omega shaped epiglottis : Laryngomalacia 

14. Turban/ Mouse nibbled vocal cord : TB larynx

15. Potato nose : Rhinophyma

16. Woody nose : Rhinoscleroma

17. Mulberry like nasal mass : Rhinosporidiosis

18. Mulberry like nasal mucus : Inferior turbinate hypertrophy

19. Frog face deformity : Angiofibroma

THYROPLASTY:

1. Type 1 : Medialization – Adductor palsy

2. Type 2 : lateralization – Abductor palsy

3. Type 3 : Shortning- Loosening – Puberphonia 

4. Type 4 : Lengthing- tightening – Androphonia

 

DRAINAGE points:

1. Nasolacrimal duct : Inferior meatus

2. Maxillary / frontal / anterior / ethmoidal : Middle meatus

3. Posterior ethmoid : Superior meatus

4. Sphenoid : Sphenoethmoidal recess

5. DCR : Middle meatus

Acoustic neuroma

Most common intracranial schwannoma.

80% of all cp angle tumours.

it's benign. B/l acoustic neuroma is diagnostic of NF2. 

Most common age group is 40 to 60 yrs of age. 

Tumour is radioresistant.90 % of cases are u/l. 

Most schwannomas are sporadic.

Earliest symptom: Deafness, tinnitus .retrocochlear hearing loss, true vertigo not seen due to central adaptation. Marked difficulty in speech understanding.earliest nerve involved is 5th cranial nerve.2nd nerve is facial.

Earliest sign: corneal reflex is impaired.

Histelberger sign and teal's sign +ve .

recruitment is negative.

BERA: delay in 5th wave.

MRI is gold standard investigation.

Vertebral angiography is done for differentiation from other CP tumours.

Surgery is TOC.

For hearing rehabilitation in b/l acoustic neuroma: Auditory brain stem implant.

Signs in ENT

BATTLE SIGN- Bruising behind earat mastoid region, due to petroustemporal bone# (middle fossa #).

BOCCA'S SIGN - Absence of postcricoid crackle(Muir's crackle) inCarcinoma post. cricoid.

BROWN SIGN - blanching of rednesson increasing pressure more thansystemic pressure see in glomusjugulare.

BOYCE SIGN - Laryngocoele-Gurgling sound on compression ofexternal laryngocoele with reductionof swelling.

DODD’S SIGN/CRESCENT SIGN - X-ray finding-Crescent of air betweenthe mass and posterior pharyngealwall. positive in AC ployp. Negativein Angiofibroma

FURSTENBERGERSSIGN-This is seenwhen nasopharyngeal cyst is communicating intracranially,there isenlargement of the cyst on crying and upon compression of jugularvein.

HITSELBERGER'SSIGN - In Acousticneuroma- loss of sensation in theear canal suppllied by Arnold'snerve( branch of Vagus nerve to ear )

HOLMAN MILLER SIGN, ANTRALSIGN-it is seen in angiofibroma,thetumor pushes forward on theposterior wall of the maxillarysinus..

HONDOUSA SIGN--X-ray finding inAngiofibroma, indicatinginfratemporal fossa involvementcharacterised by widening of gapbetween ramus of mandible andmaxillary body.

HENNEBERT SIGN- false fistula sign( cong.syphilis, Meniere's,)

IRWIN MOORE’S SIGN-------- positivesqueeze test in chronic tonsillitis

LIGHT HOUSE SIGN--- seeping outof secretions in acute OTITIS media

LYRE'S SIGN - splaying of carotidvessels in carotid body tumor

MILIAN’S EAR SIGN- Erysipelas canspread to pinna(cuticularaffection),where as cellulitis cannot.

PHELP'S SIGN - loss of crust of bonebetween carotid canal and jugularcanal in glomus jugulare

RACOON SIGN-Indicate subgalealhemorrhage,and not necessarly baseof skull #

STEEPLE SIGN- X-ray finding inAcute Laryngo tracheo bronchitis

STANKIEWICK'S SIGN - indicateorbital injury during FESS. fatprotrudes into nasal cavity oncompression of eye ball from ouside

THUMB SIGN --X-ray finding A/cepiglottitis

TRAGUS SIGN- EXTERNAL OTITIS ,Pain on pressing Tragus

TEA POT SIGN is seen in CSFrhinorrhoea..

WOODS SIGN----- palpable jugulodigastric lymphnode

Fistula test Interpretation

How are the results of Fistula test interpreted?

1. In fistula over the dome of the lateral semicircular canal: Increase pressure causes conjugate horizontal deviation of the eyes towards the normal side. As pressure is maintained, jerk nystagmus develops with fast component towards the affected ear. As pressure is released, eyes return to normal
2. Fistula of the lateral semicircular canal (anterior to the ampulla) causes deviation of eyes, to the affected side
3. Vestibular erosion causes rotatory horizontal nystagmus towards the diseased ear
4. Fistula of the posterior semicircular canal causes vertical movement of eyes.

https://youtu.be/4gEM17yTl5k

Fistula Test

How are the results of Fistula test interpreted?

1. In fistula over the dome of the lateral semicircular canal: Increase pressure causes conjugate horizontal deviation of the eyes towards the normal side. As pressure is maintained, jerk nystagmus develops with fast component towards the affected ear. As pressure is released, eyes return to normal

2. Fistula of the lateral semicircular canal (anterior to the ampulla) causes deviation of eyes, to the affected side

3. Vestibular erosion causes rotatory horizontal nystagmus towards the diseased ear

4. Fistula of the posterior semicircular canal causes vertical movement of eyes.

Laryngomalacia

*Laryngomalacia*

Laryngomalacia (literally, "soft larynx") is the most common cause of stridor in infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.

It can also be seen in older patients, especially those with neuromuscular conditions resulting in weakness of the muscles of the throat.
However, the infantile form is much more common. Laryngomalacia is one of the most common laryngeal congenital disease in infancy and public education about the signs and symptoms of the disease is lacking.

*Epidemiology*

Although this is a congenital lesion, airway sounds typically begin at age 4–6 weeks. Until that age, inspiratory flow rates may not be high enough to generate the sounds. Symptoms typically peak at age 6–8 months and remit by age 2 years.

Late-onset laryngomalacia may be a distinct entity, which can present after age 2 years.

*Presentation*

In infantile laryngomalacia, the supraglotticlarynx (the part above the vocal cords) is tightly curled, with a short band holding the cartilage shield in the front (the epiglottis) tightly to the mobile cartilage in the back of the larynx(the arytenoids).

These bands are known as the aryepiglottic folds.
The shortened aryepiglottic folds cause the epiglottis to be curled on itself.
This is the well known "omega shaped" epiglottis in laryngomalacia.

Another common finding of laryngomalacia involves the posterior or back part of the larynx, where the arytenoid cartilages or the mucosa/tissue over the arytenoid cartilages can collapse into the airway and cause airway obstruction.

Laryngomalacia results in partial airway obstruction, most commonly causing a characteristic high-pitched squeaking noise on inhalation
(inspiratory stridor).

Some infants have feeding difficulties related to this problem.
Rarely, children will have significant life-threatening airway obstruction.
The vast majority, however, will only have stridor without other more serious symptoms such as dyspnea.

*Causes*

Although laryngomalacia is not associated with a specific gene, it is evidence that some cases may be inherited. Relaxation or a lack of muscle tone in the upper airway may be a factor.
It is often worse when the infant is on his or her back, because the floppy tissues can fall over the airway opening more easily in this position.

*Diagnosis*

The physician will ask some questions about the baby’s health problems and may recommend a flexible laryngoscopy to further evaluate the infant's condition.

*Prognosis*

Laryngomalacia becomes symptomatic after the first few months of life (2–3 months), and the stridor may get louder over the first year, as the child moves air more vigorously. Most of the cases resolve spontaneously and less than 15% of the cases will need surgical intervention.

Parents need to be supported and educated about the condition.

*Treatment*

Time is the only treatment necessary in more than 90% of infant cases. In other cases, surgery may be necessary.
 Most commonly, this involves cutting the aryepiglottic folds to let the supraglottic airway spring open.
Trimming of the arytenoid cartilages or the mucosa/ tissue over the arytenoid cartilages can also be performed as part of the supraglottoplasty. Supraglottoplasty can be performed bilaterally (on both the left and right sides at the same time), or be staged where only one side is operated on at at time.

Treatment of GERD can also help in the treatment of laryngomalacia, since gastric contents can cause the back part of the larynx to swell and collapse even further into the airway. In some cases, a temporary tracheostomy may be necessary.

Nowadays, we can do Laryngoplasty surgery & also put T-Tube in the larynx via a Tracheostomy opening.
Calcium supplements are usually given to children with Laryngomalacia upto the age of 12-14 years, till the puberty changes in the larynx takes place.

Malignancies Of Nose:

*MC benign tumor- PAPILLOMA

*MC site of mc benign tumor-VESTIBULE

*MC site of capillary hemangioma-LITTLES AREA

*MC site of cavernous hemangioma-INF TURBINATE

*MC type of malignancy-SQ.C.C

*MC site of mc type of malignancy-LAT.WALL OF NASAL CAVITY

Otosclerosis

The cochlear promontory may have a faint pink tinge reflecting the vascularity of the lesion, referred to as the Schwartz sign. Conductive hearing loss is usually secondary to impingement of abnormal bone on the stapes footplate. This involvement of the oval window forms the basis of the name fenestral otosclerosis. The most common location of involvement of otosclerosis is the bone just anterior to the oval window at a small cleft known as the fissula ante fenestram.
Also there is mounting evidence that measles virus is present within the otosclerotic foci, implicating an infectious etiology (this has also been noted in Paget’s Disease).
Otosclerosis is associated with osteogenesis imperfecta in 0.15 % of cases. This is known as Van der Hoeve syndrome or Adair - Dighton syndrome.
....### cochlear implants. ....
Inserted in scala tympani
Inserted via round window
*External device: Processor, Microphone ,Transmitter.
*Internal device :Receiver, stimulator.
Lowest age 1 yr

##### types of hemorrhage
primary - at the time of operation
reactionary - within 24 hours of surgery
secondary - 5th to 10th post operative day ..

The classification system for tympanograms commonly used today was developed by Liden (1969) and Jerger (1970). There are three main types of tympanograms: A, B, and C. Type A tympanograms look like a teepee, and indicate a normal middle ear system, free of fluid or physiological anomalies which would prevent the admittance of sound from the middle ear into the cochlea.
Type B tympanograms are a flat line, which is consistent with middle ear pathology, such as fluid or infection behind the ear drum. In some cases, these tympanograms are seen when there is a hole in the ear drum; the difference lies in the ear canal volume: a larger ear canal volume indicates a perforation in the ear drum.
Type C tympanograms are still shaped like a teepee, but are shifted negatively on the graph. This indicates negative pressure in the middle ear space, often consistent with sinus or allergy congestion, or the end-stages of a cold or ear infection.

laryngeal endoscopic cordectomies

A classification of laryngeal endoscopic cordectomies was first proposed by European laryngology
society in 2000.The classification described 8 types of cordectomies, as follows:

Type I: Subepithelial cordectomy, which is the resection of vocal cord epithelium passing through the
superficial layer of lamina propria .
Type II: Subligamental cordectomy, which is resection of epithelium, or Reinke’s space and vocal ligament.
Type III: Transmuscular cordectomy, which proceeds through vocalis muscle.
Type IV: Total cordectomy, which extends from vocal process to the anterior commissure.
Type Va: Extended cordectomy encompassing the contralateral vocal fold.
Type Vb: Extended cordectomy encompassing the arytenoids.
Type Vc: Extended cordectomy encompassing the ventricular fold.
Type Vd: Extended cordectomy encompassing the subglottis.

Larynx

1.vocal cord  post 1/3rd cartilaginous. n ant 2/3rd membranous part.
2.angle. between 2 lamina of thyroid cartilage : male. 90degree. female : 120 degree.
3.lenghth of. vocal cord in male : 24-25 mm. n in female 16-17 mm.
4.length of larynx :  vocal cord + 12 mm
5.distance. between 2 vocal cord : 19 mm.
6. focal. lenght of objective lens. ear : 200-250 nm.   nose. 300 nm.    throat. 400 nm
7. position of larynx in child. c2-c3.  n. in adult. c3-c6.
8. size. of  subglottic in preterm is less than 3 mm n. full term 4. mm. you can remember from latter itself pre. 3. n. full 4.
9. ca larynx. male. female ratio :  10:1.
10.tracheotomy. reduced the dead space. upto. : 50 percent.

Muscles Acting On Vocal Cord

Muscles Acting On Vocal Cord

🎈abductor -  posterior cricoarytenoid
🎈adductor- TILAC
Thyroarytenoid
Interarytenoid
Lateral cricoarytenoid
🎈tensor of vocal cord - cricothyroid
Thyroarytenoid
🎈openers of laryngeal inlet - thyroepiglottis
🎈closers of laryngeal inlet - Interarytenoid
Aryepiglottis

Audiometry

JERGERS CURVE ON IMPEDANCE AUDIOMETRY

🍉A CURVE-
  🍍normal
  🍍ET obstruction in some cases

🍉As CURVE/FIXATION OF OSSICLES-decreased compliance at ambient pressure
   🍍otosclerosis
   🍍tumors of middle ear
   🍍fixed malleus
    🍍tympanosclerosis

🍉Ad CURVE-increased complieance at ambient pressure
    🍍ossicular discontinuty
    🍍post stapedectomy
    🍍monomeric ear drum
     🍍lax TM

🍉B CURVE/FLAT/DOME SHAPED CURVE-lack of compliance
      🍍fluid in middle ear/SOM/AOM
       🍍TM perforation
       🍍grommet in ear
        🍍thickened TM

🍉C CURVE/ROUNDED-max compliance at pressures>100mm H2O
       🍍retracted TM
       🍍Faulty function of ET

Acoustic nueroma

1.  An acoustic neuroma first distorts the eighth cranial nerve. The slowly enlarging tumor protrudes from the internal auditory canal into an area behind the temporal bone called the cerebellopontine angle.

2.It then assumes a pear shape, with the small end in the canal. The tumor presses on adjacent nerves, such as the fifth cranial nerve.

3. Ultimately, the tumor can involve other nerves. And press on the brainstem and become life threatening.

4. Its origin is INFERIOR vestibular n. And not supr vestib... nor auditory N.

5. Still 90% pts present with hearing loss and tinnitus. Not as vertigo or balance problems.. ...... bcoz auditory part more succeptible to pressure.

One liners from ENT

ENT

MCC of fungal esophagitis... Candida

Cotton's grading... Sub glottic stenosis

Cause of sudden death in a pt who underwent maxillary sinus irrigation..... Air embolism

Weber Ferguson approach.... Used for maxillectomy

Tobey ayer test +ve in lateral sinus thrombosis

Mucocoeles are most common in frontal sinus

In Dacryocystorhinostomy opening is done in middle meatus.

Nasal bone fracture corrected by Walsham's forceps

Artery responsible for epistaxis after ligating external carotid artery.... Ethmoidal artery

Epley's test is used for benign paroxysmal vertigo.

Schuller's and Law's view.... Mastoid air cells.

ENT ONE LINERS :

ENT ONE LINERS :
1.Best site for incision on pinna--Incissura terminalis..
2.Lobule is last structure to develop in intrauterine life.
3.Surgical reconstruction of pinnae should not be done before 6 yrs.
4.Pinna skin is tightly adherent on laretal aspect and loosely on medial.
5."Marx Classification is used for microtia of pinna.

High yield ENT and Opthalmology

5 cleans for eliminatn of neonatal tetanus
Clean delivary surface
Clean hands
Clean cord cut
Clean cord tie
Clean cord stump

5 f's of sanitation barrier
Fingers
Flies
Fomites
Food
Faeces

5 d's of ill health
Disease
Discomfort
Disability
Dissatisfaction
Death

5 i's of ageing
Impairment
Instability
Incontinence
Immobility
Isolation

Causes of lagopthalmos..oc pens..
Orbicularis oculi palsy
Cicatricial
Proptosis
Ectropion
Nocturnal lagopth
Symblepharon...

CI of stapedectomy -IPOD
Infection
Perforation
Only hearing ear
Deafness

Squelae of otitis media -SCALP COST
Snhl
Cholesteatoma
Atelectasis
Learning disability
Perforation tm
Conductive HL
Ossicular necrosis
Speech impairment
Tympanosclerosis

Local causes of epistaxis -Indian Drink FANTA
Infection
Dns
Foreign body
Atmospheric
Neoplasm
Trauma
Allergic

Etiology of submucous fibrosis -STAMINA
Socio eco
Tobacco
Areca nuts
Multi factorial
Immune status
Nutrition
Alcohol

Indications of
tympanoplasty -ABCDE S
Age above 10years
Benign
Conductive deafness corrected
Dry perforation
Eustachian tube func properly
Stapes mobile

Cherry red spot in retina-

Rembr:Cherry Tree Never Grows Tall
CRAO
TAYSACHS DISEASE
NIEMANAPICKS dis
GAUCHERS dis
TRAUMA.

Func of tracheostomy -VIP BAR
Ventilation
Ippr
Protects d airways
Breathing
Administer of
anaesthesia
Removal of secretions

Interstial keratitis -TIC TAC S                                    

 tb
Inherited syphilis
Congenital syphilis
Trypanosomiasis
Acquired syphilis
Cogan syn
Sarcoidosis

Causes of SNHL -FANSI  TOPS
Familial progress HL
Au.neuroma
Noise induced
Systemic diseases
Infection
Trauma
Ototoxic
Presbycusis
Sudden hearing loss

Retinal detachment causes 4'F
Floaters
Flashes
Falling acuity
Field loss

D/D of
membrane over tonsillitis:
M2-VIDAAL (form Widal test for
T yphoid)
It is:
- Membranous tonsillitis
- Malignancy
- Vincent's angina
- Infectious mononucleosis
- Diptheria
- Apthous ulcers
- Agranulocytosis
- Ludwig's angina
- T : Trauma

FESS Indications :-

FARMER

Fungal sinusitis
AC polyp
Recurrent bacterial sinusitis
Mucocele
Endoscopic septoplasty
Removal of foreign bodies

Indications for Caldwell luc-

COFFE BOARD
Chronic  max sinusitis

Oroantral fistula

Fracture maxilla

Foreign body removal

Ethmoidectomy

Biopsy for suspected neoplasm

Opening of pterygopalatine fossa for ligation of max artery

Antrochoanal polyp recurrence

Reduction of orbital blow out fracture

Dental cyst

Causes of atropic rhinitis -

HERNIA

Heridity
Endocrinal Disturbance
Race-whites
Nutritional defeciency-vit             A,D,Fe

Infective
Autoimmune

Causes of stridor :-
ABCDEFGHIJ L

Abscess(retro pharyngeal,peri tonsillar)
Adenotonsillar hypertrophy

Bacterial tracheitis

Croup

Diphtheria

Epiglottitis

Foreign body

Hemangioma

Injury,Inf. Mononucleosis

Jaw and tongue abnormalities

Laryngomalacia
Laryngeal web
Laryngeal edema
Laryngitis

Etiology of Submuous Fibrosis.STAMINA

S-Socio-economic ststus
T-Tobacco
A-Areca Nuts
M-Multifactorial
I-Immmune process
N-Nutritional
A-Alcohol

Classification of secondary glaucoma.-lip tip shant
Lens induced
Inflammatory
Pigmentary
Traumatic
Iridocorneal dystrophy
Pseudoexfoliative
Steroid induced
Hemorrhagic
Aphakic
Neovascular

Causes of scleritis
S - SURGERY INDUCED
C - COLLAGEN VASCULAR DISEASES
L - LEPROSY
E -
R - RADIATION
I - INFECTION
T - THYROTOXICOSIS
I - IDIOPATHIC
S - SLE

Points from ent

CAULIFLOWER EAR---is due to Hematoma of Auricle,"

 "ENCEPHALOCELE---Herniation of Brain tissue with its Dural covering into the Nasal cavity, "-

 "EPITYMPANUM---includes--head of Malleolus , Body of Incus," 

"FITZGERALD-HALLPIKE TEST---uses Temp. at 30oC& 44oC, also called as caloric test?,"

 "LE FORT'S FRACTURE---inv's ZYGOMA, MAXILLA, & NASAL BONES,"

 "Oblique & Horizontal Fracture of nasal septum--- is called asJARJAVAL FRACTURE,"- 

"GLOBUS HYSTERICUS---lump in throat not interfering with swallowing,"- "

GROMMET INSERTION---is done in anteroinferior quadrant,"

 GELLE'S TEST---done in Otosclerosis, "Great Auricular Nr. ---supplies Skin at Angle of JAW,"

 "GLOSSOPHARYNGEAL NEURECTOMY--- Route of Approach -Tonsillectomy approach,"- Hearing impairment due to noise starts at 4000 Hz.,- 

"HEMANGIOMA---Bleeding Polyp of nose--arises from septum,"

 HYPERACUSIS---normal sound are heard as loud & painful.

 "HYPERNASALITY---caused by Cleft palate, Submucous celft, Bifed Uvula," 

HYPOPHARYNEAL CANCER---predisposing factors -Plummer Vinson's Synd., 

"INVERTED PAPILLOMA---of Rt.side of nasal cavity -TOC.=Total Maxillectomy,"- 

"INNER AUDITORY MEATUS---facial nerve is lateral to superior vestibular nerve," 

"JUVENILE PAPILLOMA---Rx-Surgical excision," 

"KERATOSIS OBURANS---is a Premalignant condition," 

KOBARK TEST---used for Minimal Caloric Stimulation, "

KARTAGENER'S SYND.---Ass.with Sinusitis, Dextrocardia, Bronchiectasis, " 

"LARYGEAL MIRROR---warmed before use by placing glass surface on Flame,"

LARYNGOFISSURE---Opening the larynx in midline," 

"LARYNGECTOMY---after laryngectomy Voice is from Oesophagus,"

 "LARYNGOCELE---Gas filled sac in neck region after VALSALVA MANOEURVE," 

"ANAESTHESIA OF LARYNX---occurs with Diptheria, Lead Poisoning, Multiple sclerosis,"- 

"LYMPH NODE METASTASIS IN NECK --- is seen in SupraGlottic Ca., Ca.of Tonsil, Papillary Ca.of thyroid, NEVER seen in Ca.of Vocal Cords, "

 "MASKING---is applied for inability to hear,"

 "MASTOID TEMPORAL BONE AIR CELL GROUPS---include Petrosae, Retrofacial, Hypotympanic, Sublabyrinthine."

 "MASTOID TIP---appears by 2yrs. of age," 

"INFERIOR MEATUS OF NOSE---NasoLacrimal duct/ Frontonasal duct opens," 

"MONOAURAL DISPLACUSIS---due to Lesions of Cochlea,"

 "MYIASIS OF NOSE---MAGGOTS OF NOSE, Rx-TOC.--CHLOROFORM Water," "

MYRINGITIS BULLOSA---caused by Virus," 

"NASAL DEPRESSED BRIDGE--- caused by Syphylis, Septal Abscess, Injury," 

CROOKED NOSE---due to Deviated Tip & Septum , "

SADDLE SHAPED NOSE---due to Destruction of na sale septum," 

"OESOPHAGUS---cervical oesophagus receives its blood supply from Inf.Thyroid Artery, "

 "BENIGN NEOPLASMS OF OESOPHAGUS---commonest --is Intramural Tumour of oesophagus "

CARCINOMA OF OESOPHAGUS---RAT TAIL APP. on Barium swallowing,"- 

"OLFCTORY AREA---Looks YELLOW in colour," "OSSICULAR RATIO = 1.3:1 ,

" "TUBERCULAR OTITIS MEDIA---Multiple perforations of T.M.,

 "ACUTE NON SUPPURATIVE OTITIS MEDIA---Retracted drumhead with a hiar-line or air bubbles on otoscopy," 

"OTOMYCOSIS---most common fugas aspergillus fumigatus," 

CSF OTORRHOEA--- fracture of petrous ridge/ petrous temporal bone,-

"PENDRED SYND.--Thyroid swelling + nerve deafness,"

 PARAPHARYNGEAL ABCESS---swelling in post. Part of middle1/3 of sternomastoid & tonsil is pused medially "

PAROSMIA---PERVERSION OF SMELL," 

"PHARYNGITIS- MEMBRANOUS---causes--streptococcal, ludwig's angina, diptheria, "-

 PHARYNGOMAXILLARY ABSCESS---medial bulge of pharynx , "

PLEOMORPHIC ADENOMA---most common tumour of parotid gland,"--- 

PNEUMATOCELE--seen in fracture of frontal sinus,----

 PROCESSUS COCHLEARIFORMIS--attaches to handle of mallues, "

RESP.ALLERGY--house dust,"--- "

RANADIER'S OPERATION---done in Petrositis,"

 CHRONIC RETROPHARYNGEAL ABSCESS--due to caries spine,- 

"SICCA RHINITIS--anterior nares inv.,", 

"RHINOLITH--- deposition of calcium around the F.B. in nose,"- 

RHINOPHYMA---hypertrophy of sebaceous gland,---

 "SINGERS NODULE---Voice abuse," 

"SCALA MEDIA ---shows endolymph,"-"

SCHIRMER'S TEST---for lacrimal secr. To test facial nerve,"-- "

SEMICIRCULAR CANALS--senses Angular movements,"---- 

"SCHWARTZ SIGN ---seen in otosclerosis,"- 

"SCHWARTZE OPERATION---done in CSOM,"- 

"SPEECH DISCRIMINATION SCORE---lowest in retrocochlear SND,"---- 

"ALPORT'S SYND.---SNHL+Hereditary nephritis,"----

 "TEMPORAL BONE---petrous part-inner ear,"--- 

"TONE DECAY TEST---done to fineout retrocochlear lesions,"--

 "TOBEY AYER TEST---Lateral sinus thrombosis,"- 

"TRACHEOSTOMY TUBE---double tube, made of Titanium silver alloy, cuffed tube is used for IPPV,

" "TROTTER'S TRIAD---seen in nasopharyngeal ca.,"- "

UMBO---most reliable landmark on otoscopy,"--- 

"VERTIGO---peripheral/ labyrinthine V. fes--unidirectional nystagmus, marked vertigo, ass.central abn.absent,"----

 "VESTIBULE---IS present in nose, larynx, pharynx,"---- 

"VESTIBULAR SCHWANOMMA---IOC--GADOLINIUM ENHANCED MRI,"---

 VIDIAN NERVE---/ NERVE OF PTERYGOID CANAL---, 

"VOCAL NODULES---present at junction of anterior 1/3 & post. 2/3, "- "

WOODRUFF'S AREA---post. End of inferior turbinate, "--

 "WALDERYER'S RING ---inner w.group of L.N.=tonsils, lingual tonsils, adenoids,"--

 "WARTHIN'S TUMOUR---Rx superior paratidectomy,"--- 

ZENKER'S DIVERTICULUM --- it's asymp. 

"AT BIRTH---following structures are of adult size--tympanic cavity, malleus, tympanic ring , except -mastoid antrum," 

"The ADDUCTION OF V.C. cannot occur while talking , but can occur with good cough --is a condition ass. With functional aphonia,"

 "SUPRAGLOTTIS--- include -aryepiglottic folds, false cords, laryngeal surface of the epiglottis,"

 "TRANSBRONCIAL BIOPSY---is thru. Fiber-optic bronchoscopy,"-

 "NORMAL RANGE OF frequency of human haering = 20-20,000 hz,"
 
"AUDIBLE SOUND FOR NORMAL HUMANHEARING = 40-45 db," 

"PROLONGED EXPOSURE TO NOISE LEVELS > 85 db can impair hearing permanently,"

 "RUPTURE OF T.M. /EAR DRUM occur at noise level > 160 db,

" "40 db COMPARED TO 20 DB is 100 TIMES,

 "RHINITIS SYNDROME---in mast cell mediator release category are categorised by sneezing , marked postnasal discharge, lacrimation,"
 
"WATER'S VIEW ( OCCIPITOMENTAL )--- provides good visualization of maxillary sinus, orbitofrontal sinus, frontal sinus," 

"CHILD WITH COMPRESSIBLE SWELLING ROOT OF NOSE---MENINGOMYELOCELE," 

"STRUCTURES PASSING between the upper border of the superior constrictor muscle & base of the skull are levator palati muscle & the cartilagineous eustachain tube," 

QUALITY OF VOICE--- not changed in total adductor palsy

 "FAMILIAL PREDISPOSITION of malignancies--- are seen in -breast, leukaemia, thyroid

 "GLOSSOPHARYNGEAL NERVE---supplies sensation to the middle ear mucous memb.,& tongue (post1/3)"

 "MICROPHONIC POTENTIALS ORIGINATING IN COCHLEA are resistant to Ischaemia,"
 
"IVORY OSTEOMA--- sen in fronto-ethmoidal region," 
"
PLICA SEMILUNARIS---is situated in Tonsillar area,"
 "
SUBMANDIBULAR GLAND SURGERY---may result in damage of 7,11,12 Cr.N.,"
 "
MICROLARYNGOSCOPY---size of lens used is 400mm.," 
"
VOCAL FREMITUS ---decreased in Emphysema , thick pleura, Pleural effusion,"
 
"common site of F.B. in lower respiratory tract is --Rt.Main Bronchus,"
 
"IMPAIRMENT OF hearing due to noise starts at ---4000 hz.,/ 4khz. 

"U-SHAPED AUDIOGRAM---CONGENITAL DEAFNESS,"

 FLAT AUDIOGRAM---SEROUS OTITIS MEDIA,

Sinuses

💥Order of appearance of the paranasal sinuses: MEFS (maxillary, ethmoid, frontal, sphenoid)
Maxillary and ethmoid present at birth.
Frontal and sphenoid develop later.

💥Frequency of sinusitis/ carcinoma in the PNS:
AgainMEFS (maxillary mc, sphenoid least common)

💥Order of appearance of the PNS on xray:
MESF
Max 4 to 5 mths
Ethmoid 1 yr
Sphenoid 4 yrs
Frontal 6 yrs.

💥Frequency of osteoma is FEMS.

Inner ear

💫 Angular acceleration is sensed by-- semicircular canals

💫 Horizontal linear acceleration is sensed by-- utricle

💫 Vertical linear acceleration is sensed by-- saccule

💫 Gravity and position of head in space is sensed by-- utricle and saccule

Management Of Foreign Body In Respiratory Tract

Nature of Foreign Bodies
(a) Non-irritating type. Plastic, glass or metallic foreign
bodies are re latively non-irritating and may remain
symptomless for a long time.
(b) Irritating type. Vegetables or foteign bodies like
peanuts, beans, seeds, etc. set up a diffuse violent
reaction leading to congestion and oedema of the
tracheobronchi al mucosa-"vegetal bronchitis".
They also swell up with time causing ai rway obstruction
and later suppurat ion in the lung.
Clinical Features
Symptomatology of foreign body is divided into 3 stages:
1. Initial period of choking, gagging and wheezing.
This las ts for a short time. Foreign body may be coughed
out or it may lodge in the larynx or further down in the
tracheobronchial tree .
2. Symptomless interval. T he respiratory mucosa
adap ts to the presence of foreign body and initial symptoms
disappear. Symptomless interval will vary with the
size and nature of the foreign body ..
3. Later symptoms. They are caused by obstruction
to the airway, inflammation or trauma induced by the foreign
body and would depend on the site of its lodgement.
(a) Laryngeal foreign body A large foreign body may
totally obstruct the airway lead ing to sudden death
unless resuscitative measures are taken urgently. A
partially obstructive foreign body will cause discomfort
or pain in the throat, hoarseness of voice,
croupy cough, aphonia, dyspnoea, wheezing and
haemoptysis.

(b) Tracheal foreign body. A sharp foreign body will only
produce cough and haemoptysis. A loose foreign body
like seed may move up and down the trachea between
the carina and the undersurface of vocal cords causing
"audible slap" and "palpatory thud". Asthmatoid
wheeze may also be present. It is best heard at patient's
open mouth
(c) Bronchial foreign body. Most foreign bodies enter the
right bronchus because it is wider and more in line
with the tracheal lumen. A foreign body may totally
obstruct a lobar or segmental bronchus causing atelectasis
or it may ptoduce a check valve obstructionallowing
only ingress of air but, not egress, lead ing to
obstructive emphysema. For pathogenesis and clinical
picture of bronchial foreign body (see Fig. 63.2).
Emphysematous bulla may ruptu re causing spontaneous
pneumothorax. A foreign body may also shift from
one side to the other caUSing change in the physical
signs. A retained foreign body in the lung may la ter give
rise to pneumonitis, bronchiectasis or lung abscess.
Diagnosis
It can be made by detailed history of the foreign body
"ingestion", physical examinat ion of the neck and
chest and radiographs. X-rays of the following areas are
advised:
1. Soft tissue posteroanterior and lateral view of the
neck in its extended pOSition. T his can show radioopaque
and sometimes even the rad io lucent foreign
bodies in the larynx and trachea
2. Posteroanterior and lateral view of the chest.

3. X-ray chest at the end of inspiration and expiration .
Atelectasis and obstructive emphysema can be seen.
They also give indirect evidence of radiolucent
foreign bodies.
4. Fluoroscopy / videofluoroscopy. Evaluation during
inspiration and expiration can be made.
5. Bronchograms. To delineate radiolucent foreign bodies
or to evalu ate bronchiectasis.

Laryngeal foreign body. A large bolus of food
obstructed above the cords may make the patient totally
aphonic, unable to cry for help. He may die of asphyxia
unless immediate first aid measures are taken. The measures
consist of pounding on the back, turning the patient
upside down and foll owing Heimlich manoeuvre. These
measures should not be done if patient is only partially
obstructed, for fear of causing total obstruction.
Heimlich's manoeuvre. Stand behind the person, and
place your arms around his lower chest and give four
abdominal thrusts. The res idual air in the lungs may dislodge
the foreign body providing some airway.
Cricothyrotomy or emergency tracheostomy should
be done if Heimlich's manoeuvre fails. Once acute respiratory
emergency is over, foreign body can be removed
by direct laryngoscopy or by laryngofissure, if found
impacted.
Tracheal and bronchial foreign bodies can be removed
by bronchoscopy with full preparation and under general
anaesthesia. Emergency removal of these foreign bodies is
not indicated unless there is airway obstruction or they are
of the vegetable nature (e.g. seeds) and likely to swell up.
Methods to remove tracheobronchial foreign body:
1. Conventional rigid bronchoscopy.
2. Rigid bronchoscopy with telescopic aid.
3. Bronchoscopy with C-arm fluoroscopy.
4. Use of Dormia basket or Fogarty's balloon for rounded
objects.
5. Tracheostomy first and then bronchoscopy through
the tracheostome.
6. Thoracotomy and bronchotomy for peripheral foreign
bodies.
7. Flexible fibre optic bronchoscopy in selected adult
patients.