21-ENT

auditory pathway→ 1st-spiral ganglion(bipolar)

→ → 2nd-dorsal,ventral cochlear nucleus cross to opposite side(in trapezoid body)→ → 3rd-sup olivary nucleus lat laminiscus

→ → 4th-inf colliculus inf brachium→ → → 5th-med geniculate body audit radiat sublentiform part internal capsule audit

area temporal lobe

Auditory Brainstem Response Audiometry(ABRA) I-II—CNVIII(distal&proximal segment) III-cochlear nucleus IV-sup olive V-Lat Leminiscus(Largest wave) VI-VII—inf colliculus

displacusis-same tone heard as notes of diff pitch in either ear-inj to n to stapedius, cong syphilis(Hennebert sign) EAC exostosis-recur prolong cold H2O exposure hyperacusis-discomfort/pain on exposure to norm sound otitic barotrauma-underH2O diving, descend in aircraft, compression in press chamber paracusis willisi-sound heard better in presence of background noise-otosclerosis Tullio phenom-attack of vertigo/dizziness by loud sound-labyrinthine fistula

ds-TM ASOM-presuppurative-cartwheel, suppurative-lighthouse barotrauma-congested&retracted, air bubble, hgic effusion healed myringitis bullosa-sagograin hemotympanum, glue ear, glomus tm, hemangioma middle ear-blue keratin deposit, osmium tetroxide-snakelike myringitis bullosa(influenza virus)-hgic bleb otosclerosis-norm(90%)-translucent&pearly gray, active ds-flamingo tint(pink spot) retracted-dull lustreless serous otitis media-dull, opaque, grey/bluish, potbelly spontaneous heal-dimeric(sq epith–fibrous layer) TB otitis media-camphor ice, multiple perforation tympanosclerosis-chalky white plaque

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audiometry audiometric 0=25db conductive deafn(mild)≥40db sensory(cochlea) deafn(severe)≥60db neural(retrocochlear) deafn(very severe)≥80db Carhart notch=2000Hz noise induced trauma≥4000Hz auditory fatigue≥90dB×4000Hz WHO-noise exposure<85db×8h×5d Indian fact Act-noise exposure<90db discomfort≥120db pain≥130db presbyacusis-HFHL Meneire ds-LFHL high freq audiometry-ototoxic drug-8000- 20000Hz WHO 0-25db-not signif-no difficulty 26-40-mild-faint speech 41-55-mod-norm speech 56-70-mod severe-loud speech 71-91-severe-shout/amplified speech >91-profound-cant understand amplified speech

natural resonance freq ossicular chain=500-2000Hz middle ear=800Hz TM=800-1600Hz EAC=3000Hzgreatest sensitivity of sound transmission= 500-3000Hz

Rinne test 20-30db AB gap-–ve 256Hz, +ve 512Hz 30-45db AB gap-–ve 512Hz, +1024Hz 45-60db AB gap-–ve 1024Hz

speech audiometry deafn-rt shift roll over phenom-SNHL cant sustain plateau Speech Reception Threshold(SRT)=sound intensity at which 50% word rpt speech discrimination threshold=% word rpt at 30db above SRT good>90% poor=70-90%

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v poor<70%

tympanometry A-norm AS-otoSclerosis AD-ossicular Disruption B-Perforation C-EustaChian tube dysfn Flat-Fluid/glue ear

impedance audiometry=tympanometry+ stapedial reflex

rehabilitation of deaf hearing aid-RAM Receiver Amplifier Microphone

CIC-Completely In Canal BTE-Behind The Ear ITE-In The Ear BAHA-Bone Anchored Hearing Aid(TES) Titanium implant, Ext abutment, Sound processor

EAC stenosis, atresia, pus, anotia cochlear implant(MSTR)-severe deaf

→ → → Microphone(pick up acoustic signal) Speech process(sound electric energy) →Transmitter Receiver(stimulator)

elecTrode-scala Tympani multip channel>single channel implant MC indication-Mondini dysplasia(cochlea= 1½turn) C/i-MiChael dysplasia(absent cochlea) lowest age=1y ideal to avoid maldevelopm-6mth

Alexander dysplasia-basal turn of memb cochlea abs(high freq affect) Bing Siebmann dysplasia-complete absent memb labyrinth Sheibes dysplasia-absent memb cochlea, vestibule, bony part norm

lever action malleus:stapes=1.3:1

TM reliable marker uMbo>handle>cone of light

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spread of inf fr ear fissure of Santorini-Soft part fissure of Huschke-bony part

mastoid tip develop-2y pinna develop adult size-6y

cong anomaly ear Anotia-cong Absence pinna bAt-no Antihelix cleft pinna-cong fissure pinna collaural fistula-b/n EAC&neck, 1st pharyngeal cleft coloboma lobuli-cong fissure earlobe

⅓ ⅓ Darwin/auricular tubercle-thick helix(jn up -mid ) low set ear-cong low displaced pinna macrotia-cong large pinna MElotia-cong displaceMEnt pinna microtia-cong small pinna Mozart-Mixing of antihelix&helix polyotia-additional pinna preauric sinus-1st arch anomaly preauric tag-small appendage ant to pinna scroll ear-rim(helix) roll forward,inward Wildermuth-no helix

fistula SCC—nystagmus lateral-horizontal(towards normal ear) superior-rotatory(towards normal ear) posterior-vertical

abscess—site Bezold-SCM sheath Citelle-digastric triangle DuboiS-thymuS(SyphiliS) Gillete-retropharyngeal(b/n pharynx& prevertebral fascia) Luc-temporal bone(roof of EAC) parapharyngeal-parapharyngeal space peritonsillar(quinsy)-tonsillar capsule& sup constrictor PoLitzeri-Labyrinthitis postauricular-behind pinna WilD-subperiosteal mastoiD

mastoidectomy

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canal wall down-AACSOM+complication RM MRM atticotomy

canal wall up-AACSOM–complication cort mastoidectomy(Schwartz operation) combin approach tympanoplasty

mulberry like nasal polyP-rhinosPoridiosis vocal corD-rhinosporiDiosis nasal mucosa-inf turb hypertrophypotato nose-rhinophymaStrawberry nose-SarcoidosistapiR nose-Rhinosclerosis

Pure Tone Audiometry Rt ear-Red Lt ear-bLue O-AC(unmask) rt X-AC lt [-BC(mask) rt ]-BC lt <-BC(mask) rt >-BC lt

signif-TM quadrant cone of light, grommet insertion, ASOM perforation-AI incision of myringotomy-PI MC site of cholesteatoma, direction of waterjet during syringing-PS

sequele Bell palsy crocodile tear/gustatory lacrimation-faulty regeneration parasympath fibre

→ → synkinesis-cross innervation CNVII pt close eye twitch angle mouth

desc order freq-sinus developm, ca, sinusitis-MEFS mucocele, osteoma-FEMS fungal ball-MSEF orbital complication-EFMS

angiofibroma noseMx-earLy-WiLson transpalatal approach

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lAte-SArdAnA transpalatal sublab approach

laser CO2(10600nm)-larynx, ear KTP-nose, Pharynx

supraglott-insp dyspnea+feeding difficulty glottis-biphasic dyspnea+hoarseness subglottis-biphasic dyspnea trachbronch-exp dyspnea

phonaesthesia(weak voice) m palsy-glottis shape on ILscopy thyroarytenoid-ellipse interarytenoid-triangle both-keyhole

papillomatosis juvenile-multiple, spont resolve, recur SeNile-Single, Never resolve, Never recur

m—position of VC—fn—n inj add-median-phonation-RLN add-paramed-whisper-RLN cadaver-intermed-circular-RLN,ILN —-gentle abd-breathe-ILN abd-complete abduct-full breath-ILN

n palsy—VC position—sympt—Mx u/l RLN-|\-hoarseness-w/w b/l RLN-||-dyspnea-tracheostomy u/l SLN-/|-hoarseness-w/w

→ b/l SLN-/\-aphonia,aspiration-tracheostomy epiglottoplasty

20-30y fem-otosclerosis 30-40y fem-Meniere ds 40-60y-acoustic neuroma

endoscope 90°-larynx 60°,30°(best)-nose 0°-ear→ A P-Stamberger approach

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→ P A-Wigand approach 1st pass-Inf meatus 2nd pass-Sup meatus 3rd pass-Middle meatus

nasal mass <2y-intracran mass-meningocele 2-10y-recur polyp-cyst, fibrosis 10-14y-AC polyp 14y mal-angiofibroma 20-40y-ethmoidal polyp 40-60y-inverted/Schneiderian/transitional cell papilloma(always u/l, 10-15%malign-SCC) >60y-SCC

American society sympt sinusitis a/c<2w, c/c>12w, a/c on c/c=2-12w minor-halitosis, c/c fever, pain in body, headache, fatigue, cough major-Anosmia, Blockage, Congestion, Discharge(purulent), fEver, Facial pain M sinusitis-cheek, dental, swelling lower eyelid LE sinusitis-root(radix), dorsum, upper eyelid S sinusitis-retroorbital, occipital F sinusitis-office headache, just above med canthus

nasal douche=Na BBC(1:1:2), Bicarbonate, Biborate, Cl

focal lth objective lens ear-200/250mm nose/PNS-300mm larynx-400mm

Lempert endaural incision-above tragus, incisura terminalis Rosen incision(post wall EAC)-stapedectomy Wild incision-classic postaural

Last struct to develop in pinna-Lobule

grommet(ventilation tube) insert after 3mth med Rx failure

Prussac space→ → ant pouch von Trolusch ant epitympanum→ → post pouch von Trolusch post epitympanum

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ottic capsule 14centre of ossificat 1st appear-16w, last appear-20w

cholesteatoma cong-IUL prim-retraction pocket sec-perforation tert-iatrogenic

Eustach tube press diff>15mmHg #Temp bone CNVII palsy-Transv total nasal sept destruction-Weg granulomatosis enlarged vestibular aqueduct>2mm during inspiration main airflow current-middle part cavity in middle meatus parabolic curve

#temporal bone Longitudinal(80%)-CNVIIpalsy(20%) tympanic seg, less&delay, CSF otorrhoea+, Lat skull trauma(parietal blow), conductive deafn, blding fr ear+, #line parallel to Long axis petrous pyramid transverse(20%)-CNVIIpalsy(50%) labyrinthine seg, immediate, frontooccipital trauma, vertigo severe, #line across petrous

c/c hypertrophic candidiasis/candidial leukoplakia white patch oral cavity, not wipe off ant buccal mucosa, post to angle of mouthRx-excision

tonsillectomy torrential bld-paratonsillar v

globus pharyngeus something stuck in throat/sensation of lump tightn in throat relieved by food/talking

allergic pharyngitis granularity in post pharynx d/t-hyperplasia of submucosal lymphoid ts

electrolyte—endolymph—perilymph Na-3-140 K-144-10 prot-126-(200-400)

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glu-(10-40)-(85) produced by-stria vascularis-capillary of spinal lig

incis ant to SCM-parapharyng abscessincis post to SCM-retropharyng absces

UPSIT(University of Pennysylvania Smell Inventory)-olfactory power

frontal sinus Sx frontal sinus trephination Killian meth Lothrop meth Lynch procedure(frontoethmoidectomy) Riedel meth

classific-ds Antoni-vestib schwannoma

Austin Kartush classific A-M,S+,I– B-M,foot plate S+ C-M–,S+ D-M,S suprastruct– E-S fixation F-ossicul head Fixation O-intact Ossicul chain

Austin MOOre-Ossicular lOss Chandler-orbital complication, E sinusitis COhN-CONg laryng web COttoN Myer, McCaffey-CONg laryng stenosis Devlaki-cong cholesteatoma

European Laryngological Society-Endoscopic Cordectomy(ELSCEC)(SSTTCAVS) I-Subepithelial II-Subligamental III-Transmuscular IV-Total IVa-C/l fold IVb-Arytenoid IVc-Ventricular fold IVd-Subglottis

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Fisch, GLasscock Jackson-GLomus tm Ford-sulcus vocalis

Guerin-trauma to face I-Vert#-CheValley-fr bel-nasal septum, E, orbit spare II-horiz#(45°)-Jarjaway-fr front-E, orbit spare III-nothing spare

Lederman, Ohgren-ca max

leForte-facial# I-line through floor M-low max#/floating palate II-line across nasolabial fold-pyramidal# III-line through orbit-craniofacial dysjn

Levanson-malign otitis externa NelSOn-CSOM

Nodar-tiNNitus descriptioN, preseNce, contiNuous/pulsatile, siNgle/multiple, aNnoyance

SAde-pars tenSA I-slight retracted TM II-retracted TM touch incus/stapes III-TM touch promontary IV-TM adherent to promontary

Shea-Meneire ds

Issihika-thyroplasty(MLSL) I-Medialise vocal cord-u/l VC palsy II-Lateralis VC(thy cartilage split ant)

↓ III-Shortening&relaxing to pitch↑ IV-Lengthening&tensing to pitch

↑ ↓ pitch-fem- , mal-

Tos-pars flaccida(T not t) I-pars flaccida dimple II-retraction pocket is adherent to handle of malleus III-erosion of outer attic wall IV-severe erosion of outer attic wall

Wullstein-tympanoplasty

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temporalis fascia, perichondrium, periosteum, alloderm transcanal>postaural,endaural 1(myringopexy)-graft on malleus 2(myringoincudopexy)-malleus absent, graft over incus 3(columella/myringostapediopexy, bird like)-malleus,incus absent, graft on

stapes-Partial Ossicular Replacem Prosthesis(PORP) 4-malleus,incus,stapes absent, graft on round window-TORP 5-fenestration procedure

instrumentDunda grant apparatus-cold caloric test

electrolarynx Blom Singer tracheoesoph prosthesis handfree electrolarynx

head mirror concave mirror, focal lth=25cm, diam=89mm, hole=19mm

Menitt device

Siegel speculum

silastic button 2cm nasal perforat

silastic keel

Walsham forceps-#nasal bone

Abbreviations a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch, Bx-biopsy ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral, conc-concentration, cong-congenital, Cx-cervix d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis E-estrogen fem-female, fr-from gld-gland, glu-glucose h-hormone idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury lig-ligament, LL-lower limb, l/t-leading to m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor, mtx-methotrexate, Mx-management n-nerve, norm-normal

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P-progesterone, pl-plasma, prot-protein, pt-patient Rx-treatment SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure tm-tumour, ts-tissue UL-upper limb, u/l-unilateral vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume w-week, wt-weight Xr-X ray y-year #-fracture °-degree

THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.

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