Oto-rhino-laryngologic illustrations

Diagnostic ENT Unit Patient ChairExaminer Chair

• This mirror is concave

• It reflects the light beam coming from a fixed source behind and above the left shoulder of the patient

• It is placed just in front of the examiner’s right eye

The Head Mirror

The head Lamp

• Easy to use• Allows movement of

the examiner• Portable so allows

bed side examination

Examination of infant

The assistant sits on theexamination chair

The infant is lying on the lapof the assistant

The infant head is held byone of the assistant hand The body is held by theother assistant hand

• Examination of child patient The assistant sits on the examination chair The child sits on the lap of the assistantThe child hands are grasped against the abdomen by oneassistant handThe child head is grasped against the assistant chest by the otherhand

• Examination of child patient The assistant sits on the examination chair The child sits on the lap of the assistantThe child hands are grasped against the abdomen by oneassistant handThe child head is grasped against the assistant chest by the otherhand

• The auricle is pulled upwards and backwards, Why?

Answer: this will straighten the outer cartilagenous part because:

• The outer cartilagenous part is directed upwards, backwards and medially

• The inner bony part is directed downwards, forwards and medially

Hand Held Speculum

• It is held by examiner’s hand

• The speculum is placed in the cartilagenous part

• The largest speculum that is comfortable is used to provide the best vision

Otoscopic Examination

Advantage of Otoscope

1-Easy to use2-Provides magnified view3-Allows free movement of the examiner4-portable

Pneumatic examination

Left : Seigle’s SpeculumRight : Pneumatic Otoscope

To assess Mobility of DrumTo perform Fistula test

ValvelessRubber Pump

Examination under Microscope

• Mention 2 advantages

1- provides magnified view with good illumination

2-allows the use of both hands

Enumerate2 tests done bythis instrument

Mention the principle ofevery test

Mention the results ofeach test in normal caseand in conductive andsensorineural hearingloss

Tunning fork

•Pure Tone Audiometry

•Value :

Usefull for diagnosis of:1- Degree of Hearing

Loss ( mild, moderate severe or profound)

2-Type of Hearing loss, ( CD, SNHL Or Mixed)

Degree of Hearing Loss

• This audiogram shows normal hearing.

• This audiogram shows a typical picture of conductive deafness in a child’s left ear.

Conductive hearing loss

?

Mixed conductive and sensorineural hearing loss

?

• An example of a mixed deafness in the right ear. Both the bone conduction and air conduction tests show that there is a hearing loss and Air Bone Gap is also seen

• The audiogram here shows a severe SN hearing loss.

35 years old male patient C/O diminished hearing & tinnitus in Rt. Ear + vertigo

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Speech Discrimination Scores = Rt. Ear: 84% Lt. Ear: 100%

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Q1- Comment on the type hearing loss.

Q2- Give one possible etiology.

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AnswerRight Sensorineural Hearing loss affecting the lower tonesLeft Normal HearingOne possible etiology is Meniere’s Disease

Tympanometry

This graph is knownas……… type…….. and is diagnosticof………….

NormalTympanogram

Type Ad

Type B

Type C

Secretory otitis media

ET dysfunction

Ossicular discontinuity

Ossicular fixation

e.g Otosclerosis

30 years old female patient

Q1 – Comment on the type of tympanograms.Q2 – Give one possible etiology.

Type As Tympanogram( decreases compliance and normal pressure)

One etiology: Otosclerosis

• On application of a loud sound to an infant (below 6 month) the infant responds by a reflex movement

• This movement may be a jerk of the whole body called Moro or Startle reflex

The Moro reflex

• This test is known as Positional Test• One disease diagnosed by this test is

Benign Paroxysmal Positional Vertigo (BPPV)

1- The Handel of Malleus

2-The Cone of Light

3-lateral process of Malleus

4-Pars Tensa

5-Pars Flaccida

Normal Tympanic membrane

1

2

3

4

5

• The bone number…… is that one included in otosclerosis

• The handle of the bone number…….. is foreshortened when the drum is retracted

1 2 3

• The bone number 3 is that one included in otosclerosis

• The handle of the bone number 1 is foreshortened when the drum is retracted

Bat ear Bat ear

• Accessory auricle

Bifid lobule

• Microtia with atresia of the External Auditory Canal

Investigations• CT scan of Temporal

bone• Audiological

evaluationTreamentPlastic surgery

Atresia of the external auditory canal

Treatment Meatoplasty

Bat EarPre operative and postoperative

Congenital microtiawithout canal atresia

Preauricular sinus

• Infected Preauricular sinus• Infection is clear (left)

Investigations:• Culture and

sensitivity of the discharge

Treatment:- Systemic antibiotic- Analgesic

antipyretic- Incision for drainage

of pus- Later on: excision

Foreign body (FB)in the external auditory canal

- On the left side it is animate FB (insect), the treatment is to kill the insect by alcohol or oil before removal

- On the left side it is animate FB (insect), the treatment is to kill the insect by alcohol or oil before removal

Cerumen impaction

• Treatment- Removal by ear wash or instruments- If wax is hard, it should be softened by glycrine

bicarbonate or hydrogen peroxide before ear wash

A brownish mass in the external canal

• Hearing loss & Tinnitus

Wax accumulationQ- Symptoms inthis patient are:1-…………..2-…………..

Complications ?

• Perichondritis• Cauliflower ear

Auricular hematoma

• Diagnosis :………..• It is a complication of

1- ………….. 2-……………

• Diagnosis

Cauliflower ear• It is a complication of

1- hematoma auris• 2- perichondrtitis

• Painless, slowly growing, solid tumor that distorts the auricle and changes the normal architecture. It resembles a cauliflower ear, but it is much harder and cannot be compressed by squeezing it with the fingers

Chondroma of the Auricle

•Keloid

• A 64-year-old man presented with a 7-day history of pain and increased swelling behind his left ear. This 2-cm fluctuant, mass represented ………………………….., that required incision and drainage

Infected sebaceous cyst

• Severe perichondritis of the left auricle with abscess formation

• Squamous cell carcinoma (left) • Basal cell carcinoma (right)• Describe the character of each ulcer seen

Everted edge Inverted beaded

edge

Necrotic floor

• Right Facial paralysis + vesicular eruptions of the concha

• Diagnosis ?

Ramsay Hunt Syndrome

Frunculosis of the external auditory canal

Otomycosis

• Right: whitish massa filling the external canal ( Candida Albicans)• Left: black mass with hyphae and spores (asprigillus Niger)What is the main symptom that patient in patient ? • Itching

Otomycosis

Tympanic Membrane

Spores are well seen

Exostoses

Traumatic drum perforation Central perforation in the pars tensa elliptical in shape with irregular hyperaemic sharp edge

• In this pateint:1-surgical treatment is

mandatory2- conservative treatment is not

successful in most cases 3- The use of antibiotic ear

drops is helpful4- surgical treatment is indicated

when the perforation fails to heal after 3 months

Answer: 4

•Retracted Tympanic Membrane

• What are the signs of Retracted Drum seen in this case?

• Prominent lateral process of malleus

• Fore-shortened handel of malleus

• Distorted cone of light

Hyperaemic tympanic membraneNotice the hyperaemia at the periphery of thetympanic membrane

• Bulging Tympanic Membrane• Treatment of this patient : Myringotomy

In infants, the tympanic membrane is thicker than in adults, so it does not bulge easilyDon’ t wait for bulging drum and MYRINGOTOMY is done if there is persistent pain & fever for 48 hours

Right Lower Motor Neurone Facial Paralysis

Schirmer test • Principle:…………………………………………….• It is significant when…………………and this is

seen if the lesion of ………….nerve is ………….

A B

Tympanosclerosis

central drum perforation

Subtotal Drum Perforation

Moderate central perforation

• Thickened Hyperaemic middle ear mucosa

• Yellowish discharge is seen

Before myringoplasty

control of infection is

needed

Attic drum perforation with cholesteatoma

Chronic Suppurative otitis media Granulation tissue

Atelectatic ear

The drum is thin

Secretory otitis media with air bubles

Grommet tube in the antero-inferior part of the tympanic membrane

• The arrow points to ………….. which is situated in the…………quadrant of the ………..

• This patient is suffering from ………….

• The arrow points to Grommet tube which is situated in the anteroinferior quadrant of the tympanic membrane

• This patient is suffering from secretory otitis media

T tube in position

Right Auricle is pushed anteriorly and inferiorly ??

PostauricularMastoid abscess

• A patient on the operating table for mastoidectomy and drainage of Bezold abscess

Postauricular Mastoid Fistula

- Positive Kernig sign inability to extend theknee completely whenthe hip is flexedThis sign is positive inMENINGITIS

Poaitive Brudzniski signReflex flexion of thehip and knees whenthe neck is flexed

This sign is positive inMENINGITIS

Glomus tympanicum• The earliest symptom in this disease is:

………

Pulsating tinnitus

Glomus tumor

• Post Aural Hearing Aid

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• ITE (In-The-Ear) hearing aids