Ent Revision

7/31/2019 Ent Revision

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ENT REVISION


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OTOLOGY

1. HEARING: Conductive and Sensorineural deafness : Etiology andmanagement.

2. Hearing assessment using a tuning fork.

3. Minimal understanding of audiograms, tympanometry andhearing aids.

4. Infectious and non-infectious diseases of the external andmiddle ear: OME,ASOM,CSOM

5. Cholesteatoma

6. Otosclerosis

7. Menieres Disease

8. Audiology9. Facial Nerve Palsy

10. The Deaf Child

11. Vertigo and Vestibular disorders and assessment


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RHINOLOGY

1. Nasal Septum and its diseases.

2. Epistaxis

3. Allergic rhinitis

4. Acute & chronic sinusitis

5. Nasopharyngeal carcinoma and other nasal

tumours.

6. Nasal Polyps

7. Facial trauma

8. FB,CSF rhinorrhoea, Rhinolith


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LARYNGOLOGY AND HEAD & NECK

SURGERY

Diseases of PharynxAcute and Chronic Pharyngitis

Acute and Chronic tonsillitis

Laryngitis or Laryngotracheitis

Epiglottitis

Head and neck space infections-peritonsillar abscess, Hoarseness of voice

Foreign bodies

Dysphagia

Stridor

Tracheostomy/Tonsillectomy Salivary gland disorders

Swellings of neck

Thyroid


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SYMPTAMOTOLOGY

EAR

NOSE

THROAT


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ENT EXAMINATION

EAR


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INTERPRETATION

TEST NORMAL CONDUCTIVE

HEARING LOSS

SENSORINEURAL

DEAFNESS

RINNE AC>BC BC>AC AC>BC

WEBER EQUAL/NOT

LATERALIZED

LATERALIZED TO

THE POOR EAR

LATERALIZED TO

THE BETTER EAR

FALSE RINNES NEGATIVE : BC>AC BUT WEBER LATERALIZED TO BETTER EAR


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`EXAMINATION:

NOSE


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Examination:

Neck & Larynx


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Introduction to Audiology

How to Read an Audiogram

Degrees of Hearing Loss

Types, Causes and Prevalence ofHearing Loss

Types of Tests


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How to Read an Audiogram

Terminology Used

Hertz (Hz) is used to describe frequency or

pitch, cycles per second

Decibel (dB) is the unit that describes theintensity, or loudness, of the sound


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Audiometric Symbols

Universally Used Pure Tone Air Conduction

Pure Tone Bone Conduction

May be Masked or Unmasked Tests in Soundfield (Narrow Band

Noises, Warble Tones, or Speech)

May obtain responses to Speech via

Air and/or Bone Conductionpathways

N l H i


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Normal Hearing


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Determine Hearing Level Establish Hearing Threshold Level

(HTL or simply HL)

What is threshold?

With earphones or via bone, softest sound

detected 50% of time In the soundfield, tests reveal response of

better ear

Speech Reception Threshold (SRT) is softest level

possible to hear closed set of bi-syllabic words

Thresholds are measured in decibels (dB) at various

frequencies, reported in Hertz


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Determine Amount of Loss (3)

Hearing impairment is documentedunilateral or bilateral sensorineural,mixed, or conductive hearing levels

greater than 20dB HL


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Determine Amount of Loss

Minimal, or mild, hearing loss

is from

25dB - 40dB HL(4,5)

Moderate loss is from 40dB -

70dB HL

Severe loss is from

70dB - 90dB HL

Profound loss is greater than

90dB HL


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Determine Amount of Loss

From bass to treble, or low to high pitch

From

faint

to

intense,

or

softto

loud


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Types of Hearing Loss

Conductive

Bone Conduction better

than Air Conduction

Sensorineural

Bone Conduction equal to

Air Conduction

Mixed

Some amount of Air and

Bone Conduction loss


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Prevalence of Hearing Loss

Prevalence data vary by study and by

age range, but hearing loss is more

prevalent than anyother condition(5)

6:1000 infants(6)

25-40% > 65 years(7)

70-80% > 80 years(7)


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Causes of Hearing Loss

Presbyacusis (aging) is #1 cause of hearing loss(7)

Hazardous noise exposure is #2

Just a few other causes include genetics, teratogens, otitis

media, idiopathic hearing loss, fistula, congenital

anomaly, prenatal or perinatal exposures (syphilis, CMV,rubella), syndromes, head injury, among hundreds of

others!


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Tests Frequently Used

Speech Reception Threshold

Tests in Soundfield

Air Conduction

Bone Conduction

Immittance or Tympanometry

Various Screening Tests OAE, AABR, Hand-held audiometer


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Tests Via Air Conduction

May be as simple as a tuning fork

Most precise is with earphones

Audiologists can obtain results with earphones in children as

young as 6 months

With children, thresholds obtained at a high frequency in eachear, a low frequency in each ear, then additional frequencies as

attention permits

Goal is to obtain as much information as quickly as possible, short

attention of child limiting factor


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Tympanometry

Tympanometry providesobjective results todetermine status of middleear

When sound energy strikesthe TM some can beabsorbed, some can bereflected.

Probe has three parts:oscillator- tone of 220 Hz,air pump, microphone

A(d)

A

A(s)

B

C


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Five classifications of results, referred to as

Modified Jerger Classification System

Type A(d), A, A(s), B and C

A(d)

A

A(s)

B

C

0

-

200 +200-400


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Otoacoustic Emissions(14) Evoked OAE (EOAE) are sounds that come out

of the cochlea upon stimulation

Spontaneous emissions (SOAE) are found in60% of ears, 2:1 females to males OAEs should not be confused with TINNITUS

EOAE indicate movement of Outer Hair Cells

Corresponds to thresholds


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Audiology Screening Tests(3, 15)

Several screening applications exist that aretotally microprocessor driven and are

applicable for use in a newborn nursery or

physicians office

OAE - Otoacoustic Emissions (Transient Evoked or

Distortion Product Evoked)

AABR - Automatic Auditory Brainstem Response


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Normal Hearing


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Low Frequency Loss


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Conductive Hearing Loss

h


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High Frequency

Sensorineural Hearing Loss


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Mixed Hearing Loss

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