OTORHINOLARYNGOLOGY

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OTORHINOLARYNGOLOGY

CONTENTS
EAR ................................................................................................................................................................................ 5
DEVELOPMENT OF EAR ............................................................................................................................................. 5
ANATOMY OF EAR ..................................................................................................................................................... 5
PHYSIOLOGY OF EAR ................................................................................................................................................. 8
TESTS FOR HEARING.................................................................................................................................................. 9
HEARING LOSS......................................................................................................................................................... 11
OTOTOXICITY .......................................................................................................................................................... 12
MANAGEMENT OF HEARING LOSS ......................................................................................................................... 12
ASSESSMENT OF COCHLEAR AND VESTIBULAR FUNCTION .................................................................................... 13
DISEASES OF EXTERNAL EAR ................................................................................................................................... 14
FEATURES OF MIDDLE EAR DISEASES ..................................................................................................................... 15
MANAGEMENT OF MIDDLE EAR DISEASES ............................................................................................................. 17
MENIERES DISEASE ................................................................................................................................................ 18
OTOSCLEROSIS ........................................................................................................................................................ 19
FACIAL NERVE ......................................................................................................................................................... 20
BELLS PALSY ........................................................................................................................................................... 22
RAMSAY HUNT SYNDROME .................................................................................................................................... 22
CEREBELLOPONTINE ANGLE TUMORS .................................................................................................................... 22
GLOMUS TUMOR .................................................................................................................................................... 23
PIERRE ROBBIN SYNDROME .................................................................................................................................... 23
NOSE ........................................................................................................................................................................... 24
GENERAL FEATURES OF NOSE ................................................................................................................................. 24
ANATOMY OF NOSE ................................................................................................................................................ 24
PHYSIOLOGY OF NOSE ............................................................................................................................................ 25
CHOANAL ATRESIA .................................................................................................................................................. 26
RHINOLALIA............................................................................................................................................................. 26
CSF RHINORRHOEA ................................................................................................................................................. 26
Does NOT cause CSF Rhinorrhoea .............................................................................................................................. 26
DEVIATED NASAL SEPTUM ...................................................................................................................................... 26
GRANULOMATOUS DISEASES OF NOSE .................................................................................................................. 27
ALLERGIC RHINITIS .................................................................................................................................................. 28
ATROPHIC RHINITIS ................................................................................................................................................. 28

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HYPERTROPHIC RHINITIS......................................................................................................................................... 28
EPISTAXIS ................................................................................................................................................................ 29
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA ...................................................................................................... 29
NASOPHARYNGEAL CARCINOMA ............................................................................................................................ 30
NASAL POLYPOSIS ................................................................................................................................................... 31
FOREIGN BODY IN NOSE ......................................................................................................................................... 31
PARANASAL SINUSES .................................................................................................................................................. 32
DEVELOPMENT OF PARANASAL SINUSES ............................................................................................................... 32
ANATOMY OF PARANASAL SINUSES ....................................................................................................................... 32
PHYSIOLOGY OF PARANASAL SINUSES.................................................................................................................... 33
SINUSITIS ................................................................................................................................................................. 33
MANAGEMENT OF SINUSITIS .................................................................................................................................. 34
SINONASAL TUMORS .............................................................................................................................................. 35
PHARYNX ..................................................................................................................................................................... 35
DEVELOPMENT OF PHARYNX .................................................................................................................................. 35
ANATOMY OF PHARYNX ......................................................................................................................................... 35
ZENKERS DIVERTICULUM ....................................................................................................................................... 36
PLUMMER VINSON SYNDROME .............................................................................................................................. 37
HEAD AND NECK SPACE INFLAMMATION ............................................................................................................... 37
ADENOID HYPERTROPHY ........................................................................................................................................ 37
ANATOMY OF TONSILS............................................................................................................................................ 38
TONSILLITIS AND QUINSY ........................................................................................................................................ 38
MANAGEMENT OF TONSILLITIS .............................................................................................................................. 39
ORAL CAVITY ............................................................................................................................................................... 39
GENERAL FEATURES OF ORAL CAVITY .................................................................................................................... 39
RANULA ................................................................................................................................................................... 40
VINCENTS ANGINA ................................................................................................................................................. 40
LUDWINGS ANGINA ............................................................................................................................................... 40
ORAL LESIONS, ORAL CYST, SINUS AND FISTULA .................................................................................................... 40
MAXILLOFACIAL INJURIES ....................................................................................................................................... 41
ANATOMY OF SALIVARY GLANDS ........................................................................................................................... 41
DISEASES OF SALIVARY GLANDS ............................................................................................................................. 42
MANAGEMENT OF SALIVARY GLAND DISEASES ..................................................................................................... 43
ANATOMY OF TONGUE ........................................................................................................................................... 44

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MALIGNANCY OF TONGUE ...................................................................................................................................... 45

ANATOMY OF PALATE ............................................................................................................................................. 45
MALIGNANCY OF PALATE........................................................................................................................................ 45
CARCINOMA LIP ...................................................................................................................................................... 46
CARCINOMA CHEEK ................................................................................................................................................ 46
FEATURES OF CARCINOMA ORAL CAVITY ............................................................................................................... 46
MANAGEMENT OF CARCINOMA ORAL CAVITY ....................................................................................................... 47
LARYNX........................................................................................................................................................................ 47
DEVELOPMENT OF LARYNX ..................................................................................................................................... 47
ANATOMY OF LARYNX ............................................................................................................................................ 47
PHYSIOLOGY OF LARYNX ......................................................................................................................................... 49
STRIDOR .................................................................................................................................................................. 49
LARYNGOCELE ......................................................................................................................................................... 50
LARYNGOMALACIA ................................................................................................................................................. 50
VOCAL NODULE ....................................................................................................................................................... 50
LARYNGOSCOPY ...................................................................................................................................................... 50
EPIGLOTTITIS ........................................................................................................................................................... 50
LARYNGITIS ............................................................................................................................................................. 51
VOCAL CORD PARALYSIS ......................................................................................................................................... 51
DISEASES OF SPEECH ............................................................................................................................................... 52
DISEASES OF LARYNX .............................................................................................................................................. 53
TUMORS OF LARYNX ............................................................................................................................................... 53
FEATURES OF CARCINOMA LARYNX ....................................................................................................................... 53
DIAGNOSIS OF CARCINOMA LARYNX ...................................................................................................................... 54
MANAGEMENT OF CARCINOMA LARYNX ............................................................................................................... 54
TRACHEOSTOMY ..................................................................................................................................................... 55

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KEY TO THIS DOCUMENT

Text in normal font Must read point.

Asked in any previous medical entrance
examinations

Text in bold font Point from Harrisons

text book of internal medicine 18th
edition

Text in italic font Can be read if

you are thorough with above two.

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EAR

DEVELOPMENT OF EAR

Development of ear Eustachian tube opens at the level of inferior turbinate,

Pinna develops from cleft of first arch, Growth of inner
th
ear completed by 4 months
Inner ear is completely formed by 25 weeks
Periauricular sinus Improper fusion of auricular tubercles
st nd
Pinna develops from 1 and 2 pharyngeal arch
External auditory canal develops from First branchial cleft
Contains all 3 components of embryonic disc Tympanic membrane
Germ layers in Tympanic membrane All the three
Malleus and incus are derived from First arch
Handle of malleus is derived from Meckels cartilage
Foot plate of stapes derived from Reichet cartilage
Foot plate of stapes from Otic capsule
Neuroectodermal origin Annular ligament of stapes, foot plate of
stapes
Only bone developing from neural Foot plate of stapes
ectoderm
Skeletal element of second brachial arch Stapes
Third window effect Dehiscent semicircular canal
st nd
Eustachian tube develops from 1 and 2 pharyngeal pouch
Korner septum is the remnant of Petrosquamous fissure
MC congenital dysplasia Schielbes dysplasia
Bone NOT present at birth Petrosquamous
NOT formed at birth Mastoid Process
nd
Mastoid process starts developing in 2 year
Attains adult size before birth Ear ossicles
NOT attain adult size at birth Maxillary antrum, mastoid antrum, mastoid process,
orbit
NOT a pneumatic bone Mandible, Parietal

ANATOMY OF EAR

Ear lobule is made up of Elastic cartilage

Skin over Pinna is fixed loosely on Medial side
Cartilage is absent in pinna Above tragus
Calcification of Pinna Addison disease, Ochronosis, Frost bite, Gout
Ceruminous glands in the ear are Modified apocrine glands
Major part of skin of pinna is supplied by Greater auricular
Sensory supply of external auditory meatus Auriculotemporal nerve
Nerve arising by two roots that surround Auriculotemporal nerve
middle meningeal artery
Nerve supply of pinna Vagus, Auriculotemporal nerve, Greater auricular nerve,

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lesser occipital nerve

Sensory supply of pinna by Mandibular nerve
Does NOT give sensory supply to pinna Tympanic branch of glossopharyngeal nerve
Dehiscence of anterior wall of EACC cause infection in Fissure of santorini
parotid gland via
Fissure of Santorini Seen in cartilaginous part, associated with
parotid and superior mastoid infection
Foramen of Huschke Anteroinferior part of bony canal
Tympanomeningeal fissure Hyrtls fissure
Ear cough is due to irritation of Arnolds nerve
Arnold nerve Auricular branch of vagus nerve
Alderman nerve is a branch of Auricular branch of vagus nerve
Nerve supply to auricle and external canal Arnolds nerve, Auriculotemporal nerve, Lesser Occipital
nerve
Sensory supply of external auditory meatus by Auriculotemporal nerve
External ear is NOT supplied by Glossopharyngeal nerve, greater occipital nerve,
auditory nerve
Pars flaccida of tympanic membrane is called as Shrapnells membrane
Pars flaccida lies between Two malleolar folds
Cone of light is due to Handle of malleus
Cone of light Anteroinferior
Nerve supply of tympanic membrane Auriculotemporal
Inner and Medial surface of tympanic membrane Tympanic branch of glossopharyngeal nerve (Jacobson
nerve)
Nerve supply of tympanic membrane Auriculotemporal nerve, auricular branch of vagus,
glossopharyngeal nerve
NOT true about tympanic membrane Healed perforation has three layers
Tympanic cavity Malleus, Stapedius, Chorda tympani
Distance between tympanic membrane and medial wall 2mm
of middle ear at the level of center is
Distance of promontry from tympanic membrane 2 mm
Aditus is closely related to Lateral semicircular canal, short process
of incus, facial nerve
Prussak space situated in Epitympanum
NOT a component of epitympanum Foot plate of stapes
Narrowest part of middle ear Mesotympanum
Middle ear communicates anteriorly with Pharynx
Tegmen seperates middle ear from middle cranial fossa Roof of middle ear
by
Roof of middle ear is formed by Tegmen tympani
Tegmen tympani is formed by Both petrous and squamous part
Floor of middle ear cavity is related to Jugular bulb
Floor of middle ear is related to Internal jugular vein
Promontry seen in middle ear is Basal turn of cochlea
Medial wall of middle ear Round window, Oval window, Promontry
NOT a content of tympanic cavity Posterior auricular nerve
Tympanic plexus is formed by Tympanic branch of glossopharyngeal nerve
Tympanic plexus is present in Medial projection of middle ear cavity >> petrous part
of temporal bone
Tympanic plexus is present in Promontory of middle ear

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Sensory nerve supply of middle ear cavity is produced Glossopharyngeal nerve

by
Stapes foot plate cover Oval window
Smallest muscle in the body Stapedius
Stapedius Asymmetric bipennate muscle
Smallest bone Stapes
Processus cochleariformis is attached to Tendon of Tensor tympani
Toynbee muscle Tensor tympani
Tensor tympani is attached to Neck of malleus
Tensor tympani is supplied by Trigeminal nerve
Innervations of tensor tympani muscle Mandibular nerve
Anterior wall of tympanic cavity contain Tensor tympani muscle
Muscle originating from pyramid of middle ear Stapedius
Stapedius is supplied by Facial nerve
Superior Malleolar ligament connects Head of Malleus to roof of Epitympanum
Anterior malleolar fold Longer than posterior
Structure inferior to Sphenopetrosal Synchondrosis Cartilaginous part of Auditory tube
Length of adult Eustachian tube 36 mm
Elastic cartilage found in Auditory tube
rd
Eustachian tube Inner 2/3 cartilaginous, opens during swallowing,
tensor palati opens it, higher elastin content in adults
Eustachian tube opens into middle ear cavity at Anterior wall
Eustachian tube opens into nasopharynx 1 cm behind posterior end of inferior
turbinate
Pharyngeal opening of Eustachian tube in Tympanic opening
infant is at the same level of
Pressure difference between Middle ear and Eustachian 100 mm Hg
tube producing Tympanic membrane rupture
Swallowing movements open to Tensor palate
Eustachian tube
Toynbee test is for Eustachian tube dysfunction
Facial recess Posterior wall of middle ear
Boundaries of facial recess Vertical portion of facial nerve, fossa
incudis, chorda tympani branch of facial
nerve
Facial recess is bounded medially by Vertical part of facial nerve
Spine of henle Cancellous bone
Suprameatal triangle is the external marker of Mastoid antrum
Mac Ewan triangle is land mark for Mastoid antrum
Anatomical landmark for facial nerve Mastoid antrum
NOT a boundary of Mac Ewan triangle Promontry
Inner ear anatomy Vestibule is the central chamber
Inner ear is present in Petrous part of temporal bone
Number of ossification centres in bony 14
labyrinth
Stereocilia & Kinocilium are seen in Inner ear
Arcurate eminence of petrous temporal bone is caused Superior semicircular canal
by
Horizontal semicircular canal Lateral

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Lateral semicircular canal is related to Medial and posterior semicircular canal

Singular nerve Inferior vestibular nerve supplying posterior
semicircular canal
Crus commune Cochlea
Crus communae is formed by Non ampullated parts of posterior and
superior semicircular canal
Modiolus (apex) is directed Anterolateral inferior
Organ of corti situated in Scala media, basilar membrane
Organ of corti is situated on Basilar membrane
Reissners membrane Scala vestibuli
Cochlear aqueduct connects Internal ear with subarachnoid space
Infection of CNS spreads in inner ear through Cochlear aqueduct
More potential route for transmission of meningitis Cochlear aqueduct
NOT a route of spread of infection from middle ear Lymphatics
Ductus reunions connect Cochlear duct with saccule
Blood supply to inner ear derived from Anterior inferior cerebellar artery
Labyrinthine artery is a branch of Anterior inferior cerebellar artery
Base of skull fracture causes rupture of Anterior inferior cerebellar artery
NOT a feature of basal skull fracture Severe epistaxis
Length of internal auditory canal 1 cm
Vertical crest in internal auditory canal Bills bar
VIII cranial nerve Balance, Equilibrium
Nerve of pterygoid canal Vidian nerve
Endolymph is secreted by Stria vascularis
Endolymph is secreted by Secretory cells of stria vascularis of cochlea
Volume of endolymph 150 ml
High in Endolymph K+
Increase in K+ levels in ECF (ECF resembling ICF) Endolymph
Extracellular fluid having high potassium and low Endolymph
sodium
Endolymph is absorbed by Endolymphatic sac in subdural space

Endolymph is seen in Scala media

Endolymphatic duct connects Scala media to subdural space
Endolymphatic duct drains in to Sacculus
Membranous labyrinth floats in Perilymph
Perilymph is Ultrafiltrate of blood
Perilymph contains Na+
Perilymph around Organ of Corti drains into Subarachnoid space
Perilymph communicates with Subarachnoid space Aqueduct of Cochlea
through

PHYSIOLOGY OF EAR

Father of Otoneurology William House

Unit of frequency of sound Hertz
Speech frequencies 500 Hz, 1000 Hz, 2000 Hz
Area of Adult Tympanic Membrane 90 mm2 (17:1), 55 mm2 (14:1 Functional)

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Lever ratio of tympanic membrane 1.3:1

Total effective transformer ratio obtained by lever 22:1
action of ossicles and area ratio of tympanic membrane
Function of stapedius Protects ear from loud frequency sound
Reaction time for tympanic reflex 40 160 ms
Stapedial reflex is protective against Loud sounds
Stapedial reflex is mediated by VII and VIII cranial nerve
Stapedial decay reflex is positive in Vestibulocochlear nerve
Cough response mediated by cleaning the ear canal is Vagus nerve
mediated by
Bones of middle ear are responsible for Reduction of impedance to sound transmission
Movement of stapes cause vibration in Scala vestibuli
Sense organ of hearing Organ of Corti
Supporting cells of Organ of Corti Deiters cells, Pillar Cells, Hensons Cells
Base is associated with High frequency
Claudius cells Organ of corti
Otoacoustic emissions are from Outer hair cells
Hair cells Outer hair cells are in 3-4 rows, inner hair
cells in single row
Concerned with auditory pathway Trapezoid body, medial geniculte body, lateral
lemniscus
Auditory transmission along Lateral lemniscus
Auditory pathway passes through Medial geniculate body
Monoaural diplacusis is seen in lesions of Cochlea
Auditory cortex is mainly located in Part of Superior temporal gyrus
Higher auditory centre determines Sound localization
Damage to auditory cortex of one side cause NO noticeable hearing loss or loss of total
discrimination
Bilateral auditory cortical lesion commonly produce Cortical deafness
Gyroscope of head Vestibular apparatus
Vestibular sensory organ in ear at Macula
Semicircular canals are stimulated by Rotation
Horizontal semicircular canal responds to Rotational acceleration
Angular movements are sensed by Semicircular canals
Horizontal linear acceleration is sensed by Utricle
Vertical linear acceleration is sensed by Saccule
Mechanism of hearing and memory Changes in level of neurotransmitter in synapse,
increasing protein synthesis, spatial recognisation of
synapse
Masking of ear applies to Inability to hear one sound due to other
rd
3 window effect is found in Dehiscence of semicircular canal
Calcification of Pinna is NOT seen in Gout
NOT true about otolith Made of uric acid crystals

TESTS FOR HEARING

Focal Length of Head mirror 250 mm

Diameter of Head mirror 10 cm
Use of Siegels pneumatic speculum Magnification, Assessment of movement of tympanic

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membrane, applicator for powdered antibiotic of ear

Power of lens in Siegels pneumatic 10 D
speculum
Frequency of tuning fork for vibration 128 Hz
Tuning fork of 512 Hz is used to test hearing because Better heard
Threshold for bone conduction is normal and that for Middle ear
air conduction is increased is disease of
Tone decay test is done for Neural deafness
Masking of non test ear in air conduction 40 dB
only if the difference between 2 ears is
Rinne positive in Presbyacusis, normal individual
Rinne negative Tympanosclerosis, CSOM
Rinne negative Conductive deafness, CSOM
Rinne not negative in Normal ear
Rinne test is negative if minimum deafness is 15-20 decibel
False positive Rinne Sensorineural deafness
False negative Rinne Unilateral severe sensorineural deafness
Placing tuning fork on forehead and asking him to Weber test
report which ear he hears better
Webers test is best elicited by Placing tuning fork on forehead and asking him to
report in which ear he hears better
In right middle ear pathology, Weber test will be Lateralized to right side
Webers test in conductive deafness Sound louder in diseased ear
Test for detecting damage to cochlea ABC test
Gelles test is positive in Normal persons, Sensorineural deafness, Otosclerosis
Gelles test is done for Otosclerosis
Test used to detect malingering (Ear) Stenger test
Stenger test Noise induced hearing loss, Malingering
In Bing, on alternate compressing and releasing external Sensorineural deafness
acoustic meatus, sound increases and decreases
Objective tests for hearing BERA, Impedance audiometry
X-mark in Pure tone audiometry Air conduction of Left ear
O in pure tone audiometry Air conduction in right ear
Trough shaped audiogram Congenital hearing loss
Impedance audiometry is done in Pressure changes in middle ear
Impedance audiometry is done using frequency probe 220 Hz
of
Frequency related with tympanometry 250 Hz
Accident leading to loss in hearing loss in right ear,on Ad type tympanogram
examination tympanic membrane was intact,
audiometry air bone gap of 55db in right year normal
cochlear reserve, tympanometry finding
Tympanogram of Otosclerosis As
B type tympanogram Serous otitis media
Type C tympanogram in Eustachian tube dysfunction
Flat tympanogram ASOM, serous otitis media
Flat and dome shaped graph in tympanogram Middle ear fluid
Tympanogram in osteogenesis imperfecta Low compliance
Audiometric screening in Infants BERA
To distinguish between cochlear and post cochlear BERA

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damage
Wave V in ABER Lateral lemniscus
Auditory brain stem response Used for both audiological and
neurological functions
Waves in Bekesey audiometry I normal or conductive, II cochlear, III
and IV retrocochlear, V non organic
Fowler test Alternate Binaural loudness balance test
In children, acoustic reflectometry is used Middle ear fluid
to monitor
Sound energy is produced in inner ear Bekessey

HEARING LOSS

Ear sensitive to 500-5000 Hz

Range of human hearing 20 to 20,000 Hz
By attenuation reflex sounds are attenuated to lower 30 40 dB
frequency with decibels of
Whisper 30 dB
Intensity of whisper heard at 1 metre distance 30 dB
Loud voice heard from 1 m. Intensity of sound reaching 60 db
ear
Normal conversation sound 60 dB
Severe Hearing Loss 60-90 dB
According to WHO severe degree of impairment of 71-91 dB
hearing
Prolonged exposure to voice greater than following can 100 dB
impair hearing
Painful sound level 100-120 dB
Hearing loss after rupture of tympanic membrane 10-40 dB
Maximum acceptable level in class room 30 40 db
40 db Compared to 20 db 10 times
20 db means 10 folds change in sound pressure
Condition causing maximum hearing loss Ossicular disruption with intact tympanic membrane
MC cause of hearing loss in children Serous otitis media
Does NOT cause hearing loss Chicken pox
Congenital deafness Prolonged PR interval
Conductive deafness occur in Traveling in airplane, stapes abnormal at oval window,
high noise
Conductive deafness NOT seen in Endolymphatic hydrops
MC cause of SNHL Idiopathic
Viruses causing acute onset sensorineural deafness Rubella, mumps, measles
Sensorineural deafness seen in Alports syndrome, Pendreds syndrome, Treacher
collins syndrome, Michels aplasia, Bartter syndrome,
Distal renal tubular acidosis, Nail patella syndrome
Sensorineural hearing loss Distal renal tubular acidosis, Bartter syndrome, Alport
syndrome
Fluctuating recurring variable sensorineural deafness Perilabyrinthine fistula
NOT a cause of sensorineural deafness Rupture of tympanic membrane
High frequency hearing loss Presbyacusis

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Low frequency hearing loss Menieres disease

Presbyacusis SNHL associated with aging
Hyperacusis Normal sound heard as loud and painful
Otitic barotrauma results due to Descent in air
Treacher Collins syndrome Autosomal dominant, Defect in Neural migration, Due
to teratogenic effects of Isotretinoin

OTOTOXICITY

Deafness Streptomycin is vestibulotoxic, Salicylates cause

reversible deafness
Teratogen causing deafness Isotretinoin
Ototoxic drug mainly affecting vestibular component Gentamycin
Ototoxicity is associated with Erythromycin
Vestibulotoxic drugs Phenytoin, gentamycin, tobramycin,
minocycline
Cochleotoxic drugs Kanamycin, neomycin
Maximum ototoxicity with Amikacin
Mechanism of gentamicin ototoxicity Directly destroys hair cells
Ototoxicity of aminoglycoside is increased with Cisplatin, Furosemide, Vancomycin, Erythromycin
concurrent use of
NON ototoxic aminoglycoside Netilmycin
NOT associated with ototoxicity Aztreonam
NOT an ototoxic drug Penicillin
NOT ototoxic Vincristine
NOT an ototoxic drug Propanolol
High frequency audiometry used in Ototoxicity

MANAGEMENT OF HEARING LOSS

Absolute indication for cochlear implantation Auditory nerve

Cochlear implant is indicated in Severe to profound hearing loss
3 year, severe sensorineural deafness, no improvement Cochlear implant
with hearing aid
Done in bilateral hearing loss Cochlear implant
Cochlear transplant is done if one of the following is Auditory nerve
intact
Cochlear implant is done in Scala tympani
In cochlear implants, electrodes are placed at Cochlea
Posterior tympanotomy is done for Cochlear implant
Cochlear implant Improves learning and reading remarkably
MRI is contraindicated in patients with Cochlear implants
Contraindications of cochlear Absence of cochlea (Michel malformation),
implantation cochlear ossification, tympanic membrane
perforation
Cochlear implant NOT contraindicated in cochlear malformations
Most appropriate treatment for rehabilitation of a Brainstem implant

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patient who has bilateral profound deafness following

surgery for bilateral acoustic schwannoma

ASSESSMENT OF COCHLEAR AND VESTIBULAR FUNCTION

Eustachian tube is opened by Valsalva manoeuvre

Eustachian tube is opened by Tensor veli palatini, levator veli palatini,
salpingopharyngeus
Palatine aponeurosis is formed by Tendon of tensor veli palatini
Tests for eustachian tube patency Valsalva manuvere, Frenzels manuvere, Tonybees
manuvere
Eustachian tube dysfunction No movement of tympanic membrane in Siegels
speculum, malleus is easily visible, lusterless tympanic
membrane
Site of lesion in unilateral past pointing nystagmus Cerebellar hemispheres
Miners nystagmus is of Vertical type
Spontaneous vertical nystagmus is seen in lesion of Midbrain
Positional vertigo Posterior
Post traumatic vertigo is due to Perilymphatic fistula, secondary endolymphatic
hydrops, benign positional vertigo
BPPV is due to Attacks by free floating calcium carbonate
BPPV is due to Degenerate macular cells in posterior
semicircular canal
Treatment of benign positional vertigo Vestibular exercise
Vestibular neuronitis Viral infection, Vertigo, Nystagmus, No deafness
Features of caloric test in vestibular Canal paresis on affected side
neuronitis
Vertigo lasting for days after an upper Vestibular neuronitis
respiratory tract infection
Positive Romberg test with eyed closed detect lesions in Proprioceptive pathway
Pathway involved in case of positive Medial lemniscus
Romberg sign
Features of superior canal dehiscence Positive tullio phenomenon, postive Hennebert sign,
oscillopsia
Vestibular function is tested by Galvanic stimulation test, fistula test, cold caloric test
Fistula test stimulates Lateral semicircular canal
Positive fistula test Labyrinthine fistula, Hypermobile stapes footplate,
following fenestration surgery
Positive fistula test during siegelisation indicate Paralabyrinthitis due to erosion of lateral semicircular
canal
NOT have positive fistula test Dead labyrinth
False positive fistula test Congenital syphilis
Halpike test is done for Vestibular function
Angle at which hallpike thermal caloric test done 30*
Fitzgerald caloric test uses temperature 30*C and 44*C
Caloric test has Slow and fast component
Cold caloric test stimulates Lateral semicircular canal
In cold caloric stimulation test movement of eye ball in Towards opposite side

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OTORHINOLARYNGOLOGY

In caloric test Patients neck is flexed by 30* to make

Cold water
NOT true about caloric test
Electrocochleography
Best screening test for auditory function of neonate
Fastest test for Hearing assessment in Child
Best test for assessing hearing deficits in
children older than 6 months
Visual evoked myogenic potential detects lesion of
lateral semicircular canal horizontal
Opposite side, fast phase upwards
In canal paresis, test is inconclusive
Outer hair cells are mainly responsible for cochlear
microphonics and summary potential
Otoacoustic emissions
Otoacoustic emissions
Visual reinforcement audiometry
Inferior vestibular nerve

DISEASES OF EXTERNAL EAR

Malignant otitis externa is also known as Skull base osteomyelitis

MC nerve involved in Malignant Otitis externa Facial nerve
MC cause of Malignant/Necrotising Otitis Externa Pseudomonas aeuroginosa
MC cause of Perichondritis of Auricle Pseudomonas pyocyanea
(Cauliflower Ear)
NOT a typical feature of malignant otitis externa Mitotic figures high
Common causes of otitis externa Aspergillus, candida, pseudomonas
External otitis media is also known as Telephonists ear
Cause of otomycosis Candida, aspergillus
MC Human Infection by Aspergillosis Otomycosis
Otomycosis is commonly caused by Aspergillus niger
Facial nerve palsy is NOT caused by Otomycosis
Otomycosis is responsive to Nystatin ear drops
Aggressive pinkish lesion on otoscopy Myringitis bullosa
Myringitis bullosa is caused by Virus (influenza), mycoplasma
Cranial nerves involved in Ramsay Hunt syndrome Trigeminal, facial, vestibulocochlear nerve
th th
Ramsay hunt syndrome Viral etiology, involves 7 nerve, may involve 8 nerve
Herpes zoster in geniculate ganglion Ramsay Hunt syndrome
Hemorrhagic external otitis media is caused by Influenza
Treatment of furuncle of ear Ear pack with 10% ichthammol in glycerin wick
Acute severe pain in ear Furuncle
Malignant otitis externa Diabetics, granulation tissue at floor of external
auditory canal, gallium scan is helpful for monitoring
treatment
Drug of choice for malignant otitis externa Penicillin
Accumulation of desquamated epithelial cells in meatus Keratosis Obturans
Keratosis obturans is Desquamated squamous epithelial cell + cholesterol
Chondritis of aural cartilage is commonly due to Pseudomonas
Cauliflower ear Perichondritis in boxers
NOT true about auricular hematoma Resolve spontaneously
Direction of water jet while doing syringing of ear Posterior wall
Surgery in pinna done 4 months after birth
Time of surgery for microtia 5-7 years
Features of moderately retracted tympanic membrane Handle of malleus appear foreshorted, cone of light
absent or interrupted, lateral process of malleus more

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prominent
Commonest cause for brain abscess CSOM
CSOM with lateral sinus thrombophlebitis inturn can Otogenic brain abscess
cause
Least likely cause of brain abscess Hemophilus influenza
MC symptom in brain abscess Headache
Lateral sinus thrombosis Griesinger sign, lily crowe sign, tobey ayer test
Light house sign ASOM
MC presentation of Folliculitis in external ear Pain
Referred otalgia is due to Ca larynx, Ca oral cavity, Ca tongue
Burows solution 13% aluminium acetate in water

FEATURES OF MIDDLE EAR DISEASES

Impedance Disease of Ossicles

Absent molar tooth sign Incus dislocation
Feature of tympanic membrane perforation Conductive deafness
Perforation of tympanic membrane with destruction of Marginal
tympanic annulus
Subtotal perforation Only annulus is present
Perforation of pars flaccida Associated with cholesteatoma
Perforation in Safe CSOM Pars Tensa
Perforation in Unafe CSOM Pars Flaccida
Attic perforation Atticoantral disease
MC cause of Otitis Media Streptococcus pneumonia
MC Infection of Streptococcus pneumonia Otitis Media
nd
MC Complication of Otitis Media Mastoiditis, 2 Meningitis
MC CNS Complication of Otitis Media Brain abscess
MC cause of acute Otitis media in children Streptococcus pneumonia
Acute Necrotising Otitis Media is caused by -Hemolytic Streptococci
MC Complication of Measles in children ASOM
Pulsatile otorrhoea ASOM
Cart wheel sign ASOM
Important criteria for diagnosing ASOM Redness, bulging of tympanic membrane
and immobililty
MC extracranial complication of ASOM Subperiosteal abscess
Sub periosteal abscess Foul smelling discharge, fever, deafness,
swelling behind ear
Otogenic pharyngeal abscess is due to Petrositis
Treatment of petrositis Ramadier operation
True about CSOM Etiology multiple bacteria
Dangerous CSOM Attic perforation, Foul smelling discharge, Granulation
tissue
Ossicle most commonly involved in CSOM Long process of incus
CSOM patient with fever and rigor Lateral sinus thrombosis
MC Complication of Chronic Otitis Media Brain Abscess
Extracranial complications of CSOM Labyrinthitis, facial nerve palsy, bezolds abscess
Mastoid tenderness present present in Mastoid tip, root of zygoma, Mastoid antrum
Acute mastoiditis is characterised by Clouding of air cells of mastoid, obliteration of

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retroauricular sulcus
Mastoid reservoir phenomenon is positive in Coalescent mastoiditis
Bezolds Abscess Sternocleidomastoid
Politzers abscess Internal auditory meatus
Bezolds abscess Matoid tip
Mastoid tip is involved in Bezolds abscess
MC cause of CSF Otorrhoea Fracture Petrous Ridge
NOT a feature of retracted tympanic membrane Degeneration of head of malleus
Scanty foul smelling painless discharge from ear is Cholesteatoma
characteristic of
Most accepted theory for formation of cholesteatoma Retraction pocket
Theories of cholesteatoma Ruedi theory (basal cell hyperplasia),
Haberman theory (epithelial cell invasion
through perforation), Sade theory
(metaplasia)
Cholesteatoma is commonly caused by Atticoantral perforation
Cholesteatoma is seen in Acute necrotising otitis media
Cholesteatoma is usually present at Attic region
Levinsons criteria for diagnosing congenital Whitish mass behind intact TM, normal pars tensa,
cholesteatoma recurrent attacks of otorrhoea
Cholesteatoma Ossicular involvement, eustachian tube dysfunction,
erodes bone
Primary Acquired Cholesteatoma Eustachian tube Dysfunction
Secondary Acquired Cholesteatoma Acute Necrotising Otitis Media
Most difficult site to remove cholesteatoma in sinus Posterior facial ridge
tympani is related with
Bones easily necrotized in cholesteatoma Incus
Cholesteatoma commonly perforates Lateral semicircular canal
Posterior superior retraction pocket of cholesteatoma Audiometry, Mastoid exploration, tympanoplasty
Cotton wool appearance in X ray Cholesteatoma
Hemotympanum Blue drum
Glue ear Secretory Otitis media
Retracted drumhead tympanic membrane with air Acute Non suppurative otitis media
bubbles
Bilateral conductive deafness in 3 year old child Glue ear
Bluish tympanic membrane Glue ear
Fluctuating Conductive Hearing loss Serous Otitis Media
Pot Belly Tympanic Membrane Serous Otitis Media
Acute non suppurative otitis media in adult Malignancy
Cause of unilateral secretory otitis media in adult Nasopharyngeal carcinoma
Serous otitis media Type B tympanogram, middle ear effusion is sterile,
tympanostomy tubes are usually required for
treatment, marginal perforation most common
Complication of chronic secretory otitis Atelectasis
media
NOT a sign of serous otitis media Marked congestion of tympanic membrane
NOT a feature of secretory otitis media Hypermobile drum
MC indication for Grommet Insertion Secretory Otitis media
TB otitis media Pale granulation, multiple perforation
Characteristic of Tuberculous otitis media Multiple perforation

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Route of Spread of TB Otitis Media Eustachian tube

Posterosuperior retraction pocket if allowed to Secondary cholesteatoma
progress, will lead to
Chalky white tympanic membrane Tympanosclerosis
Gradenigo syndrome Retroorbital pain, Ear discharge, Diplopia
th th
Gradenigo syndrome is associated with 5 and 6 cranial nerve
NOT true about Gradenigo syndrome It is associated with conductive hearing loss
Pseudogradenigo syndrome Nasopharyngeal tumors
Otitic hydrocephalus is associated with Thrombosis of superior sagittal sinus

MANAGEMENT OF MIDDLE EAR DISEASES

Powder test is to differentiate between Retraction and perforation

Important investigation to be done before discharging BERA
H.influenza meningitis child
Investigation of choice in assessing hearing loss in BERA
neonates
Investigation of choice for Atticoantral CSOM CT Scan
Secretory otitis media is diagnosed by Impedance audiometry
Child presents with barotrauma pain, no inflammation Supportive management
in middle year
Treatment of choice in central safe perforation Conservative management
ASOM Commonly resolves sequale
Elderly diabetic, excruciating pain in ear, appearance of Penicillin
granulation in meatus, skull bone infection with flaccid
paralysis should be treated with
Medical treatment usually not effective for Serous otitis media
ASOM NOT treated using Streptomycin
Treatment of choice for glue ear Myringotomy with ventilation tube insertion
Child with acute otitis does NOT respond to ampicillin. Myringotomy
Examination reveals dull and bulging tympanic
membrane. treatment of choice
Fever, congested tympanic membrane with slight bulge Myringotomy with penicillin
Myringotomy is done in ASOM
Myringotomy incision for ASOM Circumferential Posteroinferior Quadrant
Myringotomy incision for Serous Otitis media Radial Antero Inferior Quadrant
Grommet tube is used in Secretory otitis media, mucoid otitis media, serous
otitis media
Surgery on eardrum done using Operating microscope
Focal length in objective piece of microscope commonly 250 nm
used for ear surgery
Treatment of choice in CSOM with vertigo and facial Immediate mastoid exploration
nerve palsy
Primary treatment of middle ear cholesteatoma Surgery
Treatment of choice for atticoantral type of CSOM Mastoidectomy
Mastoidectomy in children Horizontal , to prevent injury to facial
nerve
Cholesteatoma with facial paralysis in child Immediate mastoidectomy
Child, left ear hearing loss, 3 months duration, foul Tympanomastoid exploration

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smelling purulent discharge with perforation in pars

flaccid
Treatment of choice for perforation in pars flaccida of Modified radical mastoidectomy
tympanic membrane with cholesteatoma
Treatment of choice in cholesteatoma with Modified radical mastoidectomy
sensorineural deafness
CSOM, attic perforation, minimal hearing loss Modified radical mastoidectomy
Treatment of choice in perforation in pars flaccida of MRM
tympanic membrane with cholesteatoma
Modified radical mastoidectomy Bondys MRM
Operation of choice in 30 year old male with attic Canal wall down mastoidectomy
cholesteatoma left ear with lateral sinus
thrombophlebitis
Canal wall up mastoidectomy Cortical mastoidectomy
In radical mastoidectomy Eustachian tube closure is done
Treatment of Choice for CSOM Tubotympanic type with Myringoplasty
intact ossicle
Treatment of Choice for CSOM Tubotympanic type with Tympanoplasty
disrupted ossicle
Iatrogenic traumatic nerve palsy is commonly caused Mastoidectomy
during
Before attempting Tympanoplasty, Surgeon must look Cochlear nerve
for
Myringoplasty is repair of Tympanic membrane
Myringoplasty is done using Temporalis fascia and perichondrium
Columnella effect is seen in Type III tympanoplasty
Wullstein type III tympanoplasty Myringostapedopexy (columnella)
Schwartz operation is also called Cortical mastoidectomy
Simple mastoidectomy is seen in Coalescent mastoiditis
Modified radical mastoidectomy is NOT indicated in Coalescent mastoiditis
Radical mastoidectomy is done for Atticoantral cholesteatoma
Steps done in radical mastoidectomy Lowering of facial ridge, removal of middle ear mucosa
and muscles, removal of all ossicles except stapes foot
plate
NOT done in radical mastoidectomy Maintenance of patency of eustachian tube, cochlea
removed
Nerve damaged in radical mastoidectomy Facial nerve
Techniques used to control bleeding from bone during Diamond drill over mastoid area, bipolar cautery over
mastoid surgery bleeding area, bone wax

MENIERES DISEASE

Chromosome associated with Menieres Chromosome 7

disease
Mutation in Menieres disease Chromosome 14
Theories for Menieres disease Vasomotor theory, endocrinal disturbances
Bulging of Endolymphatic sac Menieres disease
Menieres disease common in Males
Fluctuating Sensorineural Hearing Loss Menieres Disease

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Menieres disease is associated with Low frequency hearing loss

Menieres disease is characterized by
Recruitment phenomenon is seen in
Vertigo is a common symptom in
Endolymphatic hydrops
Menieres disease
Hennerbet sign
NOT a typical feature of Menieres disease
Differential diagnosis of Menieres disease
To detect psychogenic deafness
Glycerol test
Investigation of choice for Menieres Disease
SISI is specific for
Vasodialtors are helpful in Menieres disease because
they
Vasodilators of internal ear
Microwick and microcatheter sustained release devices
are used in
Ficks Operation
Vertigo, tinnitus, hearing loss
Menieres disease
Labyrinthitis, Menieres disease, Basilar artery
syndrome
Vertigo, Tinnitus, Nystagmus, Sensorineural Hearing
loss, headache, diarrhoea, vomiting, endolymphatic
rd th
decompression done, 3 to 4 decade
Negative Rinnes test, hearing loss
Meniere disease
Pulsatile tinnitus, diplopia, loss of consciousness,
otorrhoea
Acoustic neuroma, CNS disease, labyrinthitis
Glycerol test
Menieres disease
Electrocochleography
Menires disease
Increase reabsorption of endolymph
Nicotinic acid, histamine
Delivering drug to round membrane
Menieres Syndrome, Sacculotomy

OTOSCLEROSIS

Inheritance of Otosclerosis Autosomal dominant

Otosclerosis 50% have family history, deafness occur in 20-30 years
but less in before 10 years and after 40 years
Common age for otosclerosis 20-30 years
Otosclerosis common in Female
Most common site of initiation of otosclerosis Fissula antefenestrum
Otosclerosis mostly affect Stapes
Common site of otosclerosis Oval window
MC Site of COCHLEAR Otosclerosis Round Window
Otosclerosis is associated with Conductive deafness
Otosclerosis cause Bilateral conductive deafness
Eustachian tube in Otosclerosis Normal
Otosclerosis Normal tympanic membrane
Paracusis Willisi Otosclerosis
Diphasic acoustic response/on off Otosclerosis
phenomenon
Schwartzs sign Otosclerosis
Rinnes Tympanic membrane Otosclerosis
Cahartzs notch in audiogram is deepest frequency of 2 Khz
Caharts notch is seen in 2000 Hz in bone conduction
Carharts notch in audiometry seen in Otosclerosis
Gold Standard for Histological Otosclerosis Bilateral Temporal Bone
HPE of otosclerosis Blue mantles of manasse

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Otosclerosis As curve treatment Hearing aid, Stapedectomy, Sodium fluoride

Medical treatment for Otosclerosis
Sodium in otosclerosis
NOT true about fluoride
NOT a treatment of otosclerosis
Surgeries for otosclerosis
Treatment of Choice for Otosclerosis (Old)
Treatment of Choice for Otosclerosis (New)
Treatment of choice for Otosclerosis
Prosthesis used for stapes in otosclerosis
Structure NOT cut in stapedectomy
Acoustic dip
Sodium Fluoride
Acts by inhibiting proteolytic enzymes in cochlea,
contraindicated in chronic nephritis, indicated in
patients with positive Schwartz sign
It inhibits osteoblastic activity
Gentamycin
Stapedectomy, fenestration, stapedotomy
Stapedectomy with prosthesis replacement
Stapedotomy
Stapedectomy
Teflon piston
Stapedial tendon
4000Hz in Noise induced hearing loss

FACIAL NERVE

Facial nerve is present in Anteroinferior part of medial wall of

middle ear
Longest Intraosseous course Facial Nerve
Shortest part of facial nerve Labyrinthine canal
Part of facial nerve commonly exposed through natural Horizontal part
dehiscence in fallopian canal
Greater Superficial Petrosal nerve is a branch of Facial Nerve
Chorda tympani Carries secretomotor fibres to submandibular gland,
joins lingual nerve in infratemporal fossa, branch of
facial nerve
Description of arrangement of facial nerve Pes anserinus
First branch of facial nerve Greater petrosal nerve
Sensory fibres from taste buds in hard and soft palate Facial nerve
travel along
Taste fibres are relayed in Nucleus tractus solitaries
Chorda tympani PREGANGLIONIC secretomotor fibres, Joins lingual
nerve in pterygopalatine fossa, Contains secretomotor
fibres to submandibular gland, Secretomotor fibres to
submandibular and sublingual gland
First branch of facial nerve Greater superficial petrosal nerve
Branches of facial nerve Chorda tympani, Greater superficial petrosal nerve,
Zygomatic nerve, Nerve to stapedius
Special Sensation of Hard Palate, Submandibular & Facial nerve
Sublingual gland
Submandibular gland is supplied by Facial Nerve
Submandibular gland is supplied by Facial Artery
Stapedius is supplied by Facial Nerve
Taste sensation in Anterior two third of tongue Chorda Tympani
Posterior belly of digastrics Facial nerve
Facial nerve supply Risorius, Zygomaticus, Auricular muscles, Stapedius,
Platysma, Stylohyoid, Buccinators
Nerve supply of platysma Facial nerve

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Nerve supplying submandibular gland Facial nerve

NOT supplied by facial nerve Parotid gland
NOT innervated by facial nerve Anterior belly of digastric
Muscle NOT supplied by Facial Nerve Levator Palpebrae Superioris
Landmarks of facial nerve during parotid Posterior belly of digastric, mastoid
surgery process, retracted lower pole of parotid
gland
NOT a landmark of facial nerve during parotid surgery Inferior belly of omohyoid
Facial nerve palsy associated with temporal bone Transverse fracture
fracture
Fracture associated with Facial nerve palsy Middle Cranial fossa
Facial nerve palsy seen in Fracture of middle cranial fossa
Unilateral Facial nerve palsy Cholesteatoma, Otosclerosis of facial canal
Van buchem syndrome Overgrowth, Facial palsy, Increased acid phosphatase
Bilateral facial nerve palsy is NOT seen in Ramsay hunt syndrome
Right upper motor neuron lesion of facial nerve cause Paralysis of lower facial muscles to left side
Lower motor neuron palsy of facial nerve Other motor cranial nerves also involved, Melkerssons
syndrome cause recurrent paralysis, eye protection
done, prognosis can be predicted by serial electrical
studies,
Features of Melkerson Rosenthal Plication of tongue, facial edema,
syndrome recurrent facial nerve palsy
Facial Nerve Palsy in Ramsay hunt Syndrome LMN
Paralysis of facial nerve causes Lagophthalmos
Facial nerve palsy Nasolabial fold is obliterated on same side
st
MC Site of Facial Nerve Injury in Trauma 1 Genu
nd
MC Site of Facial Nerve Injury during Mastoidectomy 2 Genu
Hyperacusis, loss of lacrimation and loss of taste Proximal to geniculate ganglion
sensation in anterior 2/3 of tongue. edema in facial
nerve upto
Lacrimation is affected when facial nerve injury is at Geniculate ganglion
Geniculate ganglion from First placode
Absence of lacrimation is seen in Greater petrosal nerve
Infratemporal lesion of chorda tympani nerve results in Loss of secretomotor fibres to submandibular salivary
gland
Dryness of mouth with facial nerve injury. site of lesion Chorda tympani nerve
Facial nerve palsy at sternomastoid canal can cause Loss of corneal reflex at side of lesion
Test that can detect facial nerve palsy occuring due to Deviation of angle of mouth towards oppostite side
lesion at outlet of sternocleidomastoid
Facial nerve stimulation during testing of nerve Orbicularis oris
indicated by contraction of
Nerve Decompression for Facial Nerve if No recovery 8-12 weeks
Best intervention in patients with facial nerve palsy Immediate decompression
following head trauma
Treatment of choice for mastoid fracture with facial Nerve decompression
nerve palsy
Facial nerve decompression Post auricular route
Best treatment for facial nerve injury detected at early Nerve exploration and repair
stages
Crocodile Tears due to abnormal Regeneration of Facial Nerve

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MC tumor of facial nerve Schwannoma

20 year female,6th cranial nerve palsy on T2 weighed Schwannoma
MRI, hyperintense lesion in cavernous sinus showing
homogenous contrast enhancement
Verocay bodies are found in Schwannoma
MC diabetic Cranial Neuropathy Facial Nerve
Cranial nerve commonly involved in sarcoidosis Facial nerve
MC cranial Nerve involved in Glomus tumor Facial Nerve
Myofacial pain dysfunction syndrome due to TMJ problem

BELLS PALSY

MC cause of facial nerve palsy Bells palsy

MC cause of lower motor neuron facial nerve palsy
Bells palsy
Bells palsy
Hyperacusis in Bells palsy is due to paralysis of
Synkinesia is seen in
Bells palsy patient on steroids, show no improvement
after two weeks
rd
Treatment for bells palsy patient on 3 day
A case of Bells palsy on steroids shows no
improvement after 2 weeks, next step in management
Bells palsy
Acute onset, NOT always recurrent, spontaneous
remission, increased predisposition in diabetes mellitus
Idiopathic ipsilateral paralysis of facial nerve
Stapedius
Bells palsy
Electrophysiological nerve testing
Oral steroids, acyclovir
Physiotherapy and electrical stimulation

RAMSAY HUNT SYNDROME

Ramsay hunt syndrome is caused by Herpes zoster

Vesicular lesion over external acoustic meatus, Herpes zoster
ipsilateral LMN type of facial nerve palsy
NOT true about Ramsay hunt syndrome Facial vesicle seen, surgical removal gives excellent
prognosis
Merkelson Rosenthal syndrome Recurrent seventh nerve palsy, labial
edema, plication of tongue

CEREBELLOPONTINE ANGLE TUMORS

Orbital apex syndrome Paralysis of optic nerve and maxillary

part of trigeminal nerve
Cerebellopontine angle tumor produce Tinnitus, Deafness, absent corneal reflex, trigeminal
neuralgia
MC cerebellopontine angle tumor Acoustic neuroma
MC cause of unilateral perceptive deafness in 30 year Acoustic neuroma
old
Age group of Acoustic Neuroma 40-60
th
Acoustic neuroma commonly arise from Vestibular division of 8 nerve
Acoustic neuroma commonly arise from Inferior vestibular nerve

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MC presentation of Acoustic neuroma Tinnitus and unilateral deafness

MC cranial nerve involved in Acoustic Neuroma Trigeminal nerve
Earliest sign of acoustic neuroma Reduced corneal reflex
Earliest symptom of acoustic nerve tumor Hearing loss
Earliest symptom of acoustic neuroma Sensorineural deafness
Progressive loss of hearing, tinnitus, ataxia Acoustic neuroma
Expansion & Erosion of Internal Acoustic Meatus Acoustic Neuroma
Acoustic neuroma causes Retrocochlear deafness
Jacklers staging for Acoustic neuroma
Valvasori criteria Acoustic neuroma (Enlarged Vestibular
aqueduct)
Hitzelberger sign positive Vestibular schwannoma
NOT seen in acoustic neuroma Acute episode of vertigo
Investigation of choice for Acoustic Neuroma MRI with Gadolinium
Both internal and external acoustic meatus is visualized Occipitofrontal view
by
Sterners view Internal acoustic meatus, Mastoid air cells
Treatment of Choice for Acoustic Neuroma Surgery

GLOMUS TUMOR

Most common bony tumor of middle ear Squamous cell carcinoma

MC Benign tumor of Middle ear Glomus tumor
Glomus tumor common in Females
MC Site of Glomus Tumor in Middle ear Hypotympanum
Glomus tumor Arises from non chromaffin cells, multicentric,
conductive type of hearing loss
Glomus tumor Angiomyoneuroma
Histogenesis of Glomus tumor Mesodermal
Earliest symptom of glomus tumor Pulsatile tinnitus
Pulsatile tinnitus Glomus jugulare
A 30 year lady presents with pain and tenderness in Ridging of nail, Discolouration and pin head tenderness
index finger just under nail. She was unable to wash her (glomus tumor)
hands with cold water. Patient does NOT reveal any
history of trauma or injury. Probable finding
Phelp Sign Glomus Jugulare
Brown sign Glomus Jugulare
Sun rise appearance Glomus tumor
Zellballen pattern in HPE Glomus jugulare
Investigation of choice for Glomus tumor CT Scan
Glomus tumor invasion of jugular bulb diagnosed by Jugular venography
Treatment of malignancy of middle ear Excision of petrous part of temporal bone, modified
radical mastoidectomy
Transcatheter embolization is used in Glomus jugulare
treatment of
NOT a management of glomus tumor Interferon

PIERRE ROBBIN SYNDROME

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Pierre Robin syndrome Hearing defect, Respiratory distress, Mandibular

dysplasia
NOT a feature of Pierre Robbin syndrome Coloboma iris

NOSE

GENERAL FEATURES OF NOSE

nd
MC Facial bone fractured Nasal, 2 Zygoma
In Chevalier fracture of nasal bone, the Vertical
fracture line is
Complete anosmic responds to Ammonia
Nasolabial cyst Bilateral, adults, present submucosally in anterior nasal
floor, NON odontogenic
Klestadt cyst Nasolabial cyst
Site of ringertz tumor Nasal cavity
Treatment of Nasal hematoma Incision and drainage
Rhinomanometry Form of manometry used in evaluation of nasal cavity
Bilateral nasal pink masses in 2 year child. most CT scan
important investigation prior to surgery
Blind nasal intubation TM joint ankylosis
Merits of nasotracheal intubation Good oral hygiene
Focal Length of Microscope lens in Nasal surgeries 300 nm
Laparoscopic intranasal approach is used for accessing Lacrimal sac, pituitary gland, optic nerve
To prevent synechiae after nasal surgery Mitomycin

ANATOMY OF NOSE

External nose formed from 2 paired and 2 unpaired cartilage

Nasal bone forms Lateral wall of nasal cavity
Paired bones Inferior concha, Nasal bone
Junction between bony pyramid and upper cartilage of K-area
external nose
Roof of olfactory region formed by Cribriform plate of ethmoid
NOT a part of roof of nasal cavity Palatine process of maxilla
Structure NOT found in lateral nasal wall Vomer
Anterior part of septum is mainly made up of Quadrilateral cartilage
Quadrilateral cartilage NOT attached to Sphenoid
Septal cartilage is NOT attached to Sphenoid
Nasal septum Crest of maxilla, Septal cartilage, Perpendicular plate of
ethmoid, Nasal bone
Nasal septum is NOT formed by Turbinate
Bones NOT contributing to nasal septum Lacrimal
Nasal septum is NOT formed by Crest of frontal bone

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Sphenopalatine foramen opens into which wall of Medial wall

pterygopalatine fossa
Bent & Kuhn classification of frontal cells type II Tier of cells in frontal recess above agger nasi cell
Onodi cell and Haller cell are seen in relation to Optic nerve and floor of the orbit respectively
Haller cells Infraorbital cells
Anterior most ethmoidal cell Agger nasi
Osteomeatal complex connects Nasal cavity and maxillary sinus
Choana is Posterior nares
Nasal valve is formed by Lower end of upper lateral cartilage
Valve of Hasner Nasolacrimal duct
Direction of nasolacrimal duct Downwards, backwards and laterally
Opening of nasolacrimal duct in Inferior meatus
Length of Nasogastric tube Earlobe to Umbilicus, Nasal ala to epigastrium
Anterior nares is visualized by Thudicums speculum
Nasal mucosa is supplied by Mainly external carotid artery
Blood supply of external nose Both ophthalmic and maxillary arteries
Blood supply of nasal septum Mainly external carotid artery and
partly by internal carotid artery
Secretomotor Supply of Nose Vidian Nerve
Root, Dorsum & Tip of nose is supplied by Ophthalmic division of trigeminal Nerve
Sensation at tip of nose Ophthalmic nerve
Nerve Supply of tip of nose External Nasal Branch of Trigeminal Nerve
Upper Lip, side & ala of nose is supplied by Maxillary division of trigeminal nerve
Key area of nasal septum Anteroinferior part of nasal septum
Anteroinferior nasal septum is supplied by Anterosuperior alveolar nerve
Anterosuperior Nasal septum, Duramater of anterior Anterior ethmoidal nerve
cranial fossa is supplied by
Anterior ethmoidal nerve supplies Interior of nasal cavity, Dural sheath of anterior cranial
fossa, Ethmoidal air cells
Anterior ethmoidal nerve do NOT supply Maxillary sinus
Sludders neuralgia Anterior ethmoidal nerve
Lymphatics form external nose into Submandibular node
Lymphatic drainage of Anterior Half of Nasal septum, Submandibular Node
rd
Anterior 2/3 of Tongue
Lymphatic drainage of Posterior Half of Nasal septum, Retropharyngeal Node, Deep Cervical Node
Pharynx

PHYSIOLOGY OF NOSE

During inspiration main current of air flow in a normal Middle part of cavity in middle meatus in a parabolic
nasal cavity is through curve
Nasal cycle 2 to 4 hours
Schneiderian membrane Respiratory mucosa
Speed of mucus blanket 5 10 mm/min
Cilia beats 10 20 times/sec
Complete mucus sheath cleared in Every 10 12 mins
pharynx
Nasal secretion Muramidase

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pH of nasal secretion 7

CHOANAL ATRESIA

Choanal atresia is associated with CHARGE syndrome (CHD7 gene)

Commonest presentation of infant with bilateral Difficulty in breathing
choanal atresia
Choanal atresia is associated with Colobomatous blindness, heart disorder, ear disorder,
CNS lesion
Cyclical cyanosis is associated with Bilateral complete choanal atresia
Investigation for choanal atresia HRCT
Management of choanal atresia Transnasal repair

RHINOLALIA

Rhinolalia clausa Allergic rhinitis, adenoids, nasal polyps

Rhinolalia clausa is NOT seen in Palatal paralysis

CSF RHINORRHOEA

CSF rhinorrhoea occurs due to fracture of Cribriform plate of ethmoid bone

Does NOT cause CSF Rhinorrhoea Le Fort Type I fracture
Le Fort Type I fracture do NOT cause CSF Rhinorrhoea
NOT a clinical feature of zygomatic bone fracture CSF rhinorrhoea
MC site of leak in CSF rhinorrhoea Ethmoid sinus
MC site of CSF rhinorrhea Cribriform plate
MC site of traumatic CSF rhinorrhea Fovea ethmoidalis
fistula
CSF rhinorrhoea seen in Nasoethmoid fracture, frontozygomatic fracture
CSF rhinorrhoea Contains glucose, less protein
Signs of CSF Rhinorrhoea Reservoir Sign Sudden rush of CSF on sitting upright,
Handkerchief Sign No stiffening by CSF, Double Ring
Sign Blood Stained CSF
CSF rhinorrhea diagnosed by Beta 2 transferrin
Immediate treatment of CSF rhinorrhoea Antibiotics and observation
Immediate management for CSF rhinorrhoea Wait and watch for 7 days and antibiotics

DEVIATED NASAL SEPTUM

Percentage of newborn with deviation of nasal septum 20%

Features of DNS Atrophy of turbinate, hypertrophy of turbinate,
recurrent sinusitis
Crooked nose is due to Deviated dorsum and septum
Etiology of anterior ethmoidal neuralgia Middle turbinate pressing on the nasal septum
DNS not associated with Recurrent sphenoiditis

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NOT true of DNS Hypertrophy of turbinate

NOT a complication of DNS
Thudicum nasal septum is used to visualise
Cottles test to test patency of nares in
For DNS, surgery is required for
Killians incision is used in
Surgery contraindicated below 12 years
Submucosal resection is indicated in cases
NOT true about SMR
Alternate for SMR
Common indication for septoplasty
Septal hematoma
Bony septal perforation
Septal perforation does NOT occur in
Septal spur
Anterior nasal cavity
Deviation of Nasal septum
Septal spur with epistaxis, marked septal deviation,
persistent rhinorrhoea, recurrent sinusitis
Septoplasty, submucosal resection of nasal septum
SMR
Of DNS with constant complaints to Nasal obstruction
Mucoperichondrium is removed
Septoplasty
DNS with symptom
Occurs due to trauma, can lead to saddle nose
deformity, may lead to abscess formation
Syphilis
Rhinophyma, rhinosporidiosis

GRANULOMATOUS DISEASES OF NOSE

Mucormycosis Nose is a common site, Diabetes mellitus predispose,

Vascular invasion seen
68 yr old diabetic, black foul smelling discharge, Mucormycosis
blackish discolouration of inferior turbinate
IDDM patient with septal perforation of nose with Mucormycosis
brownish black discharge
Blackish nasal discharge and mass in nose Mucormycosis
Black necrotic turbinate Mucormycosis
Recent research shows rhinosporidiosis is Bacteria
a
Rhinosporidiosis Rhinosporidium seeberi
Rhinosporidiosis is Fungal infection
Rhinosporidiosis caused by Fungus, fungal granuloma, surgery is the treatment
Rhinosporidiosis presents as Nasal polyp
Stains for rhinosporidiosis Eosin and hematoxylin, toluidine blue,
bismark brown
Size of spore is that of the Size of RBC
Spherules in rhinosporidiosis are stained Bromophenol blue
with
Centre of spherule is stained with Methyl green
Ideal treatment of rhinosporidiosis Excision with cautery at base
Rhinosporidiosis is treated by Wide excision & cauterization
Causative agent of Rhinoscleroma Frisch bacillus
Atrophic dry nasal mucosa, extensive crustation, woody Rhinoscleromatis
hard nose
Hebra nose (Woody feeling of external nose) Rhinoscleroma
Tapir nose Rhinoscleroma
Mikulicz Cells Rhinoscleroma (Granulomatous stage)
Russell bodies Rhinoscleroma
Rhinophyma occurs due to Hypertrophy of Sebaceous gland

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OTORHINOLARYNGOLOGY

Rhinophyma is a complication of Acne rosacea, treatment includes shaving,

dermabrasion, skin grafting
Rhinophyma is treated with CO2 Laser
MC Fungal infection in nose Aspergillus fumigates
Nasal blockade, many hyphae with dichotomous Aspergillus
branching typically at 45*
Best for systemic aspergillus infection Itraconazole
Saddle nose deformity Syphilis, Leprosy
Treatment of Saddle Nose Augmentation Rhinoplasty
Depressed nasal bridge Syphilis, Septal abscess, Injury
Nasal Septal perforation Syphilis, Tuberculosis, Wegener granulomatosis
Apple jelly nodule in nasal septum Lupus vulgaris
Rhinoplasty is done at 16 years

ALLERGIC RHINITIS

Chromosome associated with allergic 11q

rhinitis
Common cold is primarily caused by Viruses
NOT implicated in etiology of allergic rhinitis DNS
Early mediators of allergic rhinitis Leukotriene, IL 4,IL 5,bradykinin,PAF
Nasal mucosa in allergic rhinitis Pale and swollen
Allergic rhinitis Intracutaneous test, Rash test, Scratch test
Truck driver rhinorrhoea, sneezing Cetrizine
Most effective monotherapy for seasonal Intranasal corticosteroids
and perennial allergic rhinitis ineffective
to antihistaminics
NOT a procedure for allergic rhinitis Submucosal placement of sialistic in inferior turbinate
Vasomotor rhinitis No sneezing
Vidian neurectomy done in Vasomotor rhinitis

ATROPHIC RHINITIS

Organism known to cause atropic rhinitis Klebsiella ozonae

Cause of nasal obstruction in atrophic rhinitis
NOT true about atrophic rhinitis/ozonae
Alkaline nasal douche contain
Alkaline douche does NOT contain
Youngs Operation
Lautenslager Operation
Crusting
Common in males, usually unilateral
Sodium chloride, sodium bicarbonate, sodium biborate
Glucose
Atrophic Rhinitis - Closure of Nostrils
Atrophic Rhinitis - Narrowing of Nasal Cavity

HYPERTROPHIC RHINITIS

NOT implicated in etiology of hypertrophic rhinitis Strong hereditary factors

Mulberry Like appearance of Nasal Mucosa Hypertrophic Rhinitis

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EPISTAXIS

Bleeding Polyp of nose Hemangioma of nasal septum

st nd
MC cause of epistaxis 1 Idiopathic, 2 Trauma
MC cause of epistaxis in 3 year old child Upper respiratory catarrh
MC cause of Epistaxis in children Nose pricking
MC cause of epistaxis in adults Hypertension
MC cause of recurrent epistaxis in 15 year female Hemtopoietic disorder
MC cause of vicarious menstruation Nose
NOT a systemic cause of epistaxis Hypertension
Age group for epistaxis 3 8 years
MC Site of Venous Nose Bleeding in Young People(<35 Retrocolumnellar Vein
Years)
MC Site of Origin of Bleed in Epistaxis Anterior part of Nasal Septum
MC site of epistaxis Anteroinferior part of nasal septum
Epistaxis of internal carotid system Above the level of middle turbinate
Common sites of bleeding Woodruff plexus, brown area, little area
Browns area Posterior part of septum
Woodruff area Behind inferior turbinate
Kiesselbachs plexus is in Medial wall of nasal cavity
Bleeding from nose commonly occurs at Littles area
Little area is situated in nasal cavity in Anteroinferior
NOT a major vascular supply of littles area Palatal branch of sphenopalatine
NOT contributing to Littles area Posterior ethmoidal artery
Woodruffs plexus is situated Posterior to inferior meatus
Epistaxis, on examination no active bleeding Observation
Cauterizing agent in epistaxis Silver nitrate
Source of epistaxis after ligation of external carotid Ethmoidal artery
artery
Epistaxis (Ligation method of Choice) Endoscopic Sphenopalatine Artery Ligation (Incision in
Middle Turbinate)
If posterior epistaxis cannot be controlled, artery Sphenopalatine artery
ligated
In case of controlled epistaxis, ligation of internal Pterygopalatine fossa
maxillary artery is done at
Treatment of choice in recurrent epistaxis in a patient Septal dermoplasty
with hereditary hemotelangiectasia
NOT a method to control bleeding from nose during Cutting drill over bleeding area
surgery

JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

JNA common in Males

Juvenile nasopharyngeal angiofibroma Benign neoplasm in males
MC site of origin of nasopharyngeal angiofibroma Sphenopalatine foramen
Site of origin of Angiofibroma Posterior part of nasal cavity close to sphenopalatine
ganglion
Angiofibroma bleeds excessively because Vessels lack contractile component

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Angiofibroma bleeds excessively because of Lack of contractile element

Adolescent boy presenting with profuse nasal bleeding Nasopharyngeal angiofibroma
Unilateral nasal blockade, mass in cheek and epistaxis Angiofibroma
10 year old boy with recurrent epistaxis and unilateral Angiofibroma
mass
Adolescent boy presenting with profuse nasal bleeding Nasopharyngeal angiofobroma
Nasopharyngeal angiofibroma Hormonal etiology, surgery is the treatment of choice,
radiotherapy can be given, recurrence is common,
embolization followed by surgery
(Anterior Bowing of Posterior Wall of Maxilla) Juvenile Antral Sign (Holman Miller Sign)
Nasopharyngeal Angiofibroma
Antral Sign (Holman Miller Sign) (Anterior Bowing of Juvenile Nasopharyngeal Angiofibroma
Posterior Wall of Maxilla)
Staging of juvenile nasopharyngeal Radkowski staging
angiofibroma
Investigation of choice for Juvenile Nasopharyngeal Contrast enhanced CT Scan
Angiosarcoma
NOT done in JNA Biopsy
Radiotherapy is used in angiofibroma if it involves Middle cranial fossa
NOT a treatment for nasopharyngeal angiofibroma Transmaxillary approach

NASOPHARYNGEAL CARCINOMA

Epstein barr virus causes Nasopharyngeal carcinoma

Nickel is associated with Ca Nasopharynx
MC Site of Carcinoma Nasopharynx Fossa of Rosenmuller
Commonest site of nasopharyngeal carcinoma Lateral wall
Ca nasopharynx involve Nasal cavity, tympanic cavity, orbit
MC presentation of Carcinoma nasopharynx Mass in neck
Most common tumor to produce metastasis to cervical Nasopharyngeal carcinoma
lymph nodes
MC tumor metastasing to Cervical Lymph nodes Ca Nasopharynx
Secondaries with no obvious primary Ca nasopharynx
Secondaries in upper deep cervical group of Ca nasopharynx
Lymphnodes
Ca Nasopharynx Bimodal age distribution, IgA antibody to EBV is
observed, squamous cell carcinoma is most common
subtype
Nasopharyngeal carcinoma cause deafness by Serous effusion
Horners syndrome is caused by Nasopharyngeal carcinoma metastasis
Trotters Triad Conductive Deafness, Immobility Of Homolateral Soft
Palate, Trigeminal Neuralgia
Trotter triad does NOT involve Seizure
th
NOT true about Trotter triad 7 nerve palsy
Imaging Modality for Nasopharyngeal Carcinoma MRI with Gadolinium and Fat Suppression
Optimal treatment for Nasopharyngeal carcinoma Radiotherapy
Radiotherapy is treatment of choice for Nasopharyngeal carcinoma T3N1
Optimal treatment for Nasopharyngeal carcinoma Radiotherapy

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NASAL POLYPOSIS

Sampters Triad/Widals Triad/Francis Triad -Aspirin Aspirin Sensitivity, Nasal Polyp, Asthma
Induced Asthma
Aspirin sensitive asthma associated with Nasal polyp
Antrochoanal polyp and ethmoidal polyp Male preponderance
Bernoullies theorem explains Nasal polyp
Killian polyp Antrochoanal polyp
Antrochoanal polyp Arise from maxillary antrum, Caldwell luc operation is
treatment of choice
NOT true of Antrochoanal polyp Bleeds on touch
Laterality of antrochoanal polyp Unilateral
Most appropriate management of antrochoanal polyp Intransasal polypectomy
in children
Treatment of ACP FESS
Treatment of choice for large antrochoanal polyp in a Endoscopic sinus surgey
30 year old man
Caldwel Luc operation Radical antrostomy
MC Complication of Caldwel Luc Surgery Infraorbital Neuralgia
Recurrent polyp Ethmoidal polyp
Ethmoidal polyp Associated with bronchial asthma
NOT true about ethmoidal polyp Occurs in first decade of life
Patient with ethmoidal polyp undergoes polypectomy, Extranasal polypectomy
presents 6 months later with ethmoidal polyp
Ethmoidectomy External ethmoidectomy (Howrath),
Transantral ethmoidectomy (Jansen
Horgans)
Treatment of recurrent antrochoanal polyp Caldwell luc operation, FESS
NOT a treatment for ethmoidal polyp Amphotericin B
NOT a treatment of bilateral nasal polyposis Amphotericin B

FOREIGN BODY IN NOSE

NOT a ENT emergency Inert foreign body in nostril

Unilateral foul smelling discharge in a child
Commonest cause of unilateral mucopurulent
rhinorrhea in child
Unilateral blood stained discharge in 6 year old boy
Foreign body in child
Rhinolith
Blind Finger Technique for Foreign body
Foreign body
Foreign body
Foreign body (If JNA is not in options)
Unilateral foetid discharge, presents with unilateral
nasal obstruction, inanimates more common than
animates
Deposition of calcium around foreign body in nose
It pushes foreign body further into airway

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PARANASAL SINUSES

DEVELOPMENT OF PARANASAL SINUSES

First sinus seen at birth Maxillary

May be absent at birth Frontal sinus, sphenoid
Maxillary sinus achieve maximum size at Secondary dentition

ANATOMY OF PARANASAL SINUSES

Reichert syndrome Glossopharyngeal neuralgia

Glossopharyngeal neuralgia is associated Eagles syndrome
with
Symptom associated with Syncope
glossopharyngeal neuralgia
Olfactory cleft is between Superior turbinate and cribriform plate
Apex of maxillary antrum Zygomatic bone
Petrous apex is directed Anteriorly and medially
Anterior skull base is formed by Frontal, ethmoid and sphenoid
Lines of Beclissae in X ray base of skull Posterior wall of maxilla, lateral wall of
orbit, greater wing of sphenoid
Lines of Beclissae distorted in Nasopharyngeal malignancy, Juvenile
Nasopharyngeal angiofibroma
Maxillary sinus opens in to Posterior to infundibulum of middle meatus
Posterior ethmoid sinus opens in to Superior meatus
Type of sphenoid sinus in normal Sellar
population
Sphenoid sinus opens into Sphenoethmoidal recess
Sinus present over Falx cerebella Occipital sinus
Frontonasal duct opens into Middle meaturs
After dacryocystorhinostomy lacrimal sac drains into Middle meatus
Dacryocystorhinostomy opening is made in to Middle meatus
Maxillary sinus opens into middle meatus at the level of Hiatus semilunaris
Hiatus semilunaris present in Middle meatus
Bulla ethmoidalis Anterior hair cells of ethmoid sinus
Bulla ethmoidalis seen in Middle meatus
Opening into middle meatus Frontal, maxillary, anterior ethmoidal sinuses
Nasolacrimal duct opens into Inferior Meatus
Meatus which is NOT seen on posterior rhinoscopy Inferior meatus
Largest meatus Inferior meatus
Turbinate articulate with ethmoid Inferior
Inferior Turbinate is a Separate Bone
Fourth turbinate Anterior ethmoidal cells
Does NOT open into hiatus semilunaris Posterior ethmoidal sinus
Pain sensation from ethmoidal sinus are carried out by Nasociliary nerve

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Parasympathetic secretomotor fibres to Paranasal Pterygopalatine ganglion

sinuses

PHYSIOLOGY OF PARANASAL SINUSES

Ciliary movement rate of nasal mucosa 5-10 mm/min

Paranasal sinuses are ventilated during Expiration
During inspiration main current of airflow in a normal Middle part of cavity in middle meatus in a parabolic
nasal cavity is through curve
Function of mucociliary action of upper respiratory rate Trap the pathogenic organism in inspired air
Anosmia is associated with Foster kennedy syndrome, meningitis,
atrophic rhinitis
Hyperosmia is associated with Epilepsy
Parosmia is Perversion of smell

SINUSITIS

MC cause of Paranasal Sinus Mycosis Aspergillus

nd
MC cause of acute sinusitis Streptococcus pneumonia, 2 Hemophilus influenza,
moraxella
Moraxella 15 20% of otitis media, exacerbation of adult COPD, honey
puck sign on agar
Frontal abscess pus is aspirated. red fluorescence on UV Bacteroides
examination
Minor criteria for sinusitis Headache
Fungal sinusitis Surgery is required for treatment. Amphotericin B is
used for invasive fungal sinusitis, seen only in
immunodeficient conditions
Criteria for allergic fungal rhinosinusitis Bent and Kuhn criteria
NOT a criteria for Allergic fungal sinusitis Orbital invasion
Metallic spots in CT scan of PNS Fungal sinonasal polyposis
MC Sinus involved in Chronic sinusitis, MC Site of Maxillary sinus
Bacterial Sinusitis, MC Site of Non Invasive Fungal
Sinusitis
MC infected sinus in children Maxillary sinus
Pathognomic feature of maxillary sinusitis Mucopus in middle meatus
Periodical headache Acute Frontal sinusitis
Office Headache Frontal Sinusitis
MC Site of Acute Sinusitis in Children Ethmoid Sinus
MC sinus causing more complications in Ethmoid sinus
children
Proptosis in ethmoid mucocele Laterally
Characteristic of Frontal Sinus Infection Periodicity
Potts Puffy Tumor (Osteomyelitis), Ivory Osteoma, Frontal sinus
Mucocele
Frontal mucocele presents as Swelling above medial canthus below the floor of
frontal sinus
Pathology in frontal mucocele Bone expansion

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Frontal mucocele is associated with Loss of scalloping

In frontal sinus mucocele, eye ball is displaced Forward, downward and laterally
Office headache Frontal sinusitis
Vertical headache Sphenoid sinusitis
Least Common cause of Sinusitis Sphenoid
Pain of sphenoidal sinusitis commonly referred to Vertex > occiput
Sphenoidal mucocele is associated with Superior orbital fissure syndrome
Complications of acute sinusitis Orbital cellulitis, Potts puffy tumor, conjunctival
chemosis, subdural abscess, retrobulbar neuritis,
cavernous sinus thrombosis, superior orbital fissure
syndrome
Orbital cellulitis is a complication of Parasinusitis, Faciomaxillary trauma, endoscopic sinus
surgery
Orbital cellulitis most commonly after Ethmoid sinus
Orbital complication in children is because of Ethmoidal sinusitis
Orbital complication in adults is because of Frontal sinusitis

MANAGEMENT OF SINUSITIS

Most definite diagnosis of sinusitis Sinoscopy

Caldwell View (Occipitofrontal View) Superior Orbital fissure, Frontal, Ethmoid and Maxillary
sinus. Lamina Papyraceae
Caldwell view can visualize Nasal bone, Maxillary bone, Ethmoid, frontal sinus
Frontal sinus best visualized by Caldwell view
Best view for superior orbital fissure Caldwell view
Best view to visualize maxillary sinus Occipitomental
Waters View (Occipitomental View) Maxillary sinus, Sphenoid sinus
Basal View (Submentovertical View) Sphenoid sinus, Maxillary sinus, Posterior Ethmoid sinus
Basal skull view(submentovertical view) X ray is best to Sphenoid sinus
visualize
Best View for Sphenoid Sinus Lateral > Basal
Recurrent/Chronic Sinusitis Non Contrast CT
X ray PNS show opacification, next investigation CT scan
Fever, conjunctival congestion and edema, culture of CT scan
eye discharge negative, opacification of ethmoid sinus
in X ray, next investigation
Lichtwitz trocar and cannula is used for Inferior meatus
antral puncture of
Best surgical management of chronic maxillary sinusitis FESS
Prerequisite for Endoscopic Sinus Surgery CT Paranasal Sinuses
FESS is indicated in Chronic sinusitis, epistaxis, inverted papilloma, nasal
allergic polyposis, mucocele
ESS is NOT indicated in Posterior frontal CSF rhinorrhea
Common complication of FESS Synechiae formation
In Caldwel luc operation nasoantral window is created Inferior meatus
through

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SINONASAL TUMORS

Inverted papilloma Arises from lateral wall, can be premalignant, causes

epistaxis, Schneiderian papilloma
NOT true about inverted papilloma Common in females
Osteoma of PNS common in Frontal sinus
Exostosis are common in Frontal sinus
Intense enhancement of PNS mass in Chondrosarcoma of PNS
gadolinium MRI
Ground glass appearance of PNS on X ray Fibrous dysplasia
MC malignancy in maxillary antrum Squamous cell carcinoma
Common about Ca PNS and nasal carcinoma Squamous cell carcinoma is most common type,
melanoma can occur
Ohgren classification Maxillary carcinoma
Ohngren line associated with Adenocarcinoma PNS
Early maxillary carcinoma presents as Bleeding per nose, tooth pain
Wood workers associated with sinus carcinoma Adenocarcinoma
Basal cell carcinoma Chemotherapy can be given
Nasal tumor originating from olfactory mucosa Esthenioneuroblastoma
Treatment of squamous cell carcinoma of maxilla Radiotherapy and maxillectomy
T3N0M0
Treatment of choice of ca maxillary sinus T3N0M0 Surgery and radiotherapy
Treatment of T3N1 ca maxilla Surgery and radiation

PHARYNX

DEVELOPMENT OF PHARYNX

nd
Tonsils are derived from 2 branchial pouch
Pharyngocutanous fistula associated with Surgery, No wound care, Radiotherapy

ANATOMY OF PHARYNX

Hyaluronic acid binding protein in CD44

pharyngeal epithelial cells
Lower limit of pharynx C6
Cloison sagittale Fascial slips separating parapharyngeal
and retropharyngeal space
Oral diaphragm Mylohoid
Suprahyoid muscle Mylohoid, Geniohyoid, Digastrics
NOT a suprahyoid muscle Omohyoid
Muscle arising from pterygomandibular Superior constrictor
raphae

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Superior constrictor is inserted into Pharyngeal tubercle

Cranial part of spinal accessory nerve supplies Superior constrictor
Lesion of cranial part of XI nerve cause paralysis of Pharyngeal constrictor
Only pharyngeal muscle innervated by Stylopharyngeus
glossopharyngeal nerve
Muscle responsible for formation of Passavants ridge Palatopharyngeus
Gate of tears Killian dehiscence
Killians dehiscence seen in Cricopharynx
Pharynx into Anterior & Posterior compartment Styloid process
Nasopharynx Fossa of rosenmuller corresponds to ICA
Lower border lies at the level of soft palate
NOT a part of hypopharynx Anterior pharyngeal wall
Structure passing through sinus of morgagni Ascending palatine artery, Levator palatine muscle,
Auditory tube
Gap inferior to inferior constrictor Recurrent laryngeal nerve, inferior
laryngeal artery
Nodes of rouviere Lateral retropharyngeal node
Angle formed by Eustachian tube with 45*
horizontal
Eustachian tube is supplied by Tympanic plexus, Caroticotympanic nerve,
Glossopharyngeal nerve, Pterygopalatine ganglion
Pharygotympanic tube Supplied by glossopharyngeal nerve
Epithelium of tonsil Non keratinized stratified squamous epithelium
Main arterial supply of tonsil Facial artery
NOT a blood supply of tonsil Sphenopalatine
Gerlach Tonsil is Tubal Tonsil

ZENKERS DIVERTICULUM

Pharyngeal diverticulum is protrusion of mucosa Two parts of inferior constrictor muscle of pharynx
between
60 year old man, foul breath, regurgitates food eaten 3 Zenkers diverticulum - false diverticulum, acquired
days ago condition, Lateral X rays on barium swallow often
diagnostic
Boyces sign Pharyngeal diverticulum
NOT true about Zenkers diverticulum Outpouching of anterior pharyngeal wall just above
cricopharyngeus muscle
MC Complication of Zenkers Diverticulum Lung Abscess
Second swallowing in Barium Meal Pharyngeal Pouch
Investigation of choice for Zenkers Diverticulum Barium Swallow
Treatment of Zenkers diverticulum Simple excision
Dohlman operation Endoscopic repair of hypopharyngeal
pouch
Usual incision given for surgery for Left cervical incision
Zenker diverticulum

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PLUMMER VINSON SYNDROME

Plummer Vinson syndrome is Common in Females

Plummer Vinson Syndrome (Patterson Kelly Syndrome) Iron Deficiency Anaemia, Oesophageal Web, Glossitis
Web in Plummer Vinson Syndrome most common in Post cricoid region
Patterson Kelly syndrome is associated Increased TIBC
with
NOT a feature of Plummer Vinson syndrome Hypertrophy of Oral mucosa
Bocca sign Post cricoid growth

HEAD AND NECK SPACE INFLAMMATION

Fusobacterium necrophorum causes Pharyngitis

Lemierre disease Oropharyngeal infection, post anginal septicemia caused by
Fusobacterium necrophorum, septic cervical mucous
thrombophlebitis
Extent of retropharyngeal space Base of skull to T4
Commonest cause of retropharyngeal abscess Caries of cervical spine
Otogenic retropharyngeal abscess caused by Mastoid tip cell infection
Retropharyngeal abscess Associated with tuberculosis of spine, suppuration of
Rouviere lymph node, treatment by surgery
NOT true about retropharyngeal abscess Lies behind prevertebral fascia
Parapharyngeal space also known as Lateral pharyngeal space, pterygomaxillary space
Contents of parapharyngeal space Carotid vessels, jugular vein, 9th,10th, 11th,12th
cranial nerves
Predental extraction patient presents with swelling in Parapharyngeal abscess
posterior one third of sternocleidomastoid, tonsil
pushed medially
30 year male, trismus, fever, swelling pushing tonsil Parapharyngeal abscess
medially spreading laterally posterior to
sternocleidomastoid, history of excision of third molar
few days before for dental caries
Trismus in parapharyngeal abscess is due to Medial pterygoid
Medial bulging of pharynx Pharyngomaxillary abscess
Does NOT support diagnosis of Cough
streptococcal pharyngitis
Gold standard test for streptococcal pharyngitis Culture

ADENOID HYPERTROPHY

Luschkas tonsil Adenoids

Adenoid hypertrophy is associated with
Excluded when adult presents with secretory otitis
media
Indication for adenoidectomy in children
6 year old child, recurrent URTI, mouth breathing,
failure to grow with high arched palate, impaired
Failure to thrive, mouth breathing, high arched palate
Adenoid hyperplasia
Middle ear infection with deafness
Adenoidectomy with grommet insertion

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hearing
Average blood loss during Adenoidectomy 80 -120 ml
Contraindications of adenoidectomy Poliomyelitis, hemophilus infection, upper RTI

ANATOMY OF TONSILS

Tonsil is a Endodermal derivative

Maximum size of tonsil 5 years
Epithelial lining of tonsil Squamous epithelium without keratinisation
Palatine tonsil Lies on superior constrictor, Lymph node drains into
deep cervical node, Is a derivative of second pharyngeal
pouch
Palatine tonsil arterial supply from Facial, ascending palatine, dorsal lingual
Chief blood supply of tonsil Facial artery
Nerve supply of tonsil Glossopharyngeal Nerve & Lesser Palatine Nerve
Main nerve supply of palatine tonsil Glossopharyngeal nerve
Palatine tonsils Efferents but NO afferents
Lymphatic drainage of tonsil Jugulodigastric node
NOT true about palatine tonsil Has sensory innervation from vagus
Inner ring of Waldeyer ring does not include Submental node
NOT included in Waldeyer lymphatic chain Posterior auricular nodes
Eustachian tube is blocked by Tubal Tonsil

TONSILLITIS AND QUINSY

MC organism causing tonsillitis Group A -hemolytic streptococcus

MC cause of Acute tonsillitis in children Streptococcus pyogenes
Differentiation of Streptococcal tonsillitis from Viral Exudates are seen
tonsillitis
Complications of acute tonsillitis Chronic tonsillitis, Peritonsillar abscess, Acute
glomerulonephritis
Infection requiring systemic antibiotic therapy for Pneumococci, Beta hemolytic streptococci, Staph.
throat infection Aureus
Treatment for acute tonsillitis Crystalline penicillin
NOT an indication for Tonsillectomy Acute tonsillitis
Quinsy Peritonsillar abscess, Indication for tonsillectomy,
Should be drained, Bulging of soft palate, Swelling on
lateral aspect of face/neck, Abscess restricted lateral to
Superior constrictor muscle, Involves floor of mouth
(True/False)
Quinsy Penicillin used in treatment, patient presents with toxic
features and drooling
Best treatment for peritonsillar abscess with trismus Systemic antibiotics up to 48 hours and then drainage
Tonsillectomy after peritonsillar abscess is done after 6-8 weeks

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MANAGEMENT OF TONSILLITIS

White patch over tonsil, diagnosis best made by culture Loffler medium
with
Fever, cervical lymphadenopathy, grey membrane on Lofflers serum slope
tonsil
Penicillin for tonsillitis is given for 7-10 days
5 year old boy scheduled for tonsillectomy. on the day Cancel surgery for 3 weeks and patient on antibiotic
of surgery, he had running nose, temperature 37.5*C
dry cough
Route of approach for glossopharyngeal neurectomy Tonsillectomy approach
Tonsillectomy is indicated in Rheumatic tonsillitis
Tonsillectomy is contraindicated in Polio epidemic
Rose Position is adopted for Tonsillectomy, Tracheostomy
MC Complication of Tonsillectomy Hemorrhage
MC cause of arterial bleeding during Tonsillectomy Tonsillar Branch of Facial Artery
MC cause of Bleeding during Tonsillectomy Paratonsillar Vein
Excessive hemorrhage in tonsillectomy result from Palatine vein
injury to
Excessive hemorrhage in tonsillectomy is due to injury Ascending palatine artery
of
Average blood Loss during Tonsillectomy 50 80 ml
Hemorrhage occurring 6 hrs after tonsillectomy Reactionary hemorrhage
Secondary hemorrhage following tonsillectomy 6 days
Secondary hemorrhage following tonsillectomy is due Sepsis
to
Secondary hemorrhage occurs 5-10 days after surgery
Treatment of hemorrhage 5 hours after tonsillectomy Reopen immediately
Hypertrophy of lingual tonsil occur in Tonsillectomized patients
Grisel disease (nasopharyngeal torticollis) Non traumatic subluxation of atlas,
occurs usually after adenoidectomy or
nasal cavity inflammation
NOT true about Grisel syndrome Neurosurgical consult not required

ORAL CAVITY

GENERAL FEATURES OF ORAL CAVITY

Child able to breathe and suck at same time High arched palate
Ill defined space Mandibular space
st
Orodental fistula is most common after extraction of 1 molar
Surgical repair of Oroantral fistula accompanied by Sinus drainage procedure
Study of Salivary gland duct Sialogram
Laser uvulopharyngoplasty is done for Snoring
Pharyngoplasty in children is to improve Speech

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RANULA

Extravasation cyst of sublingual gland Ranula

Ranula Retention cyst, transluscent, plunging may be a feature,
cystic swelling in the floor of mouth
Ranula Retention cyst
Ranula Cystic swelling in floor of mouth, Retention cyst of
sublingual gland
Ranula occurs in Floor of mouth
Tail sign Dividing or plunging ranula
Plunging ranula pierce Mylohyoid
Structure injured in excision of ranula Submandibular duct

VINCENTS ANGINA

Vincents angina Fusiform bacilli, Borrelia vincenti

Vincents angina is caused by Borrelia vincenti
Greyish Black Membrane Vincents Angina
Trophic ulcer is caused by Vincents organism

LUDWINGS ANGINA

MC cause of Ludwigs angina Dental Infection

MC source of infection in Ludwigs angina Infection of root of molors
Necrotizing infection of submandibular gland and base Ludwigs angina
of mouth
Infection of cellular tissues around submandibular Ludwigs angina
gland
Ludwigs angina is characterized by Cellulitis of floor of mouth, infection spreads to
retropharyngeal space, involves both submandibular
and sublingual space, most common cause is dental
infection
Salt pork in appearance Ludwigs angina
Cause of death in Ludwigs angina Asphyxiation
NOT a cause for grey white membrane on tonsil Ludwigs angina

ORAL LESIONS, ORAL CYST, SINUS AND FISTULA

Aphthous ulcer Viral predisposition, recurrent ulcer, steroids given as

treatment
Painless ulcer of tongue Syphilis
60 year man ulcer on lateral margin of tongue and Carcinomatous ulcer
complains of ear pain
Multiple painful ulcers on tongue NOT seen in Carcinomatous ulcers
Noma Cancrum oris
Cancrum oris Associated with malnutrition, Inflammatory swelling,

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Associated with vitamin deficiency, Treatment is

excision and skin grafting
Cancrum oris is caused by Fusobacterium nucleatum
MC site of mucocele Lower lip
Trench mouth Ulcerative lesion of tonsil
Typical characteristic of diphtheric membrane Firmly attached and bleeds on removal
70 year male symptomatic white patch on oral cavity Ascertaining the denture is fit properly
following application of denture. treatment of choice
Fordycee spots Ectopic sebaceous glands
MC cyst of oral region Periapical cyst
Dentigerous cyst arise from Unerupted teeth
Dental cyst arise from Erupted infected tooth
Calcifying epithelial odontogenic cyst Gorlins cyst
Premalignant jaw cyst Dentigerous cyst
Epulis arise form Gingival
Epulis Premalignant painless swelling on gums
Quinkes disease Edema of uvula
Bifid uvula Loeys Dietz syndrome

MAXILLOFACIAL INJURIES

Tripod fracture Zygoma

Fracture zygoma Diplopia, Cheek swelling, trismus,nose bleeding,
infraorbital numbness
NOT seen in fracture zygoma CSF rhinorrhoea
MC injured in fracture maxilla Infraorbital
NOT seen in fracture maxilla Surgical emphysema
Ideal time for correction of fracture of nasal bone After few days
Lefort II fracture Fracture running through zygomatic process of maxilla,
floor of orbit, root of nose on both sides
Craniofacial dysjunction Le Fort III
Le Fort Fracture does NOT involve Mandible
Mandible is commonly fractured at Neck of condyle
Best view for mandible Orthopantatogram
Fracture mandible with edentulous jaw is treated with External fixator
Best treatment of blow out fracture of orbit Explore the orbit

ANATOMY OF SALIVARY GLANDS

Parotid gland develops from Ectoderm

Salivary secretion per day in adults 1000 ml
Unlike other GI secretion, salivary Atropine
secretion is controlled almost exclusively
by nervous system is significantly
inhibited by
th
First salivary gland to appear Parotid 6 week
Parotid gland Accessory parotid gland is above parotid duct, Mandible

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ramus grooves anteromedial surface, Styloid and

Parotid gland
Parotid gland
Fibrous Capsule of Parotid
Superficial surface of parotid gland is related to
Facial nerve
Deep lobe of parotid is related with
Parotid duct
Parotid duct can be palpated when
Secretomotor fibres to parotid passes through
Parasympathetic supply to parotid is from
Parasympathetic secretomotor fibres to parotid
traverse through
Parasympathetic secretomotor fibres to parotid does
NOT traverse through
Facial artery is associated with
Submandibular gland is seen to wrap around
Nerve associated with Whartons duct
Submandibular gland is supplied by
Preganglionic parasympathetic axons to
submandibular gland from
Demilunes are seen in
Serous demilunes are larger in number in
Stafne bone cyst
mastoid muscles are posteromedially, Auriculotemporal
nerve superiorly and greater auricular nerve laterally,
Pharynx examination is necessary
nd
Duct opens opposite to 2 molar, Develops from
ectoderm, Excised by deep cervical fascia of neck,
Retromandibular vein relation, Facial nerve relation
Stenson duct opens opposite upper second molar
Superficial Investing Layer of Deep Cervical Fascia
Greater auricular nerve
Traverses through parotid gland
Palatine tonsil
Stenson duct
Anterior border of masseter is tensed
Otic ganglion
Otic ganglion
Otic ganglion, Tympanic plexus, Auriculotemporal
nerve, Lesser petrosal nerve
Greater petrosal nerve, Deep petrosal nerve
Submandibular gland
Posterior border of myelohyoid
Lingual nerve
Lingual Nerve
Facial nerve
Submandibular gland
Mixed Salivary Gland
Ectopic salivary tissue

DISEASES OF SALIVARY GLANDS

MC Benign salivary gland tumor in Children Hemangioma

MC cause of Salivary Gland Tumor Radiation exposure
MC Site of Parotid Tumor Superficial lobe
MC Site of Minor salivary Gland Tumor Hard palate
MC Site of Ectopic Salivary Gland Tumor Palate
MC Site of Salivary Gland Tumor Parotid
Swelling of deep parotid gland presents as swelling in Temporal region
Inflammatory enlargement of deep salivary gland is Tonsillar bed/fossa
seen in
Salivary gland Pleomorphic adenoma is the most common tumor of
submandibular gland, More than 400 minor salivary
gland, 90% of minor salivary gland tumors are
malignant, Warthin tumor common in parotid
MC tumor of Salivary gland Pleomorphic adenoma
st nd
MC benign tumor of Salivary gland Pleomorphic adenoma-1 , 2 Warthins tumor
Salivary gland neoplasm associated with irradiation Pleomorphic adenoma
MC cause of unilateral parotid swelling in 27 year old Pleomorphic adenoma

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male
Mixed tumors of salivary gland common in Parotid
MC site of pleomorphic adenoma Parotid
MC Site of Pleomorphic Adenoma(Mixed tumor) Tail of parotid
Pleomorphic adenoma is common in Females
Mixed parotid tumor arise from Epithelial and mesenchymal
Mixed parotid tumor Firm and capsulated
T2 rim is associated with Pleomorphic adenoma
st
MC Malignant Salivary gland tumor in Children Mucoepidermoid Carcinoma 1 , 2nd Acini Cell
Carcinoma
MC malignant tumor of Major Salivary gland Mucoepidermoid Carcinoma
Mucoepidermoid carcinoma arise from Mucin secreting Epidermal cells
Mucoepidermoid carcinoma Equal incidence
MC Malignant tumor of Minor salivary gland Adenoid Cystic carcinoma
MC neoplasm of Submandibular salivary gland Adenoid cystic carcinoma
MC Tumor Showing Perineural Invasion in Head & Neck Adenoid Cystic Carcinoma
MC Site of Acini Cell Carcinoma Parotid
Acini cell carcinoma commonly arise from Parotid
Parotid tumor in older male smoker Warthins tumor
Adenolymphoma Not malignant
Warthin tumor Hot spot, adenolymphoma of parotid
Hot spot on T99m Adenolymphoma
NOT true regarding Warthins tumor More common in females
Lymphoepithelioma of parotid gland Associated with EBV, highly radiosensitive, type of
squamous cell carcinoma
Oncocytoma Rarely malignant
Frey syndrome Redness and sweating over auriculotemporal during
meal
Frey syndrome is due to injury of Auriculotemporal nerve
Starch iodide test for Frey syndrome
Sialolithiasis MC in Submandibular Salivary Gland
MC Salivary Gland to get Stones Submandibular Gland
Nerve least likely injured in submandibular surgery Inferior alveolar nerve
A bacterial pyogenic parotitis commonly found Debilitation after major surgery
following
Sialosis Noninflammatory parotid enlargement
Bilateral parotid enlargement seen in Sarcoidosis, Chronic pancreatitis, Sjogrens syndrome
Unexplained persistent parotid enlargement in HIV
malnourished child

MANAGEMENT OF SALIVARY GLAND DISEASES

Best diagnostic modality for parotid swelling FNAC

Neutron therapy is used in management
of
Indication for radiotherapy in pleomorphic adenoma
NOT a landmark of facial nerve during surgery
Salivary gland tumor
Involvement of deep lobe, microscopically positive
margin, malignant transformation
Inferior belly of omohyoid

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Best treatment modality for Warthins tumor Superficial parotidectomy

Treatment of pleomorphic adenoma of parotid Superficial parotidectomy
Treatment of Choice for Pleomorphic adenoma Parotid Conservative total Parotidectomy
Deep lobe involved
Pleomorphic adenoma, tonsil pushed medially Conservative total parotidectomy
Treatment of choice for dumbbell Total parotidectomy
pleomorphic adenoma
Facial nerve graft Sural nerve, medial antebrachial nerve
Facial nerve graft is not affected by Post operative radiation
Parotid abscess is drained by Multiple horizontal incisions
Sialography is contraindicated in Acute parotiditis
Submaxillary calculi can be visualised by X ray in 80% of cases
Treatment of submandibular salivary gland calculi Opening of duct and removal of calculus
During operation on submandibular gland Submandibular gland is seen to wrap around posterior
border of mylohyoid
Nerves injured during surgery of Submandibular salivary Lingual, Hypoglossal, Facial
gland
Least likely injured in submandibular salivary gland Inferior alveolar nerve
surgery
Best landmark to identify inferior Lingula of mandible
alveolar nerve
NOT injured in submandibular gland surgery Glossopharyngeal nerve

ANATOMY OF TONGUE

Glossopharyngeal nerve supplies posterior part of Hypobranchial eminence

tongue because it develops from
nd rd th
Copula of His (Hypobranchial eminence-Posterior one Mesoderm of 2 ,3 and part of 4 arch
third of tongue)formed from
Tongue muscles develop from Occipital myotome
Intrinsic muscles of tongue are derived from Occipital somites
Tongue Facial nerve supplies fungiform papillae,
Glossopharyngeal nerve supplies circumvallate papillae,
Blood supply is derived from lingual artery
Safety muscle of tongue Genioglossus
Protrusion of tongue is produced by Genioglossus
Ipsilateral deviation of tongue is due to action of Genioglossus
Palsy of right genioglossus cause Deviation of tongue to right
Deep relation of hyoglossus Lingual artery
Langley ganglion Submandibular ganglion
Langley ganglion is associated with Hyoglossus
Muscles of tongue supplied by Hypoglossal nerve
Posterior one third of tongue is supplied mainly by Glossopharyngeal nerve
Taste sensation of anterior two third of tongue Chorda tympani nerve
Taste sensation of posterior one third of tongue Glossopharyngeal nerve
Unilateral injury to hypoglossal nerve leads to Only MOTOR function lost, Hemiatrophy of involved
nerve, Deviation of tongue towards same side,
Fasciculation of tongue
Pain from anterior two third of tongue is referred to ear Auriculotemporal nerve

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by
Tip of tongue drains Submental node
Several painless large bumps at back of Circumvallate papillae
tongue
Taste buds are absent in Filiform papillae
Maximal number of papillae on tongue Filiform papilla
Glossodynia Ranula, candidiasis, leukoplakia

MALIGNANCY OF TONGUE

Treatment of Leukoplakia Surgical removal

Carcinoma of tongue Radiosensitive, Common on lateral border
Carcinoma tongue frequently develop from Lateral border
Commonly metastasize to cervical lymph nodes Posterior tongue
In carcinoma base of tongue, pain in referred to ear Lingual nerve
through
In carcinoma base of tongue, pain is referred to ear Glossopharyngeal nerve
through
NOT true about carcinoma tongue Adenocarcinoma
Carcinoma right tongue in right lateral aspect lymph N2
node 4 cm in level 3 on left side of neck
Carcinoma tongue less than 1 cm Excision
Patient presented with 1*1.5 cm growth on lateral Laser ablation
border of tongue. treatment
Carcinoma tongue more than 2 cm is treated by Radiotherapy
Surgery is preferred over Radiotherapy in Carcinoma base of tongue
Ca tongue. Lymphnodes in neck, treatment for Radical neck dissection
lymphnodes in neck

ANATOMY OF PALATE

Palate is supplied by Ascending palatine artery, Descending palatine artery,

Ascending pharyngeal artery
NOT a blood supply of palate Ascending palatine artery
Ascending pharyngeal artery is a branch of External carotid artery
Nerve supply of muscles of palate Vagus nerve, Trigeminal nerve
Sensory supply of palate Facial nerve, Glossopharyngeal nerve, Maxillary division
of trigeminal nerve
Does NOT supply the palate Tonsillar branch of facial artery, Pharyngeal branch of
ascending pharyngeal artery

MALIGNANCY OF PALATE

Form of tobacco associated with squamous cell Chutta

carcinoma of hard palate
Cigar cancer Carcinoma hard palate
Carcinoma of palate Fast growing

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Head and neck tumor with least lymph node metastasis Hard palate
Oral cancer Least Lymph node metastasis Ca Hard Palate
NOT true about Ca palate Presents with pain

CARCINOMA LIP

Premalignant lip lesion Hyperkeratosis

Carcinoma having best prognosis Carcinoma lip
Secondaries in carcinoma lower lip Upper cervical lymph nodes
Treatment of choice for carcinoma lip less than q cm Excision

CARCINOMA CHEEK

Gum tumor with 2 contralateral mobile lymphnodes in T3,N2,T2,N2,T4N2,T3N3

cheek
Ca cheek, tumor 2.5 cm located close to and involves T4N1M0
lower alveolus. single mobile homolateral lymph node
measuring 6 cm is palpable
Best single drug for carcinoma cheek Cisplatin

FEATURES OF CARCINOMA ORAL CAVITY

Female,14 years of tobacco chewing, difficulty In Submucosal fibrosis

opening mouth
Premalignant lesions of oral cavity Erythroplakia, leukoplakia, sideropenic dysphagia, oral
submucous fibrosis
Premalignant lesion with highest probability of Erythroplakia
progression to malignancy
MC premalignant condition of oral cavity Leukoplakia
Leukoplakia Inflammation, Crackling, Bleeding, Itching
Leukoplakia and erythroplakia may be 15 years
detected
NOT a predisposing factor to squamous cell carcinoma Lichen planus of mouth
of mouth
MC cancer in India Ca oral cavity
Commonest site of oral cancer among Indian population Alveobuccal complex
Second primary tumor of head and neck is most Oral cavity
commonly seen in malignancy of
Margins of squamous cell carcinoma Everted
Squamous cell carcinoma spread by Lymphatic route
Metastasis of carcinoma buccal mucosa give to Regional lymphnode
Carcinoma buccal mucosa commonly drain to Submandibular node
Mass in oral cavity. Previous biopsy papillamatosis with Verrucous carcinoma
hyperkeratosis and acanthosis infiltrating subjacent
tissues. now lymph node involvement
MC site of malignancy in India Oropharynx
rd
MC site of Carcinoma of Oropharynx Posterior 1/3 of tongue

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70 years old, history of chewing tobacco for 50 years, 6 Malignant mixed tumor
months history of large fungating, soft papillary lesion
in the oral cavity. Lesions penetrated into mandible.
lymphnodes are palpable. two biopsies taken from
lesion proper show benign appearing papillomatosis
with hyperkeratosis and acanthosis infiltrating
subjacent tissues

MANAGEMENT OF CARCINOMA ORAL CAVITY

Areas of carcinoma oral mucosa identified by 2% Toluidine blue

Radiation dose used for Oral carcinoma 4000 cGy
Visor procedure is used in surgery for Mouth
Oral cavity carcinoma of less than 2 cm in size near Local excision, Radiotherapy
mandible is treated by
Trismus in oral cancer patients treated with Surgery and radiotherapy
Midline tumor of lower jaw, involving alveolar margin, Segmental mandibulectomy
endentulous
80 year old patient midline tumor of lower jaw, Segmental mandibulectomy
involving alveolar margin. Edentelous
Edelentous old man, squamous cell carcinoma in buccal Marginal mandibulecting involving outer table only
mucosa that has infiltrated alveolus. NOT indicated in
treatment
NOT a treatment of ca buccal mucosa infiltrated into Marginal mandibulectomy involving removing of outer
alveolus table only
Ca buccal mucosa infiltrated into alveolus. NOT a Radiotherapy
treatment
Treatment of T3N2AM0 alveolar carcinoma Surgery
Commando operation Excision of carcinoma of tongue, floor of mouth, part of
jaw and lymph nodes en bloc

LARYNX

DEVELOPMENT OF LARYNX

Epiglottis is derived from Fourth Arch

Recurrent laryngeal nerve and intrinsic Sixth arch
muscles of larynx arise from

ANATOMY OF LARYNX

Adult larynx extends from C3 to C6

Vocal cord is lined by Stratified squamous epithelium
Larynx Cuneiform and corniculate cartilage are elastic,
Epiglottis cartilage is elastic

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Larynx has 9 cartilages, 3 paired, 3 unpaired

Unpaired cartilage Thyroid, cricoid, arytenoid
Paired cartilages Corniculate
Commonest cartilage to ossify Hyaline
Hyaline Thyroid, Cricoids
Elastic Corniculate, Epiglottis
Laryngeal cartilage forming complete circle Cricoid
Signet cartilage Cricoid
Shape of arytenoid cartilage Pyramidal
Santorini cartilage Corniculate cartilage
Tritiate cartilage is present on Thyrohyoid membrane
Epilarynx includes Aryepiglottic fold, Suprahyoid epiglottis, Arytenoids
Epilarynx include Suprahyoid glottis
Laryngeal cartilage above glottis Epiglottis
Epiglottis Contains mucus secreting gland, Made up of elastic
cartilage, Lined by stratified squamous epithelium
Does NOT ossify Epiglottis
Supraglottis does NOT include Lingual surface of epiglottis
Pre epiglottic space Communicates laterally with para epiglottic space, Aka
Boyer space, Supraglottic carcinoma infiltrate this space
Boyers space Pre epiglottic space
Water cane in secondary larynx are present in Laryngeal ventricles
Laryngeal ventricle lies between Vocal cord and ventricular fold
A neonate while suckling milk can respire without High larynx
difficulty due to
Level of branching of common carotid artery Upper border of thyroid cartilage
Larynx in neonate Epiglottis is large and omega shaped, cricoid narrowest
part, funnel shaped
Narrowest part in infant larynx Sub glottis
Narrowest part of Airway in children Subglottis
Normal subglottic diameter 6 mm
Narrowest part of Airway in adults Glottis
Watershed area of larynx Vocal cord
Unpaired muscle Interarytenoid
Muscle forming bulk of vocal cord Thyroarytenoid
False vocal cord Vestibular ligament
Tensor of vocal cord Cricothyroid
Adductor of vocal cord Transverse arytenoids, Lateral cricoarytenoid
Abductor of vocal cord Posterior cricoarytenoid
Elevator of larynx Thyrohyoid, mylohyoid
Vocalis muscle is a part of Thyroarytenoid
NOT a depressor of larynx Omohyoid
Delphian lymph node is over Cricoarytenoid membrane
Thyrohyoid membrane is pierced by Internal laryngeal nerve, superior
laryngeal artery
NOT an intrinsic laryngeal membrane Cricothyroid
Vocal ligament is continuous with Cricothyroid membrane
Number of laryngeal sphincters 3
Vagus nerve carries Preganglionic fibres

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Recurrent laryngeal nerve Passes between branches of inferior thyroid vessels,

Passes anterior to branches of inferior thyroid vessels,
Passes through sternomastoid muscle
Recurrent laryngeal nerve Variable relation with inferior thyroid
vessels
All Intrinsic muscles of Larynx supplied by Recurrent External Laryngeal Nerve
Laryngeal Nerve EXCEPT Cricothyroid supplied by
Cricothyroid is supplied by Superior laryngeal nerve
External branch of laryngeal nerve supplied Cricothyroid
Ansa galeni Loop containing recurrent and superior
laryngeal nerve
Sensation of Larynx above the level of vocal cord Superior Laryngeal Nerve
Anatomical relation of recurrent laryngeal nerve Superiorly passes in the groove between esophagus and
trachea
Sensation above level of vocal cord by Internal branch of superior laryngeal
nerve
Piriform recess mucosa is supplied by Internal laryngeal nerve
Sensory supply of larynx below the level of vocal cord Recurrent laryngeal nerve
Vocal cord paralysis caused by injury to Recurrent laryngeal nerve
Damage to internal laryngeal nerve results in Anesthesia of larynx
Injury to superior laryngeal nerve cause Loss of timbre of voice
Nerve supply of mucosa of larynx Internal laryngeal nerve
Anesthesia of Larynx Lead Poisoning, Multiple sclerosis, Diphtheria

PHYSIOLOGY OF LARYNX

Most important function of Larynx Protection of Lower respiratory tract

Pitch of voice depends on Length of vocal cord
Change in pitch of sound is produced by Cricothyroid

STRIDOR

Causes of congenital laryngeal stridor Laryngomalacia, hemangioma of larynx, laryngeal

stenosis
MC cause of stridor in children Foreign body (laryngomalacia resolves by 2 years of
age)
Second most common cause of stridor Congenital subglottic stenosis
MC cause of stridor in adults Malignancy
MC cause of Laryngeal stridor in 60 year old Carcinomal larynx
Recognized causes of stridor in newborn Cystic hygroma, Vascular ring, Laryngomalacia
Maximum stridor Bilateral incomplete paralysis
Biphasic stridor is seen in lesions of Glottis, subglottis, cervical trachea
Stridor is NOT caused by Asthma
Anatomic site of origin of stridor Larynx, Bronchus, trachea
2 year child emergency at 3 am, fever barking cough. Dexamethasone
Stridor only while crying, able to drink normally. RR
36/min. temp 39.6 *C

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LARYNGOCELE

Laryngocele arise from Saccule of ventricle

Laryngocele arise as a herniation of laryngeal mucosa Thyrohyoid membrane
through

LARYNGOMALACIA

MC cause of Stridor in Newborn & Children Laryngomalacia

MC cause of respiratory obstruction in infants Laryngomalacia
MC congenital anomaly of Larynx Laryngomalacia
Anomaly of larynx disappearing in Laryngomalacia
second year of life
3 month child, intermediate stridor Laryngomalacia
Laryngomalacia Omega shaped epiglottis, inspiratory stridor
NOT true about laryngomalacia Decreased symptom during prone position, surgery is
the treatment of choice
Treatment of Congenital laryngeal stridor Reassurance of Childs parents
(Laryngomalacia)

VOCAL NODULE

Most common location of vocal nodule Anterior one third and posterior two third
Treatment of vocal nodules due to GERD Speech therapy and PPI

LARYNGOSCOPY

Laryngeal mirror is warmed by Glass surface on Flame

Indirect Laryngoscopy Anterior and Posterior regions are reversed
Indirect laryngoscopy Lateral inversion
Difficult to visualise in indirect laryngoscopy Anterior commissure
Visualised in direct laryngoscopy Cricopharynx, lingual surface of epiglottis, arytenoids,
pyriform fossa, tracheal cartilage
Microlaryngoscopy was started by Kleinsasser
Procedure that should precede microlaryngoscopy Laryngoendoscopy

EPIGLOTTITIS

MC cause of Epiglottitis in Children Hemophilus influenza b

Acute Epiglottitis Tripod Sign Child prefers sitting position with
Hyperextended Neck, Thumb Sign, Vallecula Sign
Epiglottitis is associated with Drooling of saliva

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Common cause of death in acute epiglottitis Respiratory obstruction

Thumb print sign on lateral cervical X ray Epiglottitis
Drug of choice in acute epiglottitis in children Ampicillin

LARYNGITIS

Contact Ulcers/Pachydermia/Laryngitis Contact Male preponderance

Granuloma
Primitive etiological factor in contact ulcer of Larynx Tuberculosis
Cause of contact ulcer in vocal cords Voice abuse
MC site of involvement in pachyderma laryngis Arytenoid cartilage
Contact ulcer Can be caused by intubation injury, vocal process is the
site and aggravated by acid reflux
Pachyderma laryngis NOT premalignant, diagnosis made by biopsy, on
microscopy it shows acanthosis and hyperkeratosis
Laryngitis sicca Caused by Klebsiella ozonae, hemorrhagic crust
formation, microlaryngoscopic surgery is the modality
of treatment, laryngitis atrophica, common in women
Chorditis tuberosa Chronic laryngitis
Infection involving anterior larynx TB, sarcoidosis, syphilis
TB larynx Turban epiglottis, odynophagia, ulceration of arytenoids
Tuberculous laryngitis mainly affects Posterior Commissure of Larynx
Mouse nibbled appearance of vocal cord TB
Wooly voice is associated with TB larynx
Reinke space is in True vocal cord
Reinke edema Diffuse polypoidal degeneration of vocal
cords
Reinkes edema is seen in Edges of vocal cord
Reinkes layer is seen in Vocal cord
Reflux laryngitis produce Ca larynx, subglottic stenosis, laryngitis
Laryngeal pseudosulcus is seen secondary to Laryngopharyngeal reflux

VOCAL CORD PARALYSIS

Position of vocal cord in cadaver Intermediate

Vocal cord is pale because of Absence of submucosa and no blood vessels
MC cause of vocal cord palsy Total thyroidectomy
MC cause of Unilateral vocal cord palsy Thyroid surgery
Left sided vocal cord palsy commonly due to Left hilar bronchial carcinoma
MC presentation of Unilateral Vocal cord palsy Hoarseness of voice
Right sided vocal cord palsy seen in Laryngeal carcinoma
10 year old boy hoarseness of voice, after diphtheria. Wait for spontaneous recovery of vocal cord
On examination right vocal cord palsy was paralyzed.
Treatment of choice
Treatment of unilateral vocal cord palsy Type I thyroplasty, teflon injection
Position of vocal cord in superior Cadaveric
laryngeal nerve palsy
Bilateral recurrent laryngeal nerve palsy caused by Thyroid surgery, thyroid malignancy, viral infection,

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cancer cervical esophagus, cervical lymphadenopathy

Cadaveric state of Vocal cord palsy Bilateral recurrent laryngeal nerve palsy
Paralysis of recurrent laryngeal nerve Common in left side
Manipulation around aorta results in Left recurrent laryngeal nerve palsy
Semons law applies to Recurrent laryngeal palsy
Partial recurrent laryngeal nerve palsy cause vocal cord Paramedian position
in
In complete bilateral palsy of recurrent laryngeal nerve Preservation of speech, severe stridor and dyspnoea
In bilateral abductor palsy, voice is Normal
NOT done in bilateral abductor paralysis Teflon paste
Vocal cord lesion dangerous to life Bilateral adductor paralysis???bilateral abductor palsy
Adductor palsy is mostly Functional
Bilateral abductor paralysis Vocal cord in paramedian position, stridor and
dyspnoea, vocal cord lateralisation done, normal voice
Respiratory obstruction associated with Vocal cord paralysis
Vocal cord palsy NOT associated with Vertebral secondaries
Glottic diameter 3 mm, laryngeal paralysis, treatment Teflon injection
NOT done
Type I thyroplasty is done for Unilateral vocal cord palsy
Type I thyroplasty Vocal cord medialisation
In type II thyroplasty vocal cord is Lateralised
Management of bilateral abductor palsy Lateralization
Management of bilateral abductor vocal Tracheostomy
cord palsy
Bloom Singer prosthesis for Bilateral vocal cord paralysis

DISEASES OF SPEECH

19 year old female, aphonia, B/L abductor paralysis Functional Aphonia

Functional aphonia Can cough, on laryngoscopy vocal cord is abducted
Functional aphonia common in Females
Habitual dysphonia Poor voice in normal environment, treatment is vocal
exercise and reassurance, whispering voice, quality of
voice is constant
Hoarseness of voice and low volume speech Dysphonia
In dysphonia plica ventricularis sound is produced by False vocal cords
Spasmodic dysphonia Affects muscles of larynx, botulinium toxin is the
standard treatment, multiple strings of botulinium A is
required for its treatment
Best treatment for spasmodic dysphonia Botulinium toxin
Feature of adductor spasmodic dysphonia Strained or strangled speech
Treatment of choice for abductor type of Botulinium A injection
spastic dysphonia
Gutzmanns Pressure Test Puberphonia
Gutzmann pressure is given Backward and downward
Young man whose voice is NOT broken Puberphonia
Androphonia can be corrected by doing Type 4 thyroplasty
Key hole appearance of Glottis Phonaesthenia

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Subligamental cordectomy classified as Grade II

Dynamic component in esophageal speech Pharyngoesophgeal segment

DISEASES OF LARYNX

Opening of Larynx in midline Laryngofissure

Scabbard trachea is seen in Thyroid cancer, Thyroiditis, Goiter
Fracture of cricoid cartilage leads to Laryngeal collapse
Treatment of choice for cricopharyngeal diverticula Myotomy with excision of sac

TUMORS OF LARYNX

MC benign lesion of vocal cord in Multiple papilloma

pediatric age group
Multiple papillomatosis
Recurrent laryngeal papillamatosis
Juvenile laryngeal papillomatosis
Laryngeal papilloma
NOT true about recurrent laryngeal papillomatosis
On laryngoscopy, multiple juvenile papillomatosis. Next
line
Treatment of multiple juvenile papillomatosis
Preferred treatment of verrucous carcinoma of larynx
Treatment of subglottic hemangioma
Treatment of Keratosis of Larynx
Laser used in laryngeal work
Premalignant
Caused by HPV 6 and 11, HPV 11 is more virulent,
transmitted to neonate through contact with mother
during vaginal delivery
Caused by HPV, tends to disappear after puberty,
interferon therapy is useful
Single, multiple, seen in children
HPV6 is more virulent than HPV 11
Microlaryngoscopy
Microlaryngoscopy
Endoscopic removal
Steroids, tracheostomy, carbon dioxide laser treatment
Laser vaporizer, stop smoking, stripping of vocal cord
CO2 laser

FEATURES OF CARCINOMA LARYNX

Familial tendency is NOT seen in Carcinoma larynx

Premalignant conditions for carcinoma larynx Leukoplakia, papilloma, chronic laryngitis, ketatosis of
larynx
Ackermann tumor Carcinoma of larynx
Laryngeal carcinoma Common in age over 40 years, after laryngectomy,
esophageal voice can be used,
Laryngeal carcinoma Glottis is common site, metastasize to cervical lymph
nodes, lesion seen at edge of vocal cord, laryngeal
compartment act as barrier
Laryngeal cancers are mostly Squamous cell carcinoma
Commonest of laryngeal malignancies Ca pyriform sinus
MC Site of Carcinoma Larynx Glottis
Broder classification for Carcinoma larynx
NOT true about laryngeal carcinoma poor prognosis, common in females

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OTORHINOLARYNGOLOGY

Medial border of pyriform fossa is formed Aryepiglottic fold

by
Carcinoma of which presents with nodes Hypopharynx
in neck
Feature of pyriform fossa Poor nerve supply
Lymphatic drainage of pyriform fossa Upper deep cervical nodes
MC site of Primary cancer which is silent Pyriform fossa
In malignant lesion of Pyriform sinus pain is referred to Vagus nerve
ipsilateral ear via
High tracheostomy results in Supraglottic growth
Supraglottic cancer Pain is common presentation, hot potato voice,
smoking is a common risk factor
Hot potato voice Supraglottic growth
Infraglottic carcinoma larynx Commonly spreads through mediatinal lymph nodes
Carcinoma commonly presenting with neck nodes Epiglottis
Chronic smoker, reddish area of mucosal irregularity Cessation of smoking, microlaryngeal surgery for
overlying a portion of both cords, management biopsy, regular follow up
Most radiosensitive tumor Ca glottis
Most common and earliest manifestation of carcinoma Hoarseness
glottis
Glottic cancer with fixed vocal cords T3
Cervical lymphadenopathy is NOT seen in Glottic cancer

DIAGNOSIS OF CARCINOMA LARYNX

Investigation for Ca Larynx Diagnostic Laryngoscopy

Investigation of choice for laryngeal cartilage MRI
involvement

MANAGEMENT OF CARCINOMA LARYNX

Treatment of carcinoma in situ of larynx Vocal cord stripping

Patient of ca larynx present with stridor to casualty Immediate tracheostomy
Treatment of mobile tumor of vocal cord Radiotherapy
Treatment of choice in Carcinoma in situ larynx Stripping
Treatment of ca larynx T1N0M0 External beam radiotherapy
Treatment of choice for stage I glottis cancer Radiotherapy
Treatment of stage I laryngeal cancer Radiotherapy
Treatment of T1N0M0 glottic carcinoma External beam radiography
Concomitant chemotherapy is NOT indicated in T2N0M0 glottic cancer
Treatment of stage I and II carcinoma Irradiation
larynx
Treatment of Stage T3NOMO Laryngeal carcinoma Only radiotherapy
Treatment of choice in stage III carcinoma larynx Surgery and radiation
Treatment of stage III carcinoma larynx Total laryngectomy
Treatment of stage IV carcinoma larynx Palliation
Laryngotomy means opening in Cricothyroid muscle

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 LARYNX 55
OTORHINOLARYNGOLOGY

Carcinoma larynx involvement of anterior commissure Laryngectomy and postoperative radiotherapy

and right vocal cord, developed perichondritis of
thyroid cartilage
Carcinoma larynx, left false vocal cords, left arytenoids,
left aryepiglottic fold, bilateral mobile true cords,
treatment of choice
Indications for vertical partial
laryngectomy
Contraindication for supraglottic laryngectomy
NOT an indication for near total thyroidectomy
Treatment of carcinoma larynx with fixed vocal cords
High Tracheostomy is indicated in
Procedure for carcinoma larynx
Highest risk of aspiration after
Horizontal partial laryngectomy
Glottic cancer recurring after radiation
therapy, glottis cancer extending to
involve the vocal process of arytenoids,
glottic cancer with involvement of
anterior commissure
Poor pulmonary reserve, tumor involving pyriform
sinus, vocal cord fixation, cricoid cartilage extension
Anterior commissure involvement
Total laryngectomy
Carcinoma Larynx
Ongs procedure
Supraglottic laryngectomy

TRACHEOSTOMY

Boundaries of Jacksons triangle Above by lower end of thyroid cartilage,

apex in suprasternal notch, sides by inner
edges of sternocleidomastoid
MC Indication of Tracheostomy historically Foreign body
MC Indication of Tracheostomy nowadays For assisted Ventilation
MC indication for tracheostomy Foreign body Aspiration
Indication of tracheostomy Flail chest, head injury, tetanus, foreign body
High tracheostomy is indicated in Carcinoma larynx
Tracheostomy is NOT indicated in Uncomplicated bronchial asthma
Tracheostomy is NOT indicated in Pneumothorax
Gold standard treatment for obstructive sleep apnea Permanent tracheostomy
syndrome
Gold standard treatment for obstructive sleep apnea Uvulopalatopharyngoplasy
syndrome
Tracheostomy is indicated in Tetanus in Cyanotic spells
Most Definite Management of Upper Airway Tracheostomy
Obstruction
Gold standard procedure for prevention of aspiration Tracheostomy
Mid tracheostomy 3-4th rings
nd th
Elective tracheostomy done at 2 to 4 tracheal ring
Fantonis technique Translaryngeal tracheostomy
Anatomical landmark for tracheostomy with regard to Isthumus of thyroid
high, mid low pressure
Cricoid hook Tracheostomy
Structure damaged during emergency tracheostomy Isthmus of thyroid gland, thyroid ima, inferior thyroid
vein
Damaged during emergency tracheostomy Isthmus of thyroid, Thyroid ima, Inferior thyroid vein
NOT damaged during emergency tracheostomy Inferior thyroid artery

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 LARYNX 56
OTORHINOLARYNGOLOGY

Seen after tracheostomy Decrease in dead space

MC Complication of Tracheostomy Hemorrhage (Anterior Jugular Vein)
Common complication of Tracheostomy Stenosis
Commonest complication of pediatric Pneumothorax
tracheostomy
Commonest problem in pediatric Weaning
tracheostomy
MC cause of Laryngeal Stenosis Endotracheal Intubation followed by Tracheostomy
In tracheostomised patient with portex tracheostomy Immediate removal of tracheostomy tube
tube, developed sudden complete blockage of tube.
next best step
Montogomery tube Silicon T tube
Tracheostomy tube 2 metallic tube, titanium silver alloy, cuffed tubes are
used for IPPV
Fullers tracheostomy tube Good for speech
Pediatric tracheostomy tube DO NOT have cuff

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