Monday, 2 December 2013


1.Ranula: cystic swelling ofsublingual gland .Rx. Marsupialisation
2.Vincet’s angina /trench mouth /necrotizing gingio-tonsillitis :
Etiology : Borellia vincentiFusobacillus
DOC: metronidazole + penicillin
3.MC cause of membrane formation in throat : streptococcal tonsillitis
2nd MC is Diptheria.
4.Interval tonsillectomy: done for Quincy.
5.Quincy : peritonsillar abbesses. Pus between capsule of tonsil , superior Constrictor muscle.Also known as Hot potato condition. Tonsil is pushed anteromedially.Uvula is pushed on opposite side
Rx. 1. Short antibiotics
2. after 24-48 hrs – dranaige
3. after 6 wks – tonsillectomy
6.MC indication of tonsillectomy : Recurrent tonsillitis
7.Position during tonsillectomy : Rose position
8.Main complication of tonsillectomy : Bleeding
9.Primary bleeding is: bleeding during Sx.Most common source of primary bleeding is : paratonsillar vein or
tonsillar plexus. Second most common : Tonsillar branch of facial never.
10.Reactionary bleeding : bleeding within first and second hour after Sx.
11.Secondary bleeding : due to infection after 24 hrs .MC : 5-8 days after Sx.
12.Bleeding : immediate ligation under GA.
13.Main artery of tonsil : tonisllar branch of facial nerve.
14. MC indication for traceostomy is : Ca. larynx
15. MC site for tracheostomy is : T2,T3
16. Tracjeostomy damages :
a) ishmus of thyroid
b)Ant. Thyroid vein
c)Inf. Thyroid vein
d)Thyroida ima Artery
17. MC source of bleeding during tracheostomy : Ant. Throid vein
18. MC complication of tracheostomy : tracheal stenosis
19. Gold statndard t/t for Tracheal stenosis is : Removal of stenosed part of trachea +end to end anastomosis.
20. MC site for laryngeal Ca. : Glottis
21. MC type of laryngeal CA: sq. cell ca
22. First symptom of laryngeal ca. : hoarseness of voice
23. T/t of laryngeal Ca. : stage 1st+2nd is : radiotheraoy (Excellent result)If it is a Glottis Ca as Glottis doesn't have any lymphatics
Stage 3rd +4th : Sx. + radiotherapy
24. Disadvantages of total laryngectomy:
a)Complete loss of voice
b)Permanent tracheostomy
c)Thyroidectomy + parathyroidectomy
d)Hormonal supplementation for whole life.
25. MC laryngeal tumor in children : juvenile papilloma of larynx.
26. MC laryngeal tumor in adults: Laryngeal Ca.
27. Mandatory Dx. Of laryngeal papilloma by : brochoscopic examination / microlaryngoscopic
28. Laryngeal papilloma: premalignant condition. t/t : CO2 laser excision.
30. Vocal cord nodule/ singer’s nodule: junction of ant 1/3 and post. 2/3rd fibrotic , due to chronic misuse of voice , B/L . T/t: voice rest followed by speech therapy (sometimes Sx)
Vocal cord polyp: anywhere in ant. 2/3rd of vocal cord U/L.
T/t. of choice is microlaryngeal Sx.
Followed by S. therapy
31. Causes of hypernasality :
a)Cleft palate
b)Soft plalate palsy
c)Oro antral fistula
d)After adenoidectomy
e)Velo-phyryngeal insufficiency
32. Phonaesthenia: laryngeal muscles get tired faster . inter arytenoids thyroarytenoid
Laryngoscopic findings: key hole glottis
33. Puberphonia: fast voice.Male having female like voice T/t. type 3rd thyroplasty (shortening)
34. Androphonia: female having malelike voice
T/t. type 4th thyroplasty(lengthening)
35. Spasmodic dyphonia: neurologic disease
Destortion of voice
T/. botox injection into laryngeal
Recurrent laryngeal nerve resection
36. Dysphonia plica ventrivularis: voice production by false vocal cord
T/t. speech therapy
37. Rhinolalia Aperta: hyper nasality
38. Rhinolalia clausa: hypo nasality
39. Type 1st thyroplasty : medialisation for adductor palsy
40. Type 2nd thyroplasty :lateralization for abductor palsy
41. MC nerve damaged during thyroidectomy: external laryngeal n.branch of sup. Laryngeal n.
42. Mc cause of vocal cord palsy : idiopathic
2nd mc cause : thyroidectomy
43. MC cause of recurrent laryngeal N palsy : Bronchial ca. (smoking)
44. External laryngeal N palsy: cricothyroid affected . unable to raise pitch of voice
45. RLNP : all muscles affected except cricothyroid so no abduction and adduction
Position of vocal cord: aramedical /cadaveric
46. Adductor palsy: No respiration obstruction
Voice disorder : severe in B/L
Severe complication is : Aspiration
47.Adductor palsy: respiration difficulty.More severe respiration stidor in B/L palsy
48. TB larynx : affects post. 1/3rd of larynx.Turban epiglottis
Mouse nibble appearance.Cobble stone
49. Acute epiglottitis : cherry red epiglottis
MC presentation: high grade fever
Etiology: H. infuenzae (2-7days)
Stridor +dysphagia + hoarseness
Child prefers to sitdown in tripod position
X-ray : thumb sign
DOC: ampicillin or cephalosporins
50.MC congenital disorder of larynx : laryngomalacia
Very soft cartilage.Stridor only during inspiration.Increased loudness of stidor : feeding ,crying. Decreased in : pronation
Laryngposcope findings : omega shaped epiglottic
T/t. reassurance by 2 yrs childbecome normal
51. Males: low pitched voice , length of vocal cord 24-25mm
52. Females: high pitch voice
Length of vocal cord is : 16-17mm
53. Tensor of larynx : cricothyroid (Ext. LN )
To raise pitch of voice
54. Only abductor of vocal cord : post. Cricoarytenoid
55. Adduction of VC: lat.Cricoarytenoid , inter arytenoids, thyro-arytenoid , cricothyroid (weak
56. Nerve for voice production : recurrent laryngeal N (Adduction +abduction)
57. Laryngeal cartilage : unpaired : cricoids , throid, and epiglottis
Paired : arytenoid, cuneiform, corniculate
58. Adult larynx: C3-C6 narrowest part : Glottis
Infantile : C2-C3: subglottis
59. Glottis: can produce voice . No lymphatics , lined by sq. epi , rest of larynx dosent have Sq. epithelium.
Deep to glottis: Reinke’s space
61. MC site for nasopharyngeal Ca.: EBV
Fossa of Rosenmuller
MC type: undifferentiated Sq. cell ca
MC presentation: cervical lymphodenopathy
Trotter’s triad: soft palate palsy, facial pain , hearing loss
T/t Radiotherapy
62. Angiofibroma: Benign tumor (juvenile age group)
MC site: sphenopalatine foramen/ nasopharyngeal
MC C/F : Recurrent nasal bleeding.
63. CT scan findings of angiofibroma : antral sign / Halmann miller sign
Hondurus sign
64. Ringertz tumor: inverted papilloma
From lateral wall of nose.
Sx. Medical maxillectomy
65. Myiasis / maggot’s: larva of chrysomia
T/t. 10% diluted chroloform
66. MC site for madibular block : Subcondylar / neck of condyle
67. Block of floor of orbit: Blow out block
Floor+ medical wall of orbit
X-ray findings : Tear drop sign
68. Maxillary block: Le forte 1st : Transverse
Le forte 2nd : pyramidal
Le forte 3rd : craniofacial
69. Block of zygoma : tripod block
70. Septal block :
a)cherellet : vertical
b)Jarjaway: horizontal
71. MC block of bone : nasal bone
72. Rhinosporidiosis: due to seeberi
MC presentation : strawberry/
mulberry polyp
Bleeding polyp
DOC : Depsone
T/t. : cautery excision
73. Rhinoscleroma : klebsiealla rhinoscleromatis
Also known as woody nose (seen in north india)
Dx. Biopsy findings : Milulitz cells
Russel bodies
DOC: streptomycin _+ tetracyclin
T/t. of choice : Excision
74. Rhinophyma: potato NOSE Sebaceous gland hypertrophy
75. Rhinolith : old calcified FB in nose
FB of nose mc present as : U/L discharge in a child and bleeding and faul smell.
76. Maxillary polyps: antrochoanal polyp, unilateral , due to infection NL recurrent
77. Ethomoidal polyp : B/L, due to allergy, A bunch of grapes .
78. MC cause of spur: trauma during birth
79. Main complication of DNS : sinusitis
80. DNS : compensatory hypertrophy of inf. Turbinate , obstruction on opposite side
Due to ant. Ethomidal N involvement
T/t. SMR / septoplasty (most commonly done) done after 16 years of age
81. MC complication of SMR: septal perforation / Saddle nose
82. Atrophic rhinitis : Klebsiealla ozaena
MC in young females : decreased estrogen
Merciful Anosmia
Rx. 1) Alakaline nasal douche
a)Sodium bicarbonate
B)Sodium barborate
c)Sodium chloride
These are component of nasal solution.
2) Young’s operation .
83. MC X-ray from sinusitis : water’s view. Also known as submento occipital with mouth opening
84. Sinusitis Sx. : antral wash : puncture /fistula in inf. Meatus
85. MC viral rhinitis :Due to rhino virus.
86. Vasomotor Rhinitis : parasympatic activity> sym.
Boggy turbinates due to pooling of blood.
87. MC allergen for Allergic Rhinitis: House dust / Dermatophycocyte
88. MC site for nasal bleed in HTN patients: Little’s area (Kissel banch’s plexus)
89. MC site for nose bleeding in elderly : HTN
90. Mc site for nose bleed : pricking / Digital trauma
91. MC cause of oroantral fistula : removal of 1st molar
92. Largest sinus: maxillary /antrum of hignmoon
Volume : 15 CC
93. 1st sinus to develop : maxillary sinus
Starts at 10th wks of IUL.
94. Last sinus to develop : frontal , after birth
95. 2 openings in nasolacrimal duct:
a) ET( small opening)
b) Sphenopalatine foramen
(sphenopalatine arch)
96. Inf. Meatus : nasolacrimal duct opening
97. Middle meatus :
a) Ant. Ethomoidal sinus
b)Maxiallary sinus
c) Frontal sinus
98. Supreme meatus / sphenoethimoidal recess: sphenoid sinus
99. Kiessel bach’s plexus:
2.greater palatine A
3.sup. labial A: from external carotid artery
4. Ant. Ethmoidal A: from int. carotid A
100. Bones of nasal septum :
1) vomer
2) Plate of ethmoid
3)Crest of maxilla
4) Crest of palate
5) Rostrum of sphenoid
101. Middle layer of septum : most important Bones+ cartilage : mucoperichondri
um on either sides
102. Choanal atresia : persisting bucconasal memb/ emergency situation
T/t. intubation : tailed
MC Groven’s technique
103. Accoustic neuroma /vestibular schwannoma: Schwann cell tumor of sup. Vestibular N.
MC site : cerebello –pontine N.
MC involved N : trigeminal /5th N.
2nd MC facial N
Capsulated , slow growing , benign U/ L
MC in neurofibromatosis : B/L Earlest symptom : hearling loss (8th N )
Mc presentation : loss of corneal
reflex (5th N)
7th N : histex berger’s sign: anesthesia in canal
Dx: Gadolinium MRI
Reterocochlear : BERA
T/t. Gamma –knife radio Sx.
104. Meniere’s disease: inner ear disease
Membranous labrynth / saccus endolyphaticus
Increased endolymph
In middle aged males , U/L
Autosomal dominant
C/F: fluctuating tinnitus
Fluctuation hearling loss
Episodic vertigo
Diplacussis : pts hears two sounds in one ear at the same time
Glycerol test: diagnostic
Osmotic dieresis : symptoms decreases pts feel better or normal
Most sensitive test : electrochochleography
T/t. no tea . coffee . tobacco , less salt , less fluid
Anti vertigo : beta histidine , antiemetics ,
Steroids + diuretics :HL , tinnitus
Sx. Intra tympanic gentamycin
Through round window of inner ear
Chemical vestibulectomy
Vestibular N. resection
Part mann’s , Cody n Fick labrynthectomy
105. MC site for Glomus tumor : Nail bed
106. MC tumor of middle ear : Glomus tumor
Glomus tumor : juglar V Glomus
jugulave : noncapsulated , slow growing , benign, U/L
C/F : pulsatile tinnitus +CHL
Rising sun sign
Brown sings
Phlep’s sign
Dx. Of choice : contrast enhanced CT T/t. Sx.
107. MC cause of rejection of conventional hearing aids: Noise intolerance
108. Bone anchoring hearing aids (BAHA): for small child
109. Contralateral routing of singnals (CROS): sever SNHL of one side
110. Cochlear implant : speech processor
Transduction vibration to electrical energy . electrodes are inserted into scala tympani of chochlea through
round window.
111. Stapedectomy: for passive otosclerosis
112. Otosclerosis : fibrosis of ear (Disaease of bony labyrinth)
MC site : fistula ante fenestrum (Ant to oval window)
Main presentation : CHL
Young female : 30 yrs
During preg . severity increased
1. Schwartz sign : TM fleminmgo pink : only active side
2. Paracusis willi’s sign : pts hear better in noisy environment.
3. Cohart’s notch : sudden deep at 2000 Hz in audiogram . seen in only B, C audiogram . disappear after Sx.
DX. of choice : tympanometry : As
T/t. NaF : only in active stage
C/I in passive stage
Stapedectomy : passive stage , hearing Aids
113. Vestibular fun test / caloric test / Bithermal caloric test :
Warm: 44*c , cold 30*c
Tep. Of water used : 37 plus minus 4*C
Lateral semicircular canal / horizontal canal is stimulated
Cold water : opposite side nystagmus
Hot water : same side nystagmus
114. Brain stem evoked response audiometgry (BERA):
1. Hearing loss in a newborn : best investigation
2. Differentiates cochlear diseases from retrocochlear disease.
115. Tympanometry/ Impidance audiometry:
Compliance of middle ear
1. A : normal
2. As : otosclerosis
3. Ad : dissrupton of ossicles
4. B: ASOM + glue ear
5. C: glue ear
116. Pure tone audiometry : (PTO) threshold of hearing
Normal threshold of human ear : 0-20 dB
225 dB : Hearing loss
False (-)Rinne’s : Dead ear
117. Right : left
Sever lateral SNHL (Dead ear )
118. Right : left
Lateral CHL
119. Rienne’s test :
AC> BC -> +ve normal , SNHL
BC> AC -> -ve CHL
120. Weber’s test :
Centralised normal
Lateralised abnormal
CHL weber’s goes to CHL
SNHL always lateralised to opposite side which is normal Ear
MC tuning fork frequency : 512 HZ.
121. Main indications for simple mastoidectomy : mastoiditis
122. Landmark of mastoid antrum : Mc Even’s triangle / suprameatal triangle
123. Radial mastoidectomy: Exteriorisation: middle ear cleft+ ext. auditory canal converted into single
cavity. Only structure which Not removed : footplate of stapes
124. Tympanoplasty : myringoplasty + ossiculoplasty
Type 3rd : columella
Only one ossicle left behind in middle ear : stapes (MC)
125.Type 4th : fenestration
A whole or fistula is made on lateral sac canal.
126. Myringoplasty: MC used graft Temporalis fasica . its done for central perforation.
127. Myryingotomy plus minus Grommet : Main complication is permanent fistula / perforation
128. 3 perforations in TM: central ,attic and marginal
129.Steroid resistant facial N palsy: never decompression / Electoneuronography
130.MC cause of facial N palsy: idiopathic (Bell’s palsy)
131. Petrositis : extracranial complication of CSOM
Gradeningo’s syndrome : 3 Ds
1. Ear discharge
2. Retro orbital / deep seated pain
due to 5th N
3. Diolopia : due to 6th N
132. MC damaged ossicle by CSOM : Incus
133. Labrinthine fistula : seen in lateral SCC
Vertigo , fistula sign +ve
134. MC intracranial complication of CSOM: tempral lobe /cerebral abscess
135. Mc cause of brain abscess : CSOM
136. Cholesteotoma : a sac of keratinized Sq. epithelium
MC site: prussic’s space in attic postero sup. Quadrant of TM.
137. CSOM: pseudomonas Middle ear cleft infection > 3 months
1. Tubotympanic
Increased Discharge
No smell
Peforation central
Pale polyp
No cholesteotoma
Less complications
2. Attico-antral
Less discharge
Foul smelling
Marginal /attic
Red polyp
+ve cholesteotoma
More complication
Spread through blood vessles infects bones
138. Glue ear/ serous ottis media: Mc in children
Mc cause of hearling loss in child is glue ear
Child with glue ear : adenoid hypertrophy
Adult with glue ear : Ca of nasopharynx
MC complication: hearling loss
Findings : Retracted TM
Dull/ Bluish TM
Reduced mobility of TM
Fluid and air bubble are seen
Myringotomy +grommet+adenoidectomy
Done on antero-inf. Quadrant
139.ASOM: myringotomy is T/t of choice
Done in post. Inf. Quadrant of TM
140. ASOM: suppuration : rupture of TM
Discharge is always pulsatile. Perforation of TM: antero- inf. Quadrant
141. ASOM: pre suppuration
Bulging TM
Red or congested
Cart wheel appearance
Fluid lever is seen
142. ET in children : smaller wider straight
Infection of middle ear more in children
143. Middle ear infection is primary to: Nasopharynx
144. Masoiditis : MC in children U/L
Group A and B hemolytic streptococci
Pain + hearing loss
Tragal sign(-ve)
Pinna pushed ant. Inferiorly
Cymba concha : tender point
Mastoid is ironed out : smooth warm
X-ray: clouded mastoid
T/t. of choice is simple
145. Tip of mastoid : muscles attached
1. SCM
2. Digatric
146. MC abscess : post aural abscess 2nd MC : Bezold’s in SCM
147. Diagastric abscess : citelli’s abscess
148. Post –aural : luc’s abscess
Symptoms : canal wall is sagging
149. Maliagnant otitis externa: pseudomonas infection of bony canal
Elderly DM pat.
Osteomyellitis of canal, fast spread
Multiple craninal N. palsy
MC involved N: facial N
Other N. 9,10,11,12
Dx. Of choice is CT scan
150. Furunculosis : follicullitis (Hair follicle )
Cartilage part of canal
S. aureus
Severe pain in canal
Most imp. Early feature:Tragul sign +ve
Pinna pushed laterally
Retro-auricular sulcus obliterated
T/t. icthymol glycerol
151. Bullous myringitis : H’gic bullae
Myringitis H’gic : influenza virus
152. Herpes otitis externa : pain +HL No facial N palsy
153. Ramsay hunt syndrome : Herpes otitis externa + facial N. palsy
T/t. Acyclovir 800 mg/ 5times a day
Steroids for palsy
154. Fungal otitis externa :
MC: Aspergillus niger
Main problem : itching
Multiple dark spots (spores ) in canal
155. Hematoma of pinna: cauliflower Ear
Due to trauma MC in boxers
156. Perchondritis :pseudomonas
157. Artery of labyrinth : labyrinth artery
A branch of ant inf. Cerebeller artery.
158. Vestibule: Balancing organ
Saccule : macula
Urticle : macula
Semicircular canal : crista ampullaris
159. Linear Acceleration(unidirectional ) : saccule + utricle
160. Circular acceleration(multidimensional ): 3 semicircullar canals
161. SC canal: sup. , post, and lateral / horizontal
162. Cochlea: hearing
Snail shaped : 2 and half coils
Bony cochlea is longer than memb
Scala vestibule : perilymph
Scala medica : endolymph
Scala tympani: perilymph
Base : higher freq.
Apex : lower freq.
Main sensory organ of hearing : organ
of corti (in scala media )
Normal human ear hearing freq. is 20
- 20000 Hz.
163. Inner hair cells : 3500, in single row , less delicate , less sensitive
164. Outer hair cells : 12000-13000 , multiple rows , more delicate .Noise induced hearling loss can damage
165. Inner ear: labyrinth
M.L. : hearing + balancing :Endolymph
B.L.: otic capsule : perilymph
Perilymph : ECF/Na+
Endolymph: ICF/k+
Produced by stria vascullaris
166. Antrum in mastoid : depth
Newborn : 2 mm deep
Adult : 12-15 mm deep
167. Largest mastoid air cell : antrum
168. Nerves of middle ear: glossopharyngeal , supplies middle ear
Jacobson’s N : branch of 9th N enters in middle ear , spreads Tympanic plexus
169. Facial N dosent supply middle ear except : stapedius
170. Facial N : lacrimal +submandibular+sublingual
171. Chorda tympani: most imp branch of facial N
Ant. 2/3rd of tongue
Submadibular +sublingual gland
172. Stapedial reflex : Dampening
Afferent : 8th N : ear to brain
Efferent : 7th N brain to ear
Sound between 70-100 dB will produce in stapedial reflex.
173. Facial N trauma , proxiamal /before to geniculate ganglion : Dryness of eye
174. Facial N traum distal to geniculate ganglion : no dryness of eye
1st branch of facial N
Arises from geniculate ganglion
GPSN: vidien N. all glands above palate (Nose , sinuses and lacrimal gland )
176. Fallopian canal : facial N canal in middle ear
3 branches :
2. Nerve to stapedius
3. Corda tympani
177. Main function of middle ear: amplification of sound / impedense matching (17-18 times)
178. Stapedius : origin : pyramid of post. Wall
Insertion : stapes
Nerve : branch from 7th nerve
Funtions: dampens sound (decrease loudness)
179. Middle ear: Roof: tegen tympani 
Juglar vein runs just below the floor of middle ear
Length of ET: 36 mm
Outher 1/3rd Bony
Inner 2/3rd carilagenous
Maintain the pressure of middle ear
Drain the secretion of middle ear
Barotrauma : deep sea diving
Tensor veli palatine
Levator palatti
These two muscles open ET during swallowing , yawning
180. Tensor tympanii: from ant. Wall of canal
Inserts on handle of maleus
Nerve : mandibular N
Tenses the TM
181. Medical wall of middle ear : promomtory : due to base of cochlea
182. Round window : covered by secondary TM
183. Facial N : comes out through stulomestoid foramen of post wall of middle ear.
Pinna : ATN, Greater auricular , lesser occipital
Meatus ATN, Arnold’s N, facial N
Tm: ATN, Arnold’s N , tympanic plexus
ATN: branch of mandibular : trigeminal N
Arnorld’s N : Branch of vagus , does not supply the pinna.
185. Biggest part of TM : cone of lioght (ant . inf . quadrant )
186. Umbo : positions : Rt side 5 o’clock
Lt side : 7 o’clock
187. Landmarks of TM: umbo/ handle of maleus
188. From outside in TM : MIS (maleus, incus, stapeus)
189. Pars flaccida (TM): Sharpnell’s memb.
190. Pars tensa (TM): vibrates more Effective area: 45-55mm
191. TM: thickness :0.1mm
Oval shaped , pearly white
Total area of TM : 80-90mm2
192. Ear wax: collection of cerumin in canal
Wax formation : mc after ear Sx
MC procedure to remove ear wax is : syringing of canal
Most dangerous method is : probe
193. Outer 1/3rd of canal : cartilaginous , hair follicles
Sebaceous gland : cerumin
194. Narrowest part of canal : Isthmus 6mm before TM
195. Inner 2/3rd of meatus : Bony Length of meatus :24mm in adults
Inner 2/3rd : bony: 16mm
Outer 1/3rd cartilaginous : 8mm
196. Pinna : elastic cartilage
Except : lobule , incicura terminalis.
197. Pinna / auricle : Develops from fusion of 1st and 2nd brachial arch
198. Incomplete fusion: preauricular sinus it’s a developmental anomaly Pus coming out of it
Dx. Sinogram
T/t. surgical excision

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