21-ENT

auditory pathway
1st-spiral ganglion(bipolar)→

in
2nd-dorsal,ventral cochlear nucleus→ cross to opposite side(in trapezoid body)→
3rd-sup olivary nucleus→ lat laminiscus→
4th-inf colliculus→ inf brachium→
5th-med geniculate body→ audit radiat→ sublentiform part internal capsule→ audit

s.
area temporal lobe

Auditory Brainstem Response Audiometry(ABRA)

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

displacusis-same tone heard as notes of diff pitch in either ear-inj to n to stapedius,

cong syphilis(Hennebert sign)
EAC exostosis-recur prolong cold H2O exposure
4a
hyperacusis-discomfort/pain on exposure to norm sound
otitic barotrauma-underH2O diving, descend in aircraft, compression in press
chamber
paracusis willisi-sound heard better in presence of background noise-otosclerosis
Tullio phenom-attack of vertigo/dizziness by loud sound-labyrinthine fistula
m

ds-TM
ASOM-presuppurative-cartwheel, suppurative-lighthouse
barotrauma-congested&retracted, air bubble, hgic effusion
healed myringitis bullosa-sagograin
hemotympanum, glue ear, glomus tm, hemangioma middle ear-blue
Ai

keratin deposit, osmium tetroxide-snakelike

myringitis bullosa(influenza virus)-hgic bleb
otosclerosis-norm(90%)-translucent&pearly gray, active ds-flamingo tint(pink spot)
retracted-dull lustreless
serous otitis media-dull, opaque, grey/bluish, potbelly
spontaneous heal-dimeric(sq epith–fibrous layer)
TB otitis media-camphor ice, multiple perforation
tympanosclerosis-chalky white plaque
 audiometry
audiometric 0=25db
conductive deafn(mild)≥40db
sensory(cochlea) deafn(severe)≥60db
neural(retrocochlear) deafn(very severe)≥80db
Carhart notch=2000Hz
noise induced trauma≥4000Hz

in
auditory fatigue≥90dB×4000Hz
WHO-noise exposure<85db×8h×5d
Indian fact Act-noise exposure<90db
discomfort≥120db
pain≥130db

s.
presbyacusis-HFHL
Meneire ds-LFHL
high freq audiometry-ototoxic drug-8000- 20000Hz
WHO

41-55-mod-norm speech
iim
0-25db-not signif-no difficulty
26-40-mild-faint speech

56-70-mod severe-loud speech

71-91-severe-shout/amplified speech
>91-profound-cant understand amplified speech
4a
natural resonance freq
ossicular chain=500-2000Hz
middle ear=800Hz
TM=800-1600Hz
EAC=3000Hz
greatest sensitivity of sound transmission= 500-3000Hz
m

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

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

tympanometry
A-norm
AS-otoSclerosis
AD-ossicular Disruption
B-Perforation
C-EustaChian tube dysfn

in
Flat-Fluid/glue ear

impedance audiometry=tympanometry+ stapedial reflex

rehabilitation of deaf

s.
hearing aid-RAM
Receiver
Amplifier
Microphone
CIC-Completely In Canal
BTE-Behind The Ear
ITE-In The Ear
iim
BAHA-Bone Anchored Hearing Aid(TES)
Titanium implant, Ext abutment, Sound processor
EAC stenosis, atresia, pus, anotia
cochlear implant(MSTR)-severe deaf
4a
Microphone(pick up acoustic signal)→ Speech process(sound→ electric energy)→
Transmitter→ Receiver(stimulator)
elecTrode-scala Tympani
multip channel>single channel implant
MC indication-Mondini dysplasia(cochlea= 1½turn)
C/i-MiChael dysplasia(absent cochlea)
lowest age=1y
m

ideal to avoid maldevelopm-6mth

Alexander dysplasia-basal turn of memb cochlea abs(high freq affect)

Bing Siebmann dysplasia-complete absent memb labyrinth
Ai

Sheibes dysplasia-absent memb cochlea, vestibule, bony part norm

lever action
malleus:stapes=1.3:1

TM reliable marker
uMbo>handle>cone of light
 spread of inf fr ear
fissure of Santorini-Soft part
fissure of Huschke-bony part

mastoid tip develop-2y

pinna develop adult size-6y

cong anomaly ear

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

s.
Darwin/auricular tubercle-thick helix(jn up⅓-mid⅓)
low set ear-cong low displaced pinna
macrotia-cong large pinna
MElotia-cong displaceMEnt pinna
iim
microtia-cong small pinna
Mozart-Mixing of antihelix&helix
polyotia-additional pinna
preauric sinus-1st arch anomaly
preauric tag-small appendage ant to pinna
scroll ear-rim(helix) roll forward,inward
Wildermuth-no helix
4a
fistula SCC—nystagmus
lateral-horizontal(towards normal ear)
superior-rotatory(towards normal ear)
posterior-vertical

abscess—site
m

Bezold-SCM sheath
Citelle-digastric triangle
DuboiS-thymuS(SyphiliS)
Gillete-retropharyngeal(b/n pharynx& prevertebral fascia)
Ai

Luc-temporal bone(roof of EAC)

parapharyngeal-parapharyngeal space
peritonsillar(quinsy)-tonsillar capsule& sup constrictor
PoLitzeri-Labyrinthitis
postauricular-behind pinna
WilD-subperiosteal mastoiD

mastoidectomy
 canal wall down-AACSOM+complication
RM
MRM
atticotomy
canal wall up-AACSOM–complication
cort mastoidectomy(Schwartz operation)
combin approach tympanoplasty

in
mulberry like
nasal polyP-rhinosPoridiosis
vocal corD-rhinosporiDiosis
nasal mucosa-inf turb hypertrophy
potato nose-rhinophyma

s.
Strawberry nose-Sarcoidosis
tapiR nose-Rhinosclerosis

Pure Tone Audiometry

Rt ear-Red
Lt ear-bLue
O-AC(unmask) rt
X-AC lt
[-BC(mask) rt
iim
]-BC lt
<-BC(mask) rt
4a
>-BC lt

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

sequele Bell palsy

crocodile tear/gustatory lacrimation-faulty regeneration parasympath fibre
synkinesis-cross innervation CNVII→ pt close eye→ twitch angle mouth
Ai

desc order freq-sinus

developm, ca, sinusitis-MEFS
mucocele, osteoma-FEMS
fungal ball-MSEF
orbital complication-EFMS

angiofibroma nose
Mx-earLy-WiLson transpalatal approach
 lAte-SArdAnA transpalatal sublab approach

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

supraglott-insp dyspnea+feeding difficulty

glottis-biphasic dyspnea+hoarseness

in
subglottis-biphasic dyspnea
trachbronch-exp dyspnea

phonaesthesia(weak voice)
m palsy-glottis shape on ILscopy

s.
thyroarytenoid-ellipse
interarytenoid-triangle
both-keyhole

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

m—position of VC—fn—n inj

add-median-phonation-RLN
add-paramed-whisper-RLN
4a
cadaver-intermed-circular-RLN,ILN
—-gentle abd-breathe-ILN
abd-complete abduct-full breath-ILN

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

u/l SLN-/|-hoarseness-w/w
b/l SLN-/\-aphonia,aspiration-tracheostomy→ epiglottoplasty

20-30y fem-otosclerosis
Ai

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

endoscope
90°-larynx
60°,30°(best)-nose
0°-ear
A→ P-Stamberger approach
 P→ A-Wigand approach
1st pass-Inf meatus
2nd pass-Sup meatus
3rd pass-Middle meatus

nasal mass
<2y-intracran mass-meningocele
2-10y-recur polyp-cyst, fibrosis

in
10-14y-AC polyp
14y mal-angiofibroma
20-40y-ethmoidal polyp
40-60y-inverted/Schneiderian/transitional cell papilloma(always u/l,
10-15%malign-SCC)

s.
>60y-SCC

American society sympt sinusitis

a/c<2w, c/c>12w, a/c on c/c=2-12w
iim
minor-halitosis, c/c fever, pain in body, headache, fatigue, cough
major-Anosmia, Blockage, Congestion, Discharge(purulent), fEver, Facial pain
M sinusitis-cheek, dental, swelling lower eyelid
LE sinusitis-root(radix), dorsum, upper eyelid
S sinusitis-retroorbital, occipital
F sinusitis-office headache, just above med canthus
4a
nasal douche=Na BBC(1:1:2), Bicarbonate, Biborate, Cl

focal lth objective lens

ear-200/250mm
nose/PNS-300mm
larynx-400mm
m

Lempert endaural incision-above tragus, incisura terminalis

Rosen incision(post wall EAC)-stapedectomy
Wild incision-classic postaural
Ai

Last struct to develop in pinna-Lobule

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

Prussac space
→ant pouch von Trolusch→ ant epitympanum
→post pouch von Trolusch→ post epitympanum
 ottic capsule
14centre of ossificat
1st appear-16w, last appear-20w

cholesteatoma
cong-IUL
prim-retraction pocket

in
sec-perforation
tert-iatrogenic

Eustach tube press diff>15mmHg

#Temp bone CNVII palsy-Transv

s.
total nasal sept destruction-Weg granulomatosis
enlarged vestibular aqueduct>2mm
during inspiration main airflow current-middle part cavity in middle meatus parabolic
curve

#temporal bone
iim
Longitudinal(80%)-CNVIIpalsy(20%) tympanic seg, less&delay, CSF otorrhoea+, Lat
skull trauma(parietal blow), conductive deafn, blding fr ear+, #line parallel to Long
axis petrous pyramid
transverse(20%)-CNVIIpalsy(50%) labyrinthine seg, immediate, frontooccipital
trauma, vertigo severe, #line across petrous
4a
c/c hypertrophic candidiasis/candidial leukoplakia
white patch oral cavity, not wipe off
ant buccal mucosa, post to angle of mouth
Rx-excision

tonsillectomy
m

torrential bld-paratonsillar v

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

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

electrolyte—endolymph—perilymph
Na-3-140
K-144-10
prot-126-(200-400)
 glu-(10-40)-(85)
produced by-stria vascularis-capillary of spinal lig

incis ant to SCM-parapharyng abscess

incis post to SCM-retropharyng absces

UPSIT(University of Pennysylvania Smell Inventory)-olfactory power

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

s.
Riedel meth

classific-ds
Antoni-vestib schwannoma

Austin Kartush classific

A-M,S+,I–
B-M,foot plate S+
C-M–,S+
iim
D-M,S suprastruct–
E-S fixation
4a
F-ossicul head Fixation
O-intact Ossicul chain

Austin MOOre-Ossicular lOss

Chandler-orbital complication, E sinusitis
COhN-CONg laryng web
COttoN Myer, McCaffey-CONg laryng stenosis
m

Devlaki-cong cholesteatoma

European Laryngological Society-Endoscopic Cordectomy(ELSCEC)(SSTTCAVS)

I-Subepithelial
Ai

II-Subligamental
III-Transmuscular
IV-Total
IVa-C/l fold
IVb-Arytenoid
IVc-Ventricular fold
IVd-Subglottis
 Fisch, GLasscock Jackson-GLomus tm
Ford-sulcus vocalis

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

in
Lederman, Ohgren-ca max

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

s.
III-line through orbit-craniofacial dysjn

Levanson-malign otitis externa

NelSOn-CSOM

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

SAde-pars tenSA
I-slight retracted TM
II-retracted TM touch incus/stapes
4a
III-TM touch promontary
IV-TM adherent to promontary

Shea-Meneire ds

Issihika-thyroplasty(MLSL)
I-Medialise vocal cord-u/l VC palsy
m

II-Lateralis VC(thy cartilage split ant)

III-Shortening&relaxing to ↓pitch
IV-Lengthening&tensing to ↑pitch
pitch-fem-↑, mal-↓
Ai

Tos-pars flaccida(T not t)

I-pars flaccida dimple
II-retraction pocket is adherent to handle of malleus
III-erosion of outer attic wall
IV-severe erosion of outer attic wall

Wullstein-tympanoplasty
 temporalis fascia, perichondrium, periosteum, alloderm
transcanal>postaural,endaural
1(myringopexy)-graft on malleus
2(myringoincudopexy)-malleus absent, graft over incus
3(columella/myringostapediopexy, bird like)-malleus,incus absent, graft on
stapes-Partial Ossicular Replacem Prosthesis(PORP)
4-malleus,incus,stapes absent, graft on round window-TORP
5-fenestration procedure

in
instrument
Dunda grant apparatus-cold caloric test

electrolarynx

s.
Blom Singer tracheoesoph prosthesis
handfree electrolarynx

head mirror

Menitt device

Siegel speculum
iim
concave mirror, focal lth=25cm, diam=89mm, hole=19mm

silastic button
4a
2cm nasal perforat

silastic keel

Walsham forceps-#nasal bone

Abbreviations
m

a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune

bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
Ai

d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis

E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
 P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year

in
#-fracture
°-degree

THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP
TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE

s.
HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.

iim
4a
m
Ai