Professional Documents
Culture Documents
1. OTOLOGY
Common symptoms
i. Otalgia
ii. Hearing loss
iii. Tinnitus
iv. vertigo
v. Ear discharge/ otorrhea – mucoid/ purulent/ mucopurulent/
watery
Common diseases
i. ME diseases; Chronic suppurative otitis media with/out
cholesteatoma
ii. Diseases of the outer ear
iii. Inner ear diseases
Common emergency
i. ASOM
ii. Acute mastoiditis/ mastoid abscess
iii. Acute Vertigo
iv. Sudden hearing loss
v. Ear & temporal bone trauma
Common OT procedure
i. Myringotomy
ii. Myringoplasty
iii. Mastoidectomy (cortical/ radical/ Modified radical)
OTITIS EXTERNAL
-definition:
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-clasification:
Otitis external
acute chronic
Malignant type
Swimmer’s ear
Ear trauma/ water exposure
Sx: otalgia, pruritus, scanty otorrhea – tender, edema
Pseudomonas sp & staph.aureus
Tx: local heating, toileting, Ichthamol glycerine (Ig) wick, topical &
systemic antibiotics
OTOMYCOSIS:
Contributing factors: moisture, high temperature, hygiene, body immunity
Sx: pruritus & otalgia --- fungal mycelia
Organism: aspergillus sp, candida
Tx: toileting, topical anti-fungal
EXOSTOSIS
Benign periosteal outgrowths occur in the bony canal
Multiple exposure to cold water
Bilateral & multiple, near to the annulus
OSTEOMA
Single, unilateral
At bony-cartilaginous jx.
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DISEASES OF THE MIDDLE EAR
1) Acute suppurative otitis media (ASOM)
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c. Blood borne
Pre-disposing factors
d. URTI
e. Tonsillitis/ adenoiditis
f. Sinusitis
g. Nasal packing
Bacteriology; strep pneumoniae/ HI/ Moraxella catarrhalis
Pathophysiology: 4 stages
h. Tubal occlusion
i. Pre-suppurative
j. Suppurative
k. Resolution/ complication
Treatment
l. Antibiotic
m. Topical nasal decongestant
n. Oral decongestant
o. Antipyrexia/ pain-reliever
p. Myringotomy
OTITIS MEDIA
ACUTE
CHRONIC
<3/52
>6/52
ACTIVE INACTIVE
OME/MEE/ serous
OM
+CHOLESTEATOMA
-CHOLESTEATOMA
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Cholesteatoma
Primary acquired
o ET obstruction – retraction pocket at attic/ posteriorsuperior marginal
o Impaired migration
o Accumulated debris – cholesteatoma formation
o Other theory – papillary ingrowth of epit.thru its own Basement
Membrane
Secondary acquired
o Migration theory
o Metaplasia theory
Tertiary acquired
Dx – “pearly” mass in ME/ mastoid, non-resolving CSOM. Higher suspicion if;
o Scanty d/c but foul-smelly
o Marginal perforation of TM (attico-antral)
o Polyps/ granulation tissue dt low-grade osteitis
o A/w deafness
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Complications- ossicular chain disuption, unresolved CSOM, labyrinthine fistula,
FN paralysis, intracranial Cx.
Intracranial Cx
o X’tradural/ subdural/ brain abscess
o Lateral sinus thrombosis
o Meningitis
o Otitic hydrocephalus
Intratemporal Cx
o FN palsy
o Labyrinthitis
o Labyrinthine fistula
o Acute mastoiditis
o Subperiosteal Abscess
o Postauricular fistula
o Petrous apicitis
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Local Sx: Nominal aphasia, quandratic homonymus hemianopia, epileptic fits,
contralateral hemipheresis, oculomotor nerve invx, visual hallucination,
Otitic hydrocephalus
Labyrinthine fistula
Petrous apicitis
2 ways spread of infx: posterosup route around the semicircular canal &
anteroinf.route from hypotymp, peritubal air-cells.
Gradenigo sign – close anatomy to V & VI nerves
Dx: clinical & CT
Labyrinthitis
3) SEROUS OM/MEE
Fluid in the ME
Sequelae of Acute OM/ Eusthac.Tube Dysfx
Sx: aural fullness, discomfort, hearing loss, tinnitus
Dx: clinical, Tuning fork exam, toynbee’s maneuver, tympanometry
Tx: observation, topical decongestant, nasal steroid, ventilation tube
OTOSCLEROSIS (OTOSPONGIOSIS)
Abn resorption & deposition of bone in all three layers of the otic capsule
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AD trait
Most common site is at oval window (fissula ante fenestrum), 2nd most is at round
window causing fixation of the stapes to the oval window.
Clinical presentation: hearing loss most commonly CHL, paracusis willisii,
tinnitus, vertigo, Schwartze’s sign.
HL – unilateral/ bilateral, rapidly worsening during pregnancy.
DX: clinical & Audiometric assessment: tuning fork exam, PTA, Cahart notch,
tympanometri,
TINNITUS
Def: sound arising in the head/ auditory hallucination
Most intermittent & short duration
One of the ear sx. Character: uni/bilateral/ onset/ duration/ constant/ intermittent/
pitch etc
Any associated symptoms.
Problems arising from this sx
- ?underlying pathologic condition
- debilitating
Prevalent study: 32% of adult: at sometime in their lives; 6% debilitating
Pathogenesis: theories
- excitation of one nerve by neighboring nerve leading to synchronization
- spont.excess influx of potassium & calcium into sensory hair cells causing
a synchronization.
classification
tinnitus
Pulsatile/vascular Non-pulsatile/vascular
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extracranial arterial diseases muscular
intratemporal arterial anomalies cochlear disorders
arteriovenous malformations noise-induced
(AVM) TBF
Meniere’s
increased intracranial pressure Presbycusis
glomus tumor SSNHL
venous anomalies ototoxicity
hyperdynamic circulations middle ear pathology
EAC pathology
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iv. Functional endoscopic sinus surgery
Rhinitis
rhinitis
allergy Non-allergy
Intrinsic/vasomotor
Seasonal Perennial Other causes
rhinitis
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ALLERGIC RHINITIS
Definition
Predominates in younger age group esp.first 2 decades of life (15-45 y/o)
Most common form of rhinitis
Tendency for self-limiting, decreasing/cease with age
Classification
Seasonal- intermittent/ acute/ occasional
Perennial- persistent/ chronic/ long duration
Mechanism of AR
Type I HSS- Ig-E mediated
o Inflammatory cell infiltration
Primary & secondary exposure
Preformed & newly synthesized mediators
Early-phase & late-phase reaction
Perform mediators
Histamine
Chemotactic factors – ECF, NCF
Newly-synthesized
Leukotriens
Prostaglandins
PAF
Cytokines – TNF, IL
Triggers of A/R
Indoors aero-allergens- HDM, animal dander, fungal spores
Outdoors aero-allergens- pollens, fungal spores
Indoor pollutant & outdoor pollutants, haze
Aspirin & NSAID
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latex
Symptoms & signs
Co-morbidities
Asthma- 40-50% * rhinitis in Asthmatic is >75%
Allergic conjunctivitis
Sinusitis
Eczema
Otitis media
Diagnosing AR
Detail personal & Family history + nasal examination
Allergic skin test: skin prick test/ Scratch test/ Intradermal dilution test
Measurement of specific Ig-E antibody
Nasal provocation/ challenge test
Imaging – not usually necessary
Management
Avoidance and education
pharmacotherapy
specific immunotherapy
surgery if indicated
NON-ALLERGIC RHINITIS
1. infectious
viral (common cold)
rhinovirus, coronavirus, influenza, RSV, Adenovrus
bacterial
pnemococcal, HI, Staph spp, Moraxilla spp
rhinoscleroma
rhinosporidiosis
2. intrinsic/ VMR
- disease of adult, increase in intensity with age
- non-immunological pathophysiology
- idiopathic/ diagnosis of exclusion
- autonomic imbalance: parasympathetic predominant
- vasodilation & gland hyperresponsiveness
- might sensitive to cold air, fume, perfumes, smoke,
irritants etc
3. Nonallergic rhinitis with eosinophilia syndrome (NARES)
- negative allergy history & testing
- nasal smear shows eosinophilic count >10%
4. hormonal-induced
pregnancy/puberty
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hypothytoidism
acromegaly
OCP/HRT
5. drug-induced
aspirin/ NSAIDs
Anti-Hpt
B-blocker
ACE inhibitor
A-adrenoceptor antagonist
Vasoconstrictors
Cocaine
CPZ
6. Atrophic Rhinitis
Primary/ secondary
Excessive surgical removal
Cx of sinusitis/ irradiation
Ch.granulomatous disease
Patent but feel blocked, crusted, smelly
Atrophy of the mucosa & bone with decreased glands
Klebsiella ozaenae
7. rhinitis medicamentosa
Rhinosinusitis/ Sinusitis
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Definition of sinusitis: inflammation of sinus mucosa/ mucus membrane
Pathogenesis:
o Obstruction: O2 lowered, PH
o Impaired ciliary fx – stagnation of secretion
o Mucus retention – bacterial overgrowth + mediators
o Infx – change the ‘Q’ of secretion
Causes of ostial obstruction
o Mucosal swelling: URTi, AR, NAR, smoking, swimming
o Anatomy: DNS, CB, trauma, polyps, FB, neoplasm
Other causes:
- Dental cause; recurrent unilateral
- ciliary dysfx & cystic fibrosis
Bacteriology
- in acute: same as URTI
- in chronic: polymicrobial but anaerobs play
significant role
- in dental: anaerobs also play a role
Classification of sinusitis
o Acute RS
o Subacute
o Recurrent
o Chronic RS
o Acute on chronic infx
Symptomatology
o ARS: congestion, d/c, purulence, PND -- cough, facial pressure, fullness
or pain, halitosis, sore throat, dental pain, hyposmia, fever
o Major sx of CRS
Facial pressure/ pain
Facial congestion/ fullness
Obstruction/ blockage
D/c/ purulence/ PND
Hyposmia
Fever
o Minor sx of CRS
Headache
Fever
Halitosis
Fatigue
Dental pain
Cough
Earache/ pressure/ fullness
May present with recurrent pneumonia
Clinical signs: pain at specific places, pus in nasal cavity
Nasal endoscopy & C+S
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Imaging techniques
o PNS X-ray; opacities & A-F level; advantages & disadvantages
Caldwell (frontooccipital): mainly frontal, ethmoid & nasal cavity
Water’s (OM): maxillary, frontal & facial trauma & orbit
Lateral: frontal, sphenoid & maxillary.
When to do?
o CT PNS: advantageous
Indications: chronic refractory dis, complications, b4 FESS
Translumination test
Medical treatment
Simple office/ minor surgery – wash-out procedure
Functional Endoscopic Sinus Surgery
Invasive surgical procedure
o Caldwell-luc
o Ext fronto/ ethmoidectomy
o Osteoplastic surgery
Complications
o Orbital – Chandler’s classification
o Intracranial: meningitis, x’tradural, subdural, brain abscess
o Osteitis/ osteomyelitis
o Dental Cx
o Mucocele
Nasal polyp
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General term for mass or Swelling – sessile, pedunculated etc in nasal cavity
o Spectrum of disease – swollen mucosa to neoplasm (benign/ malignant)
Def of mucosal polyp - benign neoplasm/ prolapsed edematous mucosa/ ‘pale bags’
of edematous tissue
Appearance – smooth, shiny, pale, opalescent to grey/ pink with stalk, base & body
Hallmark for Chronic Rhinosinusitis
Male> female, age 30-60 years.
Incidence
o < 4% in population
o 7% in asthmatic
o 2% in CRS
o 20% in Cystic Fibrosis
o 36% in Aspirin intolerance (Samter’s triad- intrinsic asthma)
o rarely: primary ciliary dysfx syndrome
Etiology – unknown
In descending order of most affected sinuses: ethmoids/ maxillary/ frontal/ sphenoid
Theories
o Infx
o Allergy
o Mucopolysaccoride theory
o Bernoulli’s phenomenon
o VM imbalance
o Epithelial-rupture theory- breaks in LP with prolapsed stroma
Symptoms
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o Congestion
o Hyposmia
o Thick mucous/ mucopus
HPE
o Oedematous
o Thickened BM
o Hyperplasia of goblet cells
o Pronounced presence of eosinophil & mast cells
Treatment
- pharmacotherapy
- surgery: polypectomy, Functional endoscopic sinus surgery
INVERTED PAPILLOMA
Intermediate tumor/ neoplasm – locally invasive
Polyp-like str, a bit fleshy BUT pt usually 45-70 yrs & present with epistaxis
Arises from lateral nasal wall
a/w HPV types 6 & 11
look for warts elsewhere
potentially malignant transformation 10 – 15%
Dx: biopsy HPE
Tx: wide excision – medial maxillectomy
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EPISTAXIS
Bleeding from nose
Blood supply of the nose
septum
o external carotid system
sphenopalatine
greater palatine artery (septal Br)
superior labial artery
o internal carotid system
anterior ethmoidal
posterior ethmoidal
lateral nasal wall
o external carotid system
sphenopalatine
greater palatine
Br from facial arteryt
o internal carotid
anterior & posterior ethmoidal
Little area (Kiesselbach’s plexus)
Causes of epistaxis
local
o trauma
o infx- influenzae, viral, typhoid, measles, whooping cough, scarlet
o FB
o Rhinolith
o Neoplasm
o Iatrogenic (surgery)
o Severe DNS
general
o d/o of blood or vessels: Hemophilia/ vWD/ Osler WR synd./ leukaemia/
MM
o CVS diseases
o Liver disease: vit K def
o Kidney disease
o Drugs: aspirin/ warfarin/ NSAIDS
o Arteriosclerotic disease a/w HPT
idiopathic
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Site of epistaxis
Classification
anterior epistaxis
o in almost all children and young adult
o mostly from Kiesselbach’s plexus
posterior epistaxis
o most in adult
o trauma is nor important cause
o usually due to sclerotic vessel – esp.Hpt, DM
Management
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3. LARYNGOLOGY
Common symptoms
i. Dysphonia/ hoarseness
ii. Noisy breathing/ stridor
iii. Associated symptoms- dysphagia/ odynophagia/ aspiration/
heartburn, drooling
Common diseases
i. Inflammatory diseases
ii. Congenital diseases of the larynx
iii. Cancer of the larynx
iv. Benign diseases of the Vocal cord
Common emergency
i. Stridor
Common OT procedure
i. Tracheostomy
ii. Endolaryngeal microsurgery (ELMS)
iii. Laryngectomy
1. STRIDOR
Classification
Type of stridor
Common causes in adult
Common causes in children esp.pyrexial
4. Others
Common diseases of the pharynx
Obstructive sleep apnoea (OSA)
Deep neck space abscesses
Head & Neck masses in pediatrics & adults including cancers
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