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ENT

. TEMPORO-MANDIBULAR JOINT DYSFUNCTION:


--------------------------------------. H/O of teeth grinding at night.
. Referred pain to ear.
. Worse with eating.

. Peri-tonsillar abscess:
------------------------. Muffled voice make one consider other diagnosis than simple tonsillitis or
pharyngitis. . Deviation of the Uvula + Unilateral lymphadenopathy = Peri-tonsillar
abscess.
. Tx: URGENT NEEDLE ASPIRATION + IV Antibiotics.

. PRESBYCUSIS:
-------------. Old pt in 60s.
. Sensori-neural hearing loss.
. HIGH frequency BILATERAL hearing loss.
. Difficult hearing in noisy crowded places.

. OTOTOXIC drugs:
----------------. Aminoglycosides antibiotics.
. Loop diuretics e.g. Furosemide. NOT THIAZIDEs !!
. Aspirin.

. REMEMBER:
----------. SE of BBs -------> Bronchoconstriction - Bradycardia - fatigue - depression.
. SE of ACEIs -----> Cough - Hyperkalemia - Angioedema.
. SE of Aspirin ---> Tinnitus.
. SE of Thiazides -> Orthostatic Hypotension - photosensitivity - hypercalcemia.

. Serous O.M.
------------. is associated with HIV pts manifesting as middle ear effusion without infection.
. causing dull hypomobile tympanic membrane.

NASAL POLYP:

-------------. is associated with chronic rhino-sinusitis, asthma.


. H/O of aspirin or NSAIDs induced broncho-spasm
. (ASPIRIN EXACERBATED RESPIRATORY DISEASE).
. Symptoms of bilateral nasal obstruction, nasal discharge & anosmia.

. LEKOPLAKIA:
------------. Hard to remove white patches in the floor of the mouth.
. due to chronic irritation by smoking or alcohol.
. May lead to squamous cell carcinoma.

. CANDIDIASIS:
-------------. Diabetic pt. with poor control.
. Whitish plaques with underlying erythema.
. Easily scrapped off with a tongue depressor.

. Epiglottitis:
--------------. High fever.
. Severe sore throat.
. Odynophagia.
. DROOOOOOOOOOOOOOOOLING.
. Progressive airway obstruction.
. HARSH SHRILL.
. Causative organisms: Haemophilus influenzae & Streptococcus pyogenes.

. Retro-pharyngeal space is the most common neck space susceptible to infection.

. Otosclerosis:
--------------. is the most common cause of conductive hearing loss in middle aged adults 2030s.
. AMINOGLYCOSIDES - GENTAMYCIN is the most common cause of sensorineural
hearing loss.

. Retro-pharyngeal abscess:

--------------------------. Fever & sore throat.


. Dysphagia & Odynophagia.
. Trismus (pain on mouth opening).
. Pain on neck EXTENSION (pain on neck flexion = Meningitis).
. H/O of local trauma to the pharynx e.g. FISH BONE.

. MENIERE's disease:
-------------------. Vertigo = Severe spinning sensation + nausea.
. The type of vertigo is peripheral not central as it last just for 1-2 hours with the
presence of ear fullness & H/O of excessive cell phone use.
. EAR FULLNESS suggests Meniere's disease
. from an abnormal accumulation of endo-lymph within the inner ear.
. Meniere's dis. is an INNER ear disease.
. Simply exclude CEREBELLAR dis. by absence of inco-ordination or gait
disturbances!

. MALIGNANT OTITIS EXTERNA:


--------------------------. caused by PSEUDOMONAS AERUGINOSA.
. Elderly with poorly controlled DM.
. Ear pain, discharge.
. GRANULATION TISSUE within the ear canal on otoscopy.
. Progression to the base of the skull may damaga the facial nerve causing facial
palsy. . Dx: CT skull base.
. Tx: IV CIPROFLOXACIN. not surgery !!

Meniere's disease:

-------------------. Vertigo + Ear fullness + Hearing loss.


. 1st line ttt ----> LOW SALT DIET.

. ASSESSMENT a case of hearing loss:


-----------------------------------. A louder tone is heard when a TF is placed on the pt's Rt mastoid process
& a softer tone when the TF is placed near her Rt. external auditory meatus
-> Abnormal Rinne
-> CONDUCTIVE hearing loss
-> bec. the diseased ear hears better due to obscuring of the external noise.

. When the TF is placed on the middle of the forehead, she feals the vibration better
in her Rt ear than the Lt
-> Abnormal Weber test
-> The sound lateralizes to the diseased ear due to better bone conduction.
-> CONDUCTIVE hearing loss.

. APHTHOUS ULCERS:
----------------. CROHN's disease can involve any part of the GIT from the MOUTH to the ANUS.
. APTHOUS ulcers in the mouth can be seen as extra-intestinal manifestation.
. Pathology: GRANULOMATOUS inflammation.

University Questions ENT


1-THEORIES FOR ORIGIN OF CHOLESTEATOMA..CRUSH
Congenital theory
Ruedi's theory
Wittmaacks's theory(use W instead of U)
Saade's theory
Habermann's theory

2-SEQUELAE OF CSOM......O-CART
Ossicular necrosis
Cholesterol granuloma
Atrophic tympanic membrane and atelactatic middle ear
Retraction pockets and cholesteatoma
Tympanosclerosis

3-Sequelae

of Otitis media (SCALP COST)

S-SNHL
C-Cholesteatoma
A-Atelectasis
L-Learning Disability
P-Perforation of TM
C-Conductive HL
O-Ossicular Necrosis
S-Speech Impairment
T-Tympanosclerosis

4-Causes of SNHL
1.Congenital

-Prenatal factors

-Paranatal factors

2.Acquired (Narvay Makes FANSI TOPS)


N-Noise induced HL
M-Meniere's dz
F-Familial Prog HL
A-Ac. Neuroma
N-Noise Induce HL
S-Sudden HL

I-Infections
T-Trauma to labyrinth/VIIITH nv
O-Ototoxic drugs
P-Presbyacusis
S-Systemic Dz.

5- Contraindications of stapedectomy (I POD)


I-Infections in ext/middle ear
P-perforation should be closed first
O-only hearing ear is a contraindication
D-deafness (sensorineural)

6- Causes of SNHL (sensory neural hearing loss) (POINT


MASS)
P-Presbycusis
O-Ototoxic drugs
I-Infections of labyrinth
N-Noise induced
T-Trauma to labyrinth
M-Meniere's disease
A-Acoustic neuroma
S-Sudden hearing loss
S-Systemic disorders.

7- Gradinigos Syndrome ( Features )


" 3D's "
Diplopia (involvement of 6th cranial nerve)
Draining ear
Deep seated retro-orbital pain

8-Membrane over Tonsils: Differentials


" M2-VIDAAL (Read as 'Widal' for typhoid)
Membranous tonsilliti
Malignancy
Vincent's angina
Infectious mononucleosis
Diptheria
Apthous ulcers
Agranulocytosis
Ludwig's angina
Trauma

9-Tonsillectomy: Contraindications ("A,B,C,D,E" )


Active infection
Bleeding/ clotting disorders
Cervical spondylosis
Diphtheritic tonsillitis
Endemic of polio
Failure in controlling systemic diseases like hypertension, diabetes, bronchial
asthma, LRTI, etc.

10-Neoplasms of larynx: Causes

"TARGET"

Tobacco (Carcinogens: Benzopyrine)


Alcohol: synergistic with tobacco (Commonly in supraglottic ca.)
Radiation
Genetic- familial tendency
Environmental/ occupational- asbestos, petroleum, mustard gas, etc.
Tumors: Solitary papilloma, leucoplakia, erythroplakia, etc.

11-Complications of Tonsillitis "Twilight IS A Really Odd


Name"
T - Tonsillitis (Chronic Tonsillitis)
I - Infection (of middle ear cleft)
S Septicaemia\
A Abscess
R Rheumatism
O - Oedema (of the larynx)
N - Nephritis

12-Auditory pathway

' E.COLI-MA'

Eighth nerve
Cochlear nuclei
Olivary complex
Lateral lemniscus
Inferior colliculus
Medial geniculate body
Auditory cortex
M

Khizer Hayat Khan


Nishtar
Medical College Multan

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