Compiled File Notes PDF

Compiled file notes : ENT U world deviated nasal septum ⁃ If patient develops nasal whistling w respiration following rhinoplasty, suspect nasal septal perforation due to septal hematoma Nasal polyps ⁃ Aspirin exacerbated respiratory disease is a clinical condition defined by a...

Compiled file notes : ENT U world deviated nasal septum ⁃ If patient develops nasal whistling w respiration following rhinoplasty, suspect nasal septal perforation due to septal hematoma Nasal polyps ⁃ Aspirin exacerbated respiratory disease is a clinical condition defined by a triad of asthma, bronchospasm or nasal congestion following ingestion of aspirin or NSAIDs and chronic rhinosinitus w nasal polyposis Peritonsilar abscess ⁃ muffled voice raises suspicion of disease other than uncomplicated pharyngitis and tonsillitis. A peritonsillar abscess is a potential complication of tonsillitis and requires both IV Abx therapy and urgent drainage of abscess. Deviation of uvula and unilateral lymphadenopathy can be helpful in distinguishing peritonsillar abscess for epiglottitis Salivary gland tumors ⁃ Sialadenosis is a benign, non inflammatory enlargement of the salivary glands, often caused by chronic alcohol use Acute otitis media ⁃ oral Abx for otitis media should be administered to children w high fever, severe pain or bilateral disease. Amoxicillin is the first line therapy and amoxicillin clavulanate is indicated if persistent or recurrent Otitis media w effusion ⁃ Otitis media w effusion is middle ear effusion without tympanic membrane inflammation (bulging, erythema). Examination w show air fluid level and immobility. Management is observation and follow up for resolution bc otitis media w effusion is associated w speech delay and long term hearing loss Otitis externa ⁃ otitis externa is caused by pseudomonas or staph aureus Necrotizing malignant otitis externa ⁃ malignant otitis externa is a severe infection of the external auditory canal that extends to the skull base and usually caused by pseudomonas. It’s seen more frequently in elderly patients w DM. IV ciprofloxacin is the 1st line treatment Bone tumor ⁃ torus palatinus is a benign bony growth located on the midline suture of the hard palate. It can be congenital or develop later in life. It’s typically chronic and asymptomatic and diagnosis is usually clinical evident. Surgery is indicated of the mass becomes symptomatic, interferes with speech or eating or causes problems of fitting of dentures Vestibular neuritis/labeynthitis ⁃ vestibular neuritis is a self limited disorder of the vestibulocochlear nerve that sometimes follows a viral URTI. Vestibular neuritis w unilateral hearing loss is called labrynthitis Thyroid cancer ⁃ medullary thyroid cancer is followed up for reoccurrence using serum calcitonin levels Laryngeal papilloma ⁃ laryngeal papilloma can be due to recurrent respiratory papillomatosis caused by HPV 6 and 11, which also cause genital warts, so they’re most likely acquired through vertical transmission prior to delivery Ear trauma ⁃ barometric tymapnometric injuries resolve spontaneously in a few weeks so observe and follow up Osteonecrosis ⁃ biphosphonate related osteonecrosis of the jaw is characterized by chronic swelling, mild pain and exposed, necrotic bone. It’s often triggered by tooth extractions or other invasive dental procedures. The course can be intractable and treatment is largely supportive w careful oral hygiene and antibacterial rinses Perilymphatic fistula ⁃ a perilymphatic fistula can occur after head trauma and result in episodic vertigo triggered by sudden pressure changes (valsava) or loud noises Ent previous Nose anatomy and investigations ⁃ the cribiform plate of the ethmoid can’t be seen by anterior rhinoscopy ⁃ The tensor vali palentini muscle open the Eustachian tube during yawning and swallowing Ear anatomy and investigation ⁃ Galvanic stimulation is used to assess vestibular function ⁃ In case of recurrent meningitis, CT of temporal bone should be done to see if there’s any abnormalities or abnormal connections Hearing loss ⁃ ossicular discontinuity w an intact TM causes the maximum unilateral hearing loss w highly compliant TM on tympanometry (Ad) ⁃ The max decibel loss that OME can cause is 30-40 dB (actually 55 dB) ⁃ Hearing loss in presbycusis is often bilateral and symmetrical. Ototoxicity and noise induced hearing loss is also symmetrical  ⁃ Otoacpustic emission is an objective screening test of hearing loss used for neonates. It reflects the function of hair cells (hair cells in cochlea) ⁃ Auditory brainstem response is the most affective objective test of congenital hearing loss ⁃ Wax impaction is the MCC of conductive hearing loss in adults and OM in children ⁃ Hearing loss contributes to the development of dementia ⁃ If a child underwent tympanoplasty and immediately developed hearing loss, start w tuning fork ⁃ The scale of pure tone audiobram is logarithmic not linear ⁃ CMV is the MCC of viral bilateral congenital SNHL ⁃ Varicella zoster/Ramsey hunt syndrome is the MCC of unilateral viral SNHR ⁃ Ramsay hunt syndrome causes facial nerve paralysis, sensinueral hearing loss and painful auricular rash vesicular lesions at external auditory meatus ⁃ About 90% of ppl older than 15 have been infected by VZV ⁃ If a normal patients wakes up in the morning w sudden hearing loss, it’s SNHR ⁃ Imaging is imp bc 10% of SNHR is cause by acoustic neuroma and hearing loss is the MC presentation ⁃ If patient has decreased speech recognition and no hearing loss w unilateral tinnitus, it’s imp to rule out acoustic neuroma ⁃ Acoustic neuroma is detected by internal ear MRI ⁃ MRI of internal acoustic meatus is the best for detecting shwannoma ⁃ The MC form of congenital hearing loss is SNHR ⁃ Congenital hearing loss should be treated at 1 month at least (has to be before 6 months) ⁃ Osteosclerosis affects younger (30 yo) Caucasian women, is AD w incomplete penetrance. It’s due to imbalance of resorption and deposition causing stiffening of stapes. It causes progressive conductive hearing loss w paradoxical improvement in speech discrimination in noisy environment w/so reddish hue behind TM. Managed by hearing aids or surgery stapes reconstruction (stapedectomy/ stapedeostomy) ⁃ Osteoscelorosis causes hearing loss at 2000 Hz (cahart notch), which is associated with immobilization of stapes ⁃ Mild TM perforation is managed by observation at reassessing in 24 hrs ⁃ Poor speech discrimination indicates a retrocochlear lesion Ototoxicity  ⁃ CALM EAR: (C) Cisplatin and Carboplatin (A) Aminoglycoside (gentamicin and tobromycin) (L) loop diuretics (M) Malaria drug quinine (E) Erythromycin (A) Aspirin (R) Red man vancomycin Vertigo ⁃ BPPV is associated with canalolithiasis ⁃ Dix Hallpike is used to diagnose BPPV, while Eply maneuver is used to treat it ⁃ Endolympj hydrops is another name for Meniere disease, which is due to decreased reabsorption of endolymph ⁃ 40% of cases of Meniera come w hearing loss ⁃ Meniere disease causes fluctuant SNHR low pitched roaring tinnitus (not pulsating tinnitus) and vertigo ⁃ Meniere disease can be given intratympain gentamicin ⁃ Vestibular neuritis presents w acute persistent vertigo which is a self limiting disorder of the vestibulocochlear nerve following an URTI. It’s associated w significant N/ V and unsteady gait where pt falls towards affected side. The unilateral SNHR seen w vestibular neuritis is called labrynthitis. So vestibular neuritis is vertigo only, while acute labrynthitis is vertigo and hearing loss ⁃ Vertebrobasilar insufficiency is associated with vertigo ⁃ Dizziness and vertical nystagmus happens w central vertigo ⁃ If Pt has vertigo, vision loss and nausea that happens w neck extension, do carotid US to look for carotid body tumor ⁃ Carotid body tumor presents as lateral neck swelling w ipsilateral pulsatile tinnitus ⁃ Paragangliomas arising from the carotid body or vagus nerve may present as painless neck mass and some present w pulsatile tinnitus, hearing loss and otalgia ⁃ The MC site of vestibular shwannoma is vestibular nerve Otitis externa ⁃ take a biopsy of granulomatous mass in case of necrotizing otitis externa ⁃ Necrotizing otitis externa affects the external auditory canal, base of the skull and temporal bone ⁃ 3 months of bilateral OME or 6 months of unilateral OME is an indication of myringotomy ⁃ Middle ear effusion is diagnose by pneumotoscopy ⁃ Otitis media w effusion causes a retracted TM ⁃ Down syndrome is a risk factor for OM ⁃ Tonsillectomy is avoided in craniofacial anomalies like cleft palate ⁃ Otorrhia is the MC complication of myringotomy tube the TM perforation  ⁃ Gradenigo syndrome is classically described as a triad of otitis media, retro- orbital facial pain and abducens palsy that MC developed due to an infection of petrous temporal bone ⁃ Bezold abscess is a complication of OM or otomaatoiditis, an infection that erodes through the cortex medial to attachment of SCM ⁃ Sigmoid sinus thrombosis is a complication of AOM ⁃ Mastoiditis is a complication of OM that is treated with Abx, incision and drainage and myringotomy ⁃ Infection of middle ear can speed to brain through mastoid emissary veins Cholesteatoma ⁃ cholesteatoma causes TM perforation on atic (roof or top) in pars flaccida ⁃ Cholesteatoma presents w chronic supportive OM, attic TM perforation, granulation tissue, foul smelling ear discharge, and conductive hearing loss ⁃ Cholesteatoma can result in a perilymphatic fiatula Nasal wegener granuloma ⁃ wegeners granulomatosis MC affects sinonasal tract ⁃ Wegeners granulomatosis presents w nasal obstruction (nasal polypoid mass) and epistaxis, hematuria proteinuria and RBC cases Adenotonsillar hypertrophy ⁃ the greatest complication of angioneuritic edema is upper airway obstruction ⁃ Sickle cell patients may have hypoxia due to adenotonsillar hypertrophy ⁃ Bleeding is the MC complication of tonsillectomy ⁃ IgG is the most abundant immunoglobulin made by tonsils Sinusitis ⁃ Toxic shock syndrome and septicemia are complications of sinusitis but glomeronephritis is not ⁃ Nasal carcinoma MC metastasize to sphenoid sinus ⁃ Nasal swab is used to screen for MRSA ⁃ Sinusitis is a clinical diagnosis, where patient has facial pain and mucopurelant discharge but CT can be done ⁃ Viral rhinitis is the MCC of nasal mucosal obstruction Allergic rhinitis ⁃ Nasal rinsing helps clear nose via mucociliary enhancement ⁃ Pregnancy is a contraindication for immunosuppression of allergic rhinitis Nasal septal disorders  ⁃ septal deviation is the MCC of unilateral atrophic rhinitis ⁃ Nasal cavity mucosa is paeudostratified columnar ciliated epithelium w goblet cells ⁃ Nasal septum deviation is MC caused by trauma and is a common physical disorder and treated surgically. Note that nasal hematoma and perforation are complications of surgery but not common ⁃ If someone has septal deviation, ask for history of nasal surgery ⁃ Swelling in nasal septum following nasal fracture is due to collection of blood bw the nasal mucosa and perichondrium ⁃ Anti-staphylococcus are used to manage pain and swelling post rhinoscopy ⁃ Septoplasty/septal operations are the MCC of septal perforation ⁃ The MCC of saddle nose deformity in adults is trauma and iatrogenic ⁃ The nasal septum consists of vomer, quadrangular cartilage, and maxillary crest. The perpendicular plate of palatine is not part of the nasal septum Epistaxis ⁃ hereditary hemorrhagic telengiectasis (osler weber rendu disease presents w triad of recurrent epistaxis, mucocutaneous telengiectaisis and one affected 1st degree relative ⁃ Most of the blood supply to nose comes from internal maxillary artery which gives rise to sphenopalantine and greater palatine ⁃ The frequency of nasal polyp increases in ages 40 and above ⁃ Bilateral polyps are treated by intraturbinate steroid injection. If it fails, then oral/systemic steroids w/wo Abx. If fails polypectomy or FESS ⁃ Bilateral nasal polyps are seen in CF or Kartgeners Facial nerve palsy ⁃ pregnant women are likely to develop facial nerve palay ⁃ Bell’s palsy has the best prognosis. It’s due to edema of facial nerve (idiopathic) and treated by steroids ⁃ Surgical treatment of facial nerve palsy is tarsorrhaphy ⁃ Lyme disease happens in patients w history of deer tick bite, cardiac arrhythmia and facial nerve palsy. Borriella Burgdorferi is the causative agent of Lyme disease Temporal nerve ⁃ muscles of mastication are medial and lateral pterygoid, masseter, temporalis. Buccinator is not a muscle of mastication and is innervated by facial nerve OSA ⁃ tracheostomy provides 100% cure rate in morbidly obese pt w OSA Pharyngitis  ⁃ the clinical pharyngitis score is used to check for strep pharyngitis/ pharyngitonsillitis ⁃ Center criteria: cervical lymphadenopathy (1) tonsillar exudate (1) absence of cough (1) high fever > 38 (1) age 3-14 (1). 2 or more give empirical antibiotics ⁃ Pharyngitis is treated with amoxicillin ⁃ Common cold most commonly caused by rhinovirus ⁃ Lemiere’s syndrome is thrombophlebitis of internal jugular vein Scarlet fever ⁃ Scarlet fever causes fever, sand paper rash, and strawberry tongue Oral lesions ⁃ tongue is MC site of oral cancer Tonsillar and peritonsillar abscess ⁃ throat swab and culture is the gold standard ⁃ Quinsy is peritonsillar abscess ⁃ Peritonsillar abscess is treated with IV fluids, IV Abx and incision and drainage Salivary gland disorders ⁃ parotid gland has the greatest stimulation, sublingual sleeping, submandibular rest ⁃ Fever, leukocytosis and severe tenderness and swelling of left parotid gland following a recent surgical procedure is most likely acute supportive parotitis. Supportive parotitis often occurs in elderly post op patients, particularly those w dementia who are at risk of inadequate hydration and poor oral hygiene ⁃ Acute parotitis can happen in diabetic patient kept NPO for days ⁃ Lymphangioma is a parotid mass w bluish discoloration that expands w crying. Lymphangioma is not connected to orbital lymphatic system ⁃ Family history is an important risk factor of parotid pleomorphic adenoma ⁃ Pleomorphic adenoma is the MC benign salivary tumor, MC in parotid gland ⁃ Pleomorphic adenoma has a malignant potential, so it will grow rapidly if it becomes malignant ⁃ Ludwig angina is a mixed infection (strep viridans and anaerobes) usually arising from an infected mandibular molar, infection of upper airway or acute lingual tonsillitis. Predisposing factors include DM, alcoholism, or immunosuppression ⁃ Ludwig angina causes a submandibular space infection that presents w fever, mouth pain, stiff neck, difficulty swallowing and trismus. Airway obstruction may occur, thus first step in management is to secure airway Brachial cleft cysts ⁃ 1st brachial cleft opens near the mandible at submandibular region  ⁃ 2nd opens anterior to SCM at tonsillar fossa ⁃ 3 opens at piriform sinus Neck mass ⁃ fibrotic endoscopic evaluation of swallowing is used in patients w dysphagia ⁃ A mass near the piriform sinus can compress the vagus nerve, which provides sensory branches to the larynx pharynx and external auditory meatus ⁃ A brainstem lesion is the MCC of glossopharyngeal nerve disturbance ⁃ Left Supraclavicular lymphadenopathy is a marker of metastatic abdominal cancer ⁃ Facial nerve injury is a complication of removal of cystic hygroma ⁃ Following submandibular gland removal, there could be loss of somatostatin of anterior 2/3s of tongue bc of damage to lingual nerve, branch of mandibular branch of trigeminal nerve ⁃ In case of dermoid cyst, CT has to be done to check for intracranial extension ⁃ Odontogenic infections are the MCC of deep neck infections in adults. These infections are arising from dental abscess, periodontal infections, pericoronitus Nasopharyngeal carcinoma ⁃ lymphoepithelioma is a subtype of NPC characterized by presence of undifferentiated carcinoma w a prominent lymphoid infiltrate ⁃ Infectious mononucleosis causes 20% cellular Atypia (atypical lymphocytes) ⁃ There’s no vaccine for CMV, EBV RSV and HSV Epiglottis ⁃ in epiglottitis, examine patient in OR Croup ⁃ managed by nebulized epinephrine and dexamethasone, Oxygen, moist Air and IV hydration ⁃ The subglottis is the most narrow part of airway in children Stridor ⁃ laryngeal cancer is the MCC of stridor in elderly Diphtheria ⁃ Diphtheria leads to breathing difficulty, heart failure and can cause vocal cord paralysis. Give anti-toxin and Abx ⁃ Encephalocele leads to mass that enlarges when crying Laryngeotracheal stenosis ⁃ endotracheal intubation is a common cause Laryngeal carcinoma ⁃ laryngeal carcinoma is MC in true vocal cords, causes by smoking and treated by radiation. ⁃ If glottis mass is seen, do biopsy ⁃ In cases of unilateral vocal cord paralysis, think of recurrent laryngeal nerve paralysis. ⁃ Posterior cricoarytenoid is the only abductor of the larynx ⁃ Plummer-Vinson syndrome presents as triad of dysphagia, glossitis, and iron deficiency anemia, gas been associated with postcricoid hypopharyngeal cancers, especially in women from Scandinavia ⁃ Functions of larynx include phonation, cough reflex, protection of lower respiratory tract, respiration ⁃ Stage 1-2 managed by radiation or transport laser resection or transport laser endoscopic resection ⁃ Stage 3 is managed by chemo and radiation ⁃ Stage 4 is managed but total laryngectomy then radiation Tracheostomy ⁃ mediastinal emphysema is a complication of tracheostomy ⁃ Don’t intubate post radiation patients ⁃ Complications of airway and airway management in children are: failure to secure the airway, esophageal intubation, hypoxic or hypercapnic respiratory failure leading to arrest, injury to oropharynx or larynx, bleeding, soft tissue swelling, vocal cord injury ⁃ Fistula is a side effect of tracheostomy where blood gushes from tracheostomy side and should be dealt with until proven otherwise Optha Eye anatomy ⁃ most of light refraction happens in the anterior surface of cornea ⁃ The aqueous humor flow rate is 2 microliters/minute ⁃ The vitreous body is behind the lens ⁃ Ciliary body extends from root of iris to ora serrata ⁃ Ora serrata is the weakest connection point bw sclera and uvea ⁃ Photoreceptors is the outer layer of the retina ⁃ The optic media of the eye are the structures through which light passes and is refracted before reaching retina