Review for ENT (2008 Batch)

1) Differences between adult and childhood OSAS?

Adult

1. Snoring: intermittent with pauses

2. Mouth breathing: less common

3. Enlarged tonsils and Adenoids: not common

4. Sex distribution: male: female=8:1

5. Obstructive pattern: apnea

6. Arousals: common

7. Consequences: excess daytime sleepiness

Childhood

1. Snoring: continuous

2. Mouth breathing: very common

3. Enlarged tonsils and Adenoids: common

4. Sex distribution: no sex preference (1:1)

5. Obstructive pattern: hypoapneas

6. Arousals: uncommon

7. Consequences: behavioral change

2) Classify the different types of hearing loss based on pure tone audiometry (PTA) and also explain the PTA
features?

A. Sensorinural hearing loss: Cochlear or retrocochlear loss in hearing sensitivity duo to disorders including
the cochlea and/or the auditory nerves fibers of Cranial Nerve VIII.

B. Conductive hearing loss: Reduction in hearing sensitivity, despite normal cochlear function, due to impaired
sound transmission through the external auditory meatus, tympanic membrane and ossicular chain.

C. Mixed hearing loss: Hearing loss with both a conductive and a sensorineural component

Pure tone audiometry (PTA):

 Air and bone conduction audiometry, PTA is the standard behavioural procedure for describing auditory
sensitivity: AC>BC- --patient having conductive hearing loss

If air bone gap is not presented (no difference between AC and BC)---sensorineural hearing loss: AC>BC and
BC>AC ---not normal

3) What are symptoms of Foreign-body aspiration?

The initial symptoms of foreign-body aspiration depend on the size, shape, and composition of the foreign
body, its location, and the age of the patient. Usually the object provokes an immediate coughing fit with or
without cyanosis, accompanied by dyspnea ,stridor, and pain ,

Larger foreign bodies impacted in the larynx may cause death from asphyxiation , whereas smaller objects lead
to hoarseness and cough, The clinical picture of a complete obstruction is that of a cyanotic, aphonic patient
with spasmodic breathing movements that do not ventilate the lungs , Bolus death refers to acute cardiac
arrest caused by a vasovagal reflex evoked by obstruction of the upper airway. Foreign bodies in the trachea
cause far greater complaints than objects in a bronchus, ranging from a slight cough to fatal asphyxia, if a
foreign body in the trachea moves with respirations; it produces the telltale signs of a small palpable impact, an
audible click, and movement of the trachea. A foreign body close to the vocal cords may be manifested by
whistling sounds and stridor, a foreign body lodged in the cervical esophagus may compromise the upper
airway by compression, with associated symptoms. Complete obstruction of the esophagus also poses a risk of
overflow aspiration

4) What are common symptoms of adenoids?

chronic nasal airway obstruction (mouth breathing)

nasal discharge (runny nose), snoring, anorexia

a hyponasal voice ( rhinophonia )

chronic mouth breathing can lead to maxillary deformity and dental malalignment

Many of these small patients also have enlarged tonsillar lymph nodes at the mandibular angle

5) What are 7 segment of facial nerve?

Intracanial & intrameatal

Labyrinthine & Tympanic

Mastoid & Extratemporal

6) What are the symptoms of inflammation of the neck?

Pain or tenderness is typical signs of a (usually acute) inflammation but maybe absent. Additional symptoms
and findings such as neck pain, dental pain, otalgia, fever, malaise, swollen, salivary glands, skin changes, etc.
can help narrow the differential diagnosis

7) Describe lympha drainage of the pharynx?

 Lymphatic vessels from the pharynx may enter directly either the superior deep cervical nodes or indirect pass
through the retropharyngeal or paratracheal nodes to enter the same deep cervical nodes.All the nodes drain
into the deep cervical nodes from where they pass on to the jugular trunk. The jugular trunk enters the
thoracic duct on the left and the right lymph duct on the right or the jugulosubclavian junction on the right.

8) What are three types of laryngeal cavity?

Superior glottis, glottis and supglottis

9) What is goal/purpose of audiology examination?

Audiologic examination is designed to test the functions of hearing,it has following main goals:

Detect a hearing disorder

Classify a hearing disorder

Quantify a hearing disorder

The various methods that are used in audiology are of varying usefulness in achieving these goals; an effort
must be made to address the clinical problems as efficiently as possible using the most appropriate test
methods

10) What are clinical symptoms and treatment of masophryngeal carcinoma?

Symptoms

In its early stages, nasopharyngeal carcinoma may not cause any symptoms. Possible noticeable symptoms of
nasopharyngeal carcinoma include:

A lump in your neck caused by a swollen lymph node

Blood in your saliva

Bloody discharge from your nose

Nasal congestionHearing loss

Frequent ear infections, Headaches

Treatment:

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy for
nasopharyngeal carcinoma is usually administered in a procedure called external beam radiation

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be given in pill
form or administered through a vein. Chemotherapy may be used to treat nasopharyngeal carcinoma in three
ways:

Chemotherapy at the same time as radiation therapy

Chemotherapy after radiation therapy: This is called adjuvant chemotherapy

Chemotherapy before radiation therapy: Neoadjuvant chemotherapy is chemotherapy treatment administered

before radiation therapy alone or before concomitant therapy

Surgery
Surgery is not often used as a treatment for nasopharyngeal carcinoma. Surgery may be used to remove cancerous
lymph nodes in the neck. In certain cases, surgery may be used to remove a tumor from the nasopharynx.

11) What is etiopathogenesis of chronic suppurative otitis media

(CSOM) and how to diagnose?

Etiology

a) Unresolved middle ear infection.

i. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent
effusion and irreversible mucosal change

ii. Fluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic
perforation

b) Bacteria

i. Pseudomonas aeruginosa, Staphylococcus aureus, Proteus species, Klebsiella pneumoniae, and

diphtheroids

Diagnosis:

Radiographic evaluation

Indications for image study

Uncontrollable aural discharge

Complications such as facial paralysis, labyrinthitis

When central nervous stystem involvement is suspected, MRI should be considered

Axis CT and coronal CT scan is perferred

Hearing test

12) What are three parts of osicular chain in the midlle ear?
malleus, incus and stapes.
13) What are partsof bony labyrinth?
The semicircular canal system
The cochlea
The vestibule
14) What is Nasal Polyposis?
Represent edematous semitranslucent masses in the nasal and paranasal cavities mostly originating from the
mucosal linings of the sinuses and prolapsing into the nasal cavities
15) Main symptoms of allergic rhinitis and treatment?
 Symptoms:

Obstructed nasal breathing, Sneezing attacks

Watery nasal discharge and Itching of nose and eyes

Treatment:

Avoid contact with allergens or eliminate allergen irritants from environment

Pharmacotherapy: mast cell stabilizers, local and systemic H1 antihistamines, local steroids

Immunotherapy: A specially prepared antigen is administered subcutaneously to induce a systemic tolerance to

the foreign protein.

The disadvantages of this therapy include adverse effects, ranging from mild local reactions to severe systemic
symptoms, a protracted course of treatment, and a significant percentage of non responders

Surgical treatment: If the response to conservative treatment is unsatisfactory and the principal complaint is
nasal obstruction (i.e., hyperplasia of the nasal mucosa), surgical treatment is indicated. The main goal in
these cases is to reduce the size of the turbinates by coagulation (turbinate cautery),

Laser treatment: If septal pathology is also present (septal deviation, septal spur or ridge), a concomitant
septoplasty should be performed. With associated sinus complaints, endoscopic sinus surgery may also be
required

16) What is wardeyers ring and sate its types?

The palatine tonsils, nasopharyngeal tonsil (adenoid) and lingual tonsil

17) Write down the names and function of intrinsic muscles of larynx?

a. Adductors of the cord: lateral cricoarytenoid muscle, Transverse arytenoids muscle and Oblique arytenoid
muscle

b. Abductors of the cord: posterior cricoarytenoid muscle

c. Tensor of the cord: cricothyroid muscle

d. Chalasia of the cord: thyroarytenoideus

18) State definition and causes of Hoarseness of voice?

Hoarseness is an abnormal deep, harsh voice caused by a variety of conditions.

Causes:

Benign vocal cord nodules or polyps, GERD.

allergies, inhalation of irritants/smoking,

thyroid problems, trauma to the larynx/vocal cords,

 Neurological conditions (Parkinson's disease/strokes), and Cancer of the larynx

19) What is the symptoms and how to diagnose BPPV and menieres disease?

Symptoms of menieres disease:

Fluctuating hearing loss and dysacusis, Tinnitus,which is continuous but of

Varying intermsity and low frequency, sensation of aural fuulness,attack of rotary vertigo,nausea and vomiting
which last for hours,dizziness and dysquilibrium, the tinnitus and hearing loss may change before or during the
attack

Diagnosis of menieres disease:

The diagnosis is based on the typical history, otoscopic findings are normal in idiopathic menieres disease, but late
signs of previous inflammation or trauma may be found in symptomatic forms

Pue tone audiometry:demonstrates a sensorineural hearing loss

Speech audiometry and auditory brainstem response testing is normal and electrocochleography is usually shows
an elevation of the summation potential.

Symptoms of BPPV:

The patient complains of severe,recurrent attack of rotary vertigo lasting approximately 1 mins,the attacks are
provoked by certaion movements and are fatigable,nausea may occur, but there are no other associated
symptoms,often the symptoms are more intense following rst, and pts may be awakened at night byt vertiginous
attack.

Diagnosis of BPPV:

The diagnosis is based on the typical history or is established by the hallpike maneuver,placing the head over the
end of the table typically evokes arotart nystagmus to one side after a latent period of about 10 seconds,then
diminishes ,when the pts is brough back to an upright position, a similar nystagmus occurs in the opposite
direction,this positional nystigmus is fatigable and disappears after several repetition of the maneuver

20) What the definition and causes of stridor?

Stridor is a high pitched wheezing sound resulting from turbulent air flow in the upper airway.

Causes:

Foreign bodies, Tumor

Infections Subglottic stenosis, Airway edema, Subglottic hemangioma

Vascular rings compressing the trachea.

Tracheomalacia or Tracheobronchomalacia
 Congenital anomalies of the airway

Riedel's thyroiditis. And Vocal cord palsy.

21) What is the main function of cochlea?

Is to translate auditory events into a pattern of neural impules that precisely reflects the nature and timing of
the sound stimulus

22) State Vertigo (Def, Types & Managements)?

Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary.

Types:

Peripheral: Vertigo caused by problems with the inner ear or vestibular system is called "peripheral".

Central: Brain pathology can cause a sensation of disequilibrium which is an off-balance sensation.
Management: Epley maneuver, anticholinergics and antihistamines

Tinnitus:

Tinnitus is the perception of sound within the human ear in the absence of corresponding external sound.

Types:

A. Subjective tinnitus: This type of tinnitus is often a symptom of the loss of hearing associated with old age
and an overexposure to loud noises

B. Objective tinnitus: Objective tinnitus is sometimes referred to as Pulsatile Tinnitus in cases where the ringing
or pounding sound beats to the rhythm of a person's heart or pulse.\

Management:

Objective tinnitus:

Gamma knife radiosurgery , Botulinum toxin and Clearing ear canal

Subjective tinnitus:

Drugs and nutrients: Lidocaine & diazepam

Electrical stimulation

Surgery: Repair of the perilymph fistula

Dysphagia:

Dysphagia is a difficulty in swallowing. It is usually a sign of a problem with your throat or esophagus -the
muscular tube that moves food and liquids from the back of your mouth to your stomach.

Causes of oropharyngeal dysphagia include:

 Cerebrovascular Stroke,
Multiple Sclerosis

Myasthenia Gravis

Parkinson's disease & Parkinsonism syndromes,

Neck malignancies,

Oesophageal dysphagia can be divided into mechanical and functional causes.

Functional causes include

o Achalasia, myasthenia gravis, and Bulbar or pseudobulbar palsy.

Mechanical causes include

o peptic esophagitis, carcinoma of the esophagus or gastric cardia

o external compression of the esophagus

Diagnostic approach:Barium Chest X-ray: is Gold Standard, OGD, Swallow and meal

Management:Remove the underlying cause and conservative treatment

1) What is vestibular end organ? And what kind of acceleration they are sensitive to?

Is part of the inner ear,it consist of the semicircukar canals, which are sensitive to angular acceleration and tge
otolithic apparatus, which is sensitive to linear acceleration.They are sensitive to angular acceleration

2) What is vestibular function? What are VOR and VSR? What test can measure VOR and VSR? (ENG and
posturography)?

The major functios of vestibular system include the following:

Fixation of the visual horizon for spatial orientation during rapid head movements,the function relies on
interaction with visual system

Maintenance of posture and equilibrium,this function relies mainly on interaction with the proprioceptive
and motor system

VOR: Nystagmography is a procedure for recording eye movement and

evaluatin spontaneous or induced nystagmus in darkness and during

rotation,it is used to decument and calculate quantitative parameters

Tests can measure VOR and VSR: ENG and posturography

VRS: vestibulospinal reflexes:spinal motor function is controlled by

proprioceptive, visual and vestibular reflexes, these three sensory systems

 Are mutually complementary and are subject to mutual controls and Upright Gait is generally possible when
two of the systems are functioning,if

two of the systems are damaged,upright posture and movement are impaired.