Diseases of Ear, Nose and Throat

Description

Diseases of Ear, Nose and Throat, is a popular textbook of ENT. The first edition of the book was published in 1992. Since then it has received wide acceptance from the market and every attempt has been made to update the current editions in the light of the advances made by the speciality. The current fifth edition of the book marks 18th year of its publication. Key Features Simple language, concise but comprehensive coverage of the subject with explanatory diagrams, photographs and flowcharts. Clinically oriented text and problem solving approach. Provides insight of the subject to MBBS student who has taken medicine as his career. Fulfils the needs of students taking various entrance tests to postgraduate diploma, MD/MS degree courses or Diplomate National Board or other competitive examinations. Provides a foundation course for postgraduate students who have joined the speciality to pursue MS examination before taking to larger treatises on the subject before exam. Cover Jacket Title Page Copyright Dedication Preface Acknowledgements Section I: Diseases of Ear Chapter 1: Anatomy of Ear Layers of Tympanic Membrane External Auditory Canal Tympanic Membrane RELATIONS OF EXTERNAL ACOUSTIC MEATUS NERVE SUPPLY OF THE EXTERNAL EAR Pinna THE MIDDLE EAR MASTOID ANTRUM ADITUS AD ANTRUM THE MASTOID AND ITS AIR CELL SYSTEM (FIGURE 1.13) Development of Mastoid Petrous apex and its cell system OSSICLES OF THE MIDDLE EAR INTRATYMPANIC MUSCLES TYMPANIC PLEXUS CHORDA TYMPANI NERVE LINING OF THE MIDDLE EAR CLEFT BLOOD SUPPLY OF MIDDLE EAR LYMPHATIC DRAINAGE OF EAR THE INTERNAL EAR INNER EAR FLUIDS AND THEIR CIRCULATION BLOOD SUPPLY OF LABYRINTH DEVELOPMENT OF EAR Chapter 2: Peripheral Receptors and Physiology of Auditory and Vestibular Systems AUDITORY SYSTEMORGAN OF CORTI (FIGURE 2.1) NERVE SUPPLY OF HAIR CELLS AUDITORY NEURAL PATHWAYS AND THEIR NUCLEI (FIGURE 2.2) PHYSIOLOGY OF HEARING MECHANISM OF HEARING 1. Conduction of Sound 2. Transduction of Mechanical Energy to Electrical Impulses 3. Neural Pathways ELECTRICAL POTENTIALS OF COCHLEAAND CN VIII VESTIBULAR SYSTEM PERIPHERAL RECEPTORS 1. Cristae 2. Maculae VESTIBULAR NERVE CENTRAL VESTIBULAR CONNECTIONS PHYSIOLOGY OF VESTIBULAR SYSTEM SEMICIRCULAR CANALS UTRICLE AND SACCULE MAINTENANCE OF BODY EQUILIBRIUM VERTIGO AND DIZZINESS MOTION SICKNESS Chapter 3: Audiology and Acoustics Chapter 4: Assessment of Hearing ASSESSMENT OF HEARING A. CLINICAL TESTS OF HEARING 1. Finger Friction Test 2. Watch Test 3. Speech (Voice) Tests 4. Tuning Fork Tests B. AUDIOMETRIC TESTS 1. Pure Tone Audiometry Uses of Pure Tone Audiogram 2. Speech Audiometry Performance Intensity Function for PB Words 3. Bekesy Audiometry C. SPECIAL TESTS OF HEARING 1. Recruitment 2. Short Increment Sensitivity Index(SISI Test) 3. Threshold Tone Decay Test 4. Evoked Response Audiometry 5. Auditory Steady State Response (ASSR) 6. Otoacoustic Emissions (OAEs) Uses 7. Central Auditory Tests 8. Hearing Assessment in Infants andChildren (see p. 132) Chapter 5: Hearing Loss CLASSIFICATION CONDUCTIVE HEARING LOSSAND ITS MANAGEMENT AETIOLOGY AVERAGE HEARING LOSS SEEN INDIFFERENT LESIONS OF CONDUCTIVEAPPARATUS MANAGEMENT Tympanoplasty SENSORINEURAL HEARING LOSSAND ITS MANAGEMENT AETIOLOGY Congenital Acquired DIAGNOSIS MANAGEMENT SPECIFIC FORMS OF HEARING LOSS A. INFLAMMATIONS OF LABYRINTH B. FAMILIAL PROGRESSIVE SENSORINEURAL HEARING LOSS C. OTOTOXICITY D. NOISE TRAUMA E. AUTOIMMUNE (IMMUNE-MEDIATED) INNER EAR DISEASE Investigations Treatment F. SUDDEN HEARING LOSS Aetiology Management Treatment Prognosis G. PRESBYCUSIS NONORGANIC HEARING LOSS (NOHL) SOCIAL AND LEGAL ASPECTSOF HEARING LOSS HEARING LOSS AND DEAFNESS DEFINITION OF DEAF DEGREE OF HEARING LOSS(WHO CLASSIFICATION) IMPAIRMENT, DISABILITY AND HANDICAP DEGREE OF HANDICAP UNILATERAL HEARING LOSS Chapter 6: Assessment of Vestibular Functions I. CLINICAL TESTS OF VESTIBULAR FUNCTION A. SPONTANEOUS NYSTAGMUS B. FISTULA TEST C. ROMBERG TEST D. GAIT E. PAST-POINTING AND FALLING F. DIX-HALLPIKE MANOEUVRE (POSITIONAL TEST) Method G. TEST OF CEREBELLAR DYSFUNCTION II. LABORATORY TESTS OF VESTIBULAR FUNCTION A. CALORIC TEST B. ELECTRONYSTAGMOGRAPHY C. OPTOKINETIC TEST D. ROTATION TEST E. GALVANIC TEST F. POSTUROGRAPHY G. VESTIBULAR EVOKED MYOGENIC POTENTIALS (VEMP) Chapter 7: Disorders of Vestibular System I. PERIPHERAL VESTIBULAR DISORDERS II. CENTRAL VESTIBULAR DISORDERS OTHER CAUSES OF VERTIGO Chapter 8: Diseases of External Ear I. DISEASES OF THE PINNA A. CONGENITAL DISORDERS B. TRAUMA TO THE AURICLE C. INFLAMMATORY DISORDERS D. TUMOURS II. DISEASES OF EXTERNAL AUDITORY CANAL A. CONGENITAL DISORDERS B. TRAUMA TO EAR CANAL C. INFLAMMATIONS OF EAR CANAL 1. Infective Group 2. Reactive Group D. TUMOURS E. MISCELLANEOUS CONDITIONS III. DISEASES OF TYMPANIC MEMBRANE Chapter 9: Eustachian Tube and Its Disorders ANATOMY STRUCTURE MUSCLES RELATED TO EUSTACHIAN TUBE (FIGURE 9.2) LINING OF THE EUSTACHIAN TUBE NERVE SUPPLY DIFFERENCES BETWEEN THE INFANT AND ADULT EUSTACHIAN TUBE FUNCTIONS EUSTACHIAN TUBE FUNCTION TESTS DISORDERS OF EUSTACHIAN TUBE RETRACTION POCKETS AND EUSTACHIAN TUBE PATULOUS EUSTACHIAN TUBE EXAMINATION OF EUSTACHIAN TUBE Chapter 10: Disorders of Middle Ear ACUTE SUPPURATIVE OTITIS MEDIA AETIOLOGY ROUTES OF INFECTION PREDISPOSING FACTORS PATHOLOGY AND CLINICAL FEATURES TREATMENT ACUTE NECROTIZING OTITIS MEDIA OTITIS MEDIA WITH EFFUSION SYN. SEROUS OTITIS MEDIA, SECRETORY OTITIS MEDIA, MUCOID OTITIS MEDIA, “GLUE EAR” PATHOGENESIS AETIOLOGY CLINICAL FEATURES HEARING TESTS TREATMENT 1. Medical 2. Surgical BIOFILM SEQUELAE OF CHRONIC SECRETORY OTITIS MEDIA AERO-OTITIS MEDIA (OTITIC BAROTRAUMA) MECHANISM RECURRENT ACUTE OTITIS MEDIA CLINICAL FEATURES TREATMENT PREVENTION Chapter 11: Cholesteatoma and Chronic Otitis Media EXPANSION OF CHOLESTEATOMAAND DESTRUCTION OF BONE CHRONIC SUPPURATIVE OTITIS MEDIA EPIDEMIOLOGY TYPES OF CSOM A. TUBOTYMPANIC TYPE Aetiology Pathology Bacteriology Alternative Classification of ChronicOtitis Media Clinical Features Assessment Treatment B. ATTICOANTRAL TYPE Aetiology Pathology 1. Cholesteatoma Bacteriology Symptoms Signs Assessment Features Indicating Complications in CSOM Treatment TUBERCULAR OTITIS MEDIA AETIOLOGY PATHOLOGY CLINICAL FEATURES DIAGNOSIS TREATMENT SYPHILITIC OTITIS MEDIA Chapter 12: Complications of Suppurative Otitis Media FACTORS INFLUENCING DEVELOPMENT OF COMPLICATIONS PATHWAYS OF SPREAD OF INFECTION 3. Preformed Pathways CLASSIFICATION A. INTRATEMPORAL (WITHIN THE CONFINES OF TEMPORAL BONE) B. INTRACRANIAL SEQUELAE OF OTITIS MEDIA I. INTRATEMPORAL COMPLICATIONS OF OTITIS MEDIA A. (i) ACUTE MASTOIDITIS Aetiology Pathology Clinical Features Signs Investigations Differential Diagnosis 3. Infected Sebaceous Cyst Treatment Complications of Acute Mastoiditis Abscesses in Relation to Mastoid Infection A. (ii) MASKED (LATENT) MASTOIDITIS Aetiology Clinical Features Treatment B. PETROSITIS Pathology Clinical Features Treatment C. FACIAL PARALYSIS Acute Otitis Media Chronic Otitis Media D. LABYRINTHITIS Circumscribed Labyrinthitis (Fistula of Labyrinth) Diffuse Serous Labyrinthitis Aetiology Treatment Diffuse Suppurative Labyrinthitis II. INTRACRANIAL COMPLICATIONSOF OTITIS MEDIA A. EXTRADURAL ABSCESS Pathology Clinical Features Treatment B. SUBDURAL ABSCESS Pathology Clinical Features Treatment C. MENINGITIS Mode of Infection Clinical Features Diagnosis Treatment D. OTOGENIC BRAIN ABSCESS Route of Infection Bacteriology Pathology Clinical Features 1. Symptoms and Signs of Raised Intracranial Tension 2. Localizing Features Investigations Treatment E. LATERAL SINUS THROMBOPHLEBITIS (SYN. SIGMOID SINUS THROMBOSIS) Aetiology Pathology Bacteriology Clinical Features 3. Progressive Anaemia and Emaciation Investigations Complications Treatment F. OTITIC HYDROCEPHALUS Mechanism Clinical Features Symptoms Signs Treatment Chapter 13: Otosclerosis (Syn. Otospongiosis) ANATOMY OF LABYRINTH OTOSCLEROSIS AETIOLOGY TYPES OF OTOSCLEROSIS PATHOLOGY SYMPTOMS SIGNS DIFFERENTIAL DIAGNOSIS TREATMENT Contraindications to Stapes Surgery Complications of Stapedectomy Chapter 14: Facial Nerve and Its Disorders ANATOMY AND FUNCTIONS OF FACIAL NERVE NUCLEUS OF FACIAL NERVE COURSE OF FACIAL NERVE BRANCHES OF FACIAL NERVE BLOOD SUPPLY OF FACIAL NERVE SURGICAL LANDMARKS OF FACIAL NERVE VARIATION AND ANOMALIES OF FACIAL NERVE (FIGURE 14.5) STRUCTURE OF NERVE SEVERITY OF NERVE INJURY ELECTRODIAGNOSTIC TESTS CAUSES OF FACIAL PARALYSIS A. IDIOPATHIC 1. Bell’s Palsy Aetiology Treatment 2. Melkersson Syndrome B. INFECTIONS Herpes Zoster Oticus (Ramsay–HuntSyndrome) C. TRAUMA 1. Fractures of Temporal Bone 2. Ear or Mastoid Surgery 3. Parotid Surgery and Trauma to Face D. NEOPLASMS 1. Intratemporal Neoplasms 2. Tumours of Parotid E. SYSTEMIC DISEASES AND FACIALPARALYSIS LOCALIZATION OF FACIAL LESION A. CENTRAL FACIAL PARALYSIS B. PERIPHERAL FACIAL PARALYSIS TOPODIAGNOSTIC TESTS FOR LESIONS IN INTRATEMPORAL PART (FIGURE 14.12 ) COMPLICATIONS FOLLOWING FACIAL PARALYSIS HYPERKINETIC DISORDERSOF FACIAL NERVE SURGERY OF FACIAL NERVE Chapter 15: Ménière’s Disease PATHOLOGY AETIOLOGY CLINICAL FEATURES EXAMINATION INVESTIGATIONS VARIANTS OF MÉNIÈRE’S DISEASE MÉNIÈRE’S DISEASE VS MÉNIÈRE’SSYNDROME DIAGNOSIS OF MÉNIÈRE’S DISEASE STAGING OF MÉNIÈRE’S DISEASE TREATMENT A. GENERAL MEASURES B. MANAGEMENT OF ACUTE ATTACK C. MANAGEMENT OF CHRONIC PHASE Intratympanic gentamicin therapy (chemical labyrinthectomy) Microwick D. SURGICAL TREATMENT Chapter 16: Tumours of External Ear TUMOURS OF AURICLE BENIGN TUMOURS MALIGNANT TUMOURS TUMOURS OF EXTERNAL AUDITORYCANAL BENIGN TUMOURS MALIGNANT TUMOURS Chapter 17: Tumours of Middle Ear and Mastoid CLASSIFICATION 1. Primary tumours 2. Secondary tumours GLOMUS TUMOUR AETIOLOGY AND PATHOLOGY Spread of Glomus Tumour CLINICAL FEATURES DIAGNOSIS TREATMENT Surgical approaches to glomus tumours CARCINOMA OF MIDDLE EARAND MASTOID AETIOLOGY PATHOLOGY CLINICAL FEATURES DIAGNOSIS TREATMENT SARCOMAS SECONDARY TUMOURS Chapter 18: Acoustic Neuroma INCIDENCE PATHOLOGY ORIGIN AND GROWTH OF TUMOUR CLASSIFICATION 3. Cranial Nerve Involvement CLINICAL FEATURES INVESTIGATIONS AND DIAGNOSIS 5. Radiological Tests DIFFERENTIAL DIAGNOSIS TREATMENT SURGERY RADIOTHERAPY Chapter 19: The Deaf Child 5. Neonatal Meningitis 6. Sepsis 7. Time Spent in Neonatal ICU C. POSTNATAL CAUSES EVALUATION OF A DEAF CHILD FINDING THE CAUSE ASSESSMENT OF HEARING IN INFANTSAND CHILDREN 4. Conditioning techniques 5. Objective tests MANAGEMENT 3. Cochlear implants (see p. 138) Chapter 20: Rehabilitation of the Hearing Impaired I. INSTRUMENTAL DEVICES A. HEARING AIDS Conventional Hearing Aids Types of Hearing Aids Bone-anchored Hearing Aid (BAHA) Implantable Hearing Aids B. IMPLANTS Cochlear Implants Auditory Brainstem Implant (ABI) C. ASSISTIVE DEVICES 1. Assistive Listening Devices and Systems 2. Alerting Devices 3. Telecommunication Devices II. TRAINING A. SPEECH READING B. AUDITORY TRAINING C. SPEECH CONSERVATION Chapter 21: Otalgia (Earache) I. LOCAL CAUSES II. REFERRED CAUSES III. PSYCHOGENIC CAUSES Chapter 22: Tinnitus TYPES OF TINNITUS TREATMENT OF TINNITUS TINNITUS INSTRUMENT TINNITUS RETRAINING THERAPY (TRT) Section II: Diseases of Nose and Paranasal Sinuses Chapter 23: Anatomy of Nose EXTERNAL NOSE OSTEOCARTILAGINOUS FRAMEWORK Bony Part Cartilaginous Part NASAL MUSCULATURE NASAL SKIN INTERNAL NOSE VESTIBULE OF NOSE NASAL CAVITY PROPER Lateral Nasal Wall Medial Wall Roof Floor LINING MEMBRANE OF INTERNAL NOSE NERVE SUPPLY 2. Nerves of COMMON SENSATION. They are: BLOOD SUPPLY LYMPHATIC DRAINAGE Chapter 24: Physiology of Nose RESPIRATION AIR-CONDITIONING OF INSPIRED AIR PROTECTION OF LOWER AIRWAY VOCAL RESONANCE NASAL REFLEXES OLFACTION Chapter 25: Diseases of External Nose and Nasal Vestibule DISEASES OF EXTERNAL NOSE CELLULITIS NASAL DEFORMITIES Saddle Nose Hump Nose Crooked or a Deviated Nose TUMOURS 1. Congenital Tumours 2. Benign Tumours 3. Malignant Tumours DISEASES OF NASAL VESTIBULE VESTIBULITIS STENOSIS AND ATRESIA OF THE NARES TUMOURS Chapter 26: Nasal Septum and Its Diseases ANATOMY FRACTURES OF NASAL SEPTUM AETIOPATHOGENESIS TREATMENT COMPLICATIONS DEVIATED NASAL SEPTUM (DNS) AETIOLOGY CLINICAL FEATURES TREATMENT Submucous Resection (SMR) Operation Septoplasty SEPTAL HAEMATOMA AETIOLOGY CLINICAL FEATURES TREATMENT COMPLICATIONS SEPTAL ABSCESS AETIOLOGY CLINICAL FEATURES TREATMENT COMPLICATIONS 3. Drugs and Chemicals Chapter 27: Acute and Chronic Rhinitis ACUTE RHINITIS VIRAL RHINITIS BACTERIAL RHINITIS IRRITATIVE RHINITIS CHRONIC RHINITIS CHRONIC SIMPLE RHINITIS Aetiology Pathology Clinical Features Treatment HYPERTROPHIC RHINITIS Aetiology Symptoms Signs Treatment Compensatory Hypertrophic Rhinitis ATROPHIC RHINITIS (OZAENA) Primary Atrophic Rhinitis Secondary Atrophic Rhinitis RHINITIS SICCA RHINITIS CASEOSA Chapter 28: Granulomatous Diseases of Nose Treatment BACTERIAL INFECTIONS RHINOSCLEROMA Pathology Clinical Features Diagnosis SYPHILIS Diagnosis Treatment Complications TUBERCULOSIS LUPUS VULGARIS LEPROSY FUNGAL INFECTIONS Epidemiology Life Cycle Clinical Features Diagnosis Treatment ASPERGILLOSIS Clinical Features Treatment MUCORMYCOSIS OTHER FUNGAL INFECTIONS GRANULOMAS OF UNSPECIFIEDAETIOLOGY WEGENER’S GRANULOMATOSIS Aetiology Clinical Features Diagnosis Treatment T-CELL LYMPHOMA SARCOIDOSIS Chapter 29: Miscellaneous Disorders of Nasal Cavity FOREIGN BODIES AETIOLOGY CLINICAL FEATURES TREATMENT COMPLICATIONS RHINOLITH AETIOLOGY CLINICAL FEATURES TREATMENT NASAL MYIASIS (MAGGOTS IN NOSE) CLINICAL FEATURES TREATMENT NASAL SYNECHIA CHOANAL ATRESIA CSF RHINORRHOEA DEFINITION PHYSIOLOGY AETIOLOGY SITES OF LEAKAGE DIAGNOSIS LABORATORY TESTS LOCALIZATION OF SITE TREATMENT Chapter 30: Allergic Rhinitis AETIOLOGY PATHOGENESIS CLINICAL FEATURES DIAGNOSIS INVESTIGATIONS COMPLICATIONS TREATMENT 2. Treatment with Drugs Chapter 31: Vasomotor and Other Forms of Nonallergic Rhinitis VASOMOTOR RHINITIS (VMR) PATHOGENESIS SYMPTOMS SIGNS COMPLICATIONS TREATMENT Medical Surgical OTHER FORMS OF NONALLERGIC RHINITIS Chapter 32: Nasal Polypi ANTROCHOANAL POLYP(SYN. KILLIAN’S POLYP) AETIOLOGY SYMPTOMS SIGNS DIFFERENTIAL DIAGNOSIS TREATMENT BILATERAL ETHMOIDAL POLYPI AETIOLOGY PATHOGENESIS PATHOLOGY SITE OF ORIGIN SYMPTOMS SIGNS DIAGNOSIS TREATMENT Conservative Surgical SOME IMPORTANT POINTS TOREMEMBER IN A CASE OF NASAL POLYPI Chapter 33: Epistaxis NASAL SEPTUM Internal Carotid System External Carotid System LATERAL WALL Internal Carotid System External Carotid System LITTLE’S AREA WOODRUFF’S PLEXUS CAUSES OF EPISTAXIS A. LOCAL CAUSES Nose Nasopharynx B. GENERAL CAUSES C. IDIOPATHIC SITES OF EPISTAXIS CLASSIFICATION OF EPISTAXIS Anterior Epistaxis Posterior Epistaxis MANAGEMENT FIRST AID CAUTERIZATION ANTERIOR NASAL PACKING POSTERIOR NASAL PACKING ENDOSCOPIC CAUTERIZATION ELEVATION OF MUCOPERICHONDRIAL FLAP AND SUBMUCOUS RESECTION (SMR) OPERATION LIGATION OF VESSELS Transnasal Endoscopic SphenopalatineArtery Ligation (TESPAL) Embolization GENERAL MEASURES IN EPISTAXIS Chapter 34: Trauma to the Face GENERAL MANAGEMENT SOFT TISSUE INJURIES AND THEIR MANAGEMENT FACIAL LACERATIONS PAROTID GLAND AND DUCT FACIAL NERVE BONE INJURIES AND THEIR MANAGEMENT I. FRACTURES OF UPPER THIRD OF FACE A. FRONTAL SINUS B. SUPRAORBITAL RIDGE C. FRACTURES OF FRONTAL BONE II. FRACTURES OF MIDDLE THIRD OF FACE A. NASAL BONES AND SEPTUM Clinical Features Diagnosis Treatment B. NASO-ORBITAL FRACTURES Clinical Features Diagnosis Treatment C. FRACTURES OF ZYGOMA (TRIPOD FRACTURE) Clinical Features Diagnosis Treatment D. FRACTURES OF ZYGOMATIC ARCH Clinical Features Diagnosis Treatment E. FRACTURES OF ORBITAL FLOOR Clinical Features Diagnosis Treatment III. FRACTURES OF LOWER THIRD FRACTURES OF MANDIBLE Clinical Features Diagnosis Treatment OROANTRAL FISTULA Aetiology Clinical Features Diagnosis Treatment Chapter 35: Anatomy and Physiology of Paranasal Sinuses ANATOMY OF PARANASAL SINUSES Maxillary Sinus (Antrum of Highmore) Relations Frontal Sinus Ethmoidal Sinuses (Ethmoid Air Cells) Sphenoid Sinus MUCOUS MEMBRANE OF PARANASALSINUSES DEVELOPMENT OF PARANASAL SINUSES LYMPHATIC DRAINAGE PHYSIOLOGY OF PARANASAL SINUSES VENTILATION OF SINUSES MUCOCILIARY CLEARANCE OF SINUSES FUNCTIONS OF PARANASAL SINUSES Chapter 36: Acute Rhinosinusitis ACUTE MAXILLARY SINUSITIS AETIOLOGY Predisposing factors CLINICAL FEATURES DIAGNOSIS TREATMENT Medical Surgical COMPLICATIONS ACUTE FRONTAL SINUSITIS AETIOLOGY CLINICAL FEATURES TREATMENT Medical Surgical COMPLICATIONS ACUTE ETHMOID SINUSITIS AETIOLOGY CLINICAL FEATURES TREATMENT COMPLICATIONS ACUTE SPHENOID SINUSITIS AETIOLOGY CLINICAL FEATURES DIFFERENTIAL DIAGNOSIS TREATMENT Chapter 37: Chronic Rhinosinusitis DEFINITION AETIOLOGY CRS Without Polyps Treatment CRS With Polyposis Treatment OLDER SURGICAL TECHNIQUES FOR CHRONIC SINUSITIS CHRONIC MAXILLARY SINUSITIS CHRONIC FRONTAL SINUSITIS CHRONIC ETHMOID SINUSITIS CHRONIC SPHENOIDITIS FUNGAL INFECTIONS OF SINUSES FUNCTIONAL ENDOSCOPIC SURGERYOF SINUSES (FIGURES 37.4 AND 37.5) Chapter 38: Complications of Sinusitis I. LOCAL COMPLICATIONS A. MUCOCELE OF PARANASAL SINUSES AND MUCOUS RETENTION CYSTS B. OSTEOMYELITIS II. ORBITAL COMPLICATIONS III. INTRACRANIAL COMPLICATIONS CAVERNOUS SINUS THROMBOSIS IV. DESCENDING INFECTIONS V. FOCAL INFECTIONS Chapter 39: Benign and Malignant Neoplasms of Nasal Cavity BENIGN NEOPLASMS MALIGNANT NEOPLASMS Chapter 40: Neoplasms of Paranasal Sinuses BENIGN NEOPLASMS MALIGNANT NEOPLASMS CARCINOMA OF MAXILLARY SINUS Diagnosis Classification Treatment Prognosis ETHMOID SINUS MALIGNANCY Clinical Features FRONTAL SINUS MALIGNANCY Clinical Features Treatment SPHENOID SINUS MALIGNANCY Chapter 41: Proptosis AETIOLOGY EVALUATION OF PROPTOSIS MANAGEMENT Section III: Diseases of Oral Cavity and Salivary Glands Chapter 42: Anatomy of Oral Cavity APPLIED ANATOMY LYMPHATIC DRAINAGE OF ORAL CAVITY Chapter 43: Common Disorders of Oral Cavity ULCERS OF ORAL CAVITY A. INFECTION Viral Bacterial Fungal B. IMMUNE DISORDERS C. TRAUMA D. NEOPLASMS E. SKIN DISORDERS F. BLOOD DISORDERS G. DRUG ALLERGY H. VITAMIN DEFICIENCIES I. MISCELLANEOUS MISCELLANEOUS LESIONS OF TONGUEAND ORAL CAVITY SUBMUCOUS FIBROSIS AETIOLOGY PATHOGENESIS PATHOLOGY CLINICAL FEATURES TREATMENT Medical Surgical Chapter 44: Tumours of Oral Cavity CLASSIFICATION I. BENIGN TUMOURS SOLID TUMOURS CYSTIC LESIONS II. PREMALIGNANT LESIONS III. MALIGNANT LESIONS CARCINOMA ORAL CAVITY Aetiology Sites of cancer in the lip and oral cavity (AJCC, 2002) Multiple Primary Cancers NONSQUAMOUS MALIGNANT LESIONS CHEMOPREVENTION Chapter 45: Non-neoplastic Disorders of Salivary Glands MUMPS (VIRAL PAROTITIS) CLINICAL FEATURES COMPLICATIONS DIAGNOSIS TREATMENT PREVENTION ACUTE SUPPURATIVE PAROTITIS CLINICAL FEATURES INVESTIGATIONS TREATMENT CHRONIC RECURRENT SIALADENITIS SIALECTASIS GRANULOMATOUS INFECTIONS OF THESALIVARY GLANDS TUBERCULOSIS ACTINOMYCOSIS TOXOPLASMOSIS SIALOLITHIASIS (SALIVARY CALCULI) SJOGREN’S SYNDROME (SICCASYNDROME) SIALOMETAPLASIA SIALADENOSIS Chapter 46: Neoplasms of Salivary Glands BENIGN TUMOURS PLEOMORPHIC ADENOMA ADENOLYMPHOMA (PAPILLARY CYSTADENOMA LYMPHOMATOSUM, WARTHIN TUMOUR) ONCOCYTOMA (OXYPHIL ADENOMA) HAEMANGIOMAS LYMPHANGIOMAS MALIGNANT TUMOURS MUCOEPIDERMOID CARCINOMA ADENOID CYSTIC CARCINOMA (CYLINDROMA) ACINIC CELL CARCINOMA ADENOCARCINOMA MALIGNANT MIXED TUMOUR UNDIFFERENTIATED CARCINOMA LYMPHOMA SARCOMA FREY’S SYNDROME (GUSTATORYSWEATING) Section IV: Diseases of Pharynx Chapter 47: Anatomy and Physiology of Pharynx PHARYNX IN GENERAL KILLIAN’S DEHISCENCE PHARYNGEAL SPACES DIVISIONS OF PHARYNX NASOPHARYNX (EPIPHARYNX) Applied Anatomy Nasopharyngeal Tonsil (Adenoids) Rathke’s Pouch Tubal Tonsil Sinus of Morgagni Passavant’s Ridge Epithelial Lining of Nasopharynx Lymphatic Drainage Functions of Nasopharynx OROPHARYNX Applied Anatomy Boundaries of Oropharynx Lymphatic Drainage Functions of Oropharynx HYPOPHARYNX (LARYNGOPHARYNX) Applied Anatomy Lymphatic Drainage Functions of Hypopharynx Chapter 48: Adenoids and Other Inflammations of Nasopharynx ADENOIDS ANATOMY AND PHYSIOLOGY AETIOLOGY CLINICAL FEATURES 1. Nasal Symptoms 2. Aural Symptoms 3. General Symptoms DIAGNOSIS TREATMENT ACUTE NASOPHARYNGITIS AETIOLOGY CLINICAL FEATURES TREATMENT CHRONIC NASOPHARYNGITIS AETIOLOGY CLINICAL FEATURES TREATMENT THORNWALDT’S DISEASE (PHARYNGEAL BURSITIS) CLINICAL FEATURES TREATMENT Chapter 49: Tumours of Nasopharynx BENIGN TUMOURS NASOPHARYNGEAL FIBROMA (JUVENILE NASOPHARYNGEAL ANGIOFIBROMA) Aetiology Site of Origin and Growth Pathology Extensions of Nasopharyngeal Fibroma Clinical Features Diagnosis Investigations Treatment OTHER BENIGN TUMOURSOF NASOPHARYNX MALIGNANT TUMOURS NASOPHARYNGEAL CANCER Epidemiology and Geographic Distribution Aetiology Pathology Clinical Features Diagnosis Treatment OTHER MALIGNANT TUMOURSOF NASOPHARYNX Chapter 50: Acute and Chronic Pharyngitis ACUTE PHARYNGITIS AETIOLOGY CLINICAL FEATURES DIAGNOSIS TREATMENT VIRAL INFECTIONS CAUSING PHARYNGITIS FUNGAL PHARYNGITIS MISCELLANEOUS CAUSES OF PHARYNGITIS CHRONIC PHARYNGITIS AETIOLOGY SYMPTOMS SIGNS 2. Chronic Hypertrophic (Granular) Pharyngitis TREATMENT ATROPHIC PHARYNGITIS CLINICAL FEATURES KERATOSIS PHARYNGIS Chapter 51: Acute and Chronic Tonsillitis APPLIED ANATOMY OF PALATINE (FAUCIAL) TONSILS BLOOD SUPPLY VENOUS DRAINAGE LYMPHATIC DRAINAGE NERVE SUPPLY FUNCTIONS OF TONSILS ACUTE TONSILLITIS AETIOLOGY SYMPTOMS SIGNS TREATMENT COMPLICATIONS DIFFERENTIAL DIAGNOSIS OF MEMBRANE OVER THE TONSIL FAUCIAL DIPHTHERIA AETIOLOGY CLINICAL FEATURES COMPLICATIONS TREATMENT CHRONIC TONSILLITIS AETIOLOGY TYPES CLINICAL FEATURES EXAMINATION TREATMENT COMPLICATIONS DISEASES OF LINGUAL TONSILS Chapter 52: Head and Neck Space Infections PAROTID ABSCESS AETIOLOGY BACTERIOLOGY CLINICAL FEATURES DIAGNOSIS TREATMENT LUDWIG’S ANGINA APPLIED ANATOMY AETIOLOGY 2. Submandibular Sialadenitis, Injuries of Oral Mucosa and Fractures of the Mandible account for other cases. BACTERIOLOGY CLINICAL FEATURES TREATMENT COMPLICATIONS PERITONSILLAR ABSCESS (QUINSY) AETIOLOGY CLINICAL FEATURES EXAMINATION INVESTIGATION TREATMENT COMPLICATIONS RETROPHARYNGEAL ABSCESS APPLIED ANATOMY ACUTE RETROPHARYNGEAL ABSCESS AETIOLOGY CLINICAL FEATURES TREATMENT CHRONIC RETROPHARYNGEAL ABSCESS (PREVERTEBRAL ABSCESS) AETIOLOGY CLINICAL FEATURES APPLIED ANATOMY TREATMENT PARAPHARYNGEAL ABSCESS CLINICAL FEATURES DIAGNOSIS COMPLICATIONS TREATMENT MASTICATOR SPACE Chapter 53: Tumours of Oropharynx BENIGN TUMOURS PAPILLOMA HAEMANGIOMA PLEOMORPHIC ADENOMA MUCOUS CYST MALIGNANT TUMOURS A. CARCINOMA OF POSTERIOR ONE-THIRDOR BASE OF TONGUE Spread Diagnosis Treatment B. CARCINOMA TONSIL AND TONSILLAR FOSSA Spread Clinical Features Diagnosis Treatment C. CARCINOMA OF FAUCIAL (PALATINE)ARCH D. CARCINOMA OF POSTERIOR AND LATERAL PHARYNGEAL WALL PARAPHARYNGEAL TUMOURS STYALGIA (EAGLE SYNDROME) Chapter 54: Tumours of the Hypopharynx and Pharyngeal Pouch TUMOURS OF HYPOPHARYNX A. CARCINOMA PYRIFORM SINUS Spread Clinical Features Diagnosis Treatment B. CARCINOMA POSTCRICOID REGION Spread Clinical Features Diagnosis Treatment C. CARCINOMA POSTERIORPHARYNGEAL WALL Spread Clinical Features Diagnosis Treatment PHARYNGEAL POUCH AETIOLOGY PATHOLOGY CLINICAL FEATURES DIAGNOSIS TREATMENT Chapter 55: Snoring and Sleep Apnoea SNORING DEFINITION OF TERMS MECHANISM OF SNORING AETIOLOGY SITES OF SNORING SYMPTOMATOLOGY TREATMENT SLEEP APNOEA PATHOPHYSIOLOGY OF OSA PHYSIOLOGY OF SLEEP Non-REM Sleep REM Sleep CLINICAL EVALUATION OF A CASEOF SLEEP APNOEA History Physical Examination Treatment (Nonsurgical) Section V: Diseases of Larynx and Trachea Chapter 56: Anatomy and Physiology of Larynx ANATOMY OF LARYNX LARYNGEAL CARTILAGES LARYNGEAL JOINTS LARYNGEAL MEMBRANES 1. Extrinsic membranes and ligaments(Figure 56.1) 2. Intrinsic membranes and ligaments MUSCLES OF LARYNX CAVITY OF THE LARYNX MUCOUS MEMBRANE OF THE LARYNX Structure of the Vocal Cords EMBRYOLOGICAL DEVELOPMENT LYMPHATIC DRAINAGE NERVE SUPPLY (SEE P. 337) Spaces of the Larynx PAEDIATRIC LARYNX PHYSIOLOGY OF LARYNX A. PROTECTION OF LOWER AIRWAYS B. PHONATION C. RESPIRATION D. FIXATION OF THE CHEST Chapter 57: Laryngotracheal Trauma AETIOLOGY PATHOLOGY CLINICAL FEATURES DIAGNOSTIC EVALUATION TREATMENT CONSERVATIVE SURGICAL COMPLICATIONS Chapter 58: Acute and Chronic Inflammations of Larynx ACUTE LARYNGITIS AETIOLOGY CLINICAL FEATURES TREATMENT ACUTE EPIGLOTTITIS (SYN.SUPRAGLOTTIC LARYNGITIS) AETIOLOGY CLINICAL FEATURES EXAMINATION TREATMENT ACUTE LARYNGO-TRACHEO-BRONCHITIS AETIOLOGY PATHOLOGY SYMPTOMATOLOGY TREATMENT LARYNGEAL DIPHTHERIA AETIOLOGY PATHOLOGY CLINICAL FEATURES DIAGNOSIS TREATMENT COMPLICATIONS OEDEMA OF LARYNX AETIOLOGY SYMPTOMS AND SIGNS TREATMENT CHRONIC LARYNGITIS A. CHRONIC LARYNGITIS WITHOUT HYPERPLASIA (Chronic Hyperaemic Laryngitis) Aetiology Clinical Features Treatment B. CHRONIC HYPERTROPHIC LARYNGITIS (SYN. CHRONIC HYPERPLASTICLARYNGITIS) Aetiology Pathology Clinical Features Treatment POLYPOID DEGENERATION OF VOCALCORDS (REINKE’S OEDEMA) CLINICAL FEATURES TREATMENT PACHYDERMIA LARYNGIS ATROPHIC LARYNGITIS (LARYNGITIS SICCA) TUBERCULOSIS OF LARYNX AETIOLOGY PATHOLOGY SYMPTOMS AND SIGNS LARYNGEAL EXAMINATION DIAGNOSIS TREATMENT LUPUS OF THE LARYNX SYPHILIS OF THE LARYNX LEPROSY OF THE LARYNX SCLEROMA OF THE LARYNX LARYNGEAL MYCOSIS Chapter 59: Congenital Lesions of Larynx and Stridor CONGENITAL LESIONS OF LARYNX STRIDOR AETIOLOGY MANAGEMENT History Physical Examination INVESTIGATIONS Direct laryngoscopy TREATMENT Chapter 60: Laryngeal Paralysis NERVE SUPPLY OF LARYNX CLASSIFICATION OF LARYNGEALPARALYSIS CAUSES OF LARYNGEAL PARALYSIS RECURRENT LARYNGEAL NERVEPARALYSIS A. UNILATERAL Clinical Features Treatment B. BILATERAL (BILATERAL ABDUCTOR PARALYSIS) Aetiology Position of Cords Clinical Features Treatment PARALYSIS OF SUPERIORLARYNGEAL NERVE A. UNILATERAL Clinical Features B. BILATERAL Aetiology Clinical Features Treatment COMBINED (COMPLETE) PARALYSIS (RECURRENT AND SUPERIOR LARYNGEAL NERVE PARALYSIS) A. UNILATERAL Aetiology Clinical Features Treatment B. BILATERAL Clinical Features Treatment CONGENITAL VOCAL CORD PARALYSIS PHONOSURGERY Chapter 61: Benign Tumours of Larynx NON-NEOPLASTIC TUMOURS A. SOLID NON-NEOPLASTIC LESIONS 2. Vocal polyp 3. Reinke’s oedema (bilateraldiffuse polyposis) 4. Contact ulcer or granuloma 5. Intubation granuloma 6. Leukoplakia or keratosis 7. Amyloid tumour B. CYSTIC LESIONS NEOPLASTIC A. SQUAMOUS PAPILLOMAS 1. Juvenile papillomatosis (Syn. respiratory papillomatosis) 2. Adult-onset papilloma B. CHONDROMA C. HAEMANGIOMA D. GRANULAR CELL TUMOUR E. GLANDULAR TUMOURS F. RARE BENIGN LARYNGEAL TUMOURS Chapter 62: Cancer Larynx EPIDEMIOLOGY HISTOPATHOLOGY AETIOLOGY TNM CLASSIFICATION AND STAGING 1. Supraglottic Cancer 2. Glottic Cancer 3. Subglottic Cancer (1-2%) DIAGNOSIS OF LARYNGEAL CANCER 2. Indirect Laryngoscopy 5. Radiography TREATMENT OF LARYNGEAL CANCER 2. Surgery GLOTTIC CARCINOMA Invasive Carcinoma VOCAL REHABILITATION AFTER TOTAL LARYNGECTOMY Chapter 63: Voice and Speech Disorders HOARSENESS DYSPHONIA PLICA VENTRICULARIS (VENTRICULAR DYSPHONIA) AETIOLOGY EVALUATION OF HOARSENESS FUNCTIONAL APHONIA (HYSTERICAL APHONIA) PUBERPHONIA (MUTATIONAL FALSETTO VOICE) PHONASTHENIA DYSPHONIA ADDUCTOR DYSPHONIA ABDUCTOR DYSPHONIA MIXED DYSPHONIA HYPONASALITY (RHINOLALIA CLAUSA) HYPERNASALITY (RHINOLALIA APERTA) STUTTERING Chapter 64: Tracheostomy and Other Procedures for Airway Management TRACHEOSTOMY FUNCTIONS OF TRACHEOSTOMY INDICATIONS OF TRACHEOSTOMY TYPES OF TRACHEOSTOMY TECHNIQUE STEPS OF OPERATION TRACHEOSTOMY IN INFANTSAND CHILDREN POSTOPERATIVE CARE COMPLICATIONS PROCEDURES FOR IMMEDIATE AIRWAY MANAGEMENT PERCUTANEOUS DILATATIONAL TRACHEOSTOMY Chapter 65: Foreign Bodies of Air Passages AETIOLOGY NATURE OF FOREIGN BODIES CLINICAL FEATURES DIAGNOSIS MANAGEMENT Section VI: Thyroid Gland and Its Disorders Chapter 66: Thyroid Gland and Its Disorders PARATHYROID GLANDS STRAP MUSCLES AND THEIR NERVE SUPPLY RLN TRIANGLE (OF LORE) PHYSIOLOGY OF THYROID BENIGN DISORDERS OF THYROID HASHIMOTO THYROIDITIS (Syn. Chronic Lymphocytic Thyroiditis) HYPOTHYROIDISM GRAVES’ DISEASE MALIGNANT DISORDERS OF THYROID PAPILLARY THYROID CARCINOMA Risk factors for developmentof papillary cancer Clinical presentation Diagnosis Treatment Follow-up FOLLICULAR CARCINOMA Treatment HURTHLE CELL CARCINOMA Treatment ANAPLASTIC CARCINOMA MEDULLARY CARCINOMA Treatment LYMPHOMA METASTASES TO THYROID THYROID NODULE AND ITSMANAGEMENT Colloid nodule (or adenomatous nodule) Follicular adenoma Hurthle cell adenoma Thyroid cyst Dominant nodule Regenerative nodule Autonomous (or toxic) nodule Carcinoma EVALUATION OF THYROID NODULE MANAGEMENT OF THYROID NODULE Suppressive therapy for nodules THYROID SURGERY INDICATIONS PREOPERATIVE WORK-UP ANAESTHESIA POSITION STEPS OF OPERATION Incision Elevation of flaps Separation of strap muscle Palpation of thyroid gland Ligation of vessels and dissection of thyroid lobe Dissection of superior thyroid pedicle and upper pole Preservation of parathyroids and their blood supply Division of isthmus and separation of thyroid lobe Irrigation of wound Closure of wound Complications Section VII: Diseases of Oesophagus Chapter 67: Anatomy and Physiology of Oesophagus APPLIED ANATOMY NERVE SUPPLY LYMPHATIC DRAINAGE APPLIED PHYSIOLOGY PHYSIOLOGY OF SWALLOWING Chapter 68: Disorders of Oesophagus ACUTE OESOPHAGITIS PERFORATION OF OESOPHAGUS AETIOLOGY DIAGNOSIS TREATMENT CORROSIVE BURNS OF OESOPHAGUS AETIOLOGY PATHOLOGY EVALUATION OF PATIENTS MANAGEMENT BENIGN STRICTURES OF OESOPHAGUS AETIOLOGY CLINICAL FEATURES AND DIAGNOSIS TREATMENT HIATUS HERNIA TREATMENT PLUMMER–VINSON (PATTERSON– BROWN–KELLY) SYNDROME TREATMENT GLOBUS (HYSTERICUS) PHARYNGEUS MOTILITY DISORDERS OF OESOPHAGUS CRICOPHARYNGEAL SPASM DIFFUSE OESOPHAGEAL SPASM NUT-CRACKER OESOPHAGUS CARDIAC ACHALASIA GASTRO-OESOPHAGEAL REFLUX Complications of Gastro-oesophagealReflux SCLERODERMA SCHATZKI’S RING NEOPLASMS OF OESOPHAGUS BENIGN NEOPLASMS CARCINOMA OESOPHAGUS Incidence Aetiology Pathology Spread of Carcinoma Clinical Features Diagnosis Treatment Prognosis Chapter 69: Dysphagia AETIOLOGY PREOESOPHAGEAL CAUSES OESOPHAGEAL CAUSES INVESTIGATIONS 4. Radiography Chapter 70: Foreign Bodies of Food Passage AETIOLOGY SITE OF LODGEMENT OF FOREIGN BODY CLINICAL FEATURES SYMPTOMS SIGNS INVESTIGATIONS MANAGEMENT COMPLICATIONS OF OESOPHAGEALFOREIGN BODY DISC BATTERIES SOME CAVEATS IN OESOPHAGEALFOREIGN BODY Section VIII: Recent Advances Chapter 71: Laser Surgery, Radiofrequency Surgery, Hyperbaric Oxygen Therapy and Coblation I. LASER SURGERY A. LASERS TYPES OF LASERS EFFECTS OF LASER ON TISSUES PROPERTIES AND EFFECTS OF LASERS ELECTROMAGNETIC SPECTRUMAND LASERS (FIGURE 71.3) LASERS FOR USE IN EAR SURGERY OPERATIONAL PARAMETERS OF LASERS Mode Delivery System ADVANTAGES AND DISADVANTAGESOF LASERS CLINICAL APPLICATIONSOF INDIVIDUAL LASERS SAFETY PRECAUTIONS IN THE USE OF LASER PRECAUTIONS IN THE USE OF LASERS B. PHOTODYNAMIC THERAPY II. RADIOFREQUENCY SURGERY IN ENT III. HYPERBARIC OXYGENTHERAPY IN ENT INDICATIONS FOR HBOT Evidence-based Indications (Approved by UHMS) Research-based Indications PATIENTS SELECTION CRITERIA FOR SSNHL CLINICAL MANAGEMENT COST IMPACT IV. COBLATION USES Chapter 72: Cryosurgery MECHANISM OF TISSUE DESTRUCTION TECHNIQUE USES OF CRYOTHERAPY ADVANTAGES OF CRYOTHERAPY DISADVANTAGES OF CRYOTHERAPY Chapter 73: Radiotherapy in Head and Neck Cancers1 TYPES OF RADIATION BEAMS MECHANISM OF ACTION OF RADIOTHERAPY RADIOSENSITISERS AND RADIOPROTECTORS RADIOSENSITISERS Reduce Hypoxia Hypoxic Cell Sensitisers Chemotherapeutic Drugs RADIOPROTECTORS Radiation Fractionation INDICATIONS OF RADIOTHERAPY IN HEAD AND NECK CANCER DEFINITIVE RADIOTHERAPY PREOPERATIVE RADIOTHERAPY Advantages of Preoperative Radiotherapy Disadvantages of Preoperative Radiotherapy POSTOPERATIVE RADIOTHERAPY Advantages of Postoperative Radiotherapy Disadvantages of Postoperative Radiotherapy PALLIATIVE RADIOTHERAPY RADIOTHERAPY PLANNING RADIOTHERAPY TECHNIQUES CONVENTIONAL RADIATION THERAPY THREE-DIMENSIONAL CONFORMAL RADIATION THERAPY INTENSITY-MODULATED RADIATIONTHERAPY IMAGE-GUIDED RADIATION THERAPY STEREOTACTIC BODY RADIATION THERAPY STEREOTACTIC RADIOSURGERY ADAPTIVE RADIOTHERAPY TREATMENT MACHINES DOSE AND FRACTIONATION CONCURRENT CHEMOTHERAPYIN HEAD AND NECK CANCER BRACHYTHERAPY IN HEADAND NECK CANCER UNUSUAL NEOPLASMS OF THE HEAD AND NECK (TABLE 73.1) SIDE EFFECTS OF RADIATION CARE OF PATIENT DURING RADIOTHERAPY CARE OF SKIN CARE OF ORAL CAVITY AND DENTITION CARE OF HAEMOPOETIC SYSTEM CARE OF INFECTIONS CARE OF NUTRITION PSYCHOLOGICAL AND EMOTIONALCOUNSELING HOSPITAL ADMISSION Chapter 74: Chemotherapy for Head and Neck Cancer TYPES OF CHEMOTHERAPY SINGLE AGENT VS MULTIDRUG COMBINATION THERAPY PRETREATMENT WORK-UP OF THE PATIENT TOXICITY OF ANTICANCER DRUGS DRUGS USED IN CANCER THERAPY Chapter 75: HIV Infection/AIDS and ENTManifestations ACQUIRED IMMUNODEFICIENCY SYNDROME MODES OF TRANSMISSION HISTORY AND EPIDEMIOLOGY OF HIV INFECTION IN INDIA LIFE CYCLE OF HIV COURSE OF DISEASE ENT MANIFESTATIONS OF HIV INFECTION KAPOSI SARCOMA NON-HODGKIN LYMPHOMA HAIRY LEUKOPLAKIA DIAGNOSTIC TESTS HIV INFECTION AND HEALTHCAREWORKERS MANAGEMENT UNIVERSAL PRECAUTIONS ANTIRETROVIRAL DRUGS Section IX: Clinical Methods in ENT and Neck Masses Chapter 76: Clinical Methods in ENT EQUIPMENT, HISTORY TAKINGAND GENERAL SETUP HISTORY TAKING GENERAL SETUP AND POSITIONOF PATIENT I. EXAMINATION OF EAR SYMPTOMATOLOGY EXAMINATION A. Physical Examination 2. EXAMINATION of External Auditory Canal B. Functional Examination II. EXAMINATION OF NOSE AND PARANASAL SINUSES SYMPTOMATOLOGY A. EXAMINATION OF NOSE 1. External Nose 2. Vestibule 3. Anterior Rhinoscopy 4. Posterior Rhinoscopy 5. Functional Examination of Nose B. EXAMINATION OF PARANASAL SINUSES 1. Maxillary Sinus 2. Frontal Sinus 3. Ethmoid Sinuses 4. Sphenoid Sinus III. EXAMINATION OF NASOPHARYNX SYMPTOMATOLOGY EXAMINATION 1. Anterior Rhinoscopy 2. Posterior Rhinoscopy 3. Other Methods 4. Examination of Cranial Nerves 5. Examination of Cervical Lymph Nodes IV. EXAMINATION OF ORAL CAVITY SYMPTOMATOLOGY EXAMINATION 1. Lips 2. Buccal Mucosa 3. Gums and Teeth 4. Hard Palate 5. Tongue 6. Floor of Mouth 7. Retromolar Trigone PALPATION V. EXAMINATION OF OROPHARYNX SYMPTOMATOLOGY EXAMINATION 1. Tonsils and Pillars 2. Soft Palate 3. Posterior Pharyngeal Wall 4. Base of Tongue and Valleculae VI. EXAMINATION OF LARYNXAND LARYNGOPHARYNX SYMPTOMATOLOGY EXAMINATION 1. External Examination of Larynx 2. Indirect Laryngoscopy 4. Assessment of Voice 5. Assessment of Cervical Lymph Nodes 3. Flexible or Rigid Fibreoptic Endoscopy VII. LYMPH NODES OF THE HEADAND NECK 1. Nodes of Upper Horizontal Chain 2. Lateral Cervical Nodes 3. Anterior Cervical Nodes Lymph Nodes Not Clinically Palpable EXAMINATION OF NECK NODES Level I • Submental (IA) Level II: Upper Jugular Nodes Level III: Middle Jugular Nodes Level IV: Lower Jugular Nodes Level V: Posterior Cervical Group Level VI: Anterior Compartment Nodes Level VII Other Groups NECK DISSECTION CLASSIFICATION OF NECK DISSECTION Radical Neck Dissection Modified Neck Dissection Selective Neck Dissection Extended Neck Dissection Chapter 77: Neck Masses THYROGLOSSAL DUCT CYST SUBLINGUAL DERMOID CYST SUBMENTAL NODES PRELARYNGEAL AND PRETRACHEALNODES THYMIC CYST BRANCHIAL CYST CAROTID BODY TUMOUR BRANCHIAL SINUS OR FISTULA PARAPHARYNGEAL TUMOURS PLUNGING RANULA CYSTIC HYGROMA TUBERCULAR LYMPH NODES METASTATIC LYMPH NODES LYMPHOMAS CERVICAL RIB STERNOMASTOID TUMOUR Section X: Operative Surgery Chapter 78: Myringotomy (Syn. Tympanostomy) INDICATIONS ANAESTHESIA STEPS OF OPERATION PITFALLS OF MYRINGOTOMY POSTOPERATIVE CARE COMPLICATIONS GROMMET Chapter 79: Ear Surgery and Approaches INTRODUCTION TO EAR AND MASTOID SURGERY TERMINOLOGY FOR OPERATIONS PERFORMED FOR CHRONIC EAR INFECTIONS Myringoplasty Tympanoplasty without Mastoidectomy (Tympanum=middle ear) Tympanoplasty with Mastoidectomy Cortical Mastoidectomy (Simple Mastoidectomy or Schwartz Operation) Modified Radical Mastoidectomy Radical Mastoidectomy Meatoplasty Mastoid Obliteration SURGICAL APPROACHES TO THE EARAND INCISIONS Chapter 80: Cortical Mastoidectomy INDICATIONS ANAESTHESIA POSITION STEPS OF OPERATION POSTOPERATIVE CARE COMPLICATIONS Chapter 81: Radical Mastoidectomy INDICATIONS ANAESTHESIA POSITION STEPS OF OPERATION POSTOPERATIVE CARE COMPLICATIONS Chapter 82: Modified Radical Mastoidectomy INDICATIONS ANAESTHESIA POSITION STEPS OF OPERATION POSTOPERATIVE CARE AND COMPLICATIONS Chapter 83: Myringoplasty CONTRAINDICATIONS ANAESTHESIA TECHNIQUE UNDERLAY TECHNIQUE OVERLAY TECHNIQUE POSITION COMPLICATIONS UNDERLAY TECHNIQUE OVERLAY TECHNIQUE POSTOPERATIVE CARE OTHER PROCEDURES FOR CLOSURE OF TYMPANIC MEMBRANE PERFORATION Chapter 84: Proof Puncture (Syn. Antral Lavage) INDICATIONS CONTRAINDICATIONS DIAGNOSIS OF ANTRAL PATHOLOGY ANAESTHESIA POSITION TECHNIQUE POSTOPERATIVE CARE COMPLICATIONS Chapter 85: Intranasal Inferior Meatal Antrostomy INDICATIONS CONTRAINDICATIONS ANAESTHESIA POSITION TECHNIQUE POSTOPERATIVE CARE COMPLICATIONS Chapter 86: Caldwell–Luc (Anterior Antrostomy) Operation INDICATIONS CONTRAINDICATIONS ANAESTHESIA POSITION TECHNIQUE POSTOPERATIVE CARE COMPLICATIONS PRESENT STATUS Chapter 87: Submucous Resection of Nasal Septum (SMR Operation) INDICATIONS CONTRAINDICATIONS ANAESTHESIA POSITION STEPS OF OPERATION POSTOPERATIVE CARE COMPLICATIONS PRESENT STATUS Chapter 88: Septoplasty INDICATIONS CONTRAINDICATIONS ANAESTHESIA POSITION TECHNIQUE POSTOPERATIVE CARE POSTOPERATIVE COMPLICATIONS TYPES OF SEPTAL INCISIONS IN SEPTOPLASTY Chapter 89: Diagnostic Nasal Endoscopy INDICATIONS ANAESTHESIA POSITION SECOND PASS (EXAMINATION OF THE SPHENOETHMOIDAL RECESS, SUPERIOR MEATUS AND OPENINGS OF SPHENOID SINUS AND POSTERIOR ETHMOIDAL CELLS) (FIGURE 89.1) INSTRUMENTS TECHNIQUE FIRST PASS (EXAMINATION OFNASOPHARYNX AND INFERIOR MEATUS) THIRD PASS (EXAMINATION OF THEMIDDLE MEATUS IN DETAIL) COMPLICATIONS Chapter 90: Endoscopic Sinus Surgery INDICATIONS ADVANCED NASAL ENDOSCOPICTECHNIQUES CONTRAINDICATIONS ANAESTHESIA POSITION STEPS OF OPERATION POSTOPERATIVE CARE Chapter 91: Direct Laryngoscopy INDICATIONS A. DIAGNOSTIC B. THERAPEUTIC CONTRAINDICATIONS PROCEDURE ANAESTHESIA POSITION POSTOPERATIVE CARE COMPLICATIONS Chapter 92: Bronchoscopy RIGID BRONCHOSCOPY INDICATIONS Diagnostic Therapeutic ANAESTHESIA POSITION TECHNIQUE DETAILS OF TECHNIQUE POSTOPERATIVE CARE COMPLICATIONS PRECAUTIONS DURING BRONCHOSCOPY FLEXIBLE FIBREOPTIC BRONCHOSCOPY Chapter 93: Oesophagoscopy RIGID OESOPHAGOSCOPY INDICATIONS Diagnostic Therapeutic CONTRAINDICATIONS ANAESTHESIA POSITION TECHNIQUE POSTOPERATIVE CARE COMPLICATIONS FLEXIBLE FIBREOPTIC OESOPHAGOSCOPY TRANSNASAL OESOPHAGOSCOPY Chapter 94: Tonsillectomy INDICATIONS A. ABSOLUTE B. RELATIVE ANAESTHESIA POSITION STEPS OF OPERATION (DISSECTIONAND SNARE METHOD) C. AS A PART OF ANOTHER OPERATION POSTOPERATIVE CARE 1. Immediate General Care COMPLICATIONS A. IMMEDIATE B. DELAYED Chapter 95: Adenoidectomy INDICATIONS CONTRAINDICATIONS ANAESTHESIA POSITION STEPS OF OPERATION ENDOSCOPIC ADENOIDECTOMY POSTOPERATIVE CARE COMPLICATIONS Chapter 96: Some Imaging Techniques in ENT TEMPORAL BONE PARANASAL SINUSES X-RAYS FOR NASAL FRACTURES NECK, LARYNX AND PHARYNX COMPUTED TOMOGRAPHY (CT) USES OF CT ADVANTAGES OF MRI DISADVANTAGES OF MRI MAGNETIC RESONANCE IMAGING (MRI) PULSE SEQUENCES OF MRI PET-CT AND PET-MRI USES DISADVANTAGES Appendix I: Some Memorable Nuggets for Rapid Review1 Appendix II: Instruments EAR INSTRUMENTS NOSE INSTRUMENTS THROAT INSTRUMENTS LARYNX AND TRACHEA INSTRUMENTS Index