Special class notes

Layers of tympanic membrane

Outer layer Epithelial tissue
Middle Layer Flexible fibrous tissue
nerves BloodVessels

Inner layer Mucosal

Congenital Diseases of External ear

Microtia Underdeveloped Pinna

Anotia Absent Pinna a
most common

Preauricular Sinus Embryologial remnant

Pre auricular tags Skin cartilage growth
Congenital Atresia Absent ear Canal

Wax By Ceruminous glands in EAC

 Acute otitis media
most Common Cause Eustachian tubedysfunction
Most Common organism Strep Pneumoniae

Types
Suppurative OM Pus formation
Non Suppurative OM Serous effusion
Bullous Myringitis Hemorrhagic Blisters
Necrotizing otitis media Bone Destruction
Stages

Hyperemia Inflammation withVascular Congestion

Exudation Serous Purulent fluid accumulates
Suppuration Pus formation under Pressure
Perforation TM Rupture to relieve Pressure
Resolution Healing with Residual Damage

Myringotomy Used in

in Severe Pain
Bulding TM with impendingRupture
in Complications like mastoiditis
08 1 18 8 L SP I
 08 Intracranial spread
location Anteroinferior quadrant

CSOM
Tubotympanic Atticoantral
Involves anterior and Involves attic upper or Antrum
inferior Part Associated with cholesteatoma

Cholesteatoma
Abnormal Squamous Epithelium
Keratinizing
in the middle ear
Causing Bone
Destruction

Highly Destructive Due to Proteolytic Enzymes

Complications

Extracranial Intracranial
Mastoiditis Meningitis common
Subperiosteal Abscess Brain Abscess
facial Palsy
nerve otitis Hydrocephalus
Laybyrinthis Extradural Abscess
 Otosclerosis Primary Disorder of the
Bony labyrinth characterized By abnormalbone
remodeling Leading to progressive Conductive
HearingLoss Meniere's Disease Sensorineural Hearingloss

fixation of stapes at the oval window

Autosomal Dominant with incomplete Penetrance
Progressive hearing loss tinnitus normal TM
Schwartze's Sign Reddish hue over thePromontory
Carhart's notch on audiogram dip at 2kHz
Management Stapedectomy

External nose Deformities

Saddle Nose loss of nasal Bridge Height

Hump Nose Prominent Dorsal Hump on Bridge
Crooked nose Asymmetrical twisted nasal Alignment
Broad Nose Exressive width of the nasal
Dorsum
 focused
Septoplasty Surgical Procedure Solely
on Correcting the Deviated nasal Septum

Septorhinoplasty A Surgical Procedure Addressing

Both the nasal Septum and External
nasal Structure

Nasal Concha turbinates

filter warm and Humidify the
Air
Air Passes from nasal cavity through the
choanae Posterior nasal Apertures into
nasopharynx

Rhinophyma Potato tumor

Severe nasal Deformity Due to Sebaceous
Hand Hypertrophy in Advanced rosacea

DNS
Most Common Cause trauma
Most Common Symptom nasal obstruction
Epistaxis
Keisselbach's Plexus little's area

Types of Septal fractures

Simple Fracture Linear Break in Cartilage

C Shaped fracture Curvature Bowing Septum
5 Shaped fracture Double Curvature
Comminuted Fracture Multiple fragments of Cartilage
Dislocated fracture Displatement from Attachment
Crush fracture without Clear Break

Inflammation of the Paranasal

Sinusitis
Sinuses Due to infection Allergy or other
Causes
Nasal obstruction
 Facial Pain
Discharge

Acute Y weeks
Mostly Viral
chronic 12 weeks often Bacteria fungal

Recurrent Multiple acute Episodes in aYear

Fungal Sinusitis Highlighted

Allergic fungal Sinusitis noninvasive

Chronic invasive fungal Slow tissue invasion

Acute fulminant Rapid Aggressive invasion

immunocompromised

Mycetoma Fungal Ball

non invasive Collection of fungal hyphae

Commonly in the maxillary Sinus without
 y y
tissue invasion usually
caused
By Aspergillus fumigatus
cotmmon
most overall

Leprosy Hansen's Disease

Chronic granulomatous infection caused

By mycobacterium Leprae Primarily Affecting
mucosa of upper Resp tract Skin Peripheral
nerves

Transmission Prolonged Contact Resp Droplets

Complications Saddle nose Deformity
nasal Septal Perforation

Nasal Polyps Benign Edematous and

inflamed mucosal growths in the nasal cavity
or Pargnasal Sinuses

Causes
Chronic Inflammation Due to Allergic Rhinitis
most Common Cause
Recurrent infections Bacterial fungal
Aspirin exacerbated respiratory Disease
Sumter's triad
Cystic fibrosis children

Types
Antrochoanal Ethmoidal
Sinus Ethmoid Sinus
maxillary
Extends into nasopharynx multiple Bilateral
Common in Children Adults
Associated with
AllergicRhinitis

CSF Rhinosshea leakage of CSF through the nose

most Commonly Due to trauma

Diagnosed Beta 2 transferrintest Detest
By
Largest
Ethmoid and
maxillary sinuses are Present At Birth
frontal and sphenoid are Absent
affected Because
Maxillary Sinus is more
 y
Poor Drainage CloseProximity Frequent Exposure

Surgical Procedures of Sinuses

Maxillary Sinus Caldwell Luc operation

Functional EndoscopicSinus Surgery
Ethmoid Sinus Ethmoidectomy
frontal Sinus frontal Sinusotomy

Adenoids lympoid tissue

located in Posterior wall and Roof
of nasopharynx

Waldeyer's Ring Palatinetonsils Pharyngealtonsils

Adenoids
Lingualtonsils tubal
tonsils

Most Common Benign tumor of nasopharynx

Angiofibroma and malignant is NPC
Due to hormonal Adrogenicinfluence
Endoscopic Sinus treatment
Surgery
 Ranula Retention Cyst
A mucocele like cyst that forms in
the floor of the mouth Due to
accumulation
of mucus fromBlocked Damaged
Wharton's Duct
Surgical Removal marsupialization if symptomatic or large
Submucosal fibrosis
OSF Betelnut tobacco chewing
Restricted mouth
opening trismus Due
to fibrosis

Infectious mononucleosis glandular fever

EBV via Saliva kissing Disease

Tonsillitis inflammation of Palatine tonsils

Viral Cause mostCommon Adenovirus EBV

most Common Bacterial Group A B Hemolytic Streptococcus

Types of Acute tonsillitis

Catarrhal follicular Lacunar membranous

 Septic Phlegmonous

Diphtheria 3 Corynebacterium Diphtheria

Diphtheriatoxins necrosis thickPseudomembrane

in the Resp tract
Pharyngeal Diphtheria most
Common

obstruction
Laryngeal Diphtheria Stridor Airway
Nasal Diphtheria Serosanguinous Discharge Crustin

Quinsy Peritonsillar Abscess

mos Common Group A Streptococcus
other
StrepPneumoniae Staph Aureus
untreated tonsillitis
Smoking
Pathophysiology
Acute tonsillitis Spreads to Abscessformation
Weber'sgland in Peritonsillar space

Ludwig's Angina
Submandibular
Progressive Bilateral Cellulitis of Sublingual
and Submental Spaces
80 90 Due to Dental infections
 Larynx Between the Pharynx
Below the Hyoid Bone and trachea
and abovethe trachea

Cartilages

Single Paired
Thyroid largest Arytenoid Cartilages
forms ADom's Apple Pyramids ontop of Cricoid
Cricoid Cartilage Corniculate Cartilages
only Cartilagethatform horn Shaped ontopof arytenoids
Complete
Ring Cuneiform Cartilages

Epiglottis Rod shaped Supposelaryngeal

Leaf Shaped Covers glottis mulosa

Acute epiglottitis
unvaccinated
Common Cause Hinfluenzaetype B especially in
Children
Adults Strep Pneumoniae Staph Aureus

Acute Laryngitis Common Cause Viral infection

 Rhinovirus Associated with Common Cold

Vocal Cords flexible mascular Structure inlarynx

Jue Vocal Cords lower in the Larynx compared to falseVocalCords
Vestibular fold which are higher

Vocal Cord nodules Benigngrowth celluseson trueVocal Cords

Dueto chronic Vocalstrain overuse typially in Pairs
Commonest Site Junction of Anterior and Posterior of
the true Vocal Cords

most Commonlocation where foreign Body gets

Stuck in a child'sthroat at thelevel of Circopharyngeus
muscle which is the upper esophageal sphincter

trachea Extend from lower Border of Cricoid cartilage

to Carina at the level of Tu Ts
at the level of Co
intervertebral Disc

Tracheal Rings 16 20C Shaped

Performed Between 2nd and4ᵗʰ trachea

Tracheostomy is
Belowthe cricoid Cartilage Ring
tightracheostomy Performed abovethe 2nd tracheal
Ring
Low tracheostomy Below 4ᵗʰ tracheal Ring
Bothtype are less Common

Eustachiantube Pharyngotympanic tube

onnest Middle ear nasopharyx 3.5 4am long
Starts at anterior wall of middle ear and opens into
nasopharynx Posterior to the inferior nasal Concha

function Equalization of Pressure Drainage

Rhinitis inflammation of nasal mucosa

nasal Congestion Runny nose Sneezing Itching

Most Common Allergic Rhinitis

Vasomotor type non Allergic By Dysregulation of Autonomic

System Due to temp Strong odor

nervous Emotional Stres

Hormonal changes Alcohol

Rhinitis Medicamentosa Rebound rhinitis

Condition of rebound nasal Congestion caused

By Prolonged use oftopical nasal Decongestants

Cicatricial Polyps Scar fibrous tissue forms

after an injury or inflammation
Location nasal cavity or Sinuses

trephination Surgically Creating Borehole in

Sinus Relieve Pressure Drain

Complication of Sinusitis
orbital Cellulitis Meningitis Subperiosteal
Abscess
Complication of FESS orbital CSF leak
injury
Synechiaeformation

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