ENT all Explain Why and Short notes

BY DR. SHUVRO DA
MAKE MEDICAL EASY
1. Nasal Vestibulitis is life threatening
ANS. Nasal vestibulitis is a condition that occurs when the lining of the nasal vestibule, which is the
area just inside the nostrils, becomes inflamed and infected. This condition is typically caused by
bacteria, and symptoms can include pain, swelling, redness, and discharge from the affected area.
While nasal vestibulitis is not usually life-threatening, there are some rare cases where it can become
serious if left untreated. One possible complication of nasal vestibulitis is the development of a
condition called cavernous sinus thrombosis (CST). CST occurs when a blood clot forms in the
cavernous sinus, a large vein located at the base of the skull. This can lead to serious health problems,
including meningitis, brain abscess, and even death.
The risk of developing CST from nasal vestibulitis is low, but it is still a possibility. If you are
experiencing symptoms of nasal vestibulitis, it is important to see a healthcare provider as soon as
possible. They can diagnose the condition and provide appropriate treatment to help prevent
complications. In some cases, this may involve antibiotics or even surgical intervention to drain any
abscesses that have formed.
2.Tracheostomy in ward suddenly develops respiratory distress
1. Obstruction of the tracheostomy tube: The tracheostomy tube can become blocked by
secretions, blood clots, or displaced cuff leading to difficulty in breathing
2. Displacement of the tracheostomy tube: The tube may become displaced or dislodged, which
can cause difficulty in breathing or even a complete blockage of the airway.
3. Infection: A tracheostomy can increase the risk of infection, especially if the tube is not
properly cleaned or if there is a breach in aseptic technique during suctioning
4. Pneumothorax: A tracheostomy can increase the risk of pneumothorax, a condition in which
air leaks into the space between the lung and the chest wall, which can cause difficulty in
breathing.
5. Pulmonary embolism: A tracheostomy patient may have an increased risk of developing a
pulmonary embolism, a blockage in the pulmonary artery, which can cause sudden respiratory
distress
3. Diabetic patients with caries tooth presents with submental swelling
Diabetic patients with caries tooth may present with submental swelling because of the development
of a dental abscess. Dental abscesses can occur when bacteria infect the innermost part of a tooth,
which can be caused by untreated dental caries or tooth decay. The infection can then spread to the
surrounding tissues, including the gums, bones, and other structures in the mouth, resulting in
inflammation, pain, and swelling.
Diabetes can increase the risk of dental infections by weakening the immune system and reducing
blood flow to the gums and teeth. Additionally, high blood sugar levels in diabetic patients can create
a favorable environment for bacterial growth, making it easier for infections to develop and spread.
The submental swelling in diabetic patients with caries tooth may indicate the spread of the dental
abscess to the surrounding tissues, including the submental lymph nodes located under the chin. This
can lead to a painful, tender, and swollen lump in the neck or jaw area.
Therefore, it is important for diabetic patients to practice good oral hygiene, including regular
brushing and flossing, and to seek prompt dental care if they experience any dental pain or swelling.
Effective management of blood sugar levels is also important to reduce the risk of dental infections
and other complications.
4. Tympanoplasty should also be done after chronic tonsillitis/ chronic sinusitis
Tympanoplasty is a surgical procedure that is performed to repair a perforated or damaged eardrum.
Chronic tonsillitis and chronic sinusitis are conditions that can lead to chronic inflammation and
infection in the upper respiratory tract, and they may be associated with a higher risk of developing
middle ear infections and related complications.
When chronic tonsillitis or chronic sinusitis is present, the inflammation and infection can spread to
the Eustachian tube, which connects the middle ear to the back of the nose and throat. This can cause
blockage or dysfunction of the Eustachian tube, leading to a buildup of fluid and pressure in the
middle ear. Over time, this can lead to a perforation or damage of the eardrum, which can cause
hearing loss, pain, and other symptoms.
Tympanoplasty may be recommended in cases where the eardrum has been damaged or perforated
due to chronic tonsillitis or chronic sinusitis. The procedure can help to repair the eardrum and restore
normal hearing function. Additionally, tympanoplasty may also help to prevent future ear infections
and related complications, such as cholesteatoma (a type of skin growth in the middle ear).
In summary, chronic tonsillitis and chronic sinusitis can increase the risk of developing middle ear
infections and related complications, including damage to the eardrum. Tympanoplasty may be
recommended to repair the eardrum and restore normal hearing function, as well as to prevent future
ear infections and related complications.
5. Approach to diagnose a case of cervical lymphadenopathy? Make work plan for its
management
Cervical lymphadenopathy refers to the enlargement of lymph nodes in the neck region. The approach
to diagnose a case of cervical lymphadenopathy includes the following steps:
History and physical examination: The first step in diagnosing cervical lymphadenopathy is to obtain
a detailed history of the patient's symptoms and perform a physical examination of the neck region.
The physician will ask questions about the onset, duration, and progression of the lymphadenopathy,
as well as any associated symptoms such as fever, weight loss, or night sweats.
Imaging studies: Imaging studies such as ultrasound, CT scan, or MRI can be used to assess the size,
location, and character of the lymph nodes, as well as to evaluate the surrounding structures.
Fine-needle aspiration (FNA) biopsy: FNA biopsy involves inserting a thin needle into the enlarged
lymph node and aspirating a small sample of cells for examination under a microscope. This is a
minimally invasive procedure and can be done in the outpatient setting.
Excisional biopsy: In cases where the FNA biopsy is inconclusive or if the physician suspects a
malignant or infectious process, an excisional biopsy may be recommended. This involves surgically
removing the entire lymph node for further examination.
Laboratory tests: Laboratory tests such as blood tests and cultures may be ordered to help diagnose
underlying infections or other conditions.
Referral to a specialist: In cases where the diagnosis is unclear or the patient's condition is not
improving, referral to a specialist such as an oncologist or infectious disease specialist may be
necessary.
In summary, the approach to diagnosing cervical lymphadenopathy involves a comprehensive
evaluation that includes a thorough history and physical examination, imaging studies, FNA or
excisional biopsy, laboratory tests, and referral to a specialist as needed. The specific diagnostic tests
and procedures will depend on the individual patient's symptoms and medical history.
6. Patient with DNS sometimes complains pain in the root of nose radiating to the forehead
DNS or deviated nasal septum refers to a condition where the thin wall (nasal septum) that separates
the two nostrils is shifted or deviated to one side, causing obstruction or narrowing of the nasal
passages. This can lead to various symptoms such as difficulty breathing, nasal congestion, and
recurrent sinus infections.
1. In some cases, patients with DNS may complain of pain in the root of the nose that radiates to
the forehead. This can be due to a number of reasons:
2. Pressure on the nerves: The deviation of the nasal septum can cause pressure on the nerves
that supply the nose and forehead, leading to pain and discomfort.
3. Sinusitis: Patients with DNS are more likely to develop sinusitis, which is an inflammation of
the sinuses that can cause pain and pressure in the forehead and around the eyes.
4. Headaches: Chronic nasal obstruction caused by DNS can lead to frequent headaches, which
may be felt in the forehead and around the eyes.
5. Trigger points: Trigger points are areas of hypersensitivity in the muscles that can cause
referred pain to other parts of the body. In patients with DNS, trigger points may develop in
the muscles around the nose and forehead, leading to pain and discomfort.
6. Mucosal irritation: Chronic nasal obstruction can cause irritation and inflammation of the
nasal mucosa, which can cause pain and discomfort in the root of the nose and forehead.
7. Treatment of DNS may involve medical management such as nasal sprays or surgical
intervention such as septoplasty to correct the deviation of the nasal septum. Pain relief can
also be provided with over-the-counter pain medications or prescription medications.

7. Why Ethmoidal polyps are multiple in nature

Ans.
Ethmoidal polyps are benign growths that occur in the ethmoid sinus, which is located between the
eyes and behind the nose. These polyps are typically multiple in nature, meaning that they occur in
clusters rather than as single growths. There are several reasons why this may be the case
Anatomic location: The ethmoid sinus is a complex system of small air cells that are interconnected
by narrow passages. This makes it easier for polyps to spread from one cell to another and form
clusters.
Chronic inflammation: Ethmoidal polyps are often associated with chronic inflammation of the sinus
lining. This inflammation can lead to the formation of multiple polyps over time.
Mucous production: The ethmoid sinus is responsible for producing and draining mucous. When the
sinus is inflamed, it can produce excessive amounts of mucous that can trap bacteria, viruses, and
other particles. This can create a favorable environment for the growth of polyps.
Genetics: There may be a genetic component to the development of ethmoidal polyps. Some studies
have suggested that certain gene mutations may increase the risk of developing polyps in the ethmoid
sinus.
8. why Antrochoanal polyp goes posteriorly
Ans. An antrochoanal polyp is a benign growth that originates from the maxillary sinus and extends
into the choana, which is the opening at the back of the nose that leads to the nasopharynx. The
choana is located at the posterior (back) aspect of the nasal cavity. There are several reasons why an
antrochoanal polyp may grow posteriorly:
Origin: The antrochoanal polyp arises from the maxillary sinus, which is located in the posterior
aspect of the cheekbone. As the polyp grows, it extends into the nasal cavity and can reach the
posterior aspect of the nasal cavity, including the choana.
Gravity: The position of the nasal cavity and the orientation of the maxillary sinus favor the
downward gravitational pull of the polyp, which makes it more likely to extend towards the back of
the nasal cavity.
Airflow: The airflow in the nasal cavity can also contribute to the posterior extension of an
antrochoanal polyp. The air moves from the front to the back of the nasal cavity, and this can push the
polyp towards the back of the cavity.
Resistance: The choana is a relatively narrow opening, and as the polyp grows, it may encounter
resistance from the surrounding tissues, which can cause it to extend posteriorly towards the choana.

9. Why incision in SMR operation is given in muco cutaneous junction

SMR (submucous resection) is a surgical procedure used to correct a deviated nasal septum, which is
a condition where the partition between the two nostrils is off-center or crooked. During the SMR
procedure, the surgeon makes an incision on the nasal mucosa (the lining of the nose) to gain access
to the underlying cartilage and bone.

The incision in an SMR operation is typically made at the mucocutaneous junction, which is the
border between the nasal mucosa and the skin of the nose. There are several reasons why this location
is preferred:
Easy access: The mucocutaneous junction provides easy access to the underlying cartilage and bone
of the nasal septum. This allows the surgeon to remove or reshape the deviated portions of the septum
more easily.
Better visibility: The incision in the mucocutaneous junction provides better visibility of the surgical
site, which can help the surgeon to perform the procedure more accurately.
Reduced scarring: Incisions made at the mucocutaneous junction tend to heal more quickly and with
less scarring than incisions made in other locations. This can help to reduce the risk of complications
and improve the cosmetic outcome of the surgery.
Lower risk of bleeding: The mucocutaneous junction is an area where there are fewer blood vessels
than in other areas of the nasal mucosa. This reduces the risk of bleeding during and after the surgery.
10. Use of corticosteroid in a case of conductive hearing loss
Conductive hearing loss is a type of hearing loss that occurs when sound waves are not conducted
effectively through the outer and/or middle ear. This can be caused by a variety of factors, including
blockages in the ear canal, ear infections, fluid in the middle ear, and damage to the middle ear bones.
Corticosteroids are a class of drugs that are used to reduce inflammation and swelling in the body.
They are sometimes used to treat conductive hearing loss, particularly when it is caused by
inflammation or swelling in the middle ear. Some of the conditions that may benefit from
corticosteroid treatment include:
Otitis media: This is an infection of the middle ear that can cause fluid buildup and inflammation.
Corticosteroids can help to reduce the inflammation and fluid buildup, which can improve hearing.
Eustachian tube dysfunction: The Eustachian tube connects the middle ear to the back of the throat.
When the Eustachian tube becomes blocked or doesn't function properly, it can cause conductive
hearing loss. Corticosteroids can help to reduce inflammation and swelling in the Eustachian tube,
which can improve its function and relieve the hearing loss.
Meniere's disease: This is a disorder of the inner ear that can cause hearing loss, vertigo, and tinnitus.
Corticosteroids can be used to reduce the inflammation and swelling in the inner ear, which can
improve hearing and reduce other symptoms.
Acoustic trauma: This is a type of hearing loss that occurs when the ear is exposed to loud noise.
Corticosteroids can be used to reduce the inflammation and swelling in the inner ear that can occur
after acoustic trauma, which can improve hearing.
11. "Explain why After removal of foreign body by esophagoscopy chest skiagram is
mandatory"
After the removal of a foreign body by esophagoscopy, a chest X-ray (also called a chest skiagram) is
often recommended to ensure that there are no complications or residual foreign bodies left behind.
During the esophagoscopy procedure, a flexible or rigid tube with a light and camera is inserted
through the mouth and down the throat to remove the foreign object. Although great care is taken
during the procedure, there is always a risk of complications such as bleeding, perforation of the
esophagus, or swelling.
A chest X-ray can help to detect any of these complications or any residual foreign body that may
have been missed during the procedure. For example, if the esophagus was perforated during the
procedure, air may have leaked into the chest cavity, which would be visible on a chest X-ray.
Similarly, if a piece of the foreign body was inadvertently left behind, it may show up on the X-ray.
In summary, a chest X-ray after esophagoscopy is important for ensuring the procedure was
successful and that there are no complications or residual foreign bodies remaining in the esophagus
or chest cavity.
12. Immediately after opening the trachea in emergency tracheostomy pt may have a sudden
resp arrest?
Immediately after opening the trachea in an emergency tracheostomy, a patient may experience a
sudden respiratory arrest due to several reasons.
One of the most common causes is the sudden release of positive pressure ventilation that may have
been provided before the procedure. The positive pressure ventilation can cause the lungs to inflate
and exert pressure on the trachea, which can help keep it open. However, once the trachea is opened,
the positive pressure ventilation is no longer effective, and the air that was keeping the trachea open
can escape, causing the trachea to collapse and block the airway.
Another possible cause is the sudden loss of muscle tone in the tracheal muscles due to the trauma
caused by the procedure. The tracheal muscles may spasm or become paralyzed, which can cause the
airway to narrow or close.
In addition, the sudden change in the pressure gradient across the trachea can also cause respiratory
arrest. Normally, air flows from areas of high pressure to low pressure, and the trachea provides a
low-pressure pathway for air to flow into the lungs. However, when the trachea is opened, the
pressure gradient across the trachea is suddenly reversed, and air may flow out of the lungs instead of
into them, causing respiratory arrest.
Finally, there may be other underlying medical conditions, such as severe asthma or chronic
obstructive pulmonary disease, that can make the patient more susceptible to respiratory arrest during
a tracheostomy procedure.
In summary, respiratory arrest immediately after opening the trachea in an emergency tracheostomy
can occur due to a variety of reasons, including the sudden release of positive pressure ventilation,
loss of muscle tone in the tracheal muscles, sudden change in the pressure gradient across the trachea,
and underlying medical conditions.
13. Why general anesthesia is not preferred in I & D of acute retropharyngeal abscess in
children?
General anesthesia is not preferred in the incision and drainage (I&D) of an acute retropharyngeal
abscess in children because it can cause several complications and risks that may be avoidable with
other types of anesthesia.
One of the main reasons is that general anesthesia can cause airway obstruction, which can be life-
threatening in the case of a retropharyngeal abscess. The abscess can cause significant swelling of the
tissues in the throat, which can further compromise the airway. Additionally, the abscess may contain
pus, which can obstruct the airway during the procedure. In the event of airway obstruction, it may be
difficult to quickly establish an airway while the child is under general anesthesia.
Another reason is that general anesthesia can mask symptoms and signs of airway obstruction, making
it difficult to detect a potential problem during the procedure. If the child is awake during the
procedure, they can signal any issues with breathing or airway obstruction, which can be addressed
promptly.
Finally, the use of general anesthesia can also increase the risk of aspiration, where stomach contents
are regurgitated and enter the lungs, leading to pneumonia or other serious complications.
Instead, other forms of anesthesia such as sedation or local anesthesia with or without regional
anesthesia may be used to manage pain and discomfort during the I&D of an acute retropharyngeal
abscess in children. These types of anesthesia allow the child to maintain airway reflexes and protect
their airway, while still providing adequate pain control during the procedure.
In summary, general anesthesia is not preferred in the I&D of an acute retropharyngeal abscess in
children due to the potential risks and complications associated with airway obstruction, masking of
symptoms, and aspiration. Other forms of anesthesia may be used to safely and effectively manage
pain and discomfort during the procedure.
14. Why ossicular discontinuity with intact tympanic membrane causes more hearing loss than with
perforation
15. Patient with dns to right complains of obstruction in left side of nose
Ans. A patient with a deviated nasal septum (DNS) to the right may complain of obstruction in the left
side of the nose because of a compensatory mechanism called the "nasal cycle."
The nasal cycle is a natural physiological phenomenon that causes alternating congestion and
decongestion of the nasal passages. This cycle can occur spontaneously or in response to changes in
temperature, humidity, or other environmental factors. During the nasal cycle, the blood vessels in the
nasal tissues dilate and constrict, leading to a temporary reduction in airflow through one nostril while
the other nostril is relatively more open.
In the case of a patient with a DNS to the right, the left nostril may have a smaller opening due to a
compensatory increase in tissue swelling and congestion in the left nasal cavity. This occurs because
the right nasal cavity has more space due to the deviation of the septum, which can result in increased
airflow and decreased resistance through the right nostril. The left nostril compensates for this by
narrowing the opening to balance the airflow between the two nostrils.
Therefore, the patient may feel obstruction in the left side of the nose, even though the DNS is on the
right. In some cases, a patient may also have symptoms such as nasal congestion, difficulty breathing,
or recurrent sinus infections due to the DNS. Treatment options for a DNS may include medications
to reduce inflammation, nasal saline irrigation, or surgery to correct the deviation of the septum.
16. Counselling and consent for tracheostomy and tympanoplasty.
Counseling and Consent for any surgery:
Description of the Procedure: Explain to the patient or their family member what the tracheostomy
procedure involves, including the reason for the procedure, how it is performed, and the expected
outcome.
Risks and Benefits: Discuss the potential risks and benefits of the procedure, including bleeding,
infection, damage to surrounding structures, and airway obstruction. Emphasize that a tracheostomy
can be life-saving in some cases, but also that there are potential complications associated with the
procedure.
Anesthesia: Discuss the type of anesthesia that will be used during the procedure, the risks associated
with anesthesia, and the potential side effects of the anesthetic agents.
Post-Operative Care: Explain the expected post-operative care, including wound care, suctioning of
the tracheostomy tube, and monitoring for potential complications.
Alternative Options: Discuss alternative options to a tracheostomy, such as mechanical ventilation or
non-invasive ventilation, and their potential risks and benefits.
Patient Preferences: Take into consideration the patient's preferences and values when discussing the
risks, benefits, and alternatives of the procedure.
Informed Consent: Obtain written consent from the patient or their legal representative after ensuring
that they understand the procedure, the risks and benefits, and any potential alternatives.
17. Tympanoplasty - pre requisite.
Tympanoplasty is a surgical procedure used to repair a perforated eardrum or damaged ossicles (small
bones in the middle ear) to improve hearing and prevent recurrent infections. Here are some of the
pre-requisite points that are essential before undergoing a tympanoplasty procedure:
1. Diagnosis: The patient must have a confirmed diagnosis of a perforated eardrum or damaged
ossicles before undergoing tympanoplasty. Diagnosis can be made by an ENT specialist
through a physical examination, audiological tests, and imaging studies.
2. Pre-operative evaluation: The patient must undergo a thorough pre-operative evaluation to
assess their overall health, including any underlying medical conditions, allergies, or
medications they may be taking that could affect the procedure or their recovery.
3. Necessity of Surgery: The patient must be fully informed of the necessity of surgery and the
potential risks and benefits associated with the procedure. The surgeon should discuss the
potential outcomes of the procedure, including the possibility of improved hearing and the
risk of complications.
4. Anesthesia: The patient must be evaluated for anesthesia and informed of the type of
anesthesia that will be used during the procedure. The anesthesiologist will need to assess the
patient's overall health and any underlying conditions that may affect anesthesia.
 5. Fasting and Medication: The patient will be instructed to fast before the procedure and may
need to stop taking certain medications before the surgery. The surgeon will provide detailed
instructions on what medications to avoid and when to stop taking them.
6. Smoking and Alcohol: Patients who smoke or consume alcohol regularly will be advised to
quit or reduce their intake before the surgery as smoking and alcohol consumption can impair
healing and increase the risk of complications.
Recovery: The patient should have a plan in place for post-operative care and recovery. The surgeon
will provide detailed instructions on how to care for the surgical site, including any medications that
may be required, and when to return for follow-up appointments.
18. EW-FESS is the mainstay treatment for BL nasal polyposis
Functional endoscopic sinus surgery (FESS) is considered the mainstay treatment for bilateral nasal
polyposis (BNP) due to several reasons, including:
1. Comprehensive approach: FESS is a minimally invasive surgical procedure that allows for a
comprehensive approach to treating BNP. It allows the surgeon to access and remove polyps
from the sinuses, which is often not possible with other treatment options.
2. Improved access: FESS provides improved visualization and access to the nasal cavity,
allowing the surgeon to identify and remove polyps more effectively. It also allows for the
removal of diseased tissue, which may be contributing to the development of polyps.
3. Reduced recurrence: FESS has been shown to reduce the recurrence of polyps in the long-
term. By removing polyps and diseased tissue, FESS can help to open up the nasal passages
and promote better drainage, reducing the risk of polyp formation.
4. Minimal side effects: FESS is associated with minimal side effects compared to other
treatment options. It is typically performed under general anesthesia and patients can usually
go home the same day. The recovery time is also relatively short, with most patients able to
return to work or school within a week.
5. Customizable: FESS can be customized to meet the needs of each patient. The surgeon can
tailor the procedure to target specific areas of the sinuses, depending on the location and
extent of the polyps
In summary, FESS is considered the mainstay treatment for bilateral nasal polyposis due to its
comprehensive approach, improved access, reduced recurrence, minimal side effects, and
customizable nature. It is an effective and minimally invasive option for treating this condition, and
can provide long-term relief for patients with BNP.
19. Holman miller sign is seen in JNA
The Holman-Miller sign is a characteristic finding in patients with Juvenile Nasopharyngeal
Angiofibroma (JNA). It refers to the occurrence of profuse epistaxis (nosebleeds) that originates from
the nasopharynx and is triggered by palpation of the tumor.
1. The Holman-Miller sign is thought to occur because JNAs are highly vascular tumors that
receive their blood supply from the external carotid artery, which runs along the lateral aspect
of the tumor. Palpation of the tumor can cause the release of vasoactive substances that
increase blood flow to the tumor and cause it to bleed.
2. The Holman-Miller sign is named after two physicians, Holman and Miller, who first
described it in the early 1900s. It is considered a classic sign of JNA and is useful in
distinguishing this tumor from other nasal masses that may cause epistaxis.
3. In summary, the Holman-Miller sign is seen in JNA due to the tumor's highly vascular nature
and its blood supply from the external carotid artery. It is a characteristic finding that can help
 differentiate JNA from other nasal masses and is an important diagnostic tool for this
condition.
20. Complications of hypotympanic type of csom
Chronic suppurative otitis media (CSOM) is a common condition that can be divided into different
types based on the location of the disease process. The hypotympanic type of CSOM involves the
lower part of the middle ear cavity and is associated with several complications, including:
1. Cholesteatoma: This is a growth of skin cells that can develop in the middle ear and cause
destruction of the ossicles and other structures. It is more common in the hypotympanic type
of CSOM and can lead to hearing loss, facial paralysis, and other complications.
2. Hearing loss: The hypotympanic type of CSOM can cause hearing loss due to damage to the
ossicles or the formation of cholesteatoma. The severity of the hearing loss depends on the
extent of the damage and the duration of the disease.
3. Mastoiditis: Mastoiditis is an infection of the mastoid bone, which is located behind the ear. It
can occur as a complication of hypotympanic CSOM and can cause pain, swelling, and fever.
4. Facial paralysis: In severe cases of hypotympanic CSOM, the infection can spread to the
facial nerve, which can lead to facial paralysis.
5. Meningitis: Rarely, hypotympanic CSOM can lead to meningitis, which is a serious infection
of the lining of the brain and spinal cord. This can occur if the infection spreads to the inner
ear or the mastoid bone and then travels to the brain.
6. Brain abscess: Hypotympanic CSOM can also lead to the formation of a brain abscess, which
is a collection of pus in the brain. This can occur if the infection spreads from the middle ear
or mastoid bone to the brain tissue.
21. Labelled diagram of larynx as seen in indirect laryngoscopy
During indirect laryngoscopy, a small mirror is placed at the back of the throat to visualize the larynx.
The larynx is a complex structure that is involved in breathing, swallowing, and speaking. The
following structures can be seen in a labeled diagram of the larynx as seen in indirect laryngoscopy:

1. Epiglottis: The epiglottis is a flap of tissue that prevents food and liquid from entering the
trachea during swallowing.
2. Arytenoid cartilages: These cartilages are involved in the opening and closing of the vocal
cords.
3. Vocal cords: The vocal cords are two bands of tissue that vibrate to produce sound during
speech.
 4. Cricoid cartilage: The cricoid cartilage is a ring-shaped structure that forms the base of the
larynx and provides support for the vocal cords.
5. Trachea: The trachea is a tube that connects the larynx to the lungs and is responsible for
transporting air in and out of the lungs.
6. Esophagus: The esophagus is a muscular tube that connects the throat to the stomach and is
responsible for transporting food and liquid during swallowing.
22. Why In meatal antrostomy not used in drainage of maxillary sinusitis?
Metal antrostomy is a surgical procedure that involves creating a hole in the maxillary sinus wall to
provide drainage for the sinus. While this procedure has been used in the past for the treatment of
chronic maxillary sinusitis, it is no longer a common practice.
One of the reasons for this is that metal antrostomy is an invasive procedure that carries the risk of
complications, such as bleeding, infection, and damage to surrounding tissues. Additionally, it can
lead to scarring and the formation of adhesions, which can make future surgeries more difficult.
Furthermore, advances in medical treatments for sinusitis have made metal antrostomy less necessary.
Antibiotics, nasal steroid sprays, and saline irrigation are effective at treating acute and chronic
sinusitis in many cases, without the need for surgery.
In cases where medical treatment is not effective, functional endoscopic sinus surgery (FESS) is now
the preferred surgical approach for the treatment of chronic sinusitis. FESS is a minimally invasive
procedure that uses endoscopes and specialized instruments to remove tissue and create drainage
pathways in the sinus.
Therefore, while metal antrostomy may have been used in the past for the treatment of maxillary
sinusitis, it is not commonly used today due to the risks involved and the availability of less invasive
and more effective treatments.
23. Why CHL in elderly pt raises suspicion of malignancy?
CHL, or Conductive Hearing Loss, is a type of hearing loss that occurs due to a problem in the outer
or middle ear that prevents sound from reaching the inner ear. In elderly patients, CHL can be a
common finding and is often associated with age-related changes in the ear.
However, in some cases, CHL in elderly patients can be a sign of an underlying malignancy, such as a
tumor in the middle ear or the nasopharynx. These tumors can cause a conductive hearing loss by
blocking the transmission of sound through the ear.
Other signs and symptoms that may be present in cases of malignancy include persistent ear pain,
discharge from the ear, hearing loss that worsens over time, and facial weakness. If any of these
symptoms are present in an elderly patient with CHL, further investigation, such as imaging studies or
a biopsy, may be necessary to rule out malignancy.
It is important to note that while CHL in elderly patients can raise suspicion of malignancy, most
cases of CHL in this population are benign and can be treated with non-surgical interventions such as
hearing aids, antibiotics for infections, or ear wax removal. Nevertheless, any suspicious symptoms
should be evaluated by a medical professional to ensure timely diagnosis and treatment if necessary.
24. Surgical importance of nasal septum
The nasal septum is a structure that separates the two sides of the nasal cavity. It is an important
structure in nasal anatomy and has several surgical implications. Here are some of the surgical
importance of the nasal septum:
 1. Deviated septum correction: A deviated septum is a condition in which the nasal septum is
bent or crooked, leading to breathing difficulties and nasal obstruction. Surgical correction of
a deviated septum involves straightening the septum to improve nasal airflow.
2. Support for the nasal framework: The nasal septum provides support to the nasal framework
and helps maintain the shape and structure of the nose. In cases of nasal trauma, surgery
involving the nasal septum may be necessary to restore the normal shape and function of the
nose.
3. Access to the sinuses: The nasal septum provides access to the sinuses, which are located on
either side of the septum. Sinus surgery, such as endoscopic sinus surgery, often involves
manipulating the nasal septum to gain access to the sinuses.
4. Harvesting cartilage grafts: The nasal septum is a common site for harvesting cartilage grafts
for use in reconstructive surgery, such as rhinoplasty or septorhinoplasty.
5. Bleeding control: In cases of severe nosebleeds, surgical procedures such as nasal packing
may be necessary to control bleeding. The nasal septum is a common site for packing, as it is
a highly vascular structure that can be easily compressed.
25. BPPV, investigation and management
Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief
episodes of vertigo triggered by head movements. Here are the key points for investigation and
management of BPPV:

Investigation:

1. History and physical examination: A detailed history and physical examination can help
diagnose BPPV. The presence of vertigo triggered by specific head movements, such as
rolling over in bed or looking up, is a key diagnostic feature.
2. Dix-Hallpike maneuver: This is a positional test that involves moving the head to a specific
position to elicit vertigo. A positive Dix-Hallpike test result confirms the diagnosis of BPPV.
3. Videonystagmography (VNG): VNG is a diagnostic test that measures eye movements to
assess vestibular function. It can be useful in the diagnosis of BPPV and in differentiating it
from other vestibular disorders.

Management:
1. Canalith repositioning procedures: Canalith repositioning procedures, such as the Epley
maneuver, are effective in the treatment of BPPV. These procedures involve moving the head
into specific positions to reposition the calcium carbonate crystals that have become
dislodged in the inner ear, causing vertigo.
2. Medications: Medications such as anti-vertigo drugs, antihistamines, and benzodiazepines can
be used to relieve symptoms of vertigo associated with BPPV.
3. Vestibular rehabilitation therapy: Vestibular rehabilitation therapy is a type of physical
therapy that can be effective in treating BPPV. It involves exercises to improve balance and
reduce dizziness, and can also help to prevent falls
4. Lifestyle modifications: Avoiding head positions that trigger vertigo, such as lying on the
affected side, can help to prevent episodes of BPPV.
26. Clinical feature and management of cholesteatoma
Cholesteatoma is a benign but locally destructive skin cyst that can develop in the middle ear or
mastoid bone. Here are the key clinical features and management strategies for cholesteatoma:
Clinical Features:
1. Hearing loss: Cholesteatoma can cause hearing loss due to erosion of the ossicles or invasion
of the inner ear.
2. Otorrhea: Persistent or recurrent ear drainage, sometimes foul-smelling, is a common
symptom of cholesteatoma.
3. Tinnitus: Patients with cholesteatoma may experience tinnitus, a ringing or buzzing in the ear.
4. Vertigo: Cholesteatoma can cause episodes of vertigo due to involvement of the inner ear.
5. Facial paralysis: Rarely, cholesteatoma can cause facial paralysis due to erosion of the facial
nerve.

Management:
1. Surgery: Surgical removal of the cholesteatoma is the primary treatment for cholesteatoma.
The type of surgery required depends on the extent and location of the cholesteatoma. In
some cases, ossicular reconstruction may be required to restore hearing.
2. Antibiotics: Antibiotics may be used to treat associated middle ear infections and prevent the
spread of infection.
3. Hearing aids: If hearing loss is severe, hearing aids may be recommended to improve hearing
4. Lifestyle modifications: Patients with cholesteatoma should avoid activities that can cause
trauma to the ear, such as diving or contact sports.
5. Follow-up care: Regular follow-up care with an otolaryngologist is important to monitor for
recurrence and to ensure that the ear is healing properly after surgery.
27. SN- pre operative counselling and consent for tracheostomy operation.
Tracheostomy is a surgical procedure in which a tube is inserted through a hole in the neck and into
the trachea to help patients breathe. Here are the key points that should be included in the consent
process for tracheostomy:
1. Nature of the procedure: The patient should be informed about the nature of the procedure,
including the fact that it involves making an incision in the neck and inserting a tube into the
trachea.
2. Purpose of the procedure: The patient should be informed about the purpose of the procedure,
which is to provide an airway to help with breathing.
3. Risks of the procedure: The patient should be informed about the risks associated with the
procedure, including bleeding, infection, damage to nearby structures (such as blood vessels,
nerves, and the vocal cords), and the need for additional procedures (such as tube changes or
closure of the tracheostomy)
4. Benefits of the procedure: The patient should be informed about the potential benefits of the
procedure, which may include improved breathing, reduced need for mechanical ventilation,
and improved quality of life.
5. Alternatives to the procedure: The patient should be informed about alternatives to
tracheostomy, such as continued mechanical ventilation, non-invasive ventilation, or other
surgical procedures.
6. Anesthesia: The patient should be informed about the type of anesthesia that will be used for
the procedure, as well as the associated risks and benefits.
7. Postoperative care: The patient should be informed about the postoperative care that will be
required, including tube care, wound care, and potential complications.
 8. Questions: The patient should be given the opportunity to ask questions about the procedure,
risks, benefits, and alternatives, and to have those questions answered by a healthcare
professional.
28. Why small posteroinferior quadrant perforation causes more HL than large subtotal
perforation of eardrum?
Small posteroinferior quadrant perforation of the eardrum can cause more hearing loss than a large
subtotal perforation because of the location and size of the perforation.
Location: A small posteroinferior quadrant perforation is located in an area of the eardrum that is
critical for sound transmission. This area contains the ossicles, which are the tiny bones in the middle
ear that transmit sound vibrations from the eardrum to the inner ear. A small perforation in this area
can disrupt the normal functioning of the ossicles, leading to hearing loss.

Size: Although a small posteroinferior quadrant perforation is small in size, it can still cause
significant hearing loss because of its location. In contrast, a large subtotal perforation may be located
in a less critical area of the eardrum and may not affect sound transmission as much.
In addition, a small posteroinferior quadrant perforation may also cause more hearing loss than a large
subtotal perforation because it may be associated with other middle ear problems such as
cholesteatoma or ossicular erosion, which can further impair hearing.
Management of a small posteroinferior quadrant perforation may involve surgical repair or
observation depending on the severity of the hearing loss and the presence of associated middle ear
problems. In contrast, management of a large subtotal perforation may involve observation or surgical
intervention such as tympanoplasty.
29. Why Adenoid hypertrophy associated with decreased hearing?
Adenoid hypertrophy, or an enlarged adenoid, can be associated with decreased hearing because of its
location in the nasopharynx, which is close to the opening of the Eustachian tube. The Eustachian
tube is the narrow tube that connects the middle ear to the back of the throat and is responsible for
equalizing the pressure in the middle ear with the outside atmosphere.
When the adenoid becomes enlarged, it can block or partially obstruct the opening of the Eustachian
tube, leading to negative pressure in the middle ear. This negative pressure can cause retraction of the
eardrum, which can affect the functioning of the ossicles and lead to conductive hearing loss. This
type of hearing loss is often described as a feeling of fullness or pressure in the ear.
In addition, adenoid hypertrophy can also lead to the accumulation of fluid in the middle ear (otitis
media with effusion) due to the obstruction of the Eustachian tube. This can further impair hearing by
reducing the transmission of sound through the middle ear.
Treatment for adenoid hypertrophy associated with decreased hearing typically involves surgical
removal of the adenoid (adenoidectomy). This procedure can help to relieve the obstruction of the
Eustachian tube and improve the negative pressure in the middle ear, leading to a reduction in hearing
loss.
30. Methods of voice rehabilitation following total laryngectomy?
Total laryngectomy is a surgical procedure that involves the removal of the entire larynx. This results
in a permanent loss of the voice, as the larynx is responsible for producing sound. Here are some
methods of voice rehabilitation following total laryngectomy:
 1. Tracheoesophageal puncture (TEP): This is the most common method of voice restoration
following total laryngectomy. It involves creating a small hole (puncture) in the trachea and
into the esophagus. A small silicone prosthesis is then inserted into the puncture, which
allows air to pass from the lungs into the esophagus, creating a new source of sound. The
patient can then use the muscles of the throat and mouth to shape the sound into speech.
2. Esophageal speech: This method of voice restoration involves using air from the mouth to
vibrate the walls of the esophagus, which creates sound that can be shaped into speech. This
method requires extensive training and may not be suitable for all patients.

3. Electrolarynx: An electrolarynx is a small electronic device that produces sound when placed
against the neck. The device creates a vibration that can be shaped into speech by the patient's
mouth and tongue movements.
4. Tissue vibration: This method involves using tissue vibration to produce sound. A small
device is placed on the neck or in the mouth, which produces a vibration that can be shaped
into speech.
5. Speech therapy: Speech therapy can help patients learn how to use their new voice and
improve their ability to communicate. It can also help with swallowing and other functions
that may be affected by the surgery.
31. Various types of neck dissection?
Neck dissection is a surgical procedure in which the lymph nodes and other tissue in the neck are
removed for diagnostic or therapeutic purposes. There are several types of neck dissection, each with
different indications and surgical techniques. Here are the various types of neck dissection:
1. Radical neck dissection: This is the most extensive type of neck dissection and involves the
removal of all lymph nodes in the neck, as well as the sternocleidomastoid muscle, internal
jugular vein, and spinal accessory nerve. This procedure is typically reserved for advanced or
metastatic head and neck cancers.
2. Modified radical neck dissection: This type of neck dissection involves the removal of some
but not all of the structures removed in a radical neck dissection. This may include the
removal of some lymph nodes and either the sternocleidomastoid muscle, internal jugular
vein, or spinal accessory nerve.
3. Selective neck dissection: This type of neck dissection is less extensive than radical or
modified radical neck dissection and involves the removal of only certain groups of lymph
nodes in the neck. The level of dissection depends on the location and extent of the tumor.
4. Supraomohyoid neck dissection: This type of neck dissection involves the removal of lymph
nodes in levels I to III of the neck. This procedure is commonly performed for early-stage
tumors of the oral cavity and oropharynx.
5. Extended neck dissection: This is a more extensive version of the modified radical neck
dissection, which includes the removal of additional lymph nodes and structures. This type of
dissection is typically reserved for advanced tumors or tumors that have spread beyond the
head and neck region.
6. Lateral neck dissection: This type of neck dissection involves the removal of lymph nodes in
the lateral aspect of the neck. This procedure is commonly performed for tumors of the
thyroid gland or metastatic cancer to the lymph nodes in the neck.
32. Various landmarks of facial nerve during mastoid surgery?
During mastoid surgery, it is important to identify and preserve the facial nerve, which passes through
the temporal bone and controls movement of the muscles of the face. Here are the various landmarks
of the facial nerve during mastoid surgery:
 1. Mastoid segment: The mastoid segment of the facial nerve is the portion that passes through
the mastoid bone. It can be identified by tracing the nerve from the stylomastoid foramen,
where it exits the skull, and following it as it passes through the mastoid bone towards the
middle ear.
2. Tympanic segment: The tympanic segment of the facial nerve is the portion that passes
through the middle ear. It runs along the medial wall of the middle ear, just superior to the
oval window. The chorda tympani nerve, which controls taste sensation in the tongue,
branches off from this segment.
3. Geniculate ganglion: The geniculate ganglion is a bulge in the facial nerve located just before
it enters the facial canal. It contains the cell bodies of the sensory neurons that provide
sensation to the skin of the ear and palate
4. Horizontal segment: The horizontal segment of the facial nerve is the portion that runs
through the facial canal, which is a bony canal in the temporal bone. It can be identified by
following the nerve as it curves anteriorly through the facial canal towards the stylomastoid
foramen.
5. Vertical segment: The vertical segment of the facial nerve is the portion that runs downward
through the stylomastoid foramen and into the parotid gland. This segment is vulnerable to
injury during mastoid surgery, and special care must be taken to preserve it.
6. Branches of the facial nerve: The facial nerve gives off several branches that innervate the
muscles of the face, including the temporal, zygomatic, buccal, mandibular, and cervical
branches. During mastoid surgery, it is important to avoid injury to these branches to prevent
facial weakness or paralysis
33. Why cholesteatoma has bone eroding property?
Cholesteatoma is a type of benign tumor that can develop in the middle ear or mastoid bone behind
the ear. It is characterized by the growth of a cyst-like mass of squamous epithelium and keratin
debris that can lead to bone erosion and destruction.
There are several reasons why cholesteatoma has bone eroding properties:
1. Pressure: As the cholesteatoma grows, it exerts pressure on the surrounding bone, leading to
bone resorption and destruction. This can result in thinning of the bone or even perforation,
allowing the cholesteatoma to spread further.
2. Enzymes: Cholesteatoma produces enzymes that can dissolve bone tissue, leading to bone
erosion and destruction. These enzymes are produced by the epithelial cells of the
cholesteatoma and can break down the collagen and other components of bone.
3. Inflammatory response: The presence of cholesteatoma can trigger an inflammatory response
in the surrounding tissues, leading to bone resorption and destruction. The inflammation can
also lead to the production of cytokines and other mediators that can promote bone
destruction
4. Microbial infection: Cholesteatoma is often associated with chronic ear infections, which can
lead to bone erosion and destruction. The infection can cause inflammation and produce
enzymes that can dissolve bone tissue.
34. Pt with otosclerosis hears better in noisy environment?
Patients with otosclerosis may hear better in noisy environments due to a phenomenon called the
"Lombard effect." The Lombard effect is the automatic increase in vocal effort that occurs when a
person speaks in a noisy environment. This effect is thought to be a reflexive response to the need to
communicate effectively in a noisy environment
1. In patients with otosclerosis, the condition causes abnormal bone growth in the middle ear
that can impair sound transmission and reduce hearing sensitivity. However, the Lombard
 effect can help compensate for this hearing loss by increasing the patient's vocal effort and
making their speech louder and more intelligible.

2. Additionally, the Lombard effect may also improve the patient's ability to detect speech
sounds in a noisy environment by increasing their sensitivity to changes in the sound level
and frequency spectrum. This effect can help the patient filter out background noise and focus
on the speech signals they want to hear.
3. It is important to note that not all patients with otosclerosis experience the Lombard effect,
and the effect may be more pronounced in some patients than others. Additionally, the effect
may be more noticeable in certain types of noisy environments, such as crowded social
settings or busy restaurants. Overall, the Lombard effect is one of several factors that can
influence a patient's hearing ability in noisy environments and should be considered as part of
a comprehensive evaluation of their hearing function.
35. Biopsy of suspected JNA is contraindicated?
Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive tumor that arises from
the nasopharynx in adolescent males. Biopsy of suspected JNA is generally contraindicated due to the
risk of significant bleeding and other complications.
There are several reasons why biopsy of suspected JNA is contraindicated
1. Risk of bleeding: JNA is highly vascular, meaning it has a large number of blood vessels.
Biopsy of a JNA can cause significant bleeding, which can be difficult to control and may
require surgical intervention.
2. Spread of tumor: Biopsy of a JNA can also increase the risk of tumor spread or dissemination.
Because JNA is a locally aggressive tumor, it can invade nearby structures and spread to other
parts of the body. Biopsy can disrupt the tumor and increase the risk of tumor cells spreading
to surrounding tissues.
3. Diagnostic accuracy: Biopsy of a JNA may not be necessary for diagnosis since the
characteristic imaging features of the tumor are often sufficient for diagnosis. In many cases,
the diagnosis of JNA can be made based on clinical examination and imaging studies alone.
4. Delayed definitive treatment: Biopsy may delay definitive treatment of JNA, which is
typically surgical resection. Delayed treatment can allow the tumor to grow and potentially
invade nearby structures, making surgery more challenging and increasing the risk of
complications.
36. Why Tympanoplasty should only be done after treating chronic sinusitis &chronic
tonsillitis?
Tympanoplasty is a surgical procedure performed to repair a perforated eardrum or to improve
hearing in patients with conductive hearing loss. While the surgery itself is focused on the middle ear
and eardrum, it is important to address any underlying chronic sinusitis and chronic tonsillitis before
proceeding with the procedure. Here are a few reasons why:
1. Infection control: Chronic sinusitis and chronic tonsillitis can cause recurrent infections,
which can lead to inflammation and fluid buildup in the middle ear. This can increase the risk
of complications during tympanoplasty, such as infection and delayed healing. By treating
these infections before surgery, the risk of complications can be minimized.
2. Allergy control: Chronic sinusitis and chronic tonsillitis can also be associated with allergies.
Allergies can cause inflammation in the nasal passages, which can affect the function of the
Eustachian tube, a structure that connects the middle ear to the back of the throat. Dysfunction
 of the Eustachian tube can lead to fluid buildup in the middle ear and may compromise the
results of tympanoplasty. Treating allergies and controlling inflammation in the nasal
passages can improve the function of the Eustachian tube and reduce the risk of complications
during and after surgery.
3. Optimal healing environment: Chronic sinusitis and chronic tonsillitis can also cause chronic
inflammation in the surrounding tissues. This inflammation can compromise the blood supply
to the middle ear, which is essential for proper healing after surgery. By treating chronic
inflammation in the surrounding tissues, the blood supply to the middle ear can be improved,
which can lead to better healing after surgery.
37. Causes of cervical lymphadenopathy and it's management
Causes of cervical lymphadenopathy and its management:
Infection: The most common cause of cervical lymphadenopathy is infection. The lymph nodes get
enlarged as they fight off the infection. The most common infections are bacterial, viral, and fungal.
The management involves:
Antibiotics for bacterial infections
Antivirals for viral infections
Antifungals for fungal infections
Cancer: Cervical lymphadenopathy can also be caused by cancer. The lymph nodes may get enlarged
due to the spread of cancer cells. The management involves:
Biopsy of the lymph nodes to confirm the diagnosis
Surgery to remove the cancerous lymph nodes
Chemotherapy and radiation therapy
Autoimmune disorders: Some autoimmune disorders like rheumatoid arthritis and lupus can also
cause cervical lymphadenopathy. The management involves:
Treating the underlying autoimmune disorder with medications like steroids, immunosuppressants,
and biologics.
Other causes: Other causes of cervical lymphadenopathy include:
Allergies
Thyroid disorders
HIV/AIDS
Tuberculosis
Sarcoidosis
The management of cervical lymphadenopathy involves identifying the underlying cause and treating
it accordingly. This may involve a combination of medical, surgical, and supportive treatments.
38. how to investigate and manage a case of bilateral deafness?
Investigation and management of bilateral deafness may involve the following steps:
I. History and Physical Examination
A thorough history, including any medications or past medical conditions, and a physical examination
are important in identifying potential causes of bilateral deafness.
II. Audiometry
Audiometry is an essential test for the assessment of hearing loss. Pure-tone audiometry can identify
the degree and pattern of hearing loss.
III. Imaging
Imaging studies, such as a CT scan or MRI, can help to identify the underlying cause of bilateral
deafness, such as a structural abnormality or a lesion in the auditory pathway.
IV. Blood tests
Blood tests can be used to identify infections or autoimmune disorders that may cause bilateral
deafness.
V. Treatment
Treatment for bilateral deafness depends on the underlying cause. If the cause is reversible, such as an
infection or medication toxicity, treatment can involve medication or surgical intervention. If the
deafness is permanent, hearing aids or cochlear implants may be recommended.
VI. Communication strategies
For individuals with bilateral deafness, communication strategies such as sign language, lip reading,
and assistive listening devices may be helpful.
VII. Counselling
Counselling may be required for individuals with bilateral deafness, especially those who experience
sudden or rapid hearing loss, to help them cope with the emotional and social impact of their
condition.
39. Why incision is given at point of maximum bulge in peritonsillar abscess?
Peritonsillar abscess is a collection of pus in the space between the tonsillar capsule and the
pharyngeal muscles. The pus accumulates in this area due to bacterial infection, leading to
inflammation and swelling. To drain the abscess, an incision is given at the point of maximum bulge.
The following are the reasons for this:
Localization of the abscess: The point of maximum bulge indicates the location of the abscess. An
incision at this point ensures that the abscess is drained completely, reducing the chances of
recurrence.
Avoidance of vital structures: The area around the tonsils contains many important structures such as
the carotid artery and jugular vein. Incision at the point of maximum bulge ensures that these
structures are avoided, reducing the risk of damage to them.
Maximum drainage: The point of maximum bulge is the area where the pus has accumulated the most.
An incision at this point ensures maximum drainage of the abscess, reducing the chances of the pus
accumulating again.
Quick relief of symptoms: Peritonsillar abscess can cause severe pain and difficulty in swallowing.
An incision at the point of maximum bulge allows for quick drainage of the abscess, relieving the
symptoms and making the patient more comfortable.
40. How to investigate a case of vertigo
The investigation of a case of vertigo typically involves a step-by-step approach to determine the
underlying cause. The following is a pointwise explanation of the steps involved in investigating a
case of vertigo:
Detailed history taking: A detailed history should be taken to determine the nature of vertigo,
associated symptoms, duration, frequency, and triggers. A thorough review of medical and medication
history, including any past history of ear infections, head injuries, or other medical conditions, is also
important.
Physical examination: A complete physical examination, including a detailed neurological and ear
examination, should be done. The Dix-Hallpike test can be performed to assess the presence of benign
paroxysmal positional vertigo (BPPV).
Imaging studies: Imaging studies like CT scan or MRI can be used to identify the underlying
structural abnormalities in the ear or brain that may be causing the vertigo.
Audiometry: Audiometry tests can be performed to assess the hearing capacity of the individual.
Blood tests: Blood tests can be done to rule out any underlying medical conditions, such as thyroid
disorders or diabetes.
Electrocardiogram: An electrocardiogram (ECG) can be performed to rule out any cardiac
abnormalities that may be causing vertigo.
Vestibular function testing: Vestibular function testing can be done to assess the functioning of the
vestibular system. This can include videonystagmography (VNG), rotary chair testing, and caloric
testing.
Specialized tests: Specialized tests like genetic testing, if indicated, can be done to rule out any
genetic causes of vertigo.
Referral to a specialist: In cases where the underlying cause of vertigo is not clear, or if the patient is
not responding to treatment, referral to a specialist such as an otolaryngologist or a neurologist may be
necessary.
41. Thyroid swelling moves up and down with deglutition
Thyroid swelling moves up and down with deglutition (swallowing) because of the close anatomical
relationship between the thyroid gland and the larynx (voice box) and the pharynx (throat), which are
involved in the process of swallowing.
During swallowing, the larynx and pharynx move upwards and forwards, causing the hyoid bone and
the muscles attached to it to lift the thyroid gland upwards. This movement is known as the upward
excursion of the thyroid gland.
Conversely, when the larynx and pharynx move downwards and backwards during swallowing, the
thyroid gland is pulled downwards by the same hyoid bone and attached muscles, causing the gland to
move downwards. This movement is known as the downward excursion of the thyroid gland.
Therefore, any swelling or enlargement of the thyroid gland, such as in the case of a goitre or thyroid
nodules, will move up and down with deglutition because it is attached to the hyoid bone and the
muscles involved in swallowing. This is a useful clinical sign to help distinguish a thyroid swelling
from other neck swellings that do not move with deglutition.
42. Why are adenoids curetted while tonsils are dissected?
Adenoids and tonsils are both part of the lymphoid tissue located in the back of the throat, but they
have different functions and anatomical positions. The adenoids are located in the nasopharynx, while
the tonsils are located in the oropharynx.
During surgery to remove the adenoids (adenoidectomy) or tonsils (tonsillectomy), different
techniques are used because of their different anatomical positions and functions.
Adenoids are typically removed using a curette, which is a spoon-shaped surgical instrument used to
scrape and remove the tissue. This is because the adenoids are located at the back of the nasal cavity,
and are difficult to access with surgical instruments. The curette is passed through the nose and used
to remove the adenoid tissue.
On the other hand, tonsils are typically removed using a dissection technique, which involves cutting
and removing the tonsil tissue with surgical instruments such as scissors or a scalpel. This is because
the tonsils are located in the back of the oral cavity, and are easily accessible with surgical
instruments.
In summary, adenoids are curetted while tonsils are dissected during surgery because of their different
anatomical positions and the difficulty in accessing them with surgical instruments.
43. EW DCR Is better than DCT
DCR (dacryocystorhinostomy) is a surgical procedure that creates a new tear drainage pathway
between the lacrimal sac and the nasal cavity to treat nasolacrimal duct obstruction. DCT
(dacryocystectomy), on the other hand, is a surgical procedure that involves the complete removal of
the lacrimal sac.
Here are some reasons why DCR is considered better than DCT:
Preservation of tear production: DCR preserves the normal tear production by maintaining the tear
drainage pathway, while DCT removes the lacrimal sac, which may result in dry eye syndrome and
decreased tear production.
Preservation of the lacrimal pump: DCR preserves the lacrimal pump, which is important for normal
tear drainage, while DCT removes the lacrimal sac and the surrounding structures, including the
lacrimal pump.
Lower complication rates: DCR has a lower complication rate compared to DCT. Complications of
DCT may include bleeding, infection, and damage to surrounding structures.
Better success rates: DCR has higher success rates in treating nasolacrimal duct obstruction compared
to DCT. DCR is effective in more than 90% of cases, while DCT has a success rate of around 50%.
Better cosmetic outcomes: DCR results in better cosmetic outcomes compared to DCT. DCR leaves a
small scar in the nasal cavity, which is not visible externally, while DCT leaves a visible scar on the
skin.
44. Laryngopharyngeal reflux
Laryngopharyngeal reflux (LPR) is a condition where stomach acid flows back into the throat and
larynx, leading to irritation and inflammation. Here are the key points to know about LPR
Causes: LPR is caused by a malfunctioning of the lower esophageal sphincter (LES), which is the
muscle that separates the esophagus from the stomach. This can be due to various factors such as
obesity, smoking, pregnancy, hiatal hernia, and certain medications.
Symptoms: The symptoms of LPR are often different from typical acid reflux. Patients may
experience hoarseness, chronic cough, postnasal drip, throat clearing, difficulty swallowing, or a
feeling of a lump in the throat. Patients may also experience symptoms in the absence of heartburn or
acid regurgitation.
Diagnosis: LPR is diagnosed based on symptoms and a physical exam by a healthcare professional.
Further testing may include a pH monitoring test, a laryngoscopy, or a barium swallow test to
evaluate the severity of the reflux.
Treatment: The treatment of LPR involves a combination of lifestyle modifications and medications.
Patients should avoid trigger foods such as spicy and acidic foods, as well as behaviors such as lying
down after eating. They may also benefit from weight loss, smoking cessation, and elevating the head
of the bed. Medications such as proton pump inhibitors (PPIs) or H2 blockers can reduce the amount
of acid produced in the stomach and relieve symptoms.
Complications: If left untreated, LPR can lead to complications such as ulcers, strictures, or chronic
respiratory problems. It is important to seek medical attention if symptoms persist or worsen.
45. A child of 3 years presented with stridor for two hours. Causes? Investigation?
Management?
Stridor is a high-pitched wheezing or squeaking sound heard when breathing, which is usually caused
by a narrowing or obstruction of the upper airway. In a child of 3 years, the causes of stridor could be
the following:
Causes:
Croup: A viral infection that causes inflammation of the larynx and trachea.
Epiglottitis: A bacterial infection that causes inflammation of the epiglottis.
Foreign body aspiration: The presence of a foreign object in the airway.
Anaphylaxis: An allergic reaction that causes swelling of the airway.
Congenital anomalies: Such as laryngomalacia, tracheomalacia, or subglottic stenosis.
Investigations:
Physical examination: A thorough examination of the child's airway, breathing, and circulation should
be done.
Blood tests: To check for signs of infection, inflammation, or anaphylaxis.
Imaging studies: Such as a chest x-ray, computed tomography (CT) scan, or magnetic resonance
imaging (MRI).
Direct visualization: A flexible or rigid laryngoscopy or bronchoscopy may be needed to visualize the
airway and identify any obstructions.
Management:
Oxygen therapy: To improve oxygenation and reduce the workload on the child's breathing muscles.
Nebulized epinephrine: To reduce airway inflammation and swelling.
Corticosteroids: To further reduce airway inflammation and swelling
Antibiotics: If a bacterial infection is suspected
Fluids and nutrition: To maintain adequate hydration and nutrition
Supportive care: Such as maintaining a calm and reassuring environment, providing appropriate pain
relief, and monitoring the child's vital signs closely
In conclusion, a child of 3 years presenting with stridor requires urgent evaluation and management to
identify and treat the underlying cause of the airway obstruction. A comprehensive approach
involving a thorough history, physical examination, and appropriate investigations is necessary to
ensure the best outcome for the child.
46. Rhinorrhoea is a common presentation in nasal foreign body , give reason
Rhinorrhoea, or a runny nose, is a common presentation in nasal foreign body cases for several
reasons:
Irritation of nasal mucosa: The presence of a foreign body in the nasal cavity can cause irritation of
the nasal mucosa, leading to increased production of mucus and a runny nose.
Inflammation: The foreign body can cause inflammation of the nasal tissues, resulting in increased
nasal secretions and runny nose.
Obstruction: The foreign body can also cause obstruction of the nasal passage, leading to the
accumulation of mucus and resulting in a runny nose.
Infection: In some cases, the presence of a foreign body in the nasal cavity can lead to infection,
which can cause an increase in mucus production and a runny nose.
Therefore, rhinorrhoea can be a common presentation in nasal foreign body cases due to the physical
presence of the foreign body, resulting in irritation, inflammation, obstruction, and sometimes
infection of the nasal tissues.
47. Management of a 6 year old child with unilateral foul smelling discharge from nose
Management of a 6-year-old child with unilateral foul-smelling discharge from the nose can be done
as follows:
Medical History and Physical Examination: Take a detailed medical history to assess the duration,
severity, and associated symptoms of the nasal discharge, such as fever, cough, headache, and
difficulty breathing. Conduct a physical examination of the nose and sinuses to identify any structural
abnormalities or signs of inflammation.
Cultures: Collect a sample of the nasal discharge for bacterial culture to determine the type of bacteria
causing the infection.
Antibiotic Therapy: Depending on the results of the bacterial culture, a course of antibiotics may be
prescribed to treat the underlying infection.
Saline irrigation: Regular saline irrigation can be helpful to flush out the nasal passages, reduce
inflammation, and improve symptoms.
Topical Nasal Steroids: Topical nasal steroids can help to reduce inflammation in the nasal passages
and decrease the amount of discharge.
Surgery: In cases where medical management is not effective or there is an anatomical obstruction
causing the nasal symptoms, surgical management may be required. This can involve endoscopic
sinus surgery, adenoidectomy or other surgical procedures.
Hygiene: Proper hygiene practices should be followed to prevent further infection. This includes
washing hands regularly, avoiding close contact with people who are sick, and covering the mouth
and nose when coughing or sneezing.
Follow-up: Regular follow-up with the doctor is important to monitor the effectiveness of treatment
and adjust management as needed.
48. Management of 15 year old boy with chronic nasal obstruction on one side that is
occasionally associated with nasal discharge and heaviness of head
Management of a 15-year-old boy with chronic nasal obstruction on one side that is occasionally
associated with nasal discharge and heaviness of the head can be done as follows:
Medical History and Physical Examination: Take a detailed medical history to assess the duration,
severity, and associated symptoms of the nasal obstruction, such as nasal discharge, sneezing, itching,
and postnasal drip. Conduct a physical examination of the nose and sinuses to identify any structural
abnormalities or signs of inflammation.
Imaging Studies: Depending on the severity of symptoms and clinical findings, imaging studies such
as a CT scan or MRI of the sinuses may be required to evaluate the extent and severity of any sinus
disease.
Medical Management: Depending on the cause and severity of the symptoms, medical management
may include:
Intranasal corticosteroids: These medications can help reduce inflammation in the nasal passages and
improve symptoms of nasal obstruction and discharge.
Antihistamines: These medications can be useful in the presence of allergies causing nasal symptoms.
Decongestants: These medications can help reduce nasal congestion and relieve symptoms of a stuffy
nose, but should not be used for more than a few days due to risk of rebound congestion.
Saline irrigation: This can help reduce nasal congestion and improve nasal symptoms by washing
away mucus and allergens.
Surgical Management: In cases where medical management is not effective or there is an anatomical
obstruction causing the nasal symptoms, surgical management may be required. This can involve
endoscopic sinus surgery, septoplasty or other surgical procedures.
Follow-up: Regular follow-up with the doctor is important to monitor the effectiveness of treatment
and adjust management as needed.
49. Empty nose syndrome in over resection of turbinate, give reason
Empty nose syndrome (ENS) is a rare condition that is typically associated with the over-resection or
removal of the nasal turbinates, which are bony structures located in the nasal passages. The reason
for this is as follows:
Function of the turbinates: The turbinates play an important role in the nasal airway by regulating the
flow and temperature of inhaled air. They also help to filter and humidify the air before it reaches the
lungs. Over-resection or removal of the turbinates can lead to a disruption of this normal function,
resulting in a sensation of dryness and difficulty breathing through the nose.
Alteration of nasal airflow: Over-resection of the turbinates can also lead to alterations in the pattern
and distribution of nasal airflow. This can cause a sensation of congestion or blockage even in the
absence of physical obstruction.
Neural feedback: The turbinates are richly innervated with sensory nerves that provide important
feedback to the brain about the status of the nasal airway. Over-resection of the turbinates can damage
these nerves, leading to a disruption of the normal neural feedback and a sensation of numbness or
loss of sensation in the nasal passages.
Psychological factors: Patients who undergo over-resection of the turbinates may also experience
psychological factors such as anxiety, depression, or a sense of loss of control over their body. These
factors can contribute to the development of ENS or exacerbate its symptoms.
50. Itraconazone not affective for rhinosporidiosis, give reason
Itraconazole is a commonly used antifungal medication for the treatment of various fungal infections.
However, it is not effective for the treatment of rhinosporidiosis, which is caused by a unique
pathogen called Rhinosporidium seeberi. The reason for this is as follows:
Unique structure: Rhinosporidium seeberi has a unique structure that is different from most fungi. It is
a sporangium-forming protistan parasite that forms polyps in the mucous membranes of the nose,
eyes, and other parts of the body. This unique structure makes it more difficult to treat with
conventional antifungal medications like itraconazole.
Limited penetration: Itraconazole has limited penetration into the nasal tissues and may not reach the
depth of the rhinosporidial polyps, which can limit its efficacy.
Resistance: Some cases of rhinosporidiosis have been reported to be resistant to itraconazole
treatment, indicating that the drug may not be effective in all cases.
Alternative treatments: Although itraconazole is not effective for rhinosporidiosis, there are
alternative treatments that can be used, such as surgical excision of the polyps or the use of dapsone or
sulfonamide antibiotics.
51. Septoplasty is a conservative surgery while SMR is not, give reason
Septoplasty and submucous resection (SMR) are both surgical procedures performed to correct
breathing problems related to the nasal septum. However, septoplasty is considered a more
conservative surgery than SMR. Here are the reasons:
Procedure: In septoplasty, the deviated portion of the septum is removed or reshaped to improve the
airflow through the nasal passages. SMR, on the other hand, involves removal of a portion of the
nasal mucosa (lining of the nose) along with the septal cartilage.
Severity: Septoplasty is typically performed for mild to moderate cases of nasal septal deviation,
while SMR is indicated for more severe cases where the deviation is associated with significant
obstruction or enlargement of the inferior turbinates
Risks and complications: Septoplasty is associated with fewer risks and complications than SMR.
SMR involves removal of a larger area of nasal mucosa, which can lead to bleeding, scarring, and
dryness of the nasal passages.
Recovery time: Septoplasty has a shorter recovery time than SMR. Patients can typically return to
work or normal activities within a few days after the procedure, while SMR may require a longer
recovery period.
Success rate: Both septoplasty and SMR have high success rates in improving nasal breathing.
However, septoplasty has a higher success rate for correcting the nasal septal deviation, while SMR is
more effective in reducing the size of the inferior turbinates.
52. What is obstructed osteomeatal complex
The osteomeatal complex (OMC) is a critical anatomical structure in the nose that connects the nasal
cavity to the sinuses. The OMC is located on the lateral wall of the nasal cavity and comprises several
structures, including the ethmoidal infundibulum, bulla ethmoidalis, and hiatus semilunaris. When the
OMC becomes obstructed, it can cause a range of symptoms and complications. Here are some points
to explain obstructed osteomeatal complex:
Definition: Obstructed osteomeatal complex refers to a blockage or narrowing of the OMC, which
prevents proper drainage of the sinuses.
Causes: The most common causes of obstructed OMC include allergies, infection, nasal polyps,
anatomical abnormalities, and tumors.
Symptoms: The symptoms of obstructed OMC may include nasal congestion, postnasal drip, facial
pain, headache, reduced sense of smell, and recurrent sinus infections.
Diagnosis: Diagnosis of obstructed OMC can be made using imaging studies such as CT scan or MRI,
which can identify the extent and severity of the obstruction.
Treatment: The treatment of obstructed OMC depends on the underlying cause. In many cases, initial
treatment involves medical management, such as antibiotics, intranasal corticosteroids, or saline
irrigation. If medical management fails, surgery may be required to remove polyps, repair structural
abnormalities, or widen the OMC.
Complications: Untreated obstructed OMC can lead to complications such as recurrent sinus
infections, chronic sinusitis, and even meningitis in severe cases.
53. Battery in aerodigestive tract is an acute emergency
A battery in the aerodigestive tract, which includes the airway and the gastrointestinal tract, is
considered an acute emergency due to the potential for serious complications. Here are some reasons
why:
Chemical burns: Batteries contain electrolytes that can cause chemical burns when they come into
contact with the lining of the aerodigestive tract. The longer the battery remains in contact with the
tissue, the greater the risk of injury.
Perforation: In some cases, batteries can erode through the tissue of the aerodigestive tract, leading to
perforation or rupture. This can cause leakage of digestive fluids or air into the surrounding tissues,
leading to infection or other complications.
Airway obstruction: A battery in the airway can cause obstruction, leading to difficulty breathing or
even respiratory arrest. This is a potentially life-threatening emergency that requires immediate
intervention.
Gastrointestinal obstruction: A battery in the gastrointestinal tract can also cause obstruction, leading
to abdominal pain, nausea, and vomiting. In severe cases, this can also lead to perforation or other
complications.
Time-sensitive intervention: The longer a battery remains in the aerodigestive tract, the greater the
risk of complications. Therefore, prompt intervention is necessary to remove the battery as soon as
possible.
Overall, a battery in the aerodigestive tract is a serious emergency that requires immediate attention.
The potential for chemical burns, perforation, airway obstruction, gastrointestinal obstruction, and
other complications make it important to intervene as quickly as possible to minimize the risk of
serious harm.

54. Intranasal Corticosteroids for management of allergic rhinitis

Intranasal corticosteroids (INCS) are considered one of the most effective treatments for managing
allergic rhinitis. Here are some reasons why:
Anti-inflammatory properties: INCS work by reducing inflammation in the nasal passages, which is a
primary cause of allergic rhinitis symptoms such as nasal congestion, runny nose, and sneezing. By
reducing inflammation, INCS can improve symptoms and reduce the need for other medications.
Localized action: INCS are applied directly to the nasal passages, allowing them to act locally and
minimizing systemic side effects. This is in contrast to oral corticosteroids, which can have more
significant side effects when taken systemically.
Rapid onset of action: INCS can provide relief from symptoms within hours of administration,
making them a good choice for treating acute symptoms of allergic rhinitis.
Long-term efficacy: INCS have been shown to be effective over the long-term, with continued use
providing sustained relief from symptoms. This is important for managing chronic allergic rhinitis.
Safety profile: INCS are generally considered safe when used as directed, with few side effects
reported. They are also non-addictive and do not cause drowsiness, making them a good choice for
patients who need to maintain their normal daily activities.
55. Fistula test in COM should be avoided. Comment.
Fistula test is a diagnostic test that involves injecting fluid into the middle ear space to check if there
is a communication between the middle ear and the surrounding structures, such as the mastoid air
cells. This test is commonly used to diagnose chronic otitis media (COM), a condition characterized
by long-standing inflammation and infection of the middle ear.
However, in certain cases, the fistula test should be avoided in patients with COM. Here are some
reasons why:
Risk of complications: The fistula test involves puncturing the eardrum and injecting fluid into the
middle ear space. This procedure carries a risk of complications, such as infection, bleeding, and
damage to the middle ear structures. In patients with COM, who already have inflamed and damaged
middle ear tissue, the risk of complications may be higher.
Inaccurate results: The fistula test relies on the presence of a communication between the middle ear
and the surrounding structures. However, in some cases of COM, the communication may be
intermittent or may close temporarily due to inflammation or scarring. In such cases, the fistula test
may give false-negative results, leading to an incorrect diagnosis.
Limited usefulness: The fistula test has limited usefulness in diagnosing COM, as there are other tests,
such as a CT scan or MRI, that can provide more detailed information about the extent and severity of
the disease. These tests can help in planning appropriate treatment strategies for the patient.
Therefore, in patients with COM, the decision to perform a fistula test should be made on a case-by-
case basis, taking into account the individual patient's condition and the risks and benefits of the
procedure. In general, the fistula test should be avoided in patients who are at high risk of
complications or in whom the test is unlikely to provide useful information.
56. Give reason, foul smelling greenish crust is a case of atrophic rhinitis

Foul-smelling greenish crusts are a common symptom of atrophic rhinitis. Atrophic rhinitis is a
chronic condition of the nasal cavity characterized by inflammation and thinning of the nasal mucosa.
This thinning of the mucosa leads to the formation of crusts or scabs in the nasal passages, which can
be greenish in color and have a foul odor.
The foul odor is due to the presence of bacteria that thrive in the dry and poorly oxygenated
environment of the nasal cavity in atrophic rhinitis. The bacterial overgrowth produces volatile sulfur
compounds that cause the characteristic foul odor. The greenish color of the crusts is due to the
presence of dead cells and debris mixed with the bacteria.
Other symptoms of atrophic rhinitis include nasal congestion, dryness, and crusting, which can cause
discomfort and difficulty breathing. Atrophic rhinitis can be caused by various factors, including nasal
surgery, infections, and autoimmune diseases. Treatment of atrophic rhinitis may involve antibiotics
to control bacterial overgrowth, nasal saline sprays to keep the nasal passages moist, and sometimes
surgery to remove damaged tissue or improve airflow.
57. Aetiopathogenesis of antrochoanal polyp
Antrochoanal polyp is a benign growth that arises from the mucosal lining of the maxillary sinus,
extending into the nasal cavity and pharynx. The aetiopathogenesis of antrochoanal polyps is not
completely understood, but some factors have been identified as possible contributors to their
development. Here are some points on the aetiopathogenesis of antrochoanal polyps:
Chronic inflammation: The most widely accepted theory is that antrochoanal polyps develop as a
result of chronic inflammation of the maxillary sinus. This inflammation can be caused by various
factors such as allergies, infections, or irritants.
Obstruction: Obstruction of the natural drainage pathway of the maxillary sinus can also contribute to
the development of antrochoanal polyps. This obstruction can occur due to various reasons such as
anatomical variations, previous surgery, or trauma.
Immunological factors: Some studies suggest that immunological factors may also play a role in the
development of antrochoanal polyps. It has been suggested that an abnormal immune response to
allergens or infections may contribute to the chronic inflammation that leads to the formation of these
polyps.
Genetic factors: There is some evidence to suggest that there may be a genetic predisposition to the
development of antrochoanal polyps. However, the exact genes involved have not been identified.
Hormonal factors: Some studies have suggested that hormonal factors may also play a role in the
development of antrochoanal polyps. It has been observed that these polyps are more common in
males than females, and they often develop during adolescence, a time when hormonal changes are
occurring
58. 30 year old female presented with right sided nasal obstruction. Write a)differential
diagnosis, b) examination c) investigation
a) Differential diagnosis for right-sided nasal obstruction may include:
Nasal polyps
Deviated nasal septum
Allergic rhinitis
Sinusitis
Foreign body in the nose
Nasal tumors
Turbinate hypertrophy
Granulomatous diseases, such as sarcoidosis or Wegener's granulomatosis
b) Examination of the patient may include:
Inspection of the external nose and nasal passages with a light source to look for any deformities,
swelling, or visible foreign bodies
Palpation of the nasal bones and cartilage to detect any tenderness or deformities
Visualization of the nasal septum and turbinates using a nasal speculum or endoscope to check for any
deviations, polyps, or hypertrophy
Examination of the throat to check for any postnasal drip or signs of infection
c) Investigations that may be considered include:
Nasal endoscopy: This is a minimally invasive procedure that allows direct visualization of the nasal
passages, allowing for the detection of polyps, tumors, or other abnormalities.
CT scan of the sinuses: This may be ordered if sinusitis or other sinus-related conditions are
suspected.
Allergy testing: This may be done if allergic rhinitis is suspected.
Biopsy: If a tumor or other abnormal growth is suspected, a biopsy may be necessary to confirm the
diagnosis.
59. Pathogenesis of csom ( tubotympanic and atticoantral)
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear with persistent
ear discharge. It can be classified into two types based on the anatomical location of the lesion:
tubotympanic and atticoantral.
Tubotympanic type CSOM:
The tubotympanic type of CSOM, also known as the safe type, is the most common form of CSOM. It
is caused by an infection of the mucosa lining the middle ear cleft and the eustachian tube. The
infection may be caused by a variety of bacteria, including Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis.
The pathogenesis of the tubotympanic type of CSOM is thought to occur as follows:
Eustachian tube dysfunction: The eustachian tube connects the middle ear with the nasopharynx and
regulates pressure in the middle ear. Dysfunction of the eustachian tube can cause negative pressure in
the middle ear, which may lead to a decrease in the blood supply to the mucosa lining the middle ear
cleft.
Mucosal changes: The decrease in blood supply to the mucosa leads to a decrease in the thickness of
the mucosa and a reduction in its ability to resist infection.
Infection: The thinning of the mucosa makes it more susceptible to infection, which can lead to
chronic inflammation and discharge from the ear.
Atticoantral type CSOM:
The atticoantral type of CSOM, also known as the unsafe type, is less common than the tubotympanic
type. It is characterized by a defect in the bony wall of the attic of the middle ear and/or the mastoid
antrum. This defect allows the infection to spread into the mastoid cavity and can lead to
complications such as cholesteatoma and facial nerve paralysis.
The pathogenesis of the atticoantral type of CSOM is thought to occur as follows:
Cholesteatoma: The bony defect in the attic of the middle ear and/or the mastoid antrum can lead to
the formation of a cholesteatoma, which is a collection of squamous epithelium that can grow and
erode surrounding bone and tissue.
Erosion of bone: The cholesteatoma can erode the bony wall of the middle ear and/or the mastoid
antrum, allowing the infection to spread into the mastoid cavity.
Infection: The infection can lead to chronic inflammation and discharge from the ear and can cause
complications such as facial nerve paralysis and brain abscess.
60. Protrusion of tongue causes upward movement of thyroglossal cyst but in the same
manoeuvre thyroid gland doesn't move.
The thyroglossal cyst is a remnant of the thyroglossal duct, which is a tube-like structure that connects
the developing thyroid gland to the tongue during embryonic development. When the tongue is
protruded, the muscles in the neck contract, causing an upward movement of the hyoid bone. This
movement, in turn, pulls on the thyroglossal cyst, causing it to move upward.
The thyroid gland, on the other hand, is not attached to the hyoid bone or the tongue. Instead, it is
anchored to the trachea and the surrounding structures by a series of ligaments and muscles.
Therefore, when the tongue is protruded, there is no direct mechanical force acting on the thyroid
gland to cause it to move.
However, it is important to note that the movement of the thyroglossal cyst and the thyroid gland are
not always independent of each other. In some cases, the thyroglossal cyst may be located in close
proximity to the thyroid gland, and its movement may cause some displacement of the gland.
Additionally, certain medical conditions such as goiter or thyroid nodules may cause the thyroid gland
to enlarge, which could potentially affect its movement in response to tongue protrusion.

61. Right recurrent laryngeal nerve is more prone to be damaged as compared to left recurrent
laryngeal nerve during thyroid surgeries.
The recurrent laryngeal nerves (RLN) are branches of the vagus nerve that supply the muscles of the
larynx. During thyroid surgery, these nerves are at risk of injury due to their close proximity to the
thyroid gland.
The right RLN takes a longer and more circuitous route compared to the left RLN. The right RLN
loops under the right subclavian artery, while the left RLN loops around the aortic arch. This
anatomical difference makes the right RLN more prone to injury during thyroid surgery for several
reasons:
Longer path: The right RLN travels a longer path than the left RLN, which means there is a greater
chance of it being inadvertently damaged during surgery.
Higher location: The right RLN also has a higher location in the neck than the left RLN, making it
more vulnerable to injury as it passes through the narrow and crowded space between the thyroid
gland and adjacent structures.
Variability: The course of the right RLN can be highly variable, with some individuals having a
higher and more complex course than others. This variability can make it difficult for surgeons to
predict the exact location of the right RLN during surgery, increasing the risk of injury.
62. Bilateral recurrent laryngeal nerve injury following total thyroidectomy is dangerous
Here are some reasons why bilateral RLN injury following total thyroidectomy can be dangerous:
Voice changes: The most common symptom of bilateral RLN injury is a change in voice quality,
including hoarseness, breathiness, or loss of voice. These changes can be temporary or permanent and
can significantly impact a person's ability to communicate.
Difficulty swallowing: The laryngeal muscles also play an important role in protecting the airway
during swallowing. Bilateral RLN injury can cause difficulty swallowing, which can lead to aspiration
(inhaling food or liquid into the lungs), pneumonia, and other respiratory complications.
Airway obstruction: In severe cases, bilateral RLN injury can cause complete airway obstruction,
which is a life-threatening emergency that requires immediate intervention to restore breathing.
Tracheostomy: If airway obstruction occurs, a tracheostomy (a surgical procedure to create an
opening in the trachea) may be necessary to allow for breathing.
Quality of life: Bilateral RLN injury can have a significant impact on a person's quality of life,
including their ability to work, socialize, and perform daily activities.
63. child suffering from repeated throat infection has discharge of pus through ear
When a child experiences repeated throat infections, there is a possibility that they may develop a
complication known as a peritonsillar abscess. A peritonsillar abscess is a collection of pus that forms
in the tissues surrounding the tonsils, and it can be a serious condition that requires medical attention.
One of the potential complications of a peritonsillar abscess is that the pus can spread to nearby
structures, including the middle ear, through small channels called the Eustachian tubes. The
Eustachian tubes connect the middle ear to the back of the throat, and they help to equalize pressure
and drain fluid from the middle ear.
If the pus from a peritonsillar abscess reaches the middle ear, it can cause an infection called otitis
media with effusion, which is characterized by a buildup of fluid in the middle ear. The pressure from
the pus can cause the eardrum to bulge, and in some cases, the eardrum can rupture, leading to the
discharge of pus from the ear.
Symptoms of otitis media with effusion may include ear pain, hearing loss, and fever, in addition to
the discharge of pus from the ear. Treatment typically involves antibiotics to clear the infection, as
well as drainage of the abscess if necessary.
It is important to note that while a peritonsillar abscess can be a complication of repeated throat
infections, not all cases of repeated throat infections will lead to a peritonsillar abscess or discharge of
pus from the ear. If you suspect your child may have a peritonsillar abscess or otitis media with
effusion, it is important to seek medical attention from a healthcare professional.
64. Throat infection in child if neglected may lead to mastoiditis
Mastoiditis is a serious infection that can occur in the mastoid bone, which is located behind the ear.
This bone contains air cells that are connected to the middle ear, and infections can spread from the
middle ear to the mastoid bone, causing inflammation and infection.
In children, one of the common causes of mastoiditis is a neglected or inadequately treated throat
infection. When a child has a throat infection, the infection can spread to the middle ear through the
Eustachian tube, which connects the throat to the middle ear. If the infection is not treated promptly, it
can cause inflammation and fluid buildup in the middle ear, a condition known as otitis media.
Otitis media can cause pressure to build up in the middle ear, which can in turn cause the infection to
spread to the mastoid bone. Mastoiditis is a serious condition that can cause symptoms such as ear
pain, swelling and tenderness behind the ear, fever, and hearing loss.
If left untreated, mastoiditis can lead to complications such as a ruptured eardrum, meningitis
(infection of the lining of the brain), or even brain abscesses. In some cases, surgery may be required
to drain the infection and prevent further complications.
It is important to seek medical attention for any suspected throat infection in a child and to ensure that
the infection is treated promptly and effectively. This can help to prevent the spread of infection to the
middle ear and reduce the risk of complications such as mastoiditis.

65. Incision for smr given in mucocutaneous junction explain point wise
An SMR (Submucous Resection) is a surgical procedure that is commonly used to treat a deviated
nasal septum, which is a condition in which the nasal septum, the thin wall that separates the two
nostrils, is crooked or misaligned. During an SMR, the surgeon will make an incision in the
mucocutaneous junction, which is the area where the lining of the nose (mucosa) meets the skin of the
nose.
Here are some reasons why the incision for an SMR is given in the mucocutaneous junction:
Better access: The mucocutaneous junction is the area where the nasal septum and the outer skin of
the nose meet. By making an incision in this area, the surgeon can gain better access to the nasal
septum and perform the necessary surgical corrections.
Easier closure: The incision made in the mucocutaneous junction can be closed easily and effectively
because this area is well vascularized and has a good blood supply. This helps to minimize bleeding
and ensure that the incision heals properly.
Reduced scarring: Making the incision in the mucocutaneous junction can help to minimize scarring
because it is a natural crease in the skin that is less visible than other areas of the nose.
Reduced risk of complications: By making the incision in the mucocutaneous junction, the surgeon
can avoid damaging the nasal cartilage or causing other complications that can occur when incisions
are made in other areas of the nose.
Improved cosmetic results: Making the incision in the mucocutaneous junction can help to improve
the overall appearance of the nose by minimizing scarring and ensuring that the incision heals
properly.In summary, making an incision in the mucocutaneous junction during an SMR can provide
better access to the nasal septum, ensure easier closure, reduce scarring and the risk of complications,
and improve the overall cosmetic results.
66. Inferior meatal antrostomy doesn't help in drainage of Maxillary Sinus
Inferior meatal antrostomy is a surgical procedure that involves creating an opening in the inferior
meatus of the nasal cavity to facilitate drainage of the maxillary sinus. However, in some cases, this
procedure may not be effective in draining the maxillary sinus, and here's why:
Anatomical limitations: The maxillary sinus has a complex anatomy, and its opening, called the
ostium, is located high up in the sinus. Therefore, creating an opening in the inferior meatus may not
be enough to provide adequate drainage of the maxillary sinus.
Mucosal swelling: Inflammation of the nasal mucosa can cause swelling, which can obstruct the
opening created in the inferior meatus. This can prevent proper drainage of the maxillary sinus,
leading to symptoms such as pain, pressure, and infection.
Incomplete removal of diseased tissue: In some cases, the inferior meatal antrostomy may not remove
all the diseased tissue from the maxillary sinus. This can lead to recurrent infections and symptoms
that persist even after the procedure.
Narrow drainage pathway: The drainage pathway from the maxillary sinus to the inferior meatus may
be narrow, which can restrict the flow of fluid and prevent adequate drainage.
Scar tissue: Scar tissue formation after the surgery can cause the drainage pathway to narrow or even
become blocked, leading to the recurrence of symptoms.
67. TYMPANOTOMY
Tympanotomy is a surgical procedure that involves making an incision in the eardrum (tympanic
membrane) to gain access to the middle ear. Here are some points to help explain this procedure:
Indications: Tympanotomy is typically performed to treat conditions that affect the middle ear, such
as chronic otitis media, cholesteatoma, and otosclerosis. It may also be used to insert middle ear
implants, such as hearing aids.
Anesthesia: Tympanotomy is usually performed under general anesthesia or local anesthesia with
sedation. The choice of anesthesia depends on the age and health of the patient and the extent of the
surgery.
Procedure: The surgeon makes a small incision in the eardrum to gain access to the middle ear. The
incision may be made using a scalpel, laser, or other surgical instrument. Once the eardrum is open,
the surgeon can visualize the middle ear structures and perform the necessary procedures, such as
removing diseased tissue, inserting middle ear implants, or repairing the ossicles.
Risks: Tympanotomy is generally considered safe, but like any surgery, it carries some risks. These
include infection, bleeding, hearing loss, tinnitus, and damage to the facial nerve or other structures in
the ear.
Recovery: The recovery time after tympanotomy varies depending on the extent of the surgery and the
individual patient's healing ability. Patients may experience some pain, discomfort, and hearing loss
immediately after the surgery, but these symptoms typically improve within a few days to weeks.
Patients are typically advised to avoid water exposure to the ear and strenuous activity for several
weeks after the surgery.
Follow-up: Patients will typically have several follow-up appointments with their surgeon after the
surgery to monitor healing and ensure that there are no complications. They may also undergo hearing
tests to assess their hearing function after the surgery.
68. Adenoid facies-
 is a term used to describe the facial appearance of individuals who have chronic enlargement of the
adenoids. Here are some key points to help explain this condition:
Adenoids: Adenoids are a type of lymphoid tissue located in the back of the nasal cavity. They play
an important role in the immune system, but they can become enlarged due to chronic inflammation
or infection.
Facial characteristics: The most common facial characteristics of adenoid facies include a long,
narrow face, a high-arched palate, a small chin, and a mouth that is constantly open. Other features
may include a small nose, drooping eyelids, and dark circles under the eyes.
Causes: Adenoid facies is typically caused by chronic enlargement of the adenoids, which can occur
due to recurrent infections, allergies, or other chronic inflammatory conditions. The condition is most
commonly seen in children, but it can occur in adults as well.
Health implications: Adenoid facies can have several health implications, including difficulty
breathing, snoring, sleep apnea, and an increased risk of ear infections and dental problems. The
condition can also affect speech and language development in children.
Diagnosis: Adenoid facies can usually be diagnosed by a physical examination of the face and mouth.
In some cases, imaging studies may be used to assess the size of the adenoids.
Treatment: Treatment for adenoid facies typically involves addressing the underlying cause of the
adenoid enlargement. This may involve medications, such as antibiotics or allergy medications, or
surgery to remove the adenoids. In some cases, orthodontic treatment may also be needed to address
dental problems associated with the condition.
69. Vocal cord palsy –
is a condition that occurs when one or both of the vocal cords become paralyzed or weakened,
resulting in difficulty speaking and breathing. Here are some key points to help explain this condition:
Anatomy: The vocal cords are located in the larynx (voice box) and are responsible for producing
sound by vibrating as air passes through them. The vocal cords are controlled by the recurrent
laryngeal nerves, which are branches of the vagus nerve.
Causes: Vocal cord palsy can be caused by a variety of factors, including nerve damage or injury,
viral infections, tumors or growths in the throat, trauma to the neck or chest, and neurological
conditions.
Symptoms: The most common symptoms of vocal cord palsy include hoarseness, weak or breathy
voice, difficulty speaking or projecting the voice, coughing or choking while eating or drinking, and
shortness of breath.
Diagnosis: Diagnosis of vocal cord palsy typically involves a physical examination of the throat and
vocal cords, as well as imaging studies such as a laryngoscopy or CT scan.
Treatment: Treatment for vocal cord palsy depends on the underlying cause of the condition. In some
cases, vocal cord function may return on its own without treatment. However, if the condition is
caused by nerve damage or injury, surgery may be needed to repair or replace the damaged nerves.
Other treatment options may include voice therapy, medication, or injections of botulinum toxin to
relax the muscles of the vocal cords.
Complications: If left untreated, vocal cord palsy can lead to long-term speech and breathing
problems, as well as an increased risk of respiratory infections and pneumonia.
70. In recurrent laryngeal nerve palsy, vocal cords lie in median and paramedian position
Recurrent laryngeal nerve (RLN) palsy can lead to paralysis or weakness of the muscles that control
the movement of the vocal cords. When this occurs, the vocal cords may assume a median or
paramedian position, rather than their normal position.
Here are some key points that help explain why this happens:
Anatomy: The recurrent laryngeal nerve is responsible for innervating the muscles of the larynx,
including the muscles that control the movement of the vocal cords. When the nerve is damaged or
injured, these muscles may become paralyzed or weakened, leading to a loss of function.
Median and paramedian position: The vocal cords normally move together during speech and
breathing, opening during inhalation and closing during exhalation. In cases of RLN palsy, one or
both vocal cords may assume a median or paramedian position, meaning they are not moving
correctly and do not come together as they should.
Effects on voice: When the vocal cords assume a median or paramedian position, this can lead to
hoarseness, breathiness, or a weak voice. It may also cause difficulty swallowing or breathing,
particularly during physical activity.
Treatment: Treatment for RLN palsy typically depends on the underlying cause of the nerve damage.
In some cases, the condition may resolve on its own with time. In other cases, surgery may be needed
to repair or replace the damaged nerve, or voice therapy may be recommended to help improve vocal
function.
71. Hypocalcemia fractures may develop after total thyroidectomy operation explain why
Hypocalcemia fractures may develop after total thyroidectomy operation due to the disruption of the
parathyroid glands during surgery. Here are some key points to help explain why:
Anatomy: The parathyroid glands are small, hormone-secreting glands located behind the thyroid
gland in the neck. They are responsible for regulating calcium levels in the body.
Thyroidectomy: Total thyroidectomy is a surgical procedure that involves the complete removal of the
thyroid gland. During the surgery, the parathyroid glands may be disrupted, damaged, or inadvertently
removed.
Hypocalcemia: Hypocalcemia is a condition that occurs when there is a low level of calcium in the
blood. This can occur after thyroidectomy due to the disruption of the parathyroid glands, which can
lead to a decrease in parathyroid hormone production and subsequent low calcium levels.
Fractures: Calcium is an important mineral for bone health, and low calcium levels can weaken bones
and increase the risk of fractures. Hypocalcemia fractures may develop after thyroidectomy if calcium
levels remain low for an extended period of time.
Treatment: Treatment for hypocalcemia fractures may involve calcium and vitamin D
supplementation, as well as medications to stimulate the production of parathyroid hormone. Physical
therapy and other measures to prevent falls may also be recommended to reduce the risk of fractures.
72. Nasal polyps may reccur after succesful FESS explain why
Nasal polyps may recur after successful Functional Endoscopic Sinus Surgery (FESS) due to several
reasons:
Underlying inflammatory disease: Nasal polyps are often associated with chronic inflammation of the
nasal lining and sinuses, which can lead to their formation. Even after successful FESS, the
underlying inflammatory disease may persist, leading to the formation of new polyps.
Incomplete removal: During FESS, the surgeon will remove the nasal polyps using an endoscope,
which allows for precise removal of the polyps while preserving the surrounding tissue. However, it is
possible that small fragments of the polyps may be left behind, which can grow and lead to the
recurrence of the polyps.
Genetics: Studies have shown that there may be a genetic component to the development of nasal
polyps. Individuals with a family history of nasal polyps may be more prone to developing them and
may be at increased risk for recurrence after FESS.
Environmental factors: Environmental factors such as allergens, pollutants, and infections can
contribute to the development of nasal polyps. Even after FESS, exposure to these factors can lead to
the recurrence of the polyps.
Poor postoperative care: Following FESS, it is important to maintain proper nasal hygiene and follow
any postoperative care instructions provided by the surgeon. Failure to do so may increase the risk of
recurrence of the polyps.