Key to ENT Diagnosis

1. Ear
a. Hearing Loss
i. Presbycusis
1. Old patient (> 65 yr)
2. Progressive hearing loss
3. No ear discharge, earache, ototoxic drugs, or trauma
4. Normal tympanic membrane
5. PTA - downward slope

b. Diseases of External Ear

i. Boxer’s Ear / Cauliflower Ear / Pugilistic Ear
1. H/O of Trauma
2. Painless swelling affecting concha
3. Acute (< 2 days)
ii. Furuncle
1. Acute (< 3 days)
2. Progressively increasing persistent earache
3. Decreased hearing
4. Swelling around the ear + purulent discharge
5. Tragal Tenderness / Pinna tenderness
6. Difficulty in opening the mouth/chewing
7. Soft fluctuant swelling along the floor of EAC
8. Otoscopy could not be performed due to occluded meatus
9. Narrowing of EAC
10. Forward protrusion of Pinna
iii. Otomycosis
1. Ear pain with the fullness of the ear
2. Itching and irritation
3. White cheesy material -> Candidiasis
4. Black spores with filamentous mass -> Aspergillus Niger
5. Green discharge -> Aspergillus Fumigates
6. May be chronic (> 5 months)
7. Blotting paper-like discharge
iv. Otitis Externa Hemorrhagica
1. Young patient (16 yrs)
2. Symptoms of Flu/Rhinitis
3. Earache
4. Blood-stained clear discharge
5. Bluish blebs on Tympanic Membrane
v. Malignant / Necrotizing Otitis Externa
1. Diabetic patient / Immunocompromised
2. Earache (rapidly increasing in intensity) / intractable plain
3. Granulations in the external canal
4. Facial Nerve palsy / ipsilateral facial weakness
5. Blood-stained purulent discharge / thick purulent discharge
6. Conductive Deafness
7. Normal Tympanic Membrane
vi. Impacted Wax
1. Hardened black mass
vii. Foreign Body of Ear
viii. Traumatic Rupture of Tympanic Membrane
1. Slapped on the face
 Key to ENT Diagnosis
2. Excruciating pain at the time of injury
3. A few drops of blood from EAM

c. Disorders of Middle Ear

i. Acute Suppurative Otitis Media
1. Scenario usually for children
2. H/O Sore Throat / Tonsillitis / Coryza / Rhinitis
3. Severe Pain
4. Deafness
5. Weber Lateralized towards the bad ear
6. Tympanic Membrane red/bulging
ii. Otitis Media with Effusion
1. Scenario for children
2. H/O Sore Throat / Chronic Nasal obstruction / Persistent nasal discharge / Adenoid
Hyperplasia
3. Hearing problems (> 3 months) / Repeated episodes of earache
4. The child keeps their mouth open at night/snoring
5. Dull-looking eardrum with loss of landmarks

d. Cholestatoma & CSOM

i. Cholesteatoma
ii. Chronic Suppurative Otitis Media
1. Aural mass
2. Unilateral ear blockage
3. Intermittent ear discharge / profuse mucopurulent discharge -> Tubotympanic Type
4. Scanty / Blood Stained / Chronic foul smelling ear discharge -> Atticoantral Type
5. Postero-superior perforation -> Atticoantral Type
6. Antero-inferior perforation / central perforation/pars tensa perforation ->
Tubotympanic Type
7. Vertigo spells
8. Mixed Deafness - > Atticoantral type
9. Mass presence/pathology -> Cholesteatoma

e. Complications of CSOM
i. Acute Mastoiditis
1. Unilateral earache
2. Acute condition (< 4 days)
3. Painful swelling behind the same ear (soft, tender, and hot)
4. Tympanic membrane – swollen and bulging
ii. Bezold Abscess
1. H/O Ear discharge since childhood
2. Sudden onset of fever
3. Pain in neck
4. Torticollis
5. Extending in front of SCM
6. Tender swelling behind mandible
iii. Meningitis
1. H/O long standing ear discharge
2. Severe pain
3. Vomiting / Fever / Photophobia
4. Cannot bend his neck without pain / Neck rigidity
 Key to ENT Diagnosis
f. Otosclerosis
i. Female / Pregnancy
ii. Bilateral hearing loss / chronic hearing loss / increasing over time
iii. Tinnitus
iv. PTA – bone conduction hearing loss at 2000 Hz
v. Rinne’s Test – negative (conductive deafness)
vi. ABC is not shortened
vii. Hearing improves in noisy places
viii. Tympanic Membrane – Normal
ix. Impedance Audiometry – As curve + absent acoustic reflex

g. Facial Nerve
i. Sweating and Flushing in pre-auricular area in response to chewing -> Frey’s Syndrome
ii. Face deviated to one side -> Bell’s Palsy
iii. Facial nerve palsy + vesicular rash in external auditory canal -> Ramsay Hunt Syndrome

h. Meniere’s Disease
i. H/O episodic vertigo w/ nausea vomiting (recurrent) / episodes of dizziness
ii. Followed by a sense of fullness in ear/intra-aural fullness
iii. Hearing loss + Tinnitus
iv. Normal Tympanogram
v. PTA – 50 dB hearing loss
vi. SNHL

i. Deaf Child
i. Child unresponsive to normal voices
ii. No speech

j. Tumors
i. Glomus Tumor
1. Pulsatile Tinnitus
2. Chronic condition (> 6 months)
3. Decreased hearing loss unilateral
4. Mass medial to the tympanic membrane
5. Blanching of mass with positive pressure
6. Conductive Hearing loss
ii. Acoustic Neuroma
1. Progressively increasing SNHL
2. Marked difficulty in understanding speech
3. Reduced Corneal Sensitivity
4. Papilledema
iii. Carcinoma of middle ear and mastoid
1. Chronic bloody foul-smelling discharge and pain
2. Severe at night
3. Friable hemorrhagic polyp in ear
2. Nose
a. Nasal Septum & it’s Diseases
i. DNS
1. Nasal Obstruction / Occasional Epistaxis / Post-nasal Drip
2. Headache / Facial Pain / Sinusitis / Middle Ear Infection
3. Hypertrophy of Inf. Turbinate
4. Septum deflected/deviated
 Key to ENT Diagnosis
ii. Septal Abscess
1. H/O Trauma / Aggressive behavior
2. Bilateral fluctuant swelling of the nasal septum
3. Painful swelling + High Grade Fever
iii. Septal Hematoma
1. H/O Trauma > Epistaxis (within 24-72 hrs)
2. Bilateral symmetrical/smooth red swelling
3. Complete nasal obstruction/mouth-breathing
4. No bleeding upon presentation
5. Nasal patency absent
b. Acute & Chronic Rhinitis
i. Viral Rhinitis
1. Excessive sneezing / Watery rhinorrhea / Nasal Obstruction
2. Headache / Low-grade Fever / Throat aches and irritates
ii. Atrophic Rhinitis
1. Female
2. Anosmia / Loss of smell / Nasal Blockage
3. Epistaxis on cleaning the nose
4. Black Nasal Discharge + Blood Stained
5. Roomy nostrils
6. Black/Green crusting in both nostrils
7. Extremely foul-smelling
c. Granulomatous Disease of Nose
i. Mucormycosis
1. Uncontrolled Diabetes
2. Black necrotic turbinate
3. Unilateral protrusion of eye
ii. Rhinoscleroma
1. Foul-smelling purulent discharge
2. Crusting
3. Subdermal nodules/infiltration – Woody feeling
d. Miscellaneous Disorders of Nasal Cavity
i. Rhinolith
1. Child
2. Unilateral nasal blockage + Discharge ( > 2months)
3. Foul-smelling discharge
4. Blood-stained discharge / epistaxis
5. Grey/brown or Greenish/black irregular mass
6. Gritty sensation on probing
ii. Nasal Myiasis
1. Epistaxis / Pain / Nasal Obstruction / Tingling Sensation in Nose
2. Anosmia
3. Multiple LIVING white colored foreign bodies
4. Septal + palatal perforations
iii. CSF Rhinorrhea
1. H/O Trauma or Accident / Nasal Polypectomy
2. Clear water nasal discharge
3. Discharge increases on straining and bending
4. Nasal Obstruction and Headache
iv. Foreign Body
1.
e. Allergic Rhinitis
 Key to ENT Diagnosis
i. Nasal congestion / Watery Rhinorrhea / Sneezing + Itching
ii. Pale enlarged inferior turbinate
f. Non-Allergic Rhinitis
i. Rhinitis Medicamentosa
ii. Vasomotor Rhinitis
1. Triggered by emotions/stress e.g. exams
2. Nasal congestion + Sneezing
3. Antihistamines not effective
g. Nasal Polyp
i. Young patient
ii. Unilateral / Foreign body sensation in throat / Mass hanging from throat /pale mass seen in
nasopharynx or oropharynx -> Antro-choanal Polyp
iii. Does not bleed on touch
h. Epistaxis
i. Trauma to the Face
i. Nasal Fracture
1. H/O Trauma
2. Bleeding
3. Swelling on nose / Black Eyes
ii. Fracture of Maxilla
iii. Blow-out Fracture
j. Acute Rhinosinusitis
i. Acute Maxillary Sinusitis
1. Throbbing pain on left cheek area (<1 week)
2. Red nasal mucosa and swollen meatus
k. Chronic Rhinosinusitis
i. CRS with Polyposis
1. Polyp on CT
2. H/O Rhinorrhea, Nasal Congestion, Hyposmia and Facial Pressure (>12 weeks)
ii. Surgical Techniques for Chronic Sinusitis
iii. Allergic Fungal Sinusitis
1. Bilateral Nasal Polyp w Eye Proptosis
2. Pushing of lamina papyracea
3. Double Density Sign
4. All sinuses are involved
l. Complications of Sinusitis
i. Orbital Cellulitis
1. Ophthalmoplegia
2.
3. Unilateral proptosis
ii. Cavernous Sinus Thrombosis
1. H/O Rhinorrhea/Fever/Cough
2. Sudden onset bilateral proptosis
3. Pupil dilatation + fixation (CN 3, 4 and 6 involvement)
4. Optic Disk edema present
iii. Frontal Sinus Mucocele
1. Egg crackle Sound
iv. Brain abscess
1. Headache/Vomiting/High grade Fever
2. Chronic Nasal Discharge
3. Paralytic Focal Neurogenic symptoms
4. No neck rigidity / No optic disk edema
 Key to ENT Diagnosis
v. Meningitis
1. Neck rigidity present
vi. Pott’s Puffy Tumor / Osteomyelitis
1. Doughy swelling
2. Followed by sinus infection of frontal or maxilla

m. Neoplasms
i. Inverted Papilloma
1. Unilateral nasal mass
2. Biopsy shows lined epithelium with inverted pattern + finger-like projections
ii. Carcinoma of Maxillary Sinus
1. Unilateral nasal obstruction (> 6months)
2. Nasal Discharge – foul smelling / blood-stained
3. Proptosis of ipsilateral eye
4. Loose right upper molar tooth
iii. Adenocarcinoma of the ethmoid/ upper nasal cavity
1. Male Woodworker / Furniture worker
2. Nasal discharge and obstruction (>6 months)
iv. Nasopharyngeal Carcinoma
1. Adult
2. Cervical node enlargement
3. Recurrent epistaxis / Nasal regurgitation / Nasal tone
4. Unilateral decreased hearing
v. Angiofibroma
1. Teenage male
2. Recurrent bleeding (main symptom)
3. Mass bleeds to touch
4. Swelling of cheek (Holman miller sign)
n. Other topics
i. Nasal Synechiae
1. Post-septal surgery complication
2. Obliteration of nasal cavities
3. Fusion of septum and lateral nasal wall

3. Oral Cavity
a. Common Disorders
i. Ulcers
1. Aphthous Ulcer
a. Painful ulcer in throat
b. During her class test and annual exams
ii. Oral Submucosa Fibrosis
1. H/O pan chewing, alcohol consumption
2. Burning sensation in throat + Trismus (>2 years)
iii. Leukoplakia
1. Poor dental hygiene
2. White Oral Cavity Mucosa in the vestibule
3. White painless patch in the oral cavity
b. Tumors
i. Carcinoma of Tongue
1. Non-healing ulcer on the left lateral border of anterior tongue
c. Neoplasms of Salivary Gland
i. Frey’s Syndrome/Auriculotemporal Nerve Syndrome
 Key to ENT Diagnosis
1. Sweating and flushing of skin in response to mastication
2. H/O Facial mass surgery

4. Pharynx
a. Adenoids & Other Inflammation of Nasopharynx
i. Adenoid Hypertrophy
1. Mouth open at night
2. Pain behind nose
3. Postnasal catarrh
4. Change in resonance (Rhinolalia Clausa)
5. Wet bubbly nose
6. Mass in nasopharynx
b. Tumors of Nasopharynx
i. Juvenile Nasopharyngeal Angiofibroma
1. Young male
2. Unilateral nasal obstruction
3. Recurrent epistaxis
4. Globular smooth surface mass filling nasal cavity / lobulated mass / fleshy mass
5. Mass bleeds to touch
6. Bulging of ipsilateral cheek
7. Anemia
ii. Nasopharyngeal Carcinoma
c. Acute & Chronic Pharyngitis
d. Acute & Chronic Tonsillitis
i. Acute & Chronic Tonsillitis
1. Chronic Follicular Tonsillitis
a. Ant. facial flare
b. Cheesy substance coming out of crypts
c. Enlarged jugulodigastric lymph nodes
ii. Faucial Diphtheria
1. Young patient
2. Membrane on the left tonsil extending onto the soft palate
e. Head & Neck Spaces
i. Ludwig’s Angina
1. Young patient
2. Swelling in submental & submandibular region
3. Fever
4. Carious lower jaw 1st molar tooth
ii. Peritonsillar Abscess
1. Unilateral swelling of the Tonsil area / Unilateral throat pain
2. Uvula pushed to the opposite side
3. High grade fever
4. Thickened speech
5. Trismus / Difficulty in opening mouth / Difficulty in examination of throat
6. Drooling of saliva
7. Jugulodigastric Nodes were enlarged
8. Dysphagia / Odynophagia
9. TLC increased
iii. Parapharyngeal Abscess
1. H/O Dental extraction
2. No lymphadenopathy
3. No hyperemia of palate
 Key to ENT Diagnosis
4. Fluctuating swelling in the neck
5. Mass posterior to the tonsil
6. Tonsil pushed medially
7. Spreading posterior to the SCM muscle
f. Tumors of Hypopharynx
i. Zenker’s Diverticulum
1. Old man
2. Progressive dysphagia for solids
3. Regurgitation of food at night
4. Soft swelling in the left part of neck which gives gurgling sound on palpation

5. Larynx
a. Laryngotracheal Trauma
b. Acute & Chronic Inflammation of Larynx
i. Acute Epiglottitis/Supraglottic Laryngitis
1. Child
2. Sudden onset Dyspnea and Stridor/Inspiratory Stridor
3. H/O Sore throat/URTI
4. Examination was impossible due to pain
5. Tripod position
6. Drooling of Saliva / Protruding of tongue
7. High grade fever / Febrile
8. Lateral X-Ray shows Thumb sign
ii. Acute Laryngotracheobronchitis
1. Barking cough
2. Biphasic Stridor
3. Lower rib retraction at rest
iii. Chronic Laryngitis
1. Hoarseness (>6 weeks)
2. H/O Smoking
3. Edema of arytenoids and epiglottis
4. Nodular swelling of the vocal cords
iv. Tuberculosis of Larynx
1. Dysphonia since 3 months
2. H/O intermittent cough with purulent expectoration
3. H/O weight loss and lethargy
4. Ulceration on both vocal cords
c. Congenital Lesions of Larynx Stridor
i. Laryngomalacia and Stridor
1. Baby
2. Noisy breathing / Stridor
3. Increases on crying and cyanosed on feeding
4. Improves in prone position
d. Laryngeal Paralysis
i. Recurrent Laryngeal Nerve Paralysis
1. H/O Thyroidectomy
2. Paramedian position of vocal cords
e. Benign Tumors of Larynx
i. Vocal Nodules
1. Female teacher / Hafiz
2. Hoarseness of voice
ii. Juvenile Papillomatoses
 Key to ENT Diagnosis
1. Child
2. Hoarseness
3. Inspiratory Stridor
4. Pinkish grape like masses involving the supraglottic and glottic regions
f. Cancer of Larynx
i. Supraglottic Cancer
1. Progressively increasing, painless neck swelling in Level 2
2. H/O of voice change
3. Stridor
ii. Glottic Cancer
1. Old Male Smoker
2. Change in voice for 6 months / Progressive hoarseness / progressive dysphonia
3. Difficulty breathing/stridor
4. Mass on vocal cord

6. Tracheostomy & Other Procedures

7. Foreign Body
i. Decreased air entry on left side
ii. Recurrent lower respiratory tract infections

8. Esophagus
a. Disorders of Esophagus
i. Esophageal Strictures
ii. Plummer-Vinson Syndrome
1. Progressive Dysphagia for 1 year
2. Anemia
3. Smooth tongue / Glossitis
4. Pale
5. Angular cheilitis
iii. Post-Cricoid Carcinoma
1. Progressive dysphagia
2. Anemia (koilonychia, pallor)
3. Loss of laryngeal crepitus

9. Operative Surgeries
a. Bronchoscopy
b. Esophagoscopy
c. Tonsillectomy
i. Secondary Hemorrhage
1. Tonsillectomy 5 days-1 week ago
2. Bleeding from mouth for last 7 hours

Other questions:

Q. Sites of congenital cholesteatoma

Q. Pathways of the spread of Chronic Otitis Media

Q. Indications of Hyperbaric Oxygen Therapy

 Key to ENT Diagnosis
Q. Variants of Meniere’s Disease

Q. Confirmatory Test for Meningitis

Q. Barotrauma

Q. Forceps used to do anterior nasal packing

Q. Nasal Synachae