21-ENT auditory pathway 1st-spiral ganglion(bipolar)→ 2nd-dorsal,ventral cochlear nucleus→ cross to opposite side(in trapezoid body)→ 3rd-sup olivary nucleus→ lat laminiscus→ 4th-inf colliculus→ inf brachium→ 5th-med geniculate body→ audit radiat→ sublentiform part internal capsule→ audit area temporal lobe Auditory Brainstem Response Audiometry(ABRA) I-II—CNVIII(distal&proximal segment) III-cochlear nucleus IV-sup olive V-Lat Leminiscus(Largest wave) VI-VII—inf colliculus displacusis-same tone heard as notes of diff pitch in either ear-inj to n to stapedius, cong syphilis(Hennebert sign) EAC exostosis-recur prolong cold H2O exposure hyperacusis-discomfort/pain on exposure to norm sound otitic barotrauma-underH2O diving, descend in aircraft, compression in press chamber paracusis willisi-sound heard better in presence of background noise-otosclerosis Tullio phenom-attack of vertigo/dizziness by loud sound-labyrinthine fistula ds-TM ASOM-presuppurative-cartwheel, suppurative-lighthouse barotrauma-congested&retracted, air bubble, hgic effusion healed myringitis bullosa-sagograin hemotympanum, glue ear, glomus tm, hemangioma middle ear-blue keratin deposit, osmium tetroxide-snakelike myringitis bullosa(influenza virus)-hgic bleb otosclerosis-norm(90%)-translucent&pearly gray, active ds-flamingo tint(pink spot) retracted-dull lustreless serous otitis media-dull, opaque, grey/bluish, potbelly spontaneousAim4aiims.in heal-dimeric(sq epith–fibrous layer) TB otitis media-camphor ice, multiple perforation tympanosclerosis-chalky white plaque audiometry audiometric 0=25db conductive deafn(mild)≥40db sensory(cochlea) deafn(severe)≥60db neural(retrocochlear) deafn(very severe)≥80db Carhart notch=2000Hz noise induced trauma≥4000Hz auditory fatigue≥90dB×4000Hz WHO-noise exposure<85db×8h×5d Indian fact Act-noise exposure<90db discomfort≥120db pain≥130db presbyacusis-HFHL Meneire ds-LFHL high freq audiometry-ototoxic drug-8000- 20000Hz WHO 0-25db-not signif-no difficulty 26-40-mild-faint speech 41-55-mod-norm speech 56-70-mod severe-loud speech 71-91-severe-shout/amplified speech >91-profound-cant understand amplified speech natural resonance freq ossicular chain=500-2000Hz middle ear=800Hz TM=800-1600Hz EAC=3000Hz greatest sensitivity of sound transmission= 500-3000Hz Rinne test 20-30db AB gap-–ve 256Hz, +ve 512Hz 30-45db AB gap-–ve 512Hz, +1024Hz 45-60db AB gap-–ve 1024Hz speech audiometry deafn-rt shift roll over phenom-SNHL cant sustain plateau Speech Reception Threshold(SRT)=sound intensity at which 50% word rpt speech discrimination threshold=% word rpt at 30db above SRT Aim4aiims.ingood>90% poor=70-90% v poor<70% tympanometry A-norm AS-otoSclerosis AD-ossicular Disruption B-Perforation C-EustaChian tube dysfn Flat-Fluid/glue ear impedance audiometry=tympanometry+ stapedial reflex rehabilitation of deaf hearing aid-RAM Receiver Amplifier Microphone CIC-Completely In Canal BTE-Behind The Ear ITE-In The Ear BAHA-Bone Anchored Hearing Aid(TES) Titanium implant, Ext abutment, Sound processor EAC stenosis, atresia, pus, anotia cochlear implant(MSTR)-severe deaf Microphone(pick up acoustic signal)→ Speech process(sound→ electric energy)→ Transmitter→ Receiver(stimulator) elecTrode-scala Tympani multip channel>single channel implant MC indication-Mondini dysplasia(cochlea= 1½turn) C/i-MiChael dysplasia(absent cochlea) lowest age=1y ideal to avoid maldevelopm-6mth Alexander dysplasia-basal turn of memb cochlea abs(high freq affect) Bing Siebmann dysplasia-complete absent memb labyrinth Sheibes dysplasia-absent memb cochlea, vestibule, bony part norm lever action malleus:stapes=1.3:1 TM reliable marker uMbo>handle>coneAim4aiims.in of light spread of inf fr ear fissure of Santorini-Soft part fissure of Huschke-bony part mastoid tip develop-2y pinna develop adult size-6y cong anomaly ear Anotia-cong Absence pinna bAt-no Antihelix cleft pinna-cong fissure pinna collaural fistula-b/n EAC&neck, 1st pharyngeal cleft coloboma lobuli-cong fissure earlobe Darwin/auricular tubercle-thick helix(jn up⅓ -mid ⅓ ) low set ear-cong low displaced pinna macrotia-cong large pinna MElotia-cong displaceMEnt pinna microtia-cong small pinna Mozart-Mixing of antihelix&helix polyotia-additional pinna preauric sinus-1st arch anomaly preauric tag-small appendage ant to pinna scroll ear-rim(helix) roll forward,inward Wildermuth-no helix fistula SCC—nystagmus lateral-horizontal(towards normal ear) superior-rotatory(towards normal ear) posterior-vertical abscess—site Bezold-SCM sheath Citelle-digastric triangle DuboiS-thymuS(SyphiliS) Gillete-retropharyngeal(b/n pharynx& prevertebral fascia) Luc-temporal bone(roof of EAC) parapharyngeal-parapharyngeal space peritonsillar(quinsy)-tonsillar capsule& sup constrictor PoLitzeri-Labyrinthitis postauricular-behind pinna WilD-subperiostealAim4aiims.in mastoiD mastoidectomy canal wall down-AACSOM+complication RM MRM atticotomy canal wall up-AACSOM–complication cort mastoidectomy(Schwartz operation) combin approach tympanoplasty mulberry like nasal polyP-rhinosPoridiosis vocal corD-rhinosporiDiosis nasal mucosa-inf turb hypertrophy potato nose-rhinophyma Strawberry nose-Sarcoidosis tapiR nose-Rhinosclerosis Pure Tone Audiometry Rt ear-Red Lt ear-bLue O-AC(unmask) rt X-AC lt [-BC(mask) rt ]-BC lt <-BC(mask) rt >-BC lt signif-TM quadrant cone of light, grommet insertion, ASOM perforation-AI incision of myringotomy-PI MC site of cholesteatoma, direction of waterjet during syringing-PS sequele Bell palsy crocodile tear/gustatory lacrimation-faulty regeneration parasympath fibre synkinesis-cross innervation CNVII→ pt close eye→ twitch angle mouth desc order freq-sinus developm, ca, sinusitis-MEFS mucocele, osteoma-FEMS fungal ball-MSEF orbital complication-EFMS angiofibromaAim4aiims.in nose Mx-earLy-WiLson transpalatal approach lAte-SArdAnA transpalatal sublab approach laser CO2(10600nm)-larynx, ear KTP-nose, Pharynx supraglott-insp dyspnea+feeding difficulty glottis-biphasic dyspnea+hoarseness subglottis-biphasic dyspnea trachbronch-exp dyspnea phonaesthesia(weak voice) m palsy-glottis shape on ILscopy thyroarytenoid-ellipse interarytenoid-triangle both-keyhole papillomatosis juvenile-multiple, spont resolve, recur SeNile-Single, Never resolve, Never recur m—position of VC—fn—n inj add-median-phonation-RLN add-paramed-whisper-RLN cadaver-intermed-circular-RLN,ILN —-gentle abd-breathe-ILN abd-complete abduct-full breath-ILN n palsy—VC position—sympt—Mx u/l RLN-|\-hoarseness-w/w b/l RLN-||-dyspnea-tracheostomy u/l SLN-/|-hoarseness-w/w b/l SLN-/\-aphonia,aspiration-tracheostomy→ epiglottoplasty 20-30y fem-otosclerosis 30-40y fem-Meniere ds 40-60y-acoustic neuroma endoscope 90°-larynx 60°,30°(best)-nose 0°-earAim4aiims.in A→ P-Stamberger approach P→ A-Wigand approach 1st pass-Inf meatus 2nd pass-Sup meatus 3rd pass-Middle meatus nasal mass <2y-intracran mass-meningocele 2-10y-recur polyp-cyst, fibrosis 10-14y-AC polyp 14y mal-angiofibroma 20-40y-ethmoidal polyp 40-60y-inverted/Schneiderian/transitional cell papilloma(always u/l, 10-15%malign-SCC) >60y-SCC American society sympt sinusitis a/c<2w, c/c>12w, a/c on c/c=2-12w minor-halitosis, c/c fever, pain in body, headache, fatigue, cough major-Anosmia, Blockage, Congestion, Discharge(purulent), fEver, Facial pain M sinusitis-cheek, dental, swelling lower eyelid LE sinusitis-root(radix), dorsum, upper eyelid S sinusitis-retroorbital, occipital F sinusitis-office headache, just above med canthus nasal douche=Na BBC(1:1:2), Bicarbonate, Biborate, Cl focal lth objective lens ear-200/250mm nose/PNS-300mm larynx-400mm Lempert endaural incision-above tragus, incisura terminalis Rosen incision(post wall EAC)-stapedectomy Wild incision-classic postaural Last struct to develop in pinna-Lobule grommet(ventilation tube) insert after 3mth med Rx failure Prussac space →Aim4aiims.inant pouch von Trolusch→ ant epitympanum →post pouch von Trolusch→ post epitympanum ottic capsule 14centre of ossificat 1st appear-16w, last appear-20w cholesteatoma cong-IUL prim-retraction pocket sec-perforation tert-iatrogenic Eustach tube press diff>15mmHg #Temp bone CNVII palsy-Transv total nasal sept destruction-Weg granulomatosis enlarged vestibular aqueduct>2mm during inspiration main airflow current-middle part cavity in middle meatus parabolic curve #temporal bone Longitudinal(80%)-CNVIIpalsy(20%) tympanic seg, less&delay, CSF otorrhoea+, Lat skull trauma(parietal blow), conductive deafn, blding fr ear+, #line parallel to Long axis petrous pyramid transverse(20%)-CNVIIpalsy(50%) labyrinthine seg, immediate, frontooccipital trauma, vertigo severe, #line across petrous c/c hypertrophic candidiasis/candidial leukoplakia white patch oral cavity, not wipe off ant buccal mucosa, post to angle of mouth Rx-excision tonsillectomy torrential bld-paratonsillar v globus pharyngeus something stuck in throat/sensation of lump tightn in throat relieved by food/talking allergic pharyngitis granularity in post pharynx d/t-hyperplasia of submucosal lymphoid ts electrolyte—endolymph—perilymph Na-3-140 K-144-10Aim4aiims.in prot-126-(200-400) glu-(10-40)-(85) produced by-stria vascularis-capillary of spinal lig incis ant to SCM-parapharyng abscess incis post to SCM-retropharyng absces UPSIT(University of Pennysylvania Smell Inventory)-olfactory power frontal sinus Sx frontal sinus trephination Killian meth Lothrop meth Lynch procedure(frontoethmoidectomy) Riedel meth classific-ds Antoni-vestib schwannoma Austin Kartush classific A-M,S+,I– B-M,foot plate S+ C-M–,S+ D-M,S suprastruct– E-S fixation F-ossicul head Fixation O-intact Ossicul chain Austin MOOre-Ossicular