.

· ENT PRACTICALS ·

~ -·:"'i~;, , ~- ~--
- -:.:. ..-~:,===~=--:=
-:~~t~ - ~=J),~uV~ 1?~A£~;a'
· Ear 1 • ·

' _,
Nase - . Cs_
oM , : ,
l_
- .Nasal ~0 I · ·· · ·
I --..___- r___hroat Sinu 't'18 YP, Deviated Nasal Septum, Chronic Maxillary
'
I
Ch si_ , Atrophic rhinitis
I
i I - . - - - ronic tonsillitis .
i t .:, : ·-erfr CAs·r: sHeer
1
..
PRoF ,·.
.,
➔ Name ·
➔ Age
➔ Sex
➔ I : ccupation
➔ Address
➔ Phiei cornp .
..., Jlio J1nts and duration
!·
1ast P~esent illness
history ·,
~~H,t;,·s.
e~so~al hictory . •
E::, ._eral Examination · ~;}on-- Sc.~ ~~

~• -data . · - _ CG.~
.~ c· _ l, examination of E ( . . . .
;.~{-._;[n!nat!on bf Nose ar or Nose or Throat - according to the case)
0· , . 1-11 11at1on of Throat
;1~: >•.tdision di_agnos1s ·
J _·: ·. :,,~ lagement
._t -"'=1-1
·- , EAR CASE
:;: ;~~ feE EXA~1:NATJ.QJL!.N D_s:!}.'L
,'_..~~ i /4ent:s particulars ·
'_::--:--, .'t'l1ief complaints and duration
;rr) lo present illness
::,-: .' - lzarathe
-, ~. _/ · ,)· Unflateral /Bilateral ·
_) .")'// \ . :i) Severity of pain - Severe (A.SOM, perichondritis, furunculosis, otitis
) ·_ '.! . I J ~~~Jfl~JJraur.ria)
Mod t .. · 1b

·' °§'· / Mi1d·(:u~t

trauma tci pinna, CSOM) •
)_ :;~ J 3' Nature of pain I
Thro~ping or pricking
~ Duration of pain
I I
.;.. ' . , Ac~te {AS.OM). .
) . ' :,. , / ~ Chtonic (CSOM,_Malignancy)
,. :/ ; :· _- · ;} lnterm.ittent or conti~u~.lJ~.
.... ~ . i·f
" j
• _'. · .b'. Aggravat
__ · ingf and. rBhev1ng factors
ti\ .' 'I . .
. . · . Radiation o .aJn · ·
J f· .~_4.;·l~_am Guide' fo_rFinal MBBS -I 58
~ :~'1~/1/v :\l.
_. , . ,I .it ....,
l,'i ; . " ( . ·. , _\.i •. }: .
~; : '" ,7;, .
.,tl .,·' ~--\
' ~✓ -.'
f
0
ffff'7
 - Ear discharge
· ·· .·:":f-·~·_::.' --:t.~,:·t;, ,;latE;rGI /Bilateral
··.
· ·•-·· · ·•·•· L·' Ty·pe " · · ·
of discharge . a) ·
· · ··· · 0 1'f15 extarrn ;
Sero1-1s (Eczematous ~ . f Tymp~t.liG'-memhranes after ·
Muoopurulent (Per,:o~ation e.. . CSOM) it 9 ' . .
t
arise from middle ear gla nd eg,_ Acute otitis externa) · ·
Purulent (From e~terna e~r ASOM CSOM ' .
· ets int~

• (From m1l:ftfle eai - ' . •. . ·

From.ruptured parotiP ab~c~ss _into , ~~rnal ~1.!d1!ory can .. \
,
From tempro mandibular Jornt--a bsce ~·ruptunng !nto "' '. :
externar.auditory.canal)
Bloody (Trauma I malignancy) ·•
- -- Watery (GSF Otorrhoea)- -- - - ,-- ~ -
· . Sang'-:J_i~ous (Polyp, tumgur) ·
I . ~J(ej VJ~ !;fo~ '
.Duration of discharge. __ . · - -- · · ·
I! · Acute (ASOM leading to TM perforation, Traum~, AO~} or
Chronic (CSOM, Malignancy, lntr~ cerebra1 ·infect1on) .
Continuous (Trauma) or intermittent (CSO M)
.
Prhfuse (Perforation of TM; ASOM)or scanty (cerebral absce~s. menin
geal;_ ;
J - . infection, maligna_ncy) . -• . j\ I~
r· •J'.i

'
Foul smelling (intra cerebral/ n-ieningeal infection) or not foul smell
ing \j. ,.
/\ association with earache or not
Ar.y aggravating and relieving factors. .
'
,,.. ft
~V _1
.1'f ·'
f
- ;earing loss . ~ . , . -~"' ~"
~ nil!teral / Bilateral __ O;f- ~~ l _lrl-0
, u_·

.1
~ den (Viral infections: eg. Mump~:, Ac~ustic· neuroma, ~ract ure of
:~t
:/\ . . P~tr;:;u s temporal bone) o r : - - - · · --~--1
gr..§>iual (associated with ear discha rge_ serous . purule
- 91 ue ear nt - · J ~~-
· CSOM
Associated with nose discharge .E· ·stach
, . . · _.. u ean catarr.h)
.
.
/
•: ~
-;1
Fluctuating (serous otitis media} · -
· ., .11.:.b- . or constant / ' t,,_·
Mud/ Moderate ·/ Seve·r·e-.;;,ryi e-re 7_s. f.
· · <-
. is,~
f.dri . _better in Noisy enviFOnmen: (Otosclerosis) fa;~•-'·-cv,<• .,.-Ht\< .
.
u en increase in discomfort d . .. .
. I .
un, ,g normal conver-a·· . .
..
·'. &
~f;~
kl
H'o N · - ·· ' · . . ,•. •..,·_t
' 01se e,xp_osure ·
.:> t1on procedure (M · · ·, c_ i;
· d. en1ere's ~~~
. .,_·~
H/o ta½ing any ototox·1c d .
. -. rugs (Gem~,1-n- • ·
isease) ..:: :;f~{--
· ·:: · lf
of
Farnilx_histor1 heari~g lo~s ·. ;-- ~ yc,n, Frusemide, Quinine)
/ .' :~¥;
H/o p~ychogenic deal~ess , i '>}f
. '·, .

. ~uJ:" . Exam Cuid~ for final MBUS ·I

• :r
. ,,,:
 . tty due to the•causes as that of deafn
I
, · • . . in th• ears). (lll%hogenic or idiopathic) ess or may.be'
,nnitLJS (R,ng,ng . -I P,5 . ,.. -~ ~c~~ _.J '
. /Bilatera · •·--OWP'"
1 unilateral . r_,ill.P·OW')
· · interrnittent/ C . that-either
· • •
surrounding~ or himself rotatin )
. d·ness (Feelln9 . 9
G1d 1.
go{s;/ d (Sudden in Acute ve~t1bular neuraitis) ,
si:,dden I gra ua 1 . . •
, occasional I contin·uous . .
. . d with nausea, vomittinig diarrh~ea (due to vagal r
Assocratfndicates..severe vertigo) . . --_- - _ .,___ _ - -_ s nnulation,
. ted with aural discharg~ (Mi~r diseas~} - ..- .
~ • . es, d'I se ~r ca · neu~~
-L
oc1a ~Jin ·
A l
•'I
:}PY particular hea0 pos,u~(Bemgn posl _n I vertfgiif'-~ l>/p .
Induced by coughing ~r.sneezing(Per~j)pt1c fistula) · _ ,
-_f•loud sounds (Tullio. s pllenomenonV ~..rt\A

I
•, 1• "'· ,
. , "?- . ~ - ,- - ~ ~ ~ S/ h ) ~ \Y"I
H/O any trauma (Head inJ_
ury,.Surgenes over th~ ear causing causing dama Sl.c t
.
~
-labyrinth) ., ._
.,.. · · . · ge.to. '
I . H/0 any drug intake (Gentam#,"S.alicylates,Quinine,Anti hypertensives) . •'rlip,qe .
· H/0 any ·, . . . . . Gl:f -~
--7Cardiovascular-d1sease {J-iypertens1on, HyJM?tension,Atheroscli, .
.._.;,NP..J1rological disease (Transient ischemic attacks, Epilepsy, M~s,s,Anaemia) t:;
..,,!
~I,,
etabolic disease (~M, HXpothyro1d1sm) · . _tiple Seleros1s)
_ rvical spondy~os1s (It 1s ?n~ .~ the common causes
mpression of vertebral artenes1/ causirig vertigo due to

Func~I · , ;·
-JR~ itching (Fungal infection, allergy or wax)
/~urrent cold, cough
J~eadache o~ convulsion~,
or nasal blockage.
.
_ I
r
.
lf
_0l~ever · .
-,?ry suggestive of HTN, OM, TB or e~posure to STDs.
1
!
. I

I
➔ p
-=~::;.c:..:.J.:.
. .ilar complaints in the past
➔ 7r r:
· nyWotoxic drugs\
rations on the ear
➔
I
~ Person;itljislOIY
1-,
similar complaints in any · . members
other famHy , Otoscletosis
, may ~ farMal)
, ..

., ~~~~
.~t~· , .~/~ the ear
iI:••, Exam Guide for Fin:il MllBs -I
60

~ -~
 ··- ·- - ~ el'J j,UI•
' .
·tton btJ?s,.:~g alC"
. o T- Kirig the wa~ with co l<lnQ / 1aKli ·
.
... • ,1, ~-
H/o obacco cl1ewmg / s_
rno
. dal ederria-
pe
➔
·· · · · ·
·!uilr
Ge~eral examination:

· · oc.irishment ·
·
··
. . C anosis, L.yfliP
t,ade
noPatJ,Y,

. naemia, Jaundice, Clubbing, Y .. .

➔ Vital Data: · ·
PR , · 011 e afte r
I aP enient 1Y ·
, • , ·1ne d con" d ear) . .
RR · ,'lse ·
)(af11
Id be e of the dise
0

I
1
. Temp . .
➔ Loca examrnat1on of Ear (L or R_t .( ~ 0th.... ~tar.s{~
. ., bo~ . dings
a·nd write fin
J
tne oth_ er. If one ear is normal mention th a
itieS or
I
. ·· · •tal deforf11 ess)
I
/
Inspe ction : •· : · •th congen 1 toid abSC
5
,.- ~ - Norm al I absent I associated WI
' 'de (BY r11~ - . .
. inflam matio ns 51
.. ushed to anY . gs - fjstula

6A
_ /1 Place d in normal pos1t1?11 or r . uses /-swellJn
frorn
Q,·- ~ic ula r area · - --Any fistulas 151
anY .r.
~rngs / dischar el us , 1 · .,,,,_ .
3 .- P ricul~ r area -- An scvr~ I swe
auricular sU C .·
/ obliteration o re r0 ..--,;, . . j
~' - . _E,.,~ al audit.cry canal- A · 1sc,1arge.
Palp at,o Z-~: TM. ·
t · ~
TA
· sent i abse n ,
. +erna) - pre

i~
• ·· t

\_
- v-r1::nderness of pmna or tragus (Ac. Ct1t1s ~x~ . '
· · ~ ,Je~~~ss of Mast oid an.trum _(Ac. Mast oidit,s
ent / abse il
) - pres f"
,
..\~~
1t 1s 811c1ted oy press ure at 3 sites
~~
r;) Over: the antrum
b) Ove rthe tip ·
.
· ~ ~
• · ,J_
. ,
a11'1 ... .A

~
~~-T
, c) Over the part between -antrum ;_:: :d t i p ~
~ ..<:?.t_1 ff\\p · "'- ~·'
. ~
0tOSCQQY~ .
[Any disch arge if pre~ent s~ould be wipc.~ rj out bef~re oto~~OP)'.)
\Y ~J (CO >-~~ J.
t.Otosr.opy can b~ done by
_@ ff .bc:J,.. -J-
·
1. An aura l spec ulum with prope r iliurn: Jtion from
© ' fY'\, ..l
a llec:d ligh: ~.,,~ 'l:
:? . Elec tric otosc ope· . .
3. Siegle pneu mati c•spe cu ium)
(:1 Uli:i,; :.Jf oinna -
• "'"' I

~ Up1.vards and back ward s - /v.iults

lo/ Down ,Nard s and backwards-· Child ren)

~- ·· cr:- xt.:::
.
i"•;a I auo;
,.tory cana l: ·· ·\ .
,io:;n .:!I er pres ence of any \vax, debri s . : · ·;cha rge,
furuncl e or polyp .
T'.-Til Dc1 nic mem bran e:
(i) Col~: ur - Pearly white, transluscenl, con1..: , .J(; (Norm
al) or
~ ~ ( A c u t e otitis ;1~edia) or
(.J;/ ~(S ecr eto ry otitis med ia o r :faemotympanum) or
. A. · c~( Ty mp an osc ler o .::isJ
~ Position - .· .
Obliquely set ~t medial end bf rneatu ~ (Normal) ~
Retracted (Tuba! occlusion or Adhesive otitis media) .
· __21:!1£Jing (Acute otitis media or Haemo'. m c1num or Neo
-;;; ,. Ex . ~• r·l Cuidc for Final MllBS -I
~l01$tJ _fl• ,'i/

----
., I I . .

61
 '

. -·
1al)
Surface - Concave (Nom Myringitis bulfa
e) . .
@ e (He rp es zo st er o r .
~e~cles_, Bufia in a l (C S O M , Trauma}- ro u ti n_~Jy) \
_ n - ~ en tra l I m arg m (n o t e m p lo y e d
e orati~ a tic sp ecu lu
~ .. . p,:ieum
1h ~ - .It 1s te st_ed with s1egle's if perf . n .1s present . doW
G ' Mob co n ten ts o ra 1JO , o v a l w in
f middle ear und window
VisuaLlisaktiofn o d" . o f mucosa , any discharge ro •
( ·oo or con itlon
and Enstachea
n tube )
'
· - . r.n ,c;~ c11c 0
- t' . .. ·
i
l
_ -- ·s (I n th e
e sts: eh1a-n ' -· 'u b Q · - . _ • s e d g lo tl l-
teney---o f-Eus-ta lio n a g a in st c lo
- ? -l e s ts-f e r-pa
• · . . vv u re : F o rce d e xp im
ll l lhtJ t)~tr)
. VJ al s ;l v a ~ a n o ~
_ bt } ld t lo C $ Ci1JJ0 fl \)
1 t-'rfomt,on air C ri ll
of J- .
b) P o lit ze ri sa
ti o n fl o r a te d
e t~ rl sa tio n ,· th re is p e rf
ef E u st q ch ia n ca
a u
th
d io m e tr y
-
_
ro a t it in fo rm
th
s a t- e
•
a te n t
iel) Im p e d a n ce f the e a r dro os reaches th e th ti o n a n d a p
4' E a r d ro p s (I ean tube)
patent eu~ ta ch e· confirms p re se n ce o f p e
rfo ra
soM I
. ASOM / c
ar d ru m a n d
, _.,,--e th e e a r dis charg
in ear
.ff Airbubbles be . o c c ~ rs ~ n a l o r m id d le
e u st a ch ia n tu a l n e rv e
rv e (p aralysis o f fa ci o f e x e~
fo r _p a ra ly si s of F a ri a l n e
a n t o tit is e xt e rn a _/ T u m o u rs
r n @ re s ts icus / Malign
H e rp e s zo st e r opthaJm ·· ·
\. Y ) nt
/ Trauma / Idio
p a th ic
re h e a d on fr owning - a b se
n the fo ide
a (l y ri n k le s o th e ey e on ·the ·attect~d ~
clo se ed s id e
· ~ a b le to ia l fo ld on the affect
ss o f n a so la b -:-,
r w hi ~s t~ le :_ _. .,._..---=-.,...--;-:-- , .
- able to b lo w o tolo opo si te sid e o f leClsr:-n-rJ ~n£-
u th
viation o f mo u:,~
/~
.
; · , w n 'rU
-t ,
J .,.,•. --
r: .. ~
_ •

PrkfJrJ ·
ction te s ts :~ ~
•

Auditory fun .
· @ la r fu n ct io n tests:- - -
+~
@} Vest ib u 'l ,t a t
tr;) . s point ~ na.t
of N ose:
➔ E x a m ¼ ti o n f T hroat:_
➔ Examination o n (C S, RS, GIT
, C NS)..
ic e xa m in a tio
➔ S ystem sis: -(should in
clud e)
si o n a l dia g n o
➔ Provi
teral
--61nnateral / Bila ' \s O .P
-Acute / chron ic
/ severe
Mild / moderate
/ in" active state
Jri1active state r
te d w ith a n y hearing .loss o o n ~ . ,
M ib c ia l cp m p lic a ti
~my intracrania r ab~ent
/\ O A T p a th o lo gy - p re s e n t o
SE o r T H R
M so ci a te d NO
·
➔ Mana gement: ion s:
Inve stig at
- Medical
- T reatm ent
Surgic a l
•
.Fallow u p
62
llBS -I
uide fo r fi nal M
g,,Mn,Cs- Exam G
r .
·. VV " ·· 1 r::
i . ... ! ;\
• n
--~A,-.. r-.t.:·:;-: · ·
~
------

·
, pain-
.
)(tern~•. 1
IOsr·s ASOM, I.J~1:J.t ~\e< c:,:of'i
rncu · ' . 11·-- & Ill
~ fU nerVes -O(- - - - .· 1·-='f,.::- \._' v\O
'R''
..'.~ ~e") -~<
..i ,., -: i\-~
l ,,.,
-

i · ~ o·iseases of inner · ·doesn 't pro duce anY_ (•AfaX,

· ear ·usually O1·1·111: ev. Cr~n,a
~ . ·i:~
i·-.,,·.' ~•~ ..,...,<1\
.
I .,
'I I", .I'
4-,1 ' -n,• 'l" ,
.~,°'!:I ~-
,...i·r,·. • "(, .-c..C';,Y
-p~i1
1

· the ea
v• , f'
V v~
I
. ·t.{·'.·'.: ··\ ,oJ.;--...._o·
~ Ear ache may .be due-- to. diseases mear through ' ·. ·. fir' ·· · ~o'J
Eustachian catarrh) or referred to the tt(~-;~ OP.-~'i.,,~
· ~- cervical nerves . .~::,:,-::- ~
· =» Common cause£ of referred pain In the ear
t~ -:·~
;' / 1'/)·.-
a) Dental V'"' ~ · J ,:,...,,.ft''>
b) Post tonsillectomy pain ,,c..--.. \ f~J~:\ .
c) Tonsil infection ,~~ · . ;1i.21)::~
d) Oral ulcers ~ . 'It. ) ' •..
e) Malignancy in oral cafrty, la!Ynx_ C. ')(
0 · Cervical spondylosis (~'3)
. J -~,~~-~~i~-
t'- used -by .- ·l C:: .'-,t :
g) - Temporo Man dI'b ular Joint
. . arth n't' V
1s . ·s ca.
fun.inculoSI · · ·. .-trt·' ::!:Xlf
f..'C ;( .
./
:~ In 10% lcthammol ir:, glycerine is used to re LI
Staphylococcal infection and other conditions.
.d ce earache in
· .
-
·\1:~t~. if>/' •✓
·;1c.;:,;.r,1

t.
-· . · .
p,·c acli_
on ·.,.-· -:; _ ;;,...~
~ reduces oedema & pain -by hy_gros~o . :,_~ .Jr:·~,~f-
·r
/' l ~ l reduces infection - by antiseptic action · _-~)\{
... ,,/··· Typ•~s of deafness . _. 1y upto round .~~;>: .., .,-_,:: ,.
Cou:/uc-ti·; e -➔ Defect in EAC TM Ossiculi: · chain, Tympanic ca~i -

~fJ
~
i. ._, · ' '{

•;,, n ,, ;. , 1<cu1ai _:i::~:ct :gl~: ~-~~~I:,::·: ~::•:~::h~:tl::~c::::clion~stic _neu ron1a, -. :

Eg: Viral i_nfections or labyrinth, - Traumi3, Aco • , ~ ) · ,r~\:\~Q
. • Ototoxicity, Psychogen1c, ff _S'1111'fL I r:''1/L, ,.,,,,~,~ e . . : .'-(f( \J..:
i . .. . . f'~[¥/"f'NI,. F , ~ . don llr:> v{,.;
Sff_L, . .f~.J,~~-s
M,>: 1::,J . ., f::g : CSOM with _
laby_nnth1t1s, Ofot :ieros1s, !;enile de'afness superimpose · / .:.: ~ ,
1
conductive deafness, Tr,, -,-,,, :- ;,L·"., •( ~

-: Flt1ct1.«1nt deafness occurs in Serous otilis media. Meniere's disease and Perilympl1 fistula. ;- :-__.i:_--.~-::-~
_:.·.'. _.:__- .r::_;
,: _•;_·_:_ ,'
C ;1u ~.1:::; of sudden deafness - :ad injury . , . , .. ., . . , . ,:
~ 15!,sist injury to tyn 1panic membrane ~i};:/(;.
~ral infections (1:/i easles, Mumps, Hz) .i'-' - ·· > ·
Ji1ascular (embo'.i; in) \\:-:',_· ( ~.
// -
1/ Cornrnonest cause of deafness in children - cscrvl
Commonest cause of deafness in adults - Oto~-: \~rc,s is .1t· . ,~}
Presbyac:_ usis (Senile deafness) - Sensorineu;·:--:, deafness arising due to aging Bilat
. :( · ·("'
_s ymmetrical and mainly affecting high tones, ass·xiated with tinni'.;J::.;.
SocicJc..:~1sis - h,earing impairrrient due to noise in I [~creative placeQ ./ .
. em '
1
, _,.~
q~~ ·i~:;
._t_~.-.·_:! :_'.:'._:· . _· ·;,¾,-·
. __- " .
1
- P!a rP.cusis wil/isi -- Hearing better in noisy envirorirnc nt (otosclero 2j§-{ ' · -
HypC::rncusis (Pllonophobia) - increased sensitivi:/ l•) sounds (seen in i~ara!y.sis of sta . d' .:> · ·-~
n1usc 1' e in
. ff~~I r i!-1/I n:ir;:i lh1c::i·c; ) . pe IUS '
· :•.•:.·.:_· ·. ~ .

-
. .
·;- :-. ·,"i·
•: fv .
J::,:;,111 . r_;u icle /o. r 1··
·111a I Ml, 13"J -i 1
• - -• - .

------~· ~:-, .
•I ·, '',\__j
!,

63 lL-· 1{;
. f~
~
. t·' .
·.··· .----- - - · - --·-- -·-· ··- ·- ··· ,. ·--

-----------------~- .,··:r
-;. -~(, .l

V
 ' '•I,'
• JV. I
-~"-·
,~•
~ "
,
. . n ·•.~'J
.•.,t.i;>'•L
!A . .:::..
-- •· -- .-- ·•-· - -·· ___ .. ____ ·I
.!Ii·''~ip1e9usi'!_-
;~•~\ Same tone is h I

.i .2tfr4 ·' '::..1' After staoadectornv) eard as n;t;- . .

r"",.. ,,., A h ~.t , v c< d1f(
1 , •
t:f.
...,,-,::.-,,~:-,.-,: ub op
} ony patient hears h'IS ow · · erent pi'tch.1n--:--~
e·th -----
/ ,;,:~ tu_ e . . nvo,ceorbr,,- . erear(M~'
.
:.-: ~
-.:\i; , • I ~ " ·tinnitus is the f![st
H1gh-p1tch~d . · symlll!!m
. ..<1th sounds loud
. ly (seen .in palulous eustachran
. .

~' .,. . Ototoxic drugs

Antibiotics-> Ami
. m of..Qloloxii;Qy _ foll
.owed by se_!lsori neural h~
.
g
1 nog1ycosideS- ,
Ft. . $e~tamicin, i8fri . .
f- -- - -- - . Am1kacin Neo rept?mycin, ·litSbram .
' Diur;_etics ~er-a-A-tibiof mycin, Kanamycin ,Jcin (Vesti~ulotoxic)
!- ➔ Fu . •GS--Ampisilli - ochleotox1c) .
f Salicylates ➔
N;~~im•de, Ethacrinic .~;,~or-amp nicol, 7
Cytotoxic drugs ➔
c· S . oupe diuretics)
Anf~ ep1·,eptics - Phe
-> isplatin. ' N'iI rogen mustards
Ant, heparinising agOnt nytom

eta-blockers ➔
Anti protozoals -,,._ Q um1ne ~
~> Polybrene
.P ropranolol..
. -

c½\!""'f"'
,.,.-
.
. __,
,_,.,,,-c -
-. ... ~'ell~~~ t ,.,....A. ,_,,,
_.//11./.,;.,.,--
~ ~ ~ . , ~.' 4 ,e/.-:>~-
8

~Reversible ototoxins ->· . . · . / -< J· ~

~
,.,, ~ - . . i9u1mne, sahcyfates A
. . -=D.
• A noise of IS used 8tohreduce
90d8 d thO
· · tox,c,ty
- - of streptomycin
. . 011)
(prepared from Turpentine .
workers. · .' rs a ay for 5 days 1n . , week in the upper limit of safety f or ,ac,ori
- • .

~
-o."' ~upture of.dear tdrum m ay occ~r at th~ noise
Otorrhoea . level above 160d8.
. ue o causes outside the ear
•CSF rhmorrhea .
• Parotid al:)scess ruptu~ing into EAC
• TM joint absc~_ss rupturing into EAC. '. .
~Puis8tile otorrhoea is a feature of coalescent mastoiditis · '
,,,{,; Pulsalile tinnitus occurs in Glomus jugulare tumour, AV shunts.
a<> Any cause of deafness can cause linnilus, bul tinnitus without deafness occurs in anaemia, -
hypertension, hypotension, cario_us leOth and impacted wisdom toolh.0

causes of objective tinnitus:....

e:.-:>
+Live insects in the ear
-~licking TM joint arthritis
➔ Patulous enstacl1ean tube
4 lntracranial vascular tumours
➔ Aneurysms & AV shunts around the ear .
.,, Tinnitus masl<lng instruments are .based on the o.bservat1on that the tinnitus pa lie ~ts a re

1. com!ortab!• in noisy envirqnmenl. : . .· . , !:w.l"' P"""'f'.,J ~\l..J 11<MfO. ,

.., " vertigo maY be due to peripheral (Menier•·~ diSease, BPPV, Labyrinthi_lis) or central. causes
(Vertebra basilar 1nsuffrc1ency, wallenberg :, syndrome, cerebellar disease) .. Vertilgo of
, labyrinthine r,g1n 1s never accompamed L-, neurological signs hke unconsciousness or
0
64
convulusions.
_ _, E -.ni Guide for Final rv!Bl35 -1
1
<J'uz,500' ·"' .x"

.... -- •.. .. -------

 , r:i5e. i·s 11;;:-1:,,
··' ·, •·:ffl1,;, ;.> • II;!.,)

I - cochle~,i' ,;_,,.. . . ·1··". \~~ c\

vo), - · ~·:~ '1>~~ \~~~
. d. ease (,,<",... ~. ,,, ~ ":,~ ~
.,, . .
,.. . . . . . eniere's ,s t t . ~ \l'-~ -~0 .
,.
' .
\ ,.;t ltuo
:s the dominant symptom of M
001rnmm_t symptom in Lermoyez'~ syn
drome
(Dl'J) . rfescn ·
. o ,s
vertt9
..t:. r ,-,,'.' ~,X>1:-. <o'f'(,-

-
- . . where Ci'\ .
-/ . I diseases . .& -\,
./" Meniere's syndrome - a group of otolog1ca ;·.. "'-I'- u :--,
a) Meniere's disease ' e,
b) · Vestibular neurotiitis
.,· ciw~ \
' . c) BPPV
d) Lermoyez's syndrome . . fc hydrops.
. ..,.l
·· . ... _.
e) Acoustic neuroma. · . _ dolyrnpha I
I
· . with en ' · .,__ •-
- . . . . . ,5 disease . · ,. . ~ ; .
/ Se~onda~ Meniere's d1_sease:- S1m!lar to Meniere . tion c:. · ·I
Eg. Syph1l1s, _otoscleros1s, paget's disease. _ --~ ~ ~ u s e } - . , ·, \
""i'
. . thin.s!Y_g_e .QL
Secondary syphilis (congenital or aquired) causes lab.Yf'!\. -- hilis (Neuro
s h1l1s) .. .
(" e--.I 1
(vert190, s~ns?_r~ ~eu~al deafness, tinnitus) where as t e ~ ·' · . ! . -· I

. .
centrc.1I type of vestibular dysfuhcl iori.
. .
,
.
ne
. anic rnernbra
Eg: rr, A -.
=--•: .
v· , ,c / l.Jn11 ·1 - b t' .
, . i.c: _er s s1~~ . -
. ..presen ce of intact tym P
. . f',stula test ,n
p os1t1ve 1:"r •;.t,1 ~ I
congcn:tal syphilis
'
fYl llfli ,,.., n !1
~ /)
.
· t d In
k;· _f·
J:- -.,
I
E:re contraind1ca e . 'i . :
0
1•
••
.
\/a sudilator drugs (Ginnarazine) usually admi1:stered for vertigo, · t ·. I:~ ·• ,
giddiness after head injuries and Myocardial inf ·:rctiol),. · f,:·. · :

a·;> f\,•Jotion sickness is due to hyper sensitive !:_'. byrinth seen in s~me individuals car,
be
'r;L·. •c~I
~I
I

suppress·ed by Labyrinthine sedatl•,ies like proc:,:orperazine (stemet,I)

y § · s phenomenop -Aitack~ ~f dizziness orv ;,,1,go by loud, sou~ds

;. Eg . . . a/3ynntnrne fistulae, afterienestration opet":1lic>r1; fYIO'UN A l i•~I
. ~/- .•:t ~1-
"-;> In childre n EAC is small, straight and with0t 1i ~ny hair follicles, so examination can be ·: ·.
= ' . :-
· c2rri2d out withou t an aural speculum ·.,· - .-:.· , -~-----'/!
·:·_1 .
"Jr( "•___
=::, D isp lac em en t of pinna · · _ . ., f '. • .,_,, '
O;_!tis e x terna - Forwards, pinna is prominent with 0bliterated1 retrn~auricuiar groove [_· . _.t
. _:.~,{_::__
A UM & Mastoiditis - Forwards, downwards & outi.vards (Erection of pinn a) • . 117
"" Cauliflower ear - Recurrent injury lo pinna in l";xe,rs due lo organisa l:on of haematoma, it i:: ·~ ( .ii.;
p c rm cJ nc nt. : -~/,:;; ~ ;E
~_,

Ji :··. -~
;,

=;> Mobility of TM is tested by Siegle's pneumatic ~; pe ,:ulum and valsalva m·anouvre. Restri~tion~
or rnobi/itr of TM occurs in serous otitis medic1 , -1dllt~sive otitis media. .' ri~/
: )it •_. 4\ ..
. l \ :~t ~:•· ~ ' ll
,.

0· ~ In a polyp in the ear, , _. ; ?J;;: \ ··

· /f-arisin~ from extern al ear - Probe can be pas~ed all alor19 · '. :' ·~::·, t!l ~-
/f\ir,sing fr;~7~: middl§ ~ar:...
,
cann.ot""6e p.~!SS~d all al ong.
'
Probe <-J~i g-.-~~:_,
'. b'•:-·, .
• . : i-,\i>-1; 'Ir !·
- . •.-·c r,·oni tlie middle ea r should noi l )8 c:ivulsed to prevent dc1mage to middle ear ;:tl ·. t. ., ~
IJ,~~)/'J' / ) ~ Jf/Slf ,g '
I -----
-
--
-------------
•
• I • • •
~ · · / . • . -. ' ~ •
.;:-~f' •:~i'I:~: ,', ll
J"
-:>C' ,· ,'J•;,,•~.:·, .
St ruefLI r '- • U • :, •
I .
."'.!J:} L · ;
' \..S~~ :: 6,-1
-----. ,x:~~Q. ~~)~ ;
65 · :~ ..;,\~..
. ~:·( · ,r{ ~. !
. i/;.: \~ ,. ,;
. ·l~:·.~/1·-~ ' ~
.. - ;, )\··::,
-·
 ,'¥." • • 4-..~.,:. •

L~:':·.: t;y~~
~ /. 1 •· . ... -.. .:; .:, . .,.:.,; ."""'---~'---- ~----..,... , '-'-'-"--·.-~"-=""'·:· ....
/ lit ·, ~--•.
:--; --:- --:- ---
.~,. t JF-:-
Masking of an ear is ·
. .
~ ·z Ma~king of an ear ca~ecessary if sou . . ity .
i .. .
~ , . be_done by th
Making .rustling n01
a) nd intr:ns
~- ·, Barany's nojse b se With a Pi e follow;ng
b) w s ~ 60d8
ox ec~ of Paper ne!~~h
1
: Audiometry
c)
Fast rqovement of fi
d) .e ear \
I
Narrow band filt
e) nger occludi
ered White n . ng the ear
- . O~e
~ For a normal Perso n d'
t
.
- - - ---a- -e ,stance I
~nversa.t-i0n-v · a Which
a Whispered Voic!I-Ce...can-be -he.ar.d .. 2 ·1 f.
. can be heard - r '.
.eet - --
. - .
=-> A tuning fork of 512 .Hz . . 2 L:et
. .
range of spe ecu -- IS u_sed commonly r l .
~ork tests, because it is w.lt.btn_.th~
frequencies prod~ce e ~ and tone ri~nng ~un,n~ 1 as forks of lower
short decay tim sense of bone vibrar .~. cay s ~1rnmum, ofwherehigher frequency have a
e. . 1.. ,, and while those

~ Tuning fork used for Weber's test- 256 Hz

~ -
=; Tuning fork tests: ~

Test Normal Sensori neur al·-·-

· · ·Condtictive deafness
. ~
deafness
tit:' Rinne AC> BC BC AC (Rjnnenegative) AC> BC
0
•::•

{C Web er Not lat~ralised Lateralises to poor ear Letarialises to better ear

J:' ABC Same as examiner - Same as examiner~ · Reduced than examiner
4:- Schwabach' · Same as examiner Same as examiner Reduced than examiner
i, s test i '
--

Rinn e's test Weber's test

fork is held on centre of forehead on
1. Tuning fork is kept first at EAC, then 1. Tuning
upper incis~ors.
transferred to·- supra IT:E:at al region .· - vertex or on
. behind the .ear 'BC' of both the ears.
2. ~ ompares AC and BC of the same 2. Compares
ear conductive 3. Useful in identif.ying unilateral deafness
3. Usef ul in identifying
deafness
Rinne's test ~ Weber's test
Positive _ Normal or sensori neura: Normal - No lateral1sation, heard equally in
both ears ·
deafness alises to worse
Cond uctive deafness - Later
Nega tive_ conductive deafness
F 5 e _ •ve' _ unilateral severe SND ear
I ' ~ . SND - Lateralises to bette·r ear. ,
a , '
alisation of weber's test occurs wh,::-n
· _/1 Rinne's test become n~gative whde8n 5. L~terence between BC of both cmi; !'.; > ~)d!:-~.
.ft·· d uctive_ hearing loss 1s > 15-20 __ __chffer <- . ,.._.
con --

---- --.: -: Gll ide for Fin.ii Ml3BS ·I 66

~ m, . .
7 10 ,< fl f b
J', .
.v ~
l·X:101
 . deafness, ·AC_ a~ct \~/
· 0eura\ ~(\
. . • go od S c
-
_ _....:·_· -- -~ ·-
-: -: -- :; -; ~ se"ere se~so;'sti\\ }nuica 5 in \l'f--r..
. oni\atera\ t~ ue to crossing ~}~~
-Y> \n Rinne's
T~!se negativ · e· test as'° bu\ pa\leo rroa\ ea /.
r
bo~~ are marke
di se as ed ear, be
. '
dly reduced 1~t t a\\Y
·h e disease de ar
nears tnroLIQ
,
h opP 0 s·,te 00 · . .
; usefuli: · ;•::
r's test 1s
·
• 0~ ~ . -~~
·· S~ 1
ca us e he acthu . po)(, \fJebe . . , _
:_;, _·,t;r :,:_s~
so un d to op po si· ear ro ugh sku\\.
te nori:n al th any's noise - . _ -~t{{ •. · -. ~
It is avoided by . no
rmal ear w1 ·th aar
m ! ~.11.:~~:- . _
detecting fa ls e ne as~mg . e C f examin. er. .);~
...,.~'."-·· \
ga tiv e Rinne te st .
~
.
Sc hw ab ac h' s te
e
d w ith 6
. EAM BC of th pl is con1pare examiner c3~~d
° · atiei · ,·\·~--~
·.f.::.'. f, ·,
st -; w ith ou t occtud . M of both p .. ~~-::•·,~
_r vt oa ltl ed Sw ab
ac h s_ test (ABC
mij ;_ odc1uding th
e E~ . ta re compa
d ·t ~~• . ., A
(pressing th e tra tesC of examiner re .
gn
It is us ef ul in id en s !nwards) th e 8
and pat1en . ?i7~\ .;-~
tif yi ng SND. ~fi _- ,,...
~~ ·-.:.· · "'";1
,J•
~ lo)

.
A ud io m et ry :· ,;~_,.:,:.-·, :•, .
S ub je ct iv e Objective
c:r) P ur et on e -audio. a) Tympanometry d ce audiomet
(l'letry · ( l ~ ry)
b) S pe ec h au di b) Ev ok ed· Respo
nse Aud1oerns ~ 'I
c) Be~kesy au di om et ry ~ io rn e tr y
o~ et ry . i. Brainstem Ev
ok 0
ii. Cortical Evokeded R P Audiometry
R es po ns e

~ ~ea£~~r,~:~~if];~!~;~!~~!~tractio~::~pertorman
iii. Electrocochle
ography;
/ \~;itJV:~
c) O bj ec tiv e au di
om et ry .
ce test ,~ ,{~
=;> P sy ch og en ic de , -~ ,;.rt:;,·· v-
af ne ss m ay be_
~ ~~~;~e:;.~~~~
d_ue to rna_linc,ef

c) Lo m ba rd 's .te
te st ·
st (W eb er 's la te
.
ing or hysteria, it,
CJ

ra lis at io n test) ·
ca n be id en tif ie d
by )ii;~t\;~;
•.,. , ~ 1~~•"i@
_d) D ou bl e sp
e) A co u·st ic reea ki ng tu be s .
-
;,'/f]i~:." ':.
fle x threshold✓ :.-:~
" 2) :~:tz;~::,,!,"ri!., Audiometry/ l_
ti ~_·.
.. a
P u re to n e A ud

sm a ll g ap
io m et ry
S e n sc rj Ne1.1c
af' D ea fn es s ...:_ D • .
}\~j~
ea fn.e ss :-nore at _ . ·;_ ,1:T.,f.l.:?- -
, hr gh er ·tr eq ue nt :ies; bo th A C , ·s·
·
C o n d u ct iv ~ de
af ne ss - D ~a fn
es s m o /J, at lo w
· . · .· ·
c are
~~}~~rf~:~~
g~p er fr eq ue nd es , · ,_
,~ .,~-,,tC ·
M !x ec J d ea fn es
s- '- A C is + B C
.
.
A C '+ ; bu t BC no rm
al ; ;i~}~,;ti~
M il d d e a fn e ss
ivl.o d ~ ra te d e a fn
- 20 -3 0 dB
is pa rt i; i'. !y :·e du
ce d; so rn e ga p.
.
. . . ·<· Jt~~
S e ve re· d e a fn es
e ss - 30 -6
0 dB
· · 'J J1?X)·1
.- -' 1 ? se s - s - > 60 dB : t:i.t:~:::-f'-
'. ~l)j),-~~
.:1) O e~ ec t~ th e J: ' ~ f~1~f-
typ e
b) H e lps m p re sc 'a n,d d eg re e o f he:;-'. rin g los~ '. Jj} }~ }
re co n s tr u ct iv e
c ) A. p e rm a n e a
rip tio n o f a he"a
n d
n t re co rd c an be
rir, ~, a:d an d ,pro ,
m e d ic ol og al p ; :1
p o ::;e s.
vr
.
o~s zi bc!lseline
for rehab 1h
.. · 1.
tc1t1Vl~f /J/¥ i.
lf~}ft.l
cl) tvla lin g e re rs ob tai: .. :d . · · ' tfftJ .; :·
ca n b e d etected
__ _ _ __ _ h(f~"--:.;.:.
_ __ _ _
C\'.tm <; ui dc fo r Fi
na l MllUS -I ~;:}fht., -
67f',:"··.: .
·. ti}~
~; .. \-
· ..
J'/}_.~
 - .,:f,--.: _ ~1,,,;{ ,c 5 ii
~J ?t·~,,,..:.;~:,.
"'J ;:,
.K:- . .,./tt :·.. .
,;~3.~\~.}-:( .·- - - - - - _ : _ _
!~tr <~- ~/ ~ -.
Spee~h a~dio'metry:- .
l<.:·.:r. · J' · :· ... ecri Re
:spe - .
. . .
words {like ~~P~on Threshol . . .. ...... .. . .
":. -~, d
. .·· · .. . ,_,. _ ..
~ Speech Oiscrii.oss: kuch ku~~S) RT\:,..ih
. inat,on (SD) are re" · e mm,mu • . · ·
· one, can) P~afea correc: ~ntensity. at which 50% of spo
ndee
thresho1c1· ~re . Presented Sco re:. . . -.
at an inte . honetica// Y Ythe patiemon nt.
:::. ; and the Per y bala nced osyllable word s (hke
95 ¾, "'.' Norrn I . centage of w ns,ty Which 15 2°'30 dB m~re than Speech reception
. .
90%-100% b a Ords heard of
er int . correctly by the patient is noted. SD score I
poor, < 90; ut at high .
ens,ty leiie/ _,
-. -- - --: .Ve - _~S N o - conductive deaf ness .
- Uses Poor-=-R~C - h- 1 ·
eari e · ·Aco r
a) help
b)
· • ·
s in idenfifyin
helps to pred· g
.
th~
.
e nf
sion
,
,,..,_· .
1on
us ,c- ne1Jrorrra) - - -
I
·. 1ct the o u ~ ~ . .
~~o~
surg c,ry
~ Bek . . i
esy audiometry:
I
- .
I
I
Automatic se/f .. I
. . .
high frequen . recording audiome ~h1c h cont
_ inuous soun
_ ds starting from low to I
Uses cies .c.an be heard b tht,y in . . .1
-· Not u Y e Patient and threshold graphs are preapred
- . Bu .. sed now-a-c(ays . . .
) ·
. t'f ·
tit-can be useful .In Id ·
r
types of SND (cochlear and retrocochlea
I .
· and organic to funcr . en Yrng different · _
Type I cur ve_ N & CD ron,n hearinc loss
.
Type II curve - SND
Type Ill, IV cur ve_ R
. Type V curve - N etroc?chlear lesions

~ Impedance audiometry:-
-
_ . on organic hearing loss

- It consists of
a) TY!!lpanometry
b) Acoustic refle x
itory canal, compliance offered by IM._and
a) Tyn:pan9met!Y: -In a sea led external aud is tested. -
ossrcular cha in to various pressure changes
s of deafness by graphs obtained .
Uses:- Useful in identifying various type
sound
edius muse/~ recorded by .applyi.ng a loud
.• b) Aco ustic reflex: Con traction ·of stap th
ial
100d8 whic h is above the thresho ld of hearing. In it function of'?'h and 8 cran
70-
nerves is test ed.
Uses:- loud sound qf 70-1.00_ dB., but if it is pres~~t~·at
Normally stapedial reflex is present by a · .... ':
ates cochlear fype of hearing loss .
lower sound intensity i.e. 40-60d8 it indic is
if sta~edial reflex is posi!ive malingeting
If no response is obtained on PTA but
. .. • ·
proved. ~at,ents can b~ tested.
Hearing of inf'ln~ts and un co-oper~ t,v;
q. #
Lesions of 7lh and Blh CNS can be 1dent1fie

• •itment is a phenomdeno n of rapi d growth of loudness in the affected ear, ·

t· .
~ Rec r "" 1 n.
disprop ortionate to the soun s ,mu us g,ve
•

- • c am Guide for Final M8llS -I 68

9111so& s, c;.X,
 ~-;,
t··•
-· 1.>:..li>~'"t(,,
C!i~~;"'"", .. ,, 5 d1se• eJ
-'c:
i ~- ~;J•csr1,
· -~~•~ · )"I
0
..- . , ~
--· . ~en1er•
----------
. u)ct
0 ..,/ .
I 1es·1ons e9• r·o,,,a·
h\ear .. . ·511· neu '" d tee f' . · j · : '
6
. , , , ... !ll
t •"acru1trnent m; ·~
~o
,~
"

~
.. 'ReEr_u[\menr is a phenomenon ol cot_oSiig', 11cou c .15 used
is a phenomenon of Re\rocochlear le510 sl (IIBLB 1esl) to, ,.
• 1j increnlent~ in ·_
:, • -~
-, • ,·i\ • 1f,
"' Alternate Binuaral Loudness Balance \e _ ercil
unilateral cases.
of sfl1° · : · . 1e.;,
·

J~~
. . . de\et \ \Ile pfBS ' - : •:•1)[..,i~,
.., SlSI test - Tests the -ability of a pat1enl 10
,
'· ·, _'<l'J[~r p
\ ~\ intensity at·supra threshOld 1evels. . re's diseasel
S SlSI score> 70% . cochlear deafness (eg.. Menie 0. .:' , ,.
SlSI score< 20%- Normal/ conductive and tleural
deafness rna' - -~1',~
like •f\ ~J ~ ; _J~?,if:
·• Tone decay test 1s used \o 1dentl_
Normal
(y retroclachlear lesions
- 0-5 dbsiminute - .. •,~i;S
. ; · rijj}' ~ .·
Mild decay -10-15 dbs/mt ·
Moderate decay -20- 25 db/ml ·, 0t~i :,
Marked decay - > 30 db/ml :·';ikit>':f"
'. ";i/ tf· ·
·:: MoS rel;able method to differentiate cochleai from a retroc
ochlear deafnes_s is~ - '.if:f.~
L~O~~tl~ ~
';
esut ulae function tests
Clinical: ' ''.1,t;>J
'if?~' ·
Spon
Gait
taneo
F,stula testus rystag·mus test
,.... ~lectronystaSm09raPI Y
1 ~f(~
' ·,1,I,__i' --
"'1\ \-
Romberg's.test
. ,, -Unterberger'Stest _
--" llotation test "·';!
--" Oplokinetic test

,, ,n
1&71 ~:~1!~s~;oduces ny t .
c"'"'
. , -'> Galvanic test
_water produces ns agmus towards Opposile side -
:; ,,wt:1~
alenc test, the functio~s~~:i~~a\os :::r~ ;:"c:i,'.1:1 \:~~=t~coW
S) ,_gt~
·ieJa>ta

:;;,1 ~:9 f'OR MA' A case ;;;,M - . f.;f'h

""
,,
• ,, ~~ n 1e ·
IJI.,,c••"">
., Oc:, upat· --'-1~...L-~
. _.. )
.-, )·: .l"'.
,,1c, -
• A dd ~om ,on
• " •C,hfr,
---o
pl .
'Ies-· s .- aints
.
d
~_,
- /J __ i:-
-r-y'Y"V"t,lk-:
~_,c·<
,.._.
...
~!:.,"l'}: f ; :
')"" ' " ' .
~,n, ,pair
__, ,sch ed e ,_an
. arg rom - dura
eartion·

~
(R - ,vc:o--vP<Q_
s.,.,..& ,::--: -'
;:,,;<J
,,,.;:,i·'•
• ··'·"'
V.
:..,. ·
: t· ..-r•-,.... 11 111 hearin,· g ,n
:J.2. i c,....; . - ears . - ea rI or
since since - -- -J.:1·1'"'
-- J .. f . Lt) ;l . .
- •- ~"'!n f ill nee - - day, · :~.r,,;·,c .,·c,..:<.-·' w.;t•'i
,•,. j'
·:> ,-;~,+,-.
-~ ~·•:'E '·.· i'
. ,, ,• .,,.•.',''
Ear d . ness · days
. -- isch _ . · ,..-. ,: ·.
,nre cr- arge from _. , .
.N l)jsc '°"with
l, ;:u ge
is · cold and
feverear since
·
-- Jays, started ·•
r.' -_fl'-
· i':,~
- Do blee ding.. inter mitte nt. muc_ _ _~ ; ,_
;• ·Ji.
,,c1
_ • eafn «-r _-
_ day, bacl<:
op_urulent will ,,. .
as }esp1~ tract [!'JJ,;! .. ,t,t\ l.l,
I "ain in..__t,S
sin e~-~ = , ,.. .,,,_ . - : ·J~,,__
by ie ear .
d .
avs· or d
.11 ,,ny foul§mell ond in co~io us f,;,oun: ·-." 'i-•
s walt o~ . . sinc e , ' .., a ual iA -onse' , , Id . - . ,. -. , J:J
( t-Jn) I-1/o ·· ~mgrnes n--.: , ·_1_.,, ' ,n n~tur e, .,n th_e disea sed ear
')tdd " movs emen t sand ,-

~
_ · ~ . pullin _, ,{;., . "'
blowin gu ·gof';nthe -- uous , no ··ra·d-- only ,i/t
;;,;.,,·.:..'•·
··'. ·,.
• 1 •11re contin 1at1on
.~, aggrevated . +. . (J,
, •
W.
, l " ' " . .,;,- /;-u;lfc..~ tOr ;:;--- ::-- -
r-inal M8ll5 ..J .. no,e. - __. . . _\ :?,;?;l.i:~ -
·.!·_.·:ff;,(
-('JO
- - -- - - ·:-- - - - -- -- -
/ <i~, · c--t Oc•,.,.,, .,Aa.il.r __ .,./Jfl. _-. ,:;-_·,.\,i~I<,
) \f~ /;!i
'j!,_., I .,
••.,J~ ,;( vO,,p-"' \:: _,:':...,- ·r•
V •.
•• c, <,;J"..V •'-"'·-- • ,' #,

i: ;tJ~u .
~ ·~.t4;~-~•
. . .-~ • =•"."c -~ -· ..,. -- ..::.:.:. :.;::.:::~:.:::;::.-. .·•. .-··..-.;.,,,.:,j_~,
-- ---· -- ..--~- :-...·=•cc:,,;..-....

.,'
· ..- - - - - - -
1
 /-Clct"rt~ '
/-fl~ , C') CC '-''-t,q
,.. ,1.1-41.,.,.c•.1J.,
r ~-~· .
(No) H70 Tinnitus
. ·u·,rSh,., c.i L.s. C · •
- (N ot) associated with f .. . • i) ,,.) .

- ·{No) histdry suggesr ever, c6fg COL · -.·

.East history: . ive of Tuber~uloU~h · -
~ H/o of simila
Treatment h" t r complaints in th
~•; Diab~es H r ·
-•---c..JP•nension or exposure to~;,..,-'·
ios • I

.. = 1s ory: e past _ )· ·- ·
:

H/o Taking~rd · . I·
=-~ Family history~· - raps or tablets orally f ·
{Nil) significant · .or the similar compJaints in tbe pa.st
~ Personal history: .
-~. - (Net+f/e--swimm~r,~· _J

{No) H/o taking alc~~ratchi~e e3r,-✓-- - --

~ General M dexamination·· . ' or smoking or tabacco chewing .
o erately built mod . ·
(No) Anaemia J'au d_eratelynourished • ·
.,. Vt' a.I dala: . ' c n rce ' Cl ubb'Ing, Cyanosis,
· LyrnphadenopalhY, pedal edema
pR a;;· r>'•-
~- (JC' ,?1,,o AA

p C'CLL,
. RR
B . f .:L.i2 Cl-......"''

Temp j')Lo·,A (/

; ' Local examination: RI/Lt ear CT~ ~ } fjt.l"'·'[;;,..,.

Inspection: ,,.,7 • · • · /- ~
o/J Pinna . } . __7 lc9fYJ /?;:i
,-,~re;auncular aroa Normal (Provided no complicalions) IH L-', P,•(- {f5/
os -auricular area
./1 7"-<JI·'"
.-,External auditory canal - Mucopurulent discharge (may) present · {).;,,.,✓,I
Palpation: . 11
1
,-1>~J,,> a,;
No tendernes? of pinna, tragus, mastoid antrum. ') C<!.>t! ~_ $1i~.--•
Otoscopy: . N.r<')c.da
Ext. aud!tory canal - discharge ·(should be) wiped out before otoscopy. ~~~-•
Tympa.mc membrane - 1,(l.. · ·. 71
..... Congested JFP./YJg-''·
· _; . ~ ,
,,,:;✓,.,
;.., · Central perforation -- present • . 0
· t .:rJ·
(mention in which quadrant, size, shape and margrns) f;,'2>_t.. "'. ,J
,,., Cone qf light - distorted . fcJ.cfv.J .
Anterior and posterior malleoler fords - Normal I obliterated f.l.l,nf'r.11[1 ,g.0''~
..... Middle ear mucosa -visible/ Invisible
_ ~ ustachean,Tube - patent (or not patent)
facial nerve - normal (or paralysed)
_ Hearing tests:·of tick of watch-:- ·
Hearing Present (or absent) . .
Hearing of whispered voice - pres~nt (or absent. ~t what dr?tance)
I
, ~ Tuning fork tests ,
Rinne's test - AC > BC
'
Weber's test - No laleralisation (if conduction deafness is present; BC >
AC in Rinne's test and sound lateralises to diseased ear in weber's test.)

" mination _ (No) .pathology in the nose

70
Nose ~
~
d!> -
m Guicl e Ju• fj n;i I M!l 13S -I . .
':J}_ias4J,s-Exam
I .

,, ____ ,. ___ -------------

 ,: 1 ,- cc~;, . . _.,. {(9r>d1,1 ·
C~~( ,{\:: ' ~i _;;..- - r
.
.- - 0 11 ,c.,JJ
'
' ~-
,o)V;..~ rf} ,.,,,
y,a\ v, c • \ne \i,"(oa\
1' ti }.A l'
___ )11J.:
0 •
. ..~ ·rnroat exe1rnina~1on_- (N .

o)~ cVS, G\i. Cl'l

s ate atholo9Y ,n
1,ui1 • •1-tf~f :.)
,.,. ., ·
~, S"s\ernic exa~\l'\at1 .'J , ,Pi:J . 1 ·1flcP~
l
on - R.,
11.10 .,,., J/l
~
·
. ·.
'1[,-, 1(!.(::i
.,~. 0iaqnos§.
ear with central pe00 , ration t· rcations.
~ -cso~ of tt e (or in inactive sta t '\~ \' nial cornP 1
in actwe s a te) ·~g \oss or in\racra
,_.,_ wi\hout (or . t d with) any hean
assoc,a e at athology.
.. No associate_d nose
or thro p .
Oiflerential diagnosi~
- Acute otitis media ·
·
·og \oss) .
lraumatic perforation o~ evere he ofl
TM
Tuberculous OM (multip_ rf tions no earache buts
le pe ora I
0lilis extema
Non suppurative cititis. . .
media
-, .J oz:> Investigations:· .
1. Complete bloo'd
·.
picture ..- "'
..J~
2. C/s of Ear. discharg ;· c,c-,>-
S Ct l'I '~~
3. X-ray mastoid ...,.;- , .
7
Benign perforation - Sc ·. . •th t any destruction.
ler
Dangerous perforation otic/ P_neu~at1c w1 ~~truction attic and antru
- Sclerotic, with bone d rn area.
4. Audiometry · .
.
~ rreatment: _;(Jo ~ ,....,_,,_,J,t,
,/ ! I
tibiotic ear drop3, syste . .
Conservative - An ·.
rf,:(;
. . 1
•
~ f Tetanus immuniz
•
ation,
Aural toilet. J) ~ ~ \ 8nt 1b1 ot1cs, an .
"-~ ~ ..~..l~c:·-· "
Surgical - Tympanoplas ' 1 .,.~
ty / myringoplasty.
.

- ;,. l >,:: ::, ol 11 ::d lllu

ea r cleft:
Ope!11ng of ET
Muwperioste al lining
of Tympanic cavity
Aditus to antrum
Mastoid antrum
Ma stoid air cells
,-;.. F'reciisposing fac
tors for otilis media
ovErcrowding, allergy, - Poor ·,1.1l!1tion ; URTI;
cleft palate . . eustc1che,m tube block
~> Otitis media is co age,
mmon in children due
=:> Otitis 1nedia is to short , str2ight, wider
less commcii in adult tube and common UR
s due to -l Adenoid size, TI
Eustachean tuhe fun t URTI and more effective
ction.
c:;) Et iology of
CSOM:
Commonly - Pneumo
cocci; H. influenza, ~; ,~
. CSOM after trauma eptococci, Staphylococ
- 8. proteus, 8. pyocy;m ci
. Attica - antral disease eus, B. coli ~
- 8. proteus, B. py ocya .
,.- ~. ,Acute
n~crotic otitis media (H neus , B. coli • ·
·\..~i' 1
'Influenza' epidemics
)
aemorr~gic (!M) - Haem
olytic streptococci (occu
rs durin9
In Tuberculous otitis .·
:c:}
media , mult\p)e perfo 1 . . .
cqmplicaliOf,)S can oc r,1:ions, pale granulation .
cur. s and painless s_ilent
'Y-'w= d·... Exam Guide for
Fin al MB3S -l
71

J
 . ,£\\,'. ..
·· <.
~-rN''.. ·. .,.
-'.~)'-'•,..'· i. ./ ~---~ --- -
··- ____..~,.- -. .
:v e. ~ ,
,. ·· ·· •'.._ -~
-~ -", ~ - First syn, · , - ~~--- ----· - -·- - -- - -- - ···
Of As .
\ ~ _; ~. In AsoMPtorr,
.
_: ~ecunibe • Pain is Of!.1 ... DOil ach·
·; ~ In As OMnt Post lJrefl1ore sever Ing p . .
. .
. · • . rac h· e iri the . _am in the ear .
re ;n the
;
; ·sy n,P to·. Ea
ht bec a ·
I
i
· e and rirg rno
;/r mosu !TJs like, fieve r. ,ar~ deafriess . ar Use venous conges· tion occurs · 1
I
't.. the y rn AN ac h stitutiona
-Pert . e bec 0 e main I
i'
t, . M . oration ·
- ~ lllum d
ss o llad
me
ran
s
t.
SUbsl symptoms accompained
Pu1s!1d
by co~ch occurs
after the perforation of _TM, w~
orne frorn I I

.. . mem hran.e· ea fne

ccurs if
I
e mucopuru/ent discha rge m.a Y
. . panic
· ~ Earac - Pe rfor atio .
ab s . n part of tym
- pr . e Is
a Cs . - - . n res~nt in .'~ . i
. ~ ·p ev ,ous AS orv t~t in
b . . . - . - -. . rbation of j
iri.,OM Pat ien t,
.· _rofuse rnur ' 'OlP end
t it may be due t o ~ i
. dan erous ut ,r !t ,s presen

l.
'i
.· d1 sc ~r na ~ ~~r~/em
; . ~ _,..Hearing ~ du
le a~ os s . in
a) lo
a Gs
~
o~
dis
t~
e
cha
acc
rge
um
ma
occ
a/a t~~
co'!
1
1Ph
n
cafion s or d'ue to.Acute otitis Ex ter n\
a be~ign CSOM but in c h
granulations or of ps.
due to disruption of sound co!
ol~
bloody

. a paratus
1ductm 9 e..,.
I
ctiv e y be .
:'. b) R ss Of.effe w .
;. . ·.. . : • e?uce~ con, r are a/ ratio bet
and oss ic/es. . ves directly
of sec o een TM
,.. ~ ra/hng on the p ran ee
. ndary tym panic mernbrance
due to sound wa
_'.·. ~ He ari ng los s ma rou nd Win dow
. s
r Y. no t alw ays be . etim e .
r. a) Os sic ula sen t In cholesteatJrna bec aus e som
in tna y be int Pre
'' . ijr Gho/ t cha act . ,
( .. E.-.i;, 6.-.' . <?,~ -~-~ton,a·rnay
b
sent brid in between the ossicle
s j
-~ ._ Z. ,~ <~~ t-0 :forrnat,on 0- _ a ese~reomt b 'f en malleus and incus. . . h . tact ossicular
;
• -· otr lllll!l.,Pf ew.em t · e We 1
f-' -'··,.. · ~n of hea ring m
ur sometimes in benign CSOM
patient wit in . ·
io~dc
, .
aln ay occ
. ~
/J__:...n11.11.t?eJI
,· . . ..
· discharge cove
When h
n and temporar~ly_closes itthe P as~
difference) ,I U
win d . r~ the perfo~ atio /'l/1ife:YL:V .
When rou nd proves
ow rs covered wrth secretions (as it'1m ,
.
·. . ·.... ·· · {-;J ~ · h dea·f~ ;-~~..is
-~ In a benig n CSOM d ness IS usually mild to m od er at e~ ). but ,t t e
. . . : :
. 'sev ,' . . . . . . , eaf fness occurs it is
icates the oss ici.J lar chain inv olvement and if a very severe dea
. d ~re! it ind ing SND ..
. involvement of labyrinth produc
ue o
chain . .
➔ dea fness->' Oisruptiond,.ossicular
~ Be nig n CS OM Co nductive
deafness --> Destruct/on of labyrinth by choles
teatoma
neural
Da
I
ngerous OM•
-.> Sensory •
------ •
.M
is. ✓
OM patient suggest /a~yrinthit
~> Giddiness and vertigo .in a CS
mbrane:
~> Perforation of Tympanic me
nign CSOM
t all arour.d the perforation eg: Be
Central -.> Ear d?um is presen the annulus
➔ r drum is not pre sen t all around, as it is absent at
Margina l Ea . u.rkod"zlnl°'
_ Eg : Seco~dary acq_ uired chole~~eatoma v-, . . •
. ·
s rn pars fla oc1da eg: prm ,ary acqurr~d-~neuFAor:t1a.
A ttic -> Oacur
postero
s.: Pe rforatio n o rs tensa and marginal ~o ra tio n in
Da ng~rous .perforation
sa i-
su pe rio r quadrant of pars ten
teatoma·
is so called ~ec aus e the associ_ated pathology is cho/es
" ./o angerou s perfo ration ns . . ·
oys bo ne and lay s bar e vital structures leading to complicatio
~ which de str

G ·c1e for final MBBS -I

72
_ . Ill
1 ' /·X,1111
°"11NU1 111s, '

-·- -- -- -- -- -- -- ·-- I

-----·
 \n , ·· : ·
•. ne a ~ n ig n CS · _. · . · · . ·.
~ . •·\h ~r the OM c·ase, perf_ · in the '.centre'
or~t1on ·15 usua 11 of tympanic
• ·~ \ handle o f ~a lle u s In
Y ea· because th · .
area as ,he blo akidney shaped e blood sul2Ql~
.- o d vessels
. Pos~enor ma. eo ~r o s. ·co·me·from the pe;ir
a r iphery2nd run?
alo)"g t h e .
~ ~ ~t, ~
· · ~ ~ ' r . &,~J:,~~
-:> ·Qti~leste · . .· r, () t <\\.., ~\t~
al o~a: . ·· ,~
lt 1· · -. · " . .-;i.,_(o
_t~
.s flOl ~ tumou·
- ~
It is ~ .sac line r, itls ·t~e skin at a wrong plac . ~ ·;_.· ~
d by keratinisin e. . \
. · · . \\
conta

v-not by the p
es eatoma ca.
u se s destru
g stra
Chol ints desquamated epithelium tified sq~amo~s epit_hehum middie ear
arranged hke on
io n sk
. • ·

in la yer .
t . ., nc i
}.
k · . ti
r~ssure effects. ction of bone by e.nzyma t·ic degrada· tio n 1· t · • ~
• Types o ·f<i-,~a 1s en· SL S ·· ut :-- ~,t
.. ../cl) Congf_ch ol~steatoma
~ ) Acquir~enital - arisi~~ from embryo .
· L:J . . · · · ;; -~,
··
d .. · . . . nic _epithelial tis
~ Primary acquire
sue ~-1
d·- ·throug
~ , c • . n} Secondary acquired-throuhg'Rhet'Mraigc~ion poc~ts' from eardrum ; .i
Ir
hnical sta es
·t \ ~
of CSOM: .through 'Metap
ration' frorn EA
lasia'
C . -~
1

\j
S la e . . _ _ _ , in middle e9r.
1· · .: .- - - - - - :- _r. ~
Yf"~ Slage ©f ceng
esti0n · Simp
Clinical fea-turcs
le . hyperemia
. - :- - - - :: - -
·. Treatment
- - - 1 ~-( }
--tcb.Mr\ ,. mucosa of mid of Antibiotics, i /~
ppJ~ dle ear. TM Oeconge 5lion
-~ tt\·
·1 r t t ~· i;~~n;:;~l~-cke
d 5ensatio"n ,. < · 1
2. Stage of
exudaloii .
in the ear i\,."-
.
-and coogesteq
;:
v"'

~~;~~~ryT:~;~\~~~~~~ My~goto~ .
·tt~
Sever~ earachei:.,-. .·
', deafness, .~-:,:
:_.~_•:·:·•
•·1: -_.·_:_
: :_r. n__~ _-.

fever, m~laise . ,• ; ..• . :.~

\ 3. · Sta9e o
f suppurati0n
I Purulent .
M
. ··.· -:

i positive · yringtomy
I
T M -. ·e· local abscess and drainage · of
_ .· /. ·-~ ·
Muco t ear discharge
(p u ls a ti le 0
4. Stage
ctmp licat10ns • f Tenderness
over the M
mastoid region astoidectomy.
perforated. . Tf\/1 -
Mastoid absces
s m
"'~,'-- C
- 1-in-ic_a_l_st-ag_e_ resent behind th ay be ·, _;~;( ,( _'..-
s_ e ea r ·,i t~(; . :·
a) · Benign 9s o_f_C_S_O_M_.:._._______
• vt"Active 's o M ·. ·..:. .. : · . . --'---'----- -
-
· r,,l4\.. '·•
tage - Disch
arge is actively
· . , . - -;-__ ____J'!_.·-;_, _._;:·:··•
Jr."' Quiscen flowin g 1 .: _
- _'t_~,
~,
:,.
·_:__:
_~_:.
,·_:
;_i_

~ stage - Ear ·
\.H(.'" Inactiv remains dry fOi . / . .· : _1
•
e stage - ·Ear a period o@no , ~,-,. ~L
b) Dang erou remain$ dry for nths
n ~ a h 6 mo ( \f,i ;~ _.
.. r~r) i \lV!'2:f:-· s perforation · nths ✓ .:
~ ~ ; ~ ;,::ict(: fo in the _active stage · -
· ·
• f~~ -'"".'-.,
r Fin;:! M~ts -I y,{ li. . ~1 . I
-- ··- - - - -- - ~ - :-·::-~ ,, 1\
- - = - "~ ,- ,,-,.-=-~ ----
·-----
- -73-j:.\ .·. ~
?,}~. \
--,,--~- -·- ·- -cs- -· . ,:- -~...h •
{~' ~
: \~
\
· ?." '
'
ilff\11~
 ..
.C~rn~licauons-of o.:
· ~ l: · • t1t1s ·
. '.: '~~ I . ,rnedl~:.
.-..
1
l Masked .{ Acute ...... ,
lntracranli!l · ... ---
) ~ Ghr~nlc " .
2
3) F.ac1a1·n Petros · t)'Menlngitls
ltis ;
4) Labyrint~~: Palsy ~ .' 1) Extra-dural abscess
. .,,..
3>'8ub-dural abscess I lobe
4} Brain abscess • Tempora
Abscess Cerebellar ~bsp~~!~uis.
S, Lateral sinus throm O t'""'\
• M· · 6t Olitlc hydr~ceP,~ti~.irr.C~ ·
. ore common intr . by,·r~r-P ->1
• ., CSOM _ ~cr~~ial complications In
1
(~ ASOM _enin itis Brain abscess. I" ;
V - Sigmoid ·sinus t r.ombosis, Extradural abscess ./'
• Ear infection · th ·
o· es of IS e-~ost ~ommon caus e of Br~ a~ce ·. ·.
ss . .
~pread of infection from midd le ear

I
· . ·
Direct bone erosion ✓ .
('1'\ !hrombophlebiti$ ~f emissary veins ✓
.
\)I •1~tough a conaen:tal dehiscen_Ee or pa~nt sutlJie, - fracture line, o~I or roj!nd
wmdows or lab_ .
ynnth.
Routes of spread.
.
'f' ·
Medially ~~abyrinth ➔ Labrinthitis_J' . ·.
➔ Superiorly ➔ Middle cranlailossa ->Temporal lobe b ess Extradural ..,;,
v- :.::.=. ..=;.:; ;~--'-- - a sc ' . .
~
. . abscess . . . _ .,. . . ,
. . • . . b II r abscess S1gmo1d -...:·
" Posteriorly-> Posterior cranial .fossa➔ Cere e a . p risi~us fistula_
· """'aria sigmoid sinus . ·thrombosrs , : e
·· r
Inferiorly -> Jugular bulb -> Thr.QDJb0SIS O JUQU Iar ve - i n· ✓
.....
-1a stoi d abscess ·
i. . Subtemporal Subpe,;osteal - Commonest - Erec
tion of · pinn a (outwards ,
downwards, forwards) .
ii. z,ygomatic - Along zygomatic bone . ·. .
iii. . .
Bezolg's Along stecnocleidomc1sto1d - Tort1colhs, shini .
ng abscess rn the neck
iv. Citelli's-- Along Diga stric muscle · ·
v. . Cue's abscess-Subtemporal abscess
. p'. otto.:U-oco1. . . .·
· .&
<~ · . · t:,. r.111..n ~hA.O au b, ~ fO'N> CVJ
. Gredinigo's Syndrome - seen 1h _,,e1ros1U§
-r .
a) Otorrhoea - persistent, profuse
J ,consists of. ' \
.
, b)· Trigeminal neuralgia - He~clache,·deep retroorbit
lat
al pain.,,. / ·
'1 ~r
(Y 1 )
'. F
c VI CN palsy ,diplopia ...,11 l.. ~ . . ~~.1o F~UJ
\Y/ ,
• - Fever h adac vo ittin s altered sensoriurn neck stiffness ~rn
uzdinsk's · n are the fea ures of eningitis ig's s1s1r.,
Kernig's sign - with h!,P flex9d, extension of knee ca~
es spasm in the harnstrin9
/mu scles O
·

Bruzdinsk's siqri - Flex io~~N;;Ek c~~~~ flexion of

·asod,'y Exam Guide for r-inal
knc~s and thig,hs. _
Mr;P,S -I ' - :) V ) 74
JY .
~w .
= 4ii =rsmu:rr; 7AM, .:Si:PitiYJ&'ll
 . b r a t i o ~ ~~".
· . /
· C~T-s...-c,.-a~n;:-·a~ n~d--~~
11 1

Slowing of pulse subnormal temperature, sloW cere · d' b~y: ·;:.

1
- 1~1\ /
· · .
· ' t a'i~gnose . · re~. /
common features of otogenic brain absces 5' bes " ·
· ··,~
by 'burr holes'. . · ,
. .
.
,)I'• ... ·· t dilate , but pap1lloederna· .
- 'Otitic hydrocephalus' is a.· • er asyentricles are n~o obstruction t~ ·ve~e~!.Ee~~
VI CN palsy occurs due to t ICT· which oc~urs d~fa
--- : caused bti_ateral sinus thrombos~~-~nd s fsfnus thrombosis:. .. . .: :.
u p ~ f ~' ! · ·
. ,.
· • te~tures of ~ateral sl_ nu~ thrombophlebitis. ·'
~ -·H r · . · ding · to ·sinus·, the +-~
\(JI ec re _type of te.1/er - with each bout of .1·~,e~ f ct1on sprea •· ·.
~ ~ temperatu~e s_hoots up associc1ted wi_th rigor_ :-;~nr~ -fe\lfilL . .
s (P ~m bo s1 s of masto1~
.• .2r \
• :f ~ Grelslnger s srgn - Oedema over
the mas toid process
h~-
1 '" ~ etn,~~a,y veins. ~ ·: ' !/~ .
. . _. eAuf! ~ f>o~1t1ve !obey - ~yer-test - Pressure on the . . ormal _sid,e cause i, - ..
~~~ mcre~s_e ,n the intra ·cranial tension jugular vein of n . . ~~~ .
~ oslt1 ve LIiie · urec ens e est . . the oppo site side t~j_
•LlP-~ A
n
nl'J...,,..,....,,...,,......,,.__,, ._crowe ,s ~es~ - Pressure .· .
.1:\ ~ T .. on e J~9 u ar. vein on ,,, I"
t ·.
~~ at.at,on of retinal veins on · ·
I
,i p 1 ·
u,,_ -, reatment _ of ot,trs media:- · . . · . the .normal side. • · . i:{:~
of
- Ai~s treatm'ent - . .
. •f ·
·
·. _ f:A rre ~t the dis~ase process ·
Ml
. . . Eradicate th~ disease focus.if any . i: . i,_,.~
• Remc;we the rrreversible pathology
.
.
: ;
·.· . , ~fa
xl;
st
Recon ruct sound transformation mechanism
. ; : • -~
. i(_;_.'_·l_,. ·
Treatment of ASOM 1

1).. Local . . ~1( •~

.. rt:;· , •·j
a. Before perforation~ Glycerine ,.arbolic eard
b• Afte_r perf
oration - Antibiotic ea: drops
rops; warm oil application sJ-fe
~:i:;;.-::· t
-~ J~~ !f-~1ife~ntibiotics, decongestant::; anal
9}- Myring~tomy
gesics .·. J{J
•· itrC
- Treatment of CSO M ; ;(ti {
Benign CSQM (Active stage) .
a) Local antibiotics to remove disease from
remove diseas~ focus if any.
the ear, systemic antibiotics to
.., .··,ttA
iK-'.1
b) Aural toilet
:.~i'Jit-1;__:·
. .•· ,01•'
c) Systemic analge_
-f!> sics, antipyretics, decongestants.
'TT immunization', to prevent intra cranial complica
-~ )mprovement of Nutrition and general
tions
. , ""Ji~l t ·
:_:·_~!~ti
condition of the patient . . 1,1:_,f\~1
~1 Wait for 6 months, to become ear to dry

Jf~I
'l ·· g Do myringop/asty or Tympanoplasty. ·. . :. ·
-
Treatment of cholesteatoma
.
-..,. ·.v ·
~b, ·!
· r.onservati~e tr~atment' Surgery - To remove
T
possible preserve or •reconstruct hearmg
l
di~ease and maJ<e the ear safe·: ff ?ii1
~ r j/·
~f:':,-t/~
·,. ~.l;.I··
<
:Ji:a.wJ'y Exam Guide for Final MB13S -I ______
_ _ _ _7__,.;s h?~·
f " ,-{-'-'w
1· ..
·.·.•~)~·~:.!; .;I
b, ·L ,

,~-:~:--
. ,.,, '-
, * . •.
_·. ·wv ·
·;:l~t1'
1
,.
I
... ........ ..,,,,... ,,.,.,._ .,.
. ___ :::--.. .
1u,~~.:,.:.:;-:-,1 s;....·tz;'l"l'.,. _ _"""'·:::ztn..,...,...._
,.
• ·. ' ·,,J.

__
;. ,):>,,•~ .'- .. , .;•
..·:. : ~,, ..-
:.<• •~ \ •'
 . .
Canal Wall .-. ;
Canal .down Proc -
..' R n, . Wall up edures ..; A , . ·
...-..
econs tructiv ~· Procedures _ ~cot?mv, Modjfied radical mastoidecto.rrfY
Conservar e surgery omb,ned approach through meatus_and_
. IVe rna r
- . - nagernent
Treatrnent of. .
G) . COn,plj .
Sunple c_abons of otitis .
(1:,.. rna t . mastoidecto . media
-- . \1U M ds.~ldectomy) my (Schwartze mastoidectomy (or) conservative
·---(m O lfled r d' · · ·
_.- - . R-adica1 -rn!st,co:d' ma~to~dectomy
~ . ,, ee-tomy -· - .___
MYnnanru ,. . ,,,.. ·
i n ~ - Punctu ·
rn, die ear (in Eu t ring of the ear drum with ·a long thick injection needle, ~o · · mb~)air ·
t
Done without an ,s achean catarrh) or to aspirate the contents of middle ear (in A k a·nd
card' aesthesia aft ... .
iac arrest Whi h ' er ptrop1nrs1ng the patient (to preven t .vasovagal
r attac
posterior
half' of thee 'd · c occurs due to stimulation of vagus ·nerve which supp ,es .
, ar . rum) .
·' ·. ~ringo torny s . , ·
' ear in acuteoti . urg1c?I incision of the tyr.r,p~_nic membr~ne to facilatate dramag · e of middle
· . R",\. in A t~s media (or) serous otitis media.
\?«:ti~ .c , d .OM ➔ in Qostero inferior quadrant ➔ cuts the ra~ial !i~res ➔ heals slowl~ -> Ion 9.er
~ -lb . ra1nage ' r;·, ;l/ vvt.liJL 0,¥1.J-tow l,{)l,I ~ 01'
~ ; i.ttc.Js~(Y rn SOM -> in antero inferior ~~;~t- ~'alon g the radial fibres ➔ saves radial . .
fibres '.
... · • .. _~ - so holds grommet ➔ longer_drainage.
f -~
~ Done ~nder GA, after Atropinisation . .
- Post~nor_in?i~io,n is given in AOM, because drum bulgs more in posterio
· . -
r qu~drant.
· ~ - . A~tenor 1~c1~1~n .!s given in SOM for grommet, because a school of thought 1s that

.r - · ,..,. migratory act1v1ty 1s least in that area. . • ,. ·

lri AOM, the incision should not be given in eostero superior qua~rant beca~se here lies
lncus, Stapes, Chorda tympani and Facial nerves and any stnke here will put the:,e
;·

structures into jeopardy.

Grommet
- ~ vides aeratiqn of tympanic cavity and also facilitate .aspiration a,nd clrainafJC cf
the fluid
- . It is expected to extrude out after its purpose i's served but it may ren1ain there
infinitely needing ·removal manually or it may come out prematurely if ·middle ear
space is minimum. ~"0-'\na. ~ .
~yrin~ oplast y: _ . . J!,. ~ . _(j) ' . _. . .
R~pair of defect in Tympamc membrqne wJ!hout inspecting middle ear and mastoid cavity
It 1s done when perforation in TM is small. ' • ·
Done under local / generaJ anaesthesia.
=-~ Tympanoplasty:-

. Re~ons!ruction of Tympan jc membrane and ossicular chain ~nr uy ~,ML,.

~re requisites , . , .-- - --
Ear shoulg_ be dry for 6 month~ / ' ·
'fY P~ •
iftt NFunctioning eystachean tube
E{ i:o'-"t'" ~ tof-111
/ . : ,,,- . ~M
.\..7 ° focus of infection in nose PNS and throat
Good cochlear reserve ~ i
i
I
~s-Exa m Guide fo r Final Mims .1 I
I
76
bM i
tT
N.o ~ 'h,,_,. ·tJ.o""~ --r~ ~
G.m« &rtJ- ~ ·'::43:e-
-I
=
 - ..... _
..
~ontr a indications: . /
· A. :15c!Jngerous perforation ,/
BrA!='fi've discharge from the ea~ / .
. C/Ch ildre n below 8-10 years indoW
g.,,-)mmobile stapes fixed to the oval w . . tion . ·
• . t,abil1ta · ._
ErSe norin eura l deafness /
F. Bleeding disorders, ~tn, DM. / t uitabl e for hea
rin9 aid re
, '/,'t;(} cessibl~ a
has nd
~h en the other ear 1s dea_d or no 5 • uscle
_ /117 fl, if'V'7 ' . asilY ac norallS 111
' •
/'£oM,1,cu,,.,,..
.. tasit 1se a1 tot ~ .
Graft mate rial used for repai r of lM- · . ~• c;,;ed
cornmones ia just later ~
A. . T~![lp oralis fascia (Qreferred and 1_5 u eter fayer
of fas . ,
'~ f)Ot lo~ meta bolic rate) A 1.5cm diam ;)
!~ 1s excis ed) .- ......, / ..,,,;n duram al~-
8 -. Othe rs - peric · hiCh
. hond
~.::::. rum from tragu s ~ -
-~ . .
.::.:.:::::.:.:. .:.:~~ .za-- ,.,.,bra
. rne•,, . ne W
.. . . . tyrnpanIc, . ue as . .
, echrn que of graft ing . . . raft medial to red tecnn1q
. Unde r lay (Inlay ) lEfohnique - Keep1n~ the g·urs
acts ~s a scaff old on which new epithelization occ
is the prefer . . tion
' ring epitheliza .
a) It 1s easie r to perform,,... · ·
b) P reve nts invag inatio / . . to mi'ddle ear dU ·
n of squa mous epi·th e1iu~ ,
~
'·
111
. ·
·
c) No graft cholesteatoma .
I

Type ~; o f lymp anop lasty:

I .
. +-
~cx.c !l'lclccltJnA1. · intac t ··
·-> f~n/y repa ir of TM (Myringoplasty)_as ofs,~~~ , ··-ul~1r ch~in I5 age to
II u<~as partial or total darn
· ·> . ..epa,r of TM+ mino r reconstruction o ' '· _,
. · .
-. i11 c11s or ma/~eu~ is pre~ent · . _ ..
Ill a es (colu mella effect) as
-·,\ l :,ra fted drum 1s direc tly ,n _contact with 1,cad
of st P ~ . . ..
/ncu s and Malle us·are absent . . .
IV .- ·> Grafted ear drum close s round window and 5 · ~an tubeiov_a.;.,.Iw_in_d_o_~ IS
eu lach ... ~ -- .
expo sed to. the exterior as sfapes 1s absent · cl?,.-H, ~ '.:, anai
as foot
V - > Fenes·trat,o · n ·operation
to ma ke win
· dow 1,,1 I--0•teral semI circu 1ur c ' .
• . .·
plate of stape s is fixed . · _ .
-
Cl r - 4 ~ ~
In case of a bilateral CSOM, it is better to avo1.d. d .
. . pair simulta~·eously on both.
omg re · '1 • loss
sides ra ther it is prefe rable
to do repair first on the ear-tlJat.s~o~~-greater earing
· · ·. which ·can be diagnosed by weber's test and confirmed
-. .. . .1 . '.
by aud~ometry. :
=;> Mas loide ctom y:
. Sim p/e mastoi.de~tomy Radical mastoi,;cc torny Modified radical
- ---- -t-: ,,,,_ ,.c- ---- - - ---- ---1----~<-m_a__s_to_i_d_e_c_
Exen l erati on of all
to_,n_.y,_ _ --i
All midd le ear contents, a) TM, lower portions · of ·
cJcccssiblc mas toid air TM are rcmo veu cxc mallm.1s and · incus in
cells by a post , aural foot late · f f l·n,es olympanu1 n' are not
approach
L)e mov ed.
Mastoid, attic, milcile ear and Mastoid, attic and ~ external
external ear are converted ear are converted into a
into a single cavit y draining single cavity· draining through
through EAC J EP,C.
I .
- -- ---:_-:..-:..-:..::.::.::.::.::.========::::::_ - ··- ·--·--- -------- --
- - - -·----·
. .
- ······- - . --- --. ·-···-- ~--.·-·--
~

(i(J{t's, fx;;m Guide for Fina! Mil BS -I

H Pr _'1 2.
t
-- ·- --77 -
f/fC.,

1
 ·nearin.o ~ U c t i v8 . -
C) Indications· remov~ due. t0 _b)-.. Hearing is unaffected as
· cont a of middle · ',d:')nesotymeanu m is not
(t, AC mast . ~
not respOlditis. either .
c) I . ents
nd,cations.·
---.;:.. ear ~ouched. 7_,,

. antibiotics
i
0nd mg . to
or ·
·o:r
Cholesteat
affe t' oma ,-
c) Indications:
- ~holesteatoma
· Ottned abs a m c mg attic and {])- ........-- ;ffecting the attic but
'--
th e
@ Masked
and
cess.
·
-
OM
,,...
CSesofympanum - not
mastoiditis - chr
_ o~,c with mesotympanum
~ During '-""1 - · comp/icatlons
\B..I ty · Malignancies · of
mpanop/asty V"> middle ear
i:
f, ~ompression
ch for
an - approa_
of
• Decompression
both vertical
of
and
ac,aJ . · nerve horizontal portions of
Decompression of Facial nerve
endolymphatie sac
. Vestibulococh/ear ,
ll!\ ~e":e_ section,
~xc1s1on of ~stic
neuroma

=i> Mac Eva~'§ triangle (Supra ,:neatal triangle) /' / ·-

· Surgical landmark of mastoid aritrum . \a. tq; .,-c.fiF ·
• Lies at a depth of 1.5cm in adults.
Bounded by . . _- . ·
· 1 ro'
~ -
'
~bove - Supra meatal .crest . / · ~ '\\ · . _ __,...J
mfront - postero superior margin of E~C ; 5 u ra meatal crest.

.
behind - a tangential line from posterior me_atal wall cutting P
Common complications following mastoid sujrgenes
"°'': ·. f or-'>_

I
-L,./'Facial palsy
- \/injury t ~ a l sin~s, ~igm~_id sinus · , ...---r- -
- Intra c r a ~ o of mfect10n . . ,,., w
Commonest extracranialfomp lication following mastoidectomy- Facial nerve parahlsl~
- . - ~oq,
- ... \t\b-C I
. - NOSE CASE ~~o..
vJlll d ' t ~
NOSE£ASE EXAMINATION IN DETAIL ~ I ~ ~'"tfL ~."""'4.
'"':> ~me -H ( •.; o i . ti , ~~ ~""
=:;, ~ . . . ~ ~5
-~ o~§4=1/lx · ·(Pat,en
~ Q,ecup,, ·ion:
· t~ k. · d- ty er:,vironmen
'1' wor mg ,n us
· • · . t a bl e t-Q; V aso M otor ''»
t are.· svscep i1n1t1s C
oh~~.)
>I ,'")
.n-..lA:24/
., ~ Ad lfess_,l(Rhinosporidiosis is common in costa/ areas) P:,fl-
~ Histocy/of present illness:- •' I
i'
~ s a l obstruction · .
• Duration ,,,// I:
_ ____ - Unilateral I bilateral <'.'.1 _ li
. ':J,.,.w t:~-Er;;m C11icie•for Fina/ MB:;S--1-::>-" "'-~"-----
------- ----~- ---
78
!I
IiI
I
II

·- ·-· ----------- --------- --------- ------,;_ __,....,.. ,.._.•,... II.

:i
..;
 ,.~
..· ...;.:J_l~ i':! -
' ;;.,.;,;ii" -.~....,..~ t
, ... ! --~ . . ..

• ,::.1.1)1 ~ ,- ', .. ~ 4,:;\

.... •i?~i':i .,.. ~ ~

. ~v-j:.,. ~~ - •-*; ~:~ •

.
f ,.,,;.r,. ~y_... •
,.;i•: , :-:_ _ ,-- . ent
:i:,-: I ·nterrruttrri .
, . uous I I
- ont1n erinnea
seasonal I P · tion
. / AnY diurnal v~ria y i,eadache
- Associated w1lhladnrops -
• ·th nasa
eli~f w1 e (Rhinorrhoea
1d1scharg
)
t1~
. d
·

- . (I ~ '.) •-nn s t ~
3~;,:~~ral I bilateral /
: "'a,.. C~terY / b ~
Scanty I profuse urulent I rnuco1
- _..
, nLJf.) purulent I mu_cop foul smell ~ ·
~
•, ,., .,· ~ . o·
0
'--" · _ Associated wit~ a!1Ytion
diurna I va na. 8· ,('i- \.,if" ii>
-r'°\'.,~ .... _-..,,('rJ
post nasal d1scharg ·,IJ'
le.e~ing :<Epistaxis) ~.f'~ ~ ~ ~ 1 \" •

_ Duration ~ \-1"._J, ~"' .J v '> ~

_ Unilateral /p1lateral . _- -IJ,'1(-' c; l
Spontaneo~a.umatic ·
• /. .
No. of episodes
. ( ntvy /I orruof1Uu-, @-__ ----9
Am ount of blood loss. s c ~ ~
_ .
tr' - Bleeding from other sites .regnancY, diet)
_,,r9 - .: Aggravating factors (stress, ~SAIDS
.'L cJ'·_ff:, .,..- Hlo taking any_coagulant~ 1
1< -
·. ~
.
}7)6~, ·~o. '_ 0 Hypertension . :
F i/y H/o any clotting dts~rders. mpound)
•i - n zing (Any allergy t~ a particular co
.J/ _'1 H adach~ and .facial pain . ·_
~- Duration ·• · ·
;.b~ Site - localised I generalis~d
• Nature - dull athing l severe
Onset - sudden I gradual I
Radiation · . · ·· . ., ., d . es)
_ Diurnal (Mora.in the morning I more as-_tl_,~---?-~ -·
- Aggravating factors (stres~. pregna~cy) . . .· . ..
) t•t -~--Relieving factors (Analges1cs,·alk~lm~ douc_h,ng) .. · ·
• .,_r--"'-rv:,>- .- - . ·Ay -ass0 ciatio~ witlJ.-X.omitting (M1gra~~-~: 1;-ma cranial tumours)
J>-l _. . tyro ?ny _Upper resp,r~t_Ory tract mfeCflOnS
~. • Coug~ . . .- . .
. . -. Co~ . .
. ~-Fe~:i:e . ,. ·a1 (sinus) pain - site · _
. -
- ~olfactory'distrubance (Anosmia I Hyposmia / Par~mia / Cocosmia)
_ .- lo y change in the voice (HYR.~~hyponasatity) c=--
.· ~ - o · ·s ~r:,, s estive of H~_DM; TB -or-exposur e to STDs. •
=i> 'Past history , .- · ; -( ~ '
Hlo sim,1 ~co plaints in the past {Sinusitis, 1\ller) c rhinitis)
Treatment his ry . ·
Hlo taking y et ongestant drops (whi.ch cause ,.-._hinitis medica
Hlo taking an hypotens/ve drugs (which cause N ·s2! .blockage)
·•;,;.,arl,'s. Exam Guide for fi n«/ MBBS -I -· - ·- ·
 \ l •

~ F ilr
h_istory _·._•· ' . C ,,.~

H~~s,mr com . . . :· . /z:Jf'Y"' A

~ . Perso al h" Plaints mother ~. iu .
. . 1s~ry: members 0f . ·. · • · 1)·
H/o ~I( · ~ ~he fam, 131/ergic rhinitis may be fa'!""a -
..
Hlo sm~tJ'/ ;~ii
SW/mfn;n~ fl- · }t ~Jo.,~: - . . . · ···. . u/4P ·
~u
>I

~ ~
. '
Ge~ra/ examin t' ~IC,hot ('l~ . enu,r:,1-a«uU /. A,d_J..
Built. . a ion. ~. ,I) /!f' ·
{A cA-.,,

_' :__ . . . Nouns~ment . b'/fe, p0tf .

., - -- ·:-·:-- --=wl-C.L C}f.,_Bf --LA
; ; .. ~ _.-:Vital data· PR '· ~ ---L ·- -
: . ~ -.(oca," .. . _BP, RR,/f"emp . I

1 mmat1on of Nose· ~
terna/ Nose: . . \ l}JLJV.. ~
Inspection· A .J l'AZ __ ..,J.v ~~
. · ppeararice - Normal I deformed .ffe_:f!.r:;:. ~°'~ ~
Any visi~le scars/ swellings yv t7"'
,(S ddl Nasolab1al fold - Normal I ob/itera and due 0 of Nose !
!Y.,· a et' deformity is due to destruc · .
.
-
.
aroadenm9
ri~ dest septum in Tuberculosis a
..J t onrosV.l
n ~
. ~DDLE rue ion I agenous
,. ~urs i olyps, ce ymphoma/Wegener's granulomatosis
oRCJ-Abf!NlnJJpatio ,
" .tTemperature - Normal I raised (in inflammat!ons) ali nancy)
✓Tenderness -Absent/ present (in inflammat1~ns, ~ Nisal bone fracture,
I
. . Any abnormality (Swelling in malignancy, cr~pitus ma) . . . _
. . ,. r;.nto· · -~ I ~ t40ge woody feel on touch in_ Rhmoscle~~ the thumb of the examiner I

I
· 2 ' · ·stibule (Examination done by elevation of tip of nose . .
Tip elevation test) "&urunc/e: fissure, tumours ·
~ ;;-Vi · s e - Nc1~mal I Any abnormality (Lik ~,~,~s_ .~~~~---

I
3. asal Cavities (Ariforior Rhinoscopy)

, .
(In adults - by Thud,chum nasal sp_ec . m e
.
In childre~ _-by e e~~ ,ng tip ?f nose with thumb. ~
i left hand
1
,: :. chi/rlren vibrissae afe absent so
@ nasal cav1t1es are v1s1ble easily. · · .
-- -
,- ation · · .
!
·Nasal decongestant drops can be used for better v1sua rs · -,

Look .
· a)~asal mucosa - pink - (normal) I .
Congested (Infections) I
Pale (allergy) .. . . .
b) J<Gsal septum - Normal - May I may not be in the m,dline
./' · NS Deviated to one side ·
c) .,,C.ateral wall - nteria nd inferior of
and middle tubinates and their meati are visible
normally (but many times the cwterior end of inferior turbinate is only prominently
~isible) • · · .
· 1 - Any abnor.mality- ( l i k ~,-<hinospol"fdiosis,v6.ircir1oma) present or
absent. 'CJ
d) --Floor. - Normal@oncave tunnel) pr any abnormality (defects like cleft lip swellings
neoplasms) · •
e Roo sopbarynx Not ,,,isib!e norniallr - @ '
f) Nasal cav1t1es:
Normally equal on both sides
'.An.u}(t:f, Exi!m Guide for Fi11.il MIJBS .J
80
 ------ \
·,
·tile;·§
..
.{;i .
on the --1•~
••••• bY \\.t.';: .'.'

·.-,n . \0 I

in ng po s •u 0 dieS,
.. 5
f 0rel'
a O
h probe examination .of the mass (Po1YP.
. omfoft •
·tou c\1)
e aware o
1)1/" P<
;,,,. .,
~..,,=~-i"~~~!,IJ,5,i,wlJwi.lUllJ~a~te~- .
. . .pa1~ ) . d9ne b e-ry\\ium, ca
1

.f1 'J r nx (PosteriO< Rhinosc

0
P\ c•n 3isO b' fUS, chromium,
on the du-ratio•
. :;,~ io'-'-,~,.hinoscopic mirror usua
!tll!~~~:-:-:-== ~ r-:-' y' ot ell.posute . U
to'llications te~
_·." ).,o{I · ul_u_m~
~:;::.::~;;._!...-=---'--e_c_ / · ed\ca\ tteatme
es maY a\so
ch as \ead, tt'
sphotUS etc.
ute amounts
~i:ettes. 1/luch
\ ~ces and on'
\ c1,cu\atioT

te and ~ara
\ona\ -d1se,
\\ anthta1l,
{unga\
sonsW<
des) an
ica\ ha2
~
\
I
~du stc'} .
'\tts an<
1 ate s,
'

aranasal
,nspec sinuses: ce normal or any redn e:-:s , swelling , fistul as.
,on -airAppearan
I f
Palpation -- for any te ndern es~
•~axillarv_sinus - By pres~ing over the ·c ,mine Iossa· on th8 che.ck
h
· •' Anterior By pressing
e/hm-oidal
. rontal sinus sinus _ ~;~::s:i~i: - ol the gye
. •ner can U1us
, d · ,-i ~b~:el e/~;
. _,nner canthus .of the eye and nasion - s o ,e nose nudway between the
(~osteriar eth,noidal and spher·oicl
are situa ted deeply) ·

81
~1111.~mCJ, Exam Guide for Final. I\IHIIS .
1
 aniinauon
ani ina r of the tA; .
Exaniinat:~~ of the TH R .
Pro visio Of CVs RoA' . No
Ditti nar dia • Rs .
M ere nti al di 9nosis: • Grr : l'l}Ja, 1
. anagernent agnos;s: , Ct-.Js _Norrria1 I Any Patti I
~ . • . Nor Any Patti o, ogy
~ Invest; . d' · -~ ~!11 Any; 0 9Y
1) ~t :~ ns : .
2) ~e te _b l0o .
1 bnorrnality
- - - -- 3) Antra~fogica/
~ Pron,_..._,, '11inture
Pi? ex!
ation
4 ) ~merfcire==~l!Mt!..Giu.ce ·
Na sal s; Od of the tu --(~uncturin
, sept
urn nus
E endOscorbinate) g of l:1tcra1 Wnl
and tnidd Ustachea l of
.
PY (structur · f .
. S) CT S le turb;n n tube or;r, es seen in enor moatus at 2cm behind
lhe
6) MR can . ates) are .
T I Ces , roof of Pos terior choanae, pos terio
rea tme nt nasopharynx, posterior ends r end of
of inferior
1)
Medical
2) Surgical -

IN Nose CAsg_:-
~ \.1-. _ ....,
.,.~ , atio n of p
1ltMi:Ji0n ·
>._ c.m
-·
mon aranasa/ sinu
and are filled with airses .5 . ~
d . par a~1 ~a/ , i.e. .hln'
1
·
.
uses are emptied _of air .
· causes of Nas b ~rrng exprrat,on which is con dun ng
I
a o structron- trast to lungs.
In children .
·
· noi ds , -~ ~ s
~
~
r · n bod ies
mit is Sfs
K.Yf,Se~~ophic turbinates
--S!µvs,t,s
~y_ pot ens ive dru gs
~~ an cy
· ~u s1t is
I

Jl<flergic rhinitis
Co mm on cau ses of unilate
ral nasal ohs ;tion
rJl'ffi_. ~r tro ph ic inferior turbinate,t;u(A
l
~
f orergn body -../1 · · ~ choanal polyp ~
J
f3J:mriosporidiosi~ \/1
Un ilat era l sin usi tis ,._,.,..-,
Ma lign anc y '-"" '
U nila ter al cho ana l atr esi a
v1 ~~ ~ ~ . r~ t) \J€ .
Typ es of Nasal discharge:
Wa ter y -- A ~ c rhinitis, VM
./1 · Cl)i-v-vn""'0 ,-,.
R, CSE cpioorrhea _
e,o? b~ - t-t~) Q. ~_ \. \

Pu ruie nt I Mu cop uru len t -

Sinusifis, Malignancy, Foreign bod
·s,o od 'stained :- Old fore ies in children
ign body, Rbinolith, Rhinospo•ri~jos
. DiEibfilia. ~; is. Malignancy, Nasal
. ·- · •
• Foul smelling - Old neglected ·
'fB . Atrophic rhinitis, Malignanc
dental infection. y, Sin usitis secondary to

: .
ti,'."'. Ex.1111 Guide for Final MBBS -I
" 82

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