Ent cases

Chronic adenotonsilittis

Local examination:
Oral cavity:

Lips ,buccal mucosa,gingiva,anterior 2/3 rd of tongue, normal

Floor of mouth,hard palate,retromolar trigone

Normal dentition,no dental carries,no loose teeth

Oropharynx:

Uvula appears normal

Tonsils – grade 3 bilateral enlargement

There are no follicles or membrane over the tonsil.

Anterior pillar appear congested bilaterally.

Irwin moore’s sign positive: on pressing the anterior pillar there is purulent secretion coming out of
the tonsillar crypts.
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Posterior pharyngeal wall: congested

Neck examination: jugular digastric nodes – enlarged (BL)

They are about 2*2cm in diameter ,tender,firm,possible on both sides.

Nose * ear examination - normal

Systemic examination:

Cvs : s1 s2 sound heard

Rs: normal vesicular breadth sound

Cns: no focal neurological deficit

P/a: non tender , no organomegaly

Diagnosis:

From the above history, the patient is a case of chronic adenotonsillitis with bilateral cervical
lymphadenitis

Investigations: TLC,DLC,Hb,BT,CT ,platelet count,Blood grouping,ESR

Throat swab for culture & sensitivity

Treatment :

Adenoidectomy with tonsillectomy

Adenoidectomy have to perform first and the bleeding subsides, after that
tonsillectomy have to performed.

Maximum asking questions : most common method of tonsillectomy?

Other methods of tonsillectomy?

Complications of tonsillectomy?

Tonsillar bed?

Blood aupply of tonsil? Artery and veins

Grades of tonsils?

Types of chronic tonilittis?

Position of tonsillectomy? (sister mary rose position)

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Deviated nasal septum

Local examination:

Examination of external nose: normal in appearance

No swelling /scars/ ulceration

Vestibule appears normal

Anterior rhinoscopy: the nasal cavity on left side is narrow with a ‘C’ shaped deviation of the nasal
septum towards left side . Hypertropy of the inferior meatus on right side is present

Nasal mucosa in left side is congested ,floor*roof appears normal.

Posterior rhinoscopy:

‘c” shaped deviation towards the left side is seen,choana, roof,posterior wall of
nasopharynx appears normal.

Nasopharyngeal end of Eusthatian tube is normal.

Functional examination of nose:

1, cold spatula test: reduced fooging in left side

2, cotton wool test : negative in left side

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3, cottle’s test: the airway improves on drawing cheek laterally

4, test for olfaction: reduced on left side

Systemic examination:

Cvs : s1 s2 sound heard

Rs: normal vesicular breadth sound

Cns: no focal neurological deficit

P/a: non tender , no organomegaly

Diagnosis:

From the above history and clinical features the patient is a case of ‘c’ shaped deviated nasal
septum towards left

Invetigations:

X ray paranasal sinuses and nose

Diagnostic nasal endoscopy

Management:

Septoplasty , submucous resection of septum

Common asking questions:

1. Types of deviated nasal septum

2. What is the instrument used for doing posterior rhinoscopy? Say it with full name
3. Management of this case and why? Septoplasty ( because no need to excice full cartilage
and bone)
4. Difference between septoplasty and SMR
5. Incisions in septoplasty and smr? ( in septoplasty freers hemitanfixion insicion)
6. Position of septoplasty and smr
7. Cottles line
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Antrochoanal polyp :

Local examination:

Examination of external nose: normal in appearance

No swelling /scars/ ulceration

Vestibule appears normal

Anterior rhinoscopy:

Single Greyish glistening mass seen in middle turbinates

Nasal floor and roof appears normal

Posterior rhinoscopy:

The greyish mass is hanging is soft palate is seen

Probe test: insensitive and no bleeding is there

Functional examination of nose:

1, cold spatula test: reduced fooging in left side

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2, cotton wool test : negative in left side

3, cottle’s test: the airway improves on drawing cheek laterally

4, test for olfaction: reduced on left side

Systemic examination:

Cvs : s1 s2 sound heard

Rs: normal vesicular breadth sound

Cns: no focal neurological deficit

P/a: non tender , no organomegaly

Diagnosis:

From the above history and clinical features the patient is a case of left sided antrachoanal
polyp

Invetigations:

X ray paranasal sinuses and nose

Diagnostic nasal endoscopy

Management: functional endoscopic sinus surgery with removing of polyp

Common asking questions:

1.causes of unilateral obstruction and bilateral obstruction of nose?

2.types of polyp?

3. indications and contraindications of FESS?

4.why fess is called as functional?

5.cottles line
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Case 4 chronic tonsillitis

Local examination:
Oral cavity:

Lips ,buccal mucosa,gingiva,anterior 2/3 rd of tongue, normal

Floor of mouth,hard palate,retromolar trigone

Normal dentition,no dental carries,no loose teeth

Oropharynx:

Uvula appears normal

Tonsils – grade 3 bilateral enlargement

There are no follicles or membrane over the tonsil.

Anterior pillar appear congested bilaterally.

Irwin moore’s sign positive: on pressing the anterior pillar there is purulent secretion coming out of
the tonsillar crypts.

Posterior pharyngeal wall: congested

Neck examination: jugular digastric nodes – enlarged (BL)

They are about 2*2cm in diameter ,tender,firm,possible on both sides.

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Nose * ear examination - normal

Systemic examination:

Cvs : s1 s2 sound heard

Rs: normal vesicular breadth sound

Cns: no focal neurological deficit

P/a: non tender , no organomegaly

Diagnosis:

From the above history, the patient is a case of chronic tonsillitis with bilateral cervical
lymphadenitis

Investigations: TLC,DLC,Hb,BT,CT ,platelet count,Blood grouping,ESR

Throat swab for culture & sensitivity

Treatment :

Antibiotics and tonsillectomy

Maximum asking questions : most common method of tonsillectomy?

Other methods of tonsillectomy?

Complications of tonsillectomy?

Tonsillar bed?

Blood aupply of tonsil? Artery and veins

Grades of tonsils?

Types of chronic tonilittis?

Position of tonsillectomy? (sister mary rose position)

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Case 5 left side CSOM ,

Diagnosis :

From the above history and clinical findings the patient is a case of unilateral csom
on left side, tubotympanic type,in inactive stage with conductive hearing loss without complications

Investigations: examination under microscope,otoscope

Audiogram, mastoid xray-schullers view

Total blood count & urine routine

Treatment :

Myringoplasty with or without ossicular reconstruction can done

Commonly asking questions:

1.Types of perforations?

2. shape and size of normal tympanic membrane?

3. difference between tubotympanic type and atticondral type?

4. what is profuse discharge?

5.treatment of csom?

6. what is three finger test?

7.what is fistula test?

8. types of tympanoplasty (wullstein classification)

9.grafts use in myringoplasty

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10.technique of myringoplasty?

11. complications of each technique?

Case 6 bilateral CSOM

Diagnosis :

From the above history and clinical findings the patient is a case of bilateral csom on
left side, tubotympanic type,in inactive stage with conductive hearing loss without complications

Investigations: examination under microscope,otoscope

Audiogram, mastoid xray-schullers view

Total blood count & urine routine

Treatment :

Myringoplasty with or without ossicular reconstruction can done

Commonly asking questions:

1.Types of perforations?
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2. shape and size of normal tympanic membrane?

3. difference between tubotympanic type and atticondral type?

4. what is profuse discharge?

5.treatment of csom?

6. what is three finger test?

7.what is fistula test?

8. types of tympanoplasty (wullstein classification)

9.grafts use in myringoplasty

10.technique of myringoplasty?

11. complications of each technique?

Case 7: antrachonal polyp

Local examination:
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Examination of external nose: normal in appearance

No swelling /scars/ ulceration

Vestibule appears normal

Anterior rhinoscopy:

Single Greyish glistening mass seen in middle turbinates

Nasal floor and roof appears normal

Posterior rhinoscopy:

The greyish mass is hanging is soft palate is seen

Probe test: insensitive and no bleeding is there

Functional examination of nose:

1, cold spatula test: reduced fooging in left side

2, cotton wool test : negative in left side

3, cottle’s test: the airway improves on drawing cheek laterally

4, test for olfaction: reduced on left side

Systemic examination:

Cvs : s1 s2 sound heard

Rs: normal vesicular breadth sound

Cns: no focal neurological deficit

P/a: non tender , no organomegaly

Diagnosis:

From the above history and clinical features the patient is a case of left sided antrachoanal
polyp

Invetigations:

X ray paranasal sinuses and nose

Diagnostic nasal endoscopy

Management: functional endoscopic sinus surgery with removing of polyp

Common asking questions:

Ent cases
1.causes of unilateral obstruction and bilateral obstruction of nose?

2.types of polyp?

3. indications and contraindications of FESS?

4.why fess is called as functional?

5.cottles line