Tuesday, 11 April 2023 3:45 PM

Disease Aetiology C/F Tests/ lab evaluation Diagnostic criteria Management Complications D/d
Nasopharynge 1. Genetic factors 1. Features of local disease • Posterior rhino 1. Evaluation • Radiation therapy • Xerostomia,
al Ca 1. Inherited (nasal/ear) scope 1. History • 2D radiation tooth decay
a. Familial 1. Epistaxis: bloody postnatal • Neck Palpation 2. NP therapy (2DRT) • ETD- early
aggregation discharge • Endoscopy examinatio • 3D radiation (SOM), late
b. Migration study 2. Nasal obstruction (mucosal lesions) n, neck therapy (patulous ET)
2. Somatic: mutation, 3. Hearing loss and tinnitus • NASOPHARYNX nodes, CN • Intensity • Nasal synergistic
deletion, amplification 4. Serous otitis media BIOPSY ( GOLD function modulated sinusitis
of gene 2. Cranial nerve involvement STANDARD FOR 3. CT scan or radiation therapy • Endocrine
2. Environmental factors 1. Upper cranial nerve PRIMARY TUMOUR) MRI, • CHEMOTHERAPY disorders-
1. Salted fish involvement: Cavernous • Imaging PET/CT, • Cosplaying can be hypopituitarism,
(nitrosamine) sinus syndrome / orbital • CT: determine chest X-ray given before hypothyroidism,
2. Chinese herbs apex syndrome tumour 4. Biopsy of (neoadjuvant), hypothalamic
3. Tobacco a. Tumour through extent, base nasophary during dysfunction
4. Alcohol foremen lace rum, of skull ngeal mass (concurrent) or • Soft tissue
3. Virological factors:EB cavernous sinus, erosion, 5. Lab after (adjuvant) fibrosis including
superior orbital cervical evaluation • Palliative chemo trismus
fossa, deficits of II, III, lymphadenop in recurrent • Ophthalmologic
IV, V, VI athy Qualitative metastatic NPC problems
b. Signs • MRI: superior Extent • Surgery • Skull base
i. Diplopia to CT - Stage • Primary lesion: necrosis
ii. Paralysis of involvement residual or
extraocular of soft tissue; recurrent disease
motions bone (trans endoscope
iii. Ptosis disruption surgery, nasal
iv. Blindness • Pet/CT: assess lateral incision)
v. Facial pain or questionable • Regional disease:
numbness neck nodes, neck mass after
Occulomotor and abducent nerve recurrent or failure of radiation
palsy (ptosis, eye deviation to the residual and
inner side, abduction of the eye lesions, chemotherapy
failed) distant (neck dissection)
2. Lower cranial nerve metastasis • Adenocarcinoma-
involvement : Jugular • Lab evaluation trans endoscope
foremen syndrome • EB VCA-IgA surgery
a. CN: IX, X, XI, XII EB - IgA
involvement antibodies for
b. Dysphasia; paralysis viral capsid
of soft palate; antigen,
hoarseness; trapezius sensitive
and SCM muscle • EB EA-IgA EB -
function weakness; IgA antibodies
hypoglossal for early
paralysis(tongue antigen,
sticking out, specific
deviation to the • EBV-specific
involves side) Dnase (EBNA,
3. Cervical sympathetic trunk EBV DNA)
involvement : Horner’s sensitive and
syndrome specific
a. Ptosis (droopy eyelid
on the involved side)
b. Mitosis (smaller pupil
on the involved side)
c. Anhydrosis (loss of
sweating)

2. Neck masses: m/C physical

finding
1. Increased painless, hard
and fused
2. Unilateral and bilateral
3. Upper-lower cervical lymph
nodes
4. Often asymmetrical,
enlargement of the upper
deep cervical lymph nodes
3. Distant metastasis: rare
1. Invades blood vessels and
tumour cells through
circulation transfer to
lungs, liver and bones
Acute • Systemic symptoms: fever, vomit, • Otaolaroscopy: Principle: control Prevention
suppurative tire congestion, diffuse infection, dec drainage • Strengthen
otitis media • Local symptoms congestion, exercise
• Ear pain: deep pain, crying late swelling, • Antibiotics: early & • Prevention
at night, scratching ears, perforation (bright adequate use &Rx of URTI
earache relief after TM spot of pus • Decreasing nose • Popularise
perforation & purulence pulsation seen in congestive agent health
• Discharge: blood/suppurative small perforation— • Etiological knowledge
• Hearing loss: conductive BEACON SIGN) treatment: nasal & • Correct
hearing loss • Ear Palpation: mild pharyngeal d/s, blowing your
• Tinnitus tenderness of adenoid nose,
mastoid process hypertrophy, extensive
• Hearing test: chronic sinusitis, infectious
conductive hearing chronic tonsillitis disease
loss vaccination
• Blood picture: WBC Surgical Rx: TM incision: work
inc myringotomy [whwn the • TM
drum is bulging or pt has perforation
severe pain] & catheter
no swimming
Chronic • Benign type- confined only BLUE DRUM: blue-gray discolouration • Pure tone MYRINGOPLASTY • Adenoidectomy, Adv of
suppurative to the middle ear cleft of drum head & cloudiness of mastoid audiometry: mild to GRAFT MATERIAL septoplasty & antrum Myringoplasty
otitis media • Persistent mucosal d/s: cells on CT; Dark-brown slimy fluid or moderate hearing • Temporalis washes • Preossicular
Tubotympanic ET/perforated TM— sludge; Cholesterol crystals, look loss fascia • Aural polypectomy chain is
type hyperplasia of mucosa— pigments, giant cells • Culture discharge • Travail • Myringoplasty intact
polyp • CT scan/ MRI perichondriu • Dry ear>6w • Prevent
• Mucosa l hypertrophy— TUBAL TYPE: through ET: nose, sinuses m • ET is patent further
block post portion of the nasopharynx children • Homograft • No infection in the infection
tympanum—vacuum— • Mucopurulent discharge TM nose, sinuses & • Improve
extravasating of blood into • Deafness/hearing loss nasopharynx hearing
the middle ear—foreign • Features of nose or sinusitis or Inlay technique • Prevent
body reaction—formation of adenoids postoperative care: complication
cholesterol granulation— • Perforation antibiotics & nasal s
BLUE DRUM • Children: running nose, sinusitis decongestants • Prevent
typanosclero
sis
TYMPANIC TYPE: through • Enable
perforated/defective ear drum; proper fitting
adults: dirty water into the ear of hearing
• Discharge aid
• Deafness
• Large central perforation
• Granulation/polyp
• Adults: water into the ear/swim

CSOM- • Involves attic, antrum & post • Discharge: Purulent, foul smelling • Hearing test Surgery on time— INTRACRANIAL
Atticoantral tympanum scanty in amount or blood stained • Bacteriology mastoidectomy & hearing COMPLICATIONS
type UNSAFE • Bone-eroding d/s: exposed • Perforation : marginal • Radiology: CT/MRI reconstruction • Extramural
adjacent structures with • Deafness abscess
resultant complications • Tinnitus • Brain abscess
• Formation of cholesteatoma • Ear ache, vertigo, vomitting & • Meningitis
and inflammatory headache • Otitis
granulation tissue— cause hydrocephal
erosion of the bone us
• Not true tumour PARS FLACCIDA & MARGINAL • Subdural
• Sac of keratinised PERFORATIONS abscess
desquanated • Intracranial
epithelium in the infection
middle ear • Sinus
• Bone eroding thrombophle
○ Pressure effect- bitis
bone remodel • Otogenic
○ Enzymatic brain abscess
activity- bone
erosion EXTRACRANIAL
• Labrynthitis
• Petrositis
• Mastoiditis
• Facial
paralysis
• Retrpharyng
eal abscess
• Postaural
abscess
• Labyrinthine
fistula
• Parapharyng
eal abscess
• Lymphadenit
is
• Postauricular
fistula
Secretory otitis • Obstruction of ET • Usually asymptomatic • Examination of TM • Principles
media • Mechanic obstruction- • Fullness:blocked ear feeling • TM retraction • Discharge middle
• Suppurat swelling, enlarged • Hearing loss ( children- affects • TM ear fluid
ive/Purul adenoid, tumour, understanding of speech, language congestion or • Drainage,
ent/bact enlarged inferior dev, learning and behaviour) thickening ventilation of the
erial turbinate • Otalgia • Effusion middle ear
• Serous/s • Non-mechanic • Tinnitus • Air fluid levels • Treatment of
ecretory obstruction- weakness • Bubbles causative factors
/mucoid of related muscle • Pure tone test
• glue ear ○ Cleft palate • Conductive • Non-surgical
• middle ○ Myasthenia hearing loss, treatments:
ear gravis 20-40dB • Antibiotics
effusion • Infection • Tuning fork test: • Antihistamines
• Germ excretion of Rinne test- negative and
middle ear- • Mixed hearing loss decongestants,
haemophilias influenza • Bacteria or steroid
and micrococcus toxin reach • Inflation:
pneumonia E inner ear by valsalva’s
• Virus- influenza virus, RWM maneuver,
adenovirus • Hair cell hurt politerization and
• Immune reaction • Acoustic impedance catheter
• Type 1: allergic rhinitis; • Type B: poor • Control of
nasal polyp; bronchial TM mobility Etiology: nasal
asthma and middle infection, sinusitis,
• Type 3: bacteria I’m ear effusion; allergy etc
adenoid and oral TM
pharynx perforation • Surgical
• Type C: • Typanocentesis
negative • Myringotomy
middle ear (with grommet
pressure insertion)
• Tyampanotomy or
mastoidectomy

Epistaxis • Local causes • Bleeding sites • • History • Pre-hospital: pinch the

• Trauma • Little’s area • Duration, soft part of the nose
○ Nose picking • Woodruff’s area frequency (nasal dorsum) 5-10 m;
○ Foreign body • Above the level of middle & amt sitting forward to
○ Atmosphere turbinate • >500ml prevent nasal
changes • Below the level of middle dizzy & obstruction
○ Hurt in RTA turbinate thirsty • Cauterisation: chemical
• Inflammation • Naso pharynx • >1000ml BP (silver nitrate),
○ Allergic rhinitis • Diffuse & HR electrocautery,
○ Sinusitis • Anterior epistaxis accelerated endoscopic
○ Upper • More common • Primary site cauterisation)
respiratory • Occurs in children & young & • Nasal packing: lodoform
infection adults underlying gauze, merocel, ant
• Structure differences • Usually due to nasal mucosal causes packing, Foley catheter,
○ Nasal septal dryness • PE epistat, an & post
deviation • Alarming as bleeding seen • Endoscopy packing
• Tumour readily but generally less • Radiological • Artery ligation: external
○ Tumour in nasal severe evaluation incision approach,
cavity, sinuses • Posterior epistaxis • Blood testing: Hb, endoscopic endonasal
and nasopharynx • Older population platelet level, approach
• Systemic causes • HTN & ASVD common causes coagulation func • Artery embolization
• Cardiovascular • Significant bleeding in post • Adjuvant therapy
diseases pharynx
○ Arteriosclerosis • More severe & treatment
○ HTN more challenging
• Coagulation deficits
○ Haemophilia
○ Thrombocytope
nia
• Medications
○ Warfarin
○ Heparin
○ Aspirin
• Toxic agents: heavy
metals
Chronic • Stuffy nose • Hypertrophied & • Systemic decongestants
hypertrophic • Anosmia congested mucosa • Antihistamines
rhinitis • Enlarged turbinates • Surgery
• No reaction to
vasoconstrictors
Atrophied • Infection, endocrine • Dryness of nose • Broadened nose • Nasal hygiene
rhinitis (ozena) imbalance, deficient diet, • Nasal obstruction • Widened nostrils • Surgery: narrow the
developmental factor • Headache • Crusts internal dimensions of
• Chronic inflammatory • Epistaxis • Mucosa congested the nose
condition of nose • Fetor & atrophic
• Turbinate atrophic
& shriveled up
Allergic rhinitis Type • Watery rhinorrhea • Skin testing • Avoidance • Sinusitis—> nasal
• Pale discolouration of • Sneezing • Sr specific I gE level • Pharmacological Rx polyp—>
the nasal mucosa • Nasal obstruction • Immunotherapy asthma—> otitis
• Clear rhinorrhea • Nasal pruritis • Surgery media—>
• Nasal congestion URTI—> sinusitis
• Red & watery eyes
Acute rhino • Infection Etiology • 7-14d — 1m of symptoms Primary clinical Goal: control infection,
sinusitis • Viral (rhinovirus, • Purulent nasal drainage + facial diagnosis, based on diminish tissue edema,
parainfluenza, RSV, pain/pressure + nasal obstruction time course & restablishment of normal
influenza v) • May also have recent onset symptoms drainage, ventilation of
• Bacterial (strep hyposmia, fever, headache, tooth sinuses
pneumo, H. flu, pain, cough, headache
Moraxella catarrhalis) • Medical therapy
○ Amoxicillin-
clavilanic acid
○ Decongestant
s
○ Topical
steroids
○ Antihistamine
s
○ Antileukotrien
es
• Antrum puncture
• FESS
Chronic • Infectious • >12w • Endoscopic Same as above
rhinosinusitis • Staph aureus, coag- • Chronic purulent nasal drainage + evidence of
negative staph, facial pain/pressure + nasal polyps, purulent
anaerobe, obstruction + hyposmia mucus from
polymicrobial sinuses
infections, • Ct sinus findings
pseudomonas
• Culture-directed
antimicrobial therapy
essential
• Can be fungal
Acute • Common cold viruses • High fever, malaise, headache, • Viral • Evidence of • Medical mx • Peritonsillar • Infectious
tonsillitis (adenovirus, rhinovirus, vomitting • Low grade inflammation of • Bed rest abscess mononucle
influenza, coronavirus, • Sore throat & odynophagia fever the tonsils: pus • Penicillin- 1st line • Cervical adenitis osis: EBV
respiratory syncytial virus) • Dysphagia • Lower WBC, • Pyrexia is 38.5 of culture is -ve • Acute infections,
• EBV, HSB, cytomegalovirus, • Tender cervical lymphadenopathy Lymphocytic orally for GABHS (7-10d) myocarditis enlarged
HIV • Erythematous/ exudative tonsils shift • Enlarged, tender, • Local Rx- gargle, • Acute congested
• Bacterial - grp A (3-hemolytic • Purulent exudate from the crypts • Less tonsillitis ant cervical LN spray glomerulonephri tonsils, LN
streptococcus [GABHS]), • A white membrane exudate • Documentation tis & spleen
staph aureus, strep • Bacterial of GABHS • Rheumatic fever enlarged
pneumoniaw • Higher WBC, infection by • Vincent’s
• Anaerobic bacteria granulocytic throat swab angina:
shift (antigen trench
• More detection or mouth,
exudative culture) yellowish-
green
exudate
• Malignancy:
lymphoma,
leukemia,
carcinoma
• Diphtheria:
bull neck
• Scarlet
fever; fine
red rough
textured
rash
• A
granulocyto
sis:
ulcerative
necrotic
lesion
Chronic • Strep pyogens (GABHS) • Recurrent attack of sore throat or Signs • Histories of • Medical mx • Myocarditis • Infectious
tonsillitis • H influenza cute tonsillitis • Enlarged, mildly recurrent throat • 1st line: • Glomerulonephri mononucle
• Staph aureus • Chronic irritation in throat with red tonsils, infections ○ Penicillin/ tis osis - EBV
• Strep pneumoniae cough scarred with • Examinations cephalospor • Rheumatic fever • Scarlet
• Lasting infection of tonsils • Bad taste in mouth & halitosis d/t large pits • Size of in 10d • Fever fever
• Symptoms>4w pus in crypts • Crypts tend to tonsil nor ○ Injectable • Corynebact
• Difficulty in swallowing & choking at become correlative forms for erium
night impacted C C degree of noncomplia • Surgical diphtheriae
white foul- inflammati nce complications • Malignancy
smelling on • Macrolides • Anaesthetic • Hyperkerat
Surgical absolute indications (owner) debris • Yellowish ○ Penicillin complications osis
• Obstructive airway C cor • Slightly beads of allergy • ET injury • Candidiasis
pulmonale enlarged LN not pus ○ Erythromyci • Nasopharyngeal • Syphilis
• Severe dysphagia tender n/ stenosis • Retention
• Failure to thrive clarithromyc • Pulmonary cysts
in 10d edema • Supratonsill
○ Azithromyci • Atlantoaxial ar cleft
Surgical relative indications: n(12mg/kg/ subluxation
• Recurrent acute tonsillitis d) 5d
(4/yr for 2yr or 3/yr for 3yr) • Innovative surgical
• Chronic tonsillitis techniques
• Obstructive sleep apnea • Cold dissection
• Peritonsillar abscess • Electro surgery
• Halitosis • Intracapsular
• Suspected neoplasia/tonsillitis partial
hyperplasia tonsillectomy
• Harmonic scalpel
• Radio frequency
tonsillitis ablation
MD • Dilation of membranous • Recurrent vertigo • Audiometry: SNHL • More than 2 No definite treatment • Vestibular
labyrinth (endolymphatic • Hearing loss: sensorineural in type • Vestibular function typical episodes neurontis
hydops) • Tinnitus: low-pitched test of vertigo Alleviate symptoms • Acoustic
• Excessive endolymph • Feeling of fullness • CT scan • Vertigo lasts for Rx of acute attack neuroma
secreted • N/V • Glycerol test: pure more than 20 min • Dietetic therapy • Benign
• Blockage of endolymph tone audiometry • At least one • Vitamin therapy positional
absorbed • Electrochleography: attack of pure • Diuretic therapy vertigo
• Hypothyroidism SP/AP tone audiometry • Vasodilators BPPV
• Autoimmune d/s was confirmed as • Streptomycin • Epileptic
• Viral Etiological sensorineural therapy: induce vertigo
• Tinnitus or labyrinthine damage • Vertebroba
feeling of fullness silar
in ears Surgical treatment insufficienc
• Other factors • Cervical y
causing labyrinth sympathectomy
edema can be • Vestibular
excluded neurectomy
• Myringotomy with
grommet insertion
• Labyrinth
destruction: whole
labyrinth
• Operations on the
endolymphatic sac
• Selective
destruction of
vestibular labyrinth
by cryosurgery or
ultrasound :
semicircular canal
obliteration
• Cryosurgical
methods
• Ultrasound
Vestibular Viral infection: URTI Sudden severe attack of vertigo • Spontaneous
neuronitis N/V nystagmus
• Caloric test:
diminished
response
• Hearing test:
normal
BPPV (otolith Otolith in utricle fall off & • Head is placed in a particular Dixhallpike positional • Habituation exercises:
syndrome detached into the semicircular position test - right post EPLEY MANEUVER &
canal — lead to vertigo • Sudden/ severe attack of vertigo semicircular canal vestibular rehabilitation
<1min
• N/V

Thyroglossal Most common congenital neck • Midline or near midline mass Surgical removal Lymph nodes,
duct cysts mass • Elevates on swallowing or protrusion dermoids,
of tongue ectopic
thyroid tissue
Cystic Congenital neck mass • Found in left post triangle of the Surgical removal
hygroma neck
• Contains large cyst like cavities
containing lymph
• Found at birth not discovered late in
infant stage

Branchial cleft Congenital neck mass • Late childhood or early adukthood Initial control of infection,
cyst • Skin erythema & tenderness after surgery
recent infection
• May express Purulent material of
sinus tract is present
Tb of cervical • Post or ant triangle lymph nodes Surgical excision or anti
lymph nodes • Brawny skin, induration skin neck tuberculous
mass
• Complicated with pulmonary tb
Lymphadenitis Diabetes, HIV ptn Systemic signs of infection: Initial treatment directed
dermohemia skin, pain, hot antibiotics
Thyroid Children Leading cause of anterior neck masses Surgical excision
masses • Make predominance
• Greater chance of
malignancy
Adults
• Female predominance
• Mostly benign
Salivary • Parotid & submaxillary common Surgical removal
tumours • Any preauricular enlarging mass or
at the angle of mandible is
suspicious
• Benign: asymptomatic
• Malignancy: rapid growth, skin
fixation or cranial nerve palsies:
skewed of mouth
Neurogenic Peripheral nervous system Include schwannomas(mc),
rumours tumours neurofibromas & malignant peripheral
nerve sheath tumours
Vascular Hemangiomas; most often slowly Surgery
tumours enlarge, bluish, compressible
Lymphoma More common in pediatric & • Mass only FNAB- 1st line; Chemotherapy & radiation
young adults • Fever open biopsy if
8-% of children. With Hodgkin • Diffuse adenoma they suggestive
have neck mass CT scan (H&N,
chest, abdomen ) &
bone marrrow
biopsy
Laryngeal Ca Tobacco & alcohol Ca in supraglottis & subglottic more Surgery, with or without
frequently metastasis than in glottis chemotherapy & radiation
Hypopharynge Advanced disease Surgery chemotherapy &
al Ca radiation
OSAHS • History PHYSICAL EXAMINATION • Palate: velum of • Flexible • Non-surgical Tongue base
• Loud snoring and • General appearance: palate long or nasopharyngosco • Obese pt-wt loss obstruction
observed apneas overweight, obese, wide & short flaccid; pharyngeal py • Sleep hygiene: alc • Lingual
• Obese neck, narrow pharynx & palatial edema— • Miiller maneuver & sedating tonsillectom
• Increasing age • Facial & cervical: micrognathia, snoring-induces • Radiological medicines, y
• Sleep hygiene: retrognathia, short & thick neck, trauma; larger uvula • Cephalome nighttime caffeine • Uppp
nighttime alc & abnormal positioning of hyoid. d/t edema try & avoid activity • Laser midline
caffeine Chronic nasal obs, large vol of • Tongue: • CT; MRI such as reading or glossectomy
• Morning headaches tongue & soft palate, open-bite macroglossia, • Polysomno watching TV in • Lingualplasty
• Wt loss, otalgia, tendency bet incisors obesity, down gram bed • Radio
dysphasia, dyspnea, & • Nasal: external nasal valve syndrome (PSG) - • Sleeping on the frequency
hoarseness: possibility collapse; internal nasal valve- • Oropharynx: GOLD STD same side volumetric
of malignancy deflection of nasal septum; obesity; adenoid • Continuous positive tissue
hypertrophic turbinate: hypertrophy; airway pressure CPAP reduction
contralat inf turbinate dev tonsillar Positive Dx • Oral appliances:
hypertrophy to compensate hypertrophy more • Apnea-hyoapnea mechanically moving
excessive widening of the nasal common in children index AHI>5 the jaw or tongue
fossa • Collapsibility of • Have apnea and forward & opening the
• Rhinitis or sinusitis; nasal pharynx MULLER hypo apnea more airway
polyposis; chia all stenosis & MANEUVER than 30 times in • UPPP -
atresia • Hypopharynx :size 7hrs one night uvulopalatopharyngopla
• Nasopharynx: adenoid of hypopharynx sty
hypertrophy — 6m to 5-6yrs dec; obesity ; • Portion of soft
• Oral and oropharyngeal: open- lingual tonsils— palate, uvula and
bite deformity or micrognathia hypertrophied; tonsils removed;
class II occlusion, high arched tumour—lingual post pillars sewn
palate, hypertrophic gums thyroid, E-iglottis— anterolat
prolapse during • Complications:
inspiration voice changes,
oronasal
regurgitation of
food or liquids,
nasopharyngeal
stenosis
• Tongue suspension: for
hypopharyngeal & base
of tongue obstruction;
mechanical advances
tongue relative to post
pharynx

Foreign body • Organic material such as • Signs of tracheal foreign body • CT • History • Prehospital care
peanuts, sunflower seeds are • Audible slap at open mouth • X-ray • Symptoms & • Coughing,
most commonly aspirated during cough • Direct: signs wheezing but
material in children • Asthmatoid wheeze with ear radiopaque • Image study maintains
• In adults, meats and bones at ptns mouth foreign body airways—no
rank highest • Palpatory thud with • Indirect: intervention
• Complete obstruction induce respirations atelectasis; • Severe airway
obstructive atelectasis • Bronchial foreign body accident obstructive compromise/total
• Partial obstruction induce • Initial stage: choking, gasping, emphysema; obstruction—
obstructive emphysema coughing or airway mediastinal chest
obstruction at the time of shift; compressions or
aspiration pneumonia HEIMLICH
• Asymptomatic interval: MANEUVER
subsequent lodging of object c • Initial supportive
relaxation of reflexes resulting therapy
in reduction of symptoms, • Oxygen
lasting hrs to wks administration
• Complications stage: foreign • Cardiac monitor
body producing erosion, • Pulse oximetry
obstruction leading to • Antibiotics &
pneumonia, atelectasis or steroids
abscess • Removal of foreign body
• Bronchoscope: 1st
choice
• Fibrotic
bronchoscope
• Thoracotomy
• Tracheostomy
• Treatment of
complications