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CLINICAL OTO-RHINO-
LARYNGOLOGY

BY
MITHRAAZ 2013
KILPAUK MEDICAL COLLEGE
CHENNAI
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EAR
1. What is otitis media?

Inflammation of part of or whole of the mucoperiosteal lining of the middle ear

cleft

2. What do you mean by central perforation?

Perforation in the pars tensa and is surrounded all around by the pars tensa

3. What is subtotal perforation?

Perforation in the pars tensa which is surrounded by the fibrous annulus

4. What is total perforation?

Perforation in the pars tensa in which the annulus is also lost

5. What is marginal perforation?

Perforation at the margin of the tympanic membrane with erosion of the fibrous
annulus and bounded on one side by bone

6. What is attic perforation?

Perforation in the pars flaccida or Shrapnell’s membrane

7. How will you divide the pars tensa into 4 quadrants?

Thru a vertical line running along the handle of malleus and a horizontal line at
the level of umbo

8. How is the cone of light formed?

Because of the attachment of the pars tensa inferiorly to the inferior aspect of the
EAC which is reflected as cone of light in the antero inferior quadrant

9. What type of deafness you get in pure central perforation?

Conductive deafness
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10. Why do you get conductive deafness?

Because the vibratory area of the tm is reduced

The round window is exposed to sound

11. How much conductive deafness you expect?

20- 4o dB

12. If the deafness is 45 dB or exceeds 45 dB what is your interpretation?

Ossicular disruption

13. Which ossicle is more prone for necrosis and why?

Lenticular process of the long process of incus because of its precarious blood
supply

14.Why do you say tubotympanic disease is safe?

Because ventilation is good as Eustachian tube is situated anteriorly

Presence of pseudo-stratified ciliated columnar epithelium leading to clearance of

secretions by the mucociliary clearance

Presence of numerous goblet cells and mucus secreting glands

No vital structures

15. Why is the discharge profuse and mucopurulent in tubotympanic disease?

Because of the presence of numerous mucus secreting glands

16. Why is attico antral disease unsafe?

Ventilation is poor

Crowding of structures

Single layer of flattened pavement epithelium, without cilia, so no clearance of

secretions
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Vital structures like the incudostapedial joint, horizontal semicircular canal,

horizontal part of facial nerve

Persistent negative pressure due to mucosal fold and ossicles

17. Why do you get foul smelling scanty discharge in attico antral disease?

Because of the underlying osteitis

Single pavement epithelium with no secretory activity

18. What is cholesteatoma?

Cystic bag like structure containing squamous epithelium and debris resting on a
fibrous tissue stroma and has the property of eroding bone

19. What is halisterisis?

Hyperemic osteoclastic enzyme mediated decalcification

20. What is masked mastoiditis?

Latent, silent, masked mastoiditis.May be due to

Improper or inadequate treatment in ASOM/Organism resistant/ Pneumococcal

infection

The infection is controlled but not eradicated

Infection in the middle ear is slowed down but not checked

Slight stiffness in the ear or tinnitus

Tympanic membrane intact with persistent inflammatory thickening or

inflammatory change

Persistent impaired hearing deep mastoid tenderness

X-ray mastoid reveals extensive changes of decalcification and coalescence

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Acute symptoms subside and the patient appears well for a time- but after a
period of weeks may present with fever of unknown origin, recurring attacks of
AOM or meningitis

Facial nerve paralysis , labyrinthitis - calls attention of possible atypical

mastoiditis .

21. What is coalescent mastoiditis ?

Destruction of mastoid air cells .

Pus under pressure leads to venous stasis , local acidosis , osteoclastic

decalcification and whole of mastoid antrum is converted into sac

Creamy discharge, fever, headache, malaise and mastoid tenderness

Postero superior osseous meatal wall sagging is present

22. What is McEwen’s triangle?

Suprameateal triangle bounded by the suprameatal crest above, posterosuperior

osseous meatal wall in front and a tangential line from posterior meatal wall
cutting the suprameatal crest behind. Surgical landmark for mastoid antrum ,
mastoid antrum lies at a depth of 1.5 cms

23. What are the investigations you will do for a patient with CSOM?

Ear swab pus for culture and sensitivity

Pure tone audiometry

X-ray of both the mastoids

24. What are the uses of PTA?

To confirm the tuning fork test findings

To know the type of hearing loss

To know the degree of hearing loss

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To know the level of hearing loss

25. Why do you take an x-ray of both the mastoids?

To compare between the two sides

26. What do you look for in the x-ray?

Type of mastoid-80%cellular, 20% acellular

Mastoid outline – low lying dura and forward lying sinus plate

Cavity in the mastoid

27. What is the view?

Lateral oblique view or Law’s view

28. What is the differential diagnosis for cavity in the mastoid?

A large antral cell

Cholesteatoma cavity

Surgical cavity

Eosinophilic granuloma

29. How will you differentiate between a cholesteatomatous cavity and a

surgically created cavity?

Cholesteatomatous cavity has a sclerosed margin, surgically created cavity is

smooth

30. How do you do the fistula test?

Applying pressure on the tragus

Application of pressure using a snuggly fitting Siegle’s pneumatic speculum

31. What is false positive fistula test?

Fistula sign without a fistula
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Seen in congenital luteic syphilis (abnormal mobility of foot plate/ abnormal

laxity of stapedio-vestibular ligament) and Endolymphatic hydrops – Meniere’s
disease (distended saccule pressing upon the footplate and frequent rupture of
Reissner’s membrane with healing by formation of fibrous strands which vibrate)

32. What is false negative fistula test?

Fistula sign is absent in the presence of a fistula

Seen in dead labyrinth

33. What is Hennebert’s sign?

False positive fistula test

34. What is Tullio’s phenomenon?

Occasionally patients with a labyrinthine fistula (third window) will experience

momentary vertigo when exposed to loud noise

35. Why is ASOM more common in children?

Eustachian tube is shorter, horizontally placed

Upto 6 months the child is protected by the mother’s immunity, after that there is
a state of hypogammaglobulinemia

All exanthematous fevers like measles, chicken pox are common in children

Other reasons like overcrowding, unhygienic, poor nutrition and spread of

infection from children in day care centres and school going children

36. Why aural polyp should not be avulsed?

Because of a chance of possibility of injury to the tympanic plexus present over

the mucosa covering the promontory

Dislocation of incudostapedial joint

Subluxation of foot plate

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In 30-50% there can be a dehiscence of facial canal and a chance of injury to facial
nerve.

37. How will you differentiate an aural polyp from a mass arising from the
external auditory canal?

Aural polyp can be probed all around whereas granulation in the EAC cannot be
probed all around.

There will be H/O ear discharge and conductive deafness in aural polyp.

38. What will you do for a dry central perforation?

Myringoplasty

39. What is myringoplasty?

Surgical closure of perforation in the tympanic membrane

40. What is ABC?

Bone conduction of patient is compared with that of the examiner assuming the
examiner has normal hearing by occluding the EAC by pressing the tragus

41. What are the inferences of tuning fork tests?

In normal patients air conduction is better than bone conduction i.e., Rinne is
positive and Weber is centralized

In conductive deafness bone conduction is better than air conduction i.e., Rinne is
negative in the affected ear and Weber is lateralized to the worst ear

In sensorineural deafness, the air conduction is better than bone conduction but
it is reduced,Rinne is positive and Weber is lateralized to the better hearing ear

42. Which material is used for myringoplasty and why?

Temporalis fascia

Because : It lies in the vicinity of the surgical field

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It is available in plenty

It resembles the TM structurally

BMR is low so the uptake ratio is good

43. What are the prerequisites for myringoplasty?

Reasonably dry ear

Adequate cochlear reserve

Functioning Eustachian tube

Some amount of normal middle ear mucosa

Allergy is to be excluded

44. What are the advantages of myringoplasty?

By closing the perforation in the tympanic membrane the vibratory area of the
tympanic membrane is restored, hearing is improved

Round window is protected thereby preventing the development of sensorineural

deafness

Prevents infection from the exterior reaching the middle ear

Decreases the frequency of tinnitus

Those who require binaural hearing like telephone operators are benefitted

Patient can perform social activities like swimming

Those with a pre-existing SN loss can fit a hearing aid

45. What are the types of myringoplasty?

On lay or overlay

Underlay
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46. What are the disadvantages of on lay technique?

Epithelial pearls

Anterior blunting

Lateralization of graft

47. What are the differences between pars tensa and pars flaccida?

Pars tensa has 3 layers – outer epithelial, middle fibrous and inner mucosal layer

In pars flaccida middle fibrous layer is absent

Pars tensa is attached to the tympanic sulcus

Pars flaccida is attached to the notch of Rivinus

48. What are the parts of the middle ear?

Meso,epi and hypo tympanum

49. What is middle ear cleft and middle ear cavity?

Middle ear cleft includes the Eustachian tube, middle ear cavity, aditus ad antrum,
mastoid antrum and mastoid air cells

Middle ear cavity is that part which lies opposite to the tympanic membrane

50. What are the different types of mastoid air cells?

Zygomatic cells Perilabyrinthine cells Sinodural cells

Tegmen cells Peritubal cells Periantral cells

Perisinus cells Tip cells

Retrofacial cells Petrous cells

51. Tubotympanic CSOM occurs in which type of mastoid? Atticoantral disease

occurs in which type of mastoid?
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Tubotympanic – Cellular mastoid

Atticoantra l – Sclerotic mastoid

52. How is the tympanic plexus formed?

Parasympathetic fibres from the tympanic branch (Jacobson’s nerve) of

Glossopharyngeal nerve and sympathetic fibres from the superior and inferior
carotico tympanic nerves ramify over the medial wall of the middle ear

Post ganglionic fibres leave thru the Lesser petrosal nerve and the
auriculotemporal nerve and supply the parotid gland

53. Why do you get mixed deafness in CSOM?

In long standing cases of tympanic membrane perforation the round window is

exposed to noise and toxins, leading to hair cell damage and sensorineural
hearing loss

54. What do you mean by tympanoplasty?

It is an operation to eradicate disease in the middle ear and to reconstruct the

middle ear hearing mechanism

55. What are the types of tympanoplasty?

Type I - Myringoplasty

Type II - Absent long process of incus , incus remnant or homograft ossicle is

shaped and placed between head of stapes and handle of malleus

Type III - Malleus and incus are absent,graft is placed directly over the stapes
head, also called myringostapediopexy or columellar effect

Type IV – Round window baffle effect,only mobile foot plate of stapes is present

Type V – Fenestration - opening is made in the bony lateral semicircular canal

Type VI- Sonoversion-round window is exposed to sound

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56. What surgery do you do for a wet ear?

Cortical mastoidectomy

57. What is pre auricular sinus?

Pinna develops from six tubercles or hillocks of His. First tubercle arises from the
first arch gives rise to the tragus and the remaining five arise from the second
arch give rise to the rest of the pinna. Preauricular sinus is a sinus developing due
to a congenital malfusion of first and second arches and is found between the
tragus and the ascending limb of helix. If it is symptomatic surgical excision of the
sinus tract is done

58. What is keratosis obturans?

Amalgamation of wax, desquamated squamous epithelium with cholesterin

crystals which accumulates in deeper bony ear canal

59. What is malignant otitis externa?

Condition of otitis externa due to Pseudomonas aeruginosa that occurs in diabetic,

aged and debilitated patients and immunocompromised

Not malignant but behaves aggressively and expands the deeper bony canal

It has got a tendency to extend thru’ perineural and perivascular sheaths

Treatment – debridement, carbenicillin

60. What are the signs of retracted tympanic membrane?

Distortion of the cone of light

Foreshortening of the handle of malleus

Prominence of the lateral process of the malleus

Sickling of the anterior and posterior malleolar folds

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61. What is myringitis bullosa haemorrhagica?

Inflammation of Tympanic Membrane and formation of serous or haemmorhagic

bullae on its epithelial Surface.

Middle ear effusion may also be present

Sensory hearing loss frequently accompanies.

Often follows nonspecific upper respiratory illness, influenza infection.

Blisters are seen over the deep auditory meatus and tympanic membrane

62. What are the functions of the Eustachian tube?

Ventilation and regulation of middle ear pressure

Clearance of middle ear secretions

Prevent reflux of nasopharyngeal secretions

63. What is the locking pressure of the Eustachian tube?

90 mm Hg

64. What is myringotomy?

Incision of the tympanic membrane to drain effusion in the middle ear and for
ventilation of the middle ear

65. In which quadrant myringotomy is done in ASOM?

Curvilinear incision is made in the posteroinferior quadrant to prevent the incision

from closing and to establish adequate drainage of the ear discharge

66. What type of incision is made in SOM?

Radial incision in the antero inferior quadrant as ET is present anteriorly

67. What is the use of acetic acid for aural toileting?

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To remove the epithelial debris and by providing an acidic medium it prevents the
growth of pseudomonas.

68. What is light house sign?

Pulsatile ear discharge seen in mastoiditis when product ion of pus exceeds
drainage and the perforation is small

69. What is Luc’s abscess?

Abscess at the root of zygoma

70. What is Bezold’s abscess?

Abscess tracking along the sternocleidomastoid

71. What is Citelli’s abscess?

Abscess tracking along the posterior belly of digastric muscle

72. How will you differentiate between acute mastoiditis and externa?

Painful movements of pinna and tragal tenderness is present in OE,no mucoid or

mucopurulent ear discharge and no conductive hearing loss in OE

In mastoiditis, ear discharge is present with mastoid tenderness and conductive

hearing loss and pinna is pushed forward,outward and downward

73. What is Gradenigo’s syndrome?

Persistent ear discharge,lateral rectus palsy and retro-orbital pain in acute

petrositis

74. What % of mastoid is pneumatised? What % of petrous apex is pneumatised?

80%, 30% of 80% of petrous apex is pneumatised

75. Why do you get persistent ear discharge in petrositis?

Bony labyrinth acts as a bottleneck preventing drainage of discharge

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76. Why do you get diplopia in Gradenigo’s Syndrome?

Due to Abducent nerve involvement in Dorello’s canal

77. Why do you get retro orbital pain?

Due to irritation of Trigeminal ganglion or Gasserian ganglion in the Cave of

Retzius

78. How will you differentiate between diffuse serous labyrinthitis and diffuse
suppurative labyrinthitis?

There is no pus formation in serous labyrinthitis and is reversible

In suppurative labyrinthitis there is pus with permanent loss of vestibular and

cochlear functions

79. Why suppurative labyrinthitis does not produce systemic effects?

The quantity of endolymph (0.3 ml) is not sufficient to produce septicemia

80. What are the organisms in ASOM?

Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrrhalis

81. What are the organisms in CSOM?

Pseudomonas, Proteus, E.coli, Staph aureus, Bacteroides

82. What is Greisinger’s sign?

Oedema over the posterior part of mastoid due to thrombosis of mastoid

emissary vein in Lateral sinus thrombosis

83. What is the type of fever in lateral sinus thrombosis?

Picket fence fever

84. Why do you get anaemia in lateral sinus thrombosis?

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Due to hemolysis caused by beta hemolytic Streptococcus

85. What is Symond’s disease?

Otitic hydrocephalus –raised intracranial pressure with normal CSF findings due to
decreased absorption by arachnoid villi

86. What is flamingo pink tint of Schwartz?

Reddish hue seen on the promontory thru the tympanic membrane indicative of
active focus with increased vascularity in otosclerosis

87. What is Bell’s palsy?

Idiopathic, sudden lower motor neuron type of facial nerve palsy unassociated
with middle ear pathology

88. What is Ramsay Hunt Syndrome?

Geniculate herpes, Herpes zoster oticus

Viral infection of geniculate ganglion of the facial nerve due to dormant HZV

Sensory root of facial nerve is involved, LMN facial palsy

Severe otalgia is present,Herpetic eruptions, blisters and crusts are formed over
EAC and pinna

Vomiting and giddiness may be present

89. What is crocodile tears?

Synkinesis - During nerve regeneration axons enter empty tubules of different

nerves

Axons for salivation will go for lacrimation

90. What are the causes for pain referred to the ear?
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Lesions in the regions supplied by the trigeminal nerve, glossopharyngeal nerve

and vagus can produce pain in the ear thru the auriculotemporal, tympanic and
auricular branches respectively

91. What are the uses of Siegle’s speculum?

Designed like the TM -2 D magnification

Fistula test can be elicited

Demonstrate mobility of TM

Suction of ear discharge

92. What are the indications for cortical mastoidectomy?

Also known as simple or complete or Schwartz mastoidectomy

Acute coalescent mastoiditis incompletely resolved ASOM with reservoir sign

Masked mastoiditis

CSOM TTD/ SOM refractive to treatment

Approach to endolymphatic surgery,facial decompression,vestibulo-cochlear

nerve section, translabyrinthine approach for cerebellopontine angle, cochlear
implant surgery, combined approach tympanoplasty

93. What is the incision used for mastoidectomy?

Modified William Wilde’s incision made 5mm behind the post auricular sulcus
starting from above the pinna to the mastoid tip

94. What are the complications of mastoidectomy?

Injury to facial nerve – pyramidal part

Dislocation of incus

Injury to horizontal semicircular canal

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Injury to sigmoid sinus

Injury to dura

95. What is chemical cautery for myringoplasty?

In a small central perforation with no active ear discharge chemicals like

Trichloroacetic acid and silver nitrate are used to cauterize the edges of
perforation for the epithelium to grow.

96. What is BAD syndrome?

Bell’s phenomenon is absent

Anaesthesia of cornea

Dryness of eyes

97. What is Dorello’s canal?

Present in the petrous apex.Formed by the Gruber’s ligament which extends from
the petrous apex to the posterior clinoid process of sphenoid.Important because
through this canal Abducent nerve travels from the posterior cranial fossa to the
middle cranial fossa.In acute petrositis due to inflammation and edema the nerve
can be compressed in the canal leading to palsy.

98. What is Trautmann’s triangle?

Bounded Anteriorly by the bony labyrinth, Posteriorly by the sigmoid sinus

Superiorly dura/superior petrosal sinus

99. What are the theories of pneumatisation?

Epithelial outpouching from middle ear cleft

Degeneration and de-differentiation of mesenchyme

Distraction of outer and inner plate of mastoid

100. What are the reasons for failure of pneumatisation?

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Infantile otitis media, Heredity, Normal variant

101. What is the incision made for mastoidectomy in infants and why?

Incision is made more horizontally as the mastoid process is not developed and
the facial nerve lies exposed near its exit

102. What is atypical Meniere’s?

Vestibular Meniere’s – episodic vertigo without auditory symptoms

Cochlear Meniere’s – manifests with recurrent aural fullness fluctuation in

hearing and tinnitus without episodic vertigo or disequilibrium

Lermoyez Syndrome_ deafness and tinnitus first occur followed by vertigo with
improvement of hearing and tinnitus

103. What is Korner’s septum?

Persistent petro squamous suture persisting as a bony plate separating superficial

squamous cells from deep petrosal cells

104. DD for blue drum?

Hemotympanum,Glue ear,Glomus tumor, Hemangioma of middle ear

105. What is Carhart’s notch?

Dip in bone conduction curve at 2000 Hz seen in otosclerosis

Disappears after successful stapedectomy

106. What is Arnold’s nerve?

Auricular branch of vagus

107. What is Alderman’s nerve?

Auricular branch of vagus

108.What is Jacobson’s nerve?

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Tympanic branch of Glossopharyngeal nerve

109. What is Parascusis Willisi?

An otosclerotic patient hears better in noisy surroundings as people tend to raise

voice in noisy surroundings

110. Why is central perforation kidney shaped?

Because the central part receives poor blood supply as compared to the handle of
malleus, periphery

and the pars flaccida

111. What is otitic barotruma?

Otitis media due to pressure changes on either side of ear drum that occurs due
to rapid descent while flying or diving

112. What is the function of the Tympanic membrane and ossicles?

Preferential conduction of sound pressure to the oval window and to prevent

sound from reaching the round window

113. What is Toby Ayer test?

Also known as QUECKENSTEDT’ test

Lumbar puncture is done. Manometer is attached to needle. In normal

individuals pressure over the jugular vein increases the CSF pressure. If the
lateral sinus is thrombosed, pressure on the jugular vein on that side does not
alter CSF pressure

114. How will you differentiate between a traumatic perforation and a

perforation due to CSOM?

There will be H/O injury in traumatic perforation

Always confined to the pars tensa, Margins are ragged

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Bleeding points present

115. What is deafness?

Measurable loss of hearing

116. Why do you use tuning fork of 512Hz and 1024Hz for testing hearing?

Because it lies in the human speech frequency range

117. What is sociable hearing?

Any patient who has a hearing loss of upto 40 dB cannot be found as having
hearing loss

118. What are the features of tuberculous otitis media?

Painless,thin non odorless ear discharge

Multiple perforations

Hearing loss – disproportionate hearing loss

Facial palsy

Labyrinthitis

Pale granulations
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NOSE
1. What is Bernoulli’s phenomenon?

When gas or liquid passes through a narrow constricted area at a high velocity,
negative pressure develops in the vicinity so that mucosa is sucked along with
occurrence of edema.

2. What are the types of nasal polyp?

Antrochoanal polyp and Ethmoidal polyposis

3. What are the causes for development of nasal polyposis?

Allergy

Infection

Bernoulli’s phenomenon

Vasomotor instability

Non allergic rhinitis with eosinophilia

Allergic fungal sinusitis

Associated with Karatagener’s syndrome, cystic fibrosis and Sampter’s triad

4. Why antrochoanal polyp goes posteriorly?

Because it comes out thru’ the accessory ostium which is directed

posteriorly

The normal anatomical contour of the nasopharynx is sloping downwards

and backwards

The mucociliary clearance is directed posteriorly

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Due to the effect of gravity

5. Differences between AC polyp and ethmoidal polyposis?

ETHMOIDAL POLYP

AC POLYP

Multiple-bilateral

Single-unilateral

Affects adolescents and middle age

Affects children and younger individuals

Site of origin; ethmoidal labyrinth

Maxillary antrum

Aetiology: allergy and infection

Aetiology is not known allergy may play a role

Anterior rhinoscopy-multiple polypi in middle meatus

Posterior rhinoscopy-single polypus in choana

X ray paranasal sinuses haziness in ethmoidal labyrinth and often antra

Haziness in affected antrum

Recurrences are common

Recurrences are less common

6. DD for nasal polyp.

Hypertrophied turbinate JNA

Inverted papilloma Rhinosporidiosis

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Encephalocoele/ meningoencephalocoele in children

7. How will you differentiate between an AC polyp and a mass arising from
the roof of the

nasopharynx?

X-ray lateral view of the nasopharynx will show a curvilinear or crescentric

air shadow between the

mass and roof of nasopharynx in an antrochoanal polyp

8. What are the structures you see on post nasal examination?

Posterior end of nasal septum

Choanae

Posterior ends of the middle and inferior turbinates

Nasopharyngeal end of the Eustachian tube

Torus tubaris or tubal elevation

Fossa of Rosenmuller

9. What is Cottle’s test,line and areas?

TEST: When the cheek is drawn laterally if there is improvement of airway

on the affected side it

indicates abnormality of the vestibular component of nasal valve

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LINE : A line drawn from the nasal spine of the frontal bone to the anterior
nasal spine of the

maxilla

For any deviation anterior to the line septoplasty is done

For posterior deviations SMR is done

AREA : Vestibular, attic, valvular, turbinal and choanal

10. What is Little’s area ?

An area of arterial anastamosis between the branches of the external and

internal carotid arteries

situated in the antero inferior part of the nasal septum

Major site of bleeding

11. What are the arteries taking part in the formation of Kiesselbach’s plexus?

Anterior Ethmoidal artery Sphenopalatine artery

Greater palatine artery Superior labial artery

12. What is olfactory area?

Situated in the roof of the nasal cavity between the superior turbinate and
corresponding area of

The nasal septum

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13. What is paradoxical nasal obstruction?

A patient with a deviated nasal septum to one side complains of nasal

obstruction on the opposite

side due to the compensatory hypertrophy of the inferior turbinate on the

opposite side

14. What is compensatory hypertrophy?

Hypertrophy of the inferior turbinate on the concave side of septal

deviation to take over the

Humidification and warming

15. What are the reasons for headache in deviated nasal septum?

Deviated nasal septum can lead to obstruction of sinus ostia leading to

sinusitis and headache

Pressure on the anterior ethmoidal nerve due to impaction of septum on

the middle

turbinate leading to headache

16. What is Sluder’s neuralgia?

Pressure on the anterior ethmoidal nerve due to impaction of septum on

the middle

turbinate
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17. What are the types of septal deviation?

C shaped , S shaped, septal spur and caudal septal dislocation

18. What are the indications for SMR?

DNS with nasal obstruction

Deviation causing Sluder’s neuralgia

To close septal perforation

19. What are the indications for septoplasty?

a) Nowadays it is preferred in the majority of cases of nasal septal deflections.

b) In children (All septal surgery should if possible be left until facial growth is
complete).

c) In anterior deflections of septum where S.M.R is contraindicated.

d) In caudal dislocations

e) Approach route for trans-sphenoidal surgery

20. What are the differences between septoplasty and SMR?

S.M.R

SEPTOPLASTY

1
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Usually indicated for deflections posterior to the vertical line passing between the
nasal processes of the frontal and maxillary bones.

Indicated for anterior segment deflections and dislocations

Killian’s incision is used. Oblique incision about 5mm above the caudal border of
the septal cartilage.

Usually Freer’s hemitransfixation incision.

Mucoperichondrium is elevated on both sides

Mucoperichondrium is elevated on one or both sides.

Obstructing cartilage and bone are removed leaving only the dorsal and caudal
struts of cartilage.

Septal cartilage is freed from all its attachments and maintained in its new
position by sutures after suitable scoring.

Complications include perforation, supra tip saddling , retraction of the columella

and septal hematoma.

Complications are rare

Revision difficult

Recurrence is possible.
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21. What are the complications of septal surgery?

Hemorrhage Septal Hematoma

Septal abscess Septal perforation

Columellar retraction Flapping of the septum

Saddle nose Tip collapse

Synechiae formation

22. What are the causes for septal perforation?

Traumatic – due to septal surgery, fracture, nose picking, cautery

Infective – syphilis (bony), leprosy (bony and cartilaginous), TB

Malignancy

Chemicals – cocaine, chromic acid

23. What are the constituents of nasal septum?

Quadrangular septal cartilage, perpendicular plate of the ethmoid , vomer

with contributions from

the crest of the nasal bones, nasal spine of frontal bone, rostrum of
sphenoid, crest of palatine

bones, maxillary crest and anterior nasal spine of maxilla

24. Why ethmoidal polyp is bilateral and multiple?

Because the ethmoidal labyrinth is a single midline unit

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There are 15 -20 air cells with multiple ostia

25. What is Frog face?

Broadening of the nose. May be seen in extensive ethmoidal polyposis and

JNA

26. What is hypertelorism?

Widening of the inter canthal distance

27. Define polyp.

Polyp is a soft, smooth, cystic swelling of mucosa usually translucent may be

opaque or pale due to

exposure to air currents or trauma

Microscopically it consists of hypertrophied edematous mucosa usually lined

by ciliated columnar

epithelium, may be transitional or squamous due to exposure to air

currents, consisting of fibrillar

stroma with intercellular fluid spaces with lymphocytes, polymorphs and

eosinophils

28. Why polyp is insensitive to touch?

Because it does not have nerve endings

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29. Why polyp does not bleed on touch?

Because it is avascular

30. If a polyp bleeds what will you suspect?

Metaplasia to transitional or squamous epithelium due to exposure to air

currents

Underlying malignancy in an elderly patient

31. A child with a unilateral nasal obstruction with foul smelling nasal
discharge and bleeding, what

Will you suspect?

Foreign body

32. What is atrophic rhinitis?

Non-specific chronic inflammatory condition of the nasal cavity

characterized by progressive

atrophy of the nasal mucosa with underlying turbinates resulting in

abnormal patency with

yellowish - green crust formation and usually associated with ozaena

33. What is cacosmia?

Perception of bad odour

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34. What is merciful anosmia?

Patient with atrophic rhinitis has hyposmia or anosmia but foul odour is
detected from the patient

by others due to presence of foul smelling crusts

35. What are the organisms present in atrophic rhinitis?

Coccobacillus, Bacillus mucosus, Coccobacilus foetidus ozenae, Klebsiella

and Diphtheroids

36. What are the causes of Atrophic rhinitis?

Primary – cause is not known, may be due to hormonal , hereditary,

autoimmune response of

Mucosa , zinc, iron and Vitamin A deficiency and a variant of Reflex

Sympathetic Dystrophy

syndrome

Secondary – may be due to trauma, extensive nasal surgery and

inflammatory due to

Tuberculosis , syphilis

37. What are the types of Atrophic rhinitis?

Type I – Terminal arterioles show endarteritis and periarteritis

Type II – Vasodilatation is present

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38. What are the conventional methods of polypectomy?

Intranasal polypectomy (avulsion)

Intranasal ethmoidectomy

External ethmoidectomy

Transantral ethmoidectomy

FESS

39. What are the indications for Caldwell- Luc surgery?

Chronic maxillary sinusitis unresponsive to medical treatment and minor

surgical procedures like

antral lavage

Recurrent antrochoanal polyp

Trans antral ethmoidectomy

Suspected antral malignancy for doing a biopsy

Removal of foreign bodies in the antrum (most common FB is tooth)

Blow out fractures of the orbit

Repair of oro antral fistula

Transantral ligation of maxillary artery in the pterygopalatine fossa

Transantral vidian neurectomy

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40. Which is the indication as well as complication for Caldwell- Luc surgery?

Oro-antral fistula

41. How will you treat atrophic rhinitis medically?

MEDICAL : Alkaline douche with soda bicarbonate, sodium biborate and

sodium chloride in the

ratio of 1:1:2 dissolved in 280 ml of water

Application of 25% glucose in glycerine will inhibit proteolytic organisms

and keep the mucosa

moist

Oestradiol in arachis oil

Injection of placentrex – biological product which has got biogenic action

Kemicetine antiozaena solution – chlormycetin,estradiol and vitamin D2

42. What is the surgery you do for atrophic rhinitis?

Aim is to narrow the nasal cavity and give rest to the nasal mucosa

Young’s operation /Modified Young’s operation

Lautenslager’s operation

Transpositioning of the Stensen’s duct into the maxillary antrum to moisten

the nasal cavity

43. What is the characteristic nasal bleeding in JNA?

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Repeated unprovoked uncontrollable profuse torrential bleeding

44. What is the use of carotid angiography in a case of JNA and what is
therapeutic embolisation?

Angiography is done 1 or 2 days before surgery to know the vascularity of

the tumor and to know

the feeding vessel and for intentional intravascular embolisation using

gelfoam or catgut to reduce

the peroperative bleeding.It can occasionally cause cerebral embolism.

45. What is Holman-Miller sign?

Anterior bowing of the posterior wall of the maxillary sinus seen in JNA

46. What are the functions of the nose?

Respiration Air conditioning of inspired air

Protection of lower airway Vocal resonance

Olfaction

47. What is the nerve supply of nose?

Anterior Ethmoidal nerve

Branches of sphenopalatine ganglion

Branches of infraorbital nerve

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48. What are the clinical findings in sinusitis?

Presence of mucopurulent or purulent discharge in the meati

Sinus tenderness

Post nasal drip

49. What are the investigations you will do for a patient with DNS and
sinusitis?

Diagnostic nasal endoscopy

X ray para nasal sinuses – Water’s view

CT scan of the paranasal sinuses

50. What will you look for in the X ray?

Anterior group of sinuses will be visualized

Compare the sinuses on both sides

Look for haziness,thickening of mucosa and fluid level

Scalloped appearance of the frontal sinus

51. What are the findings in x-ray of PNS suggestive of malignancy?

Haziness or opacity

Enlargement of corresponding antrum

Thinning of outline

Discontinuity of outline due to erosion

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52. Where will you palpate for sinus tenderness?

Maxillary sinus – Canine fossa

Frontal sinus - Floor of the frontal sinus

Ethmoidal sinus – Just medial to the medial canthus

53. What is transillumination test?

It is done by placing a torch inside the oral cavity and observing the infra-
orbital crescent in a dark

room. When there is pus in the maxillary antrum the crescent is absent.For
the frontal sinus it is

done thru the floor of the frontal sinus

54. What is antral lavage?

It is a minor surgical procedure done through the inferior meatus and

puncturing of the lateral wall

to enter the maxillary antrum

Diagnostic - aspirate can be sent for culture and sensitivity

Therapeutic - antral wash can be given for chronic sinusitis

A Tilley-Lichtwitz trocar and cannula is used

55. What is Pott’s puffy tumor?

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It occurs as a complication of sinusitis where there is subperiosteal abscess

outside,extradural

abscess intracranially and osteomyelitis of the frontal bone in between.

56. What are the structures passing thru’ the superior orbital fissure?

It is made up of three compartments.

The lateral compartment -the lacrimal N, frontal N., trochlear N and

superior ophthalmic vein

The middle compartment has the tendinous ring which gives origin to the
extra ocular muscles,

the upper and lower divisions of the III CN are present, in between the
nasociliary nerve,in between

the 2 heads of the lateral rectus VI CN passes

The medial compartment contains the inferior ophthalmic vein and the
optic nerve in its own canal,

the optic canal

57. What is superior orbital fissure syndrome?

Infection of sphenoid sinus can affect the superior orbital fissure leading to
deep orbital

pain, frontal headache and progressive paralysis of CN VI,III and IV

58. What is orbital apex syndrome?

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It is superior orbital fissure syndrome with blindness due to involvement of

the optic nerve

59. What do you mean by mucocele?

It is a cystic swelling of the frontal,ethmoidal or frontoethmoidal which

contains mucous

secretions

Situated near the medial canthus in the case of a Frontal mucocele.

In ethmoidal or frontoethmoidal mucocele a cystic swelling is seen in the

middle meatus

On palpation there is a non tender irreducible rubbery swelling with

absence of inflammatory signs

If the bone is thin and breaking – egg shell crackling is present

If the bone is totally absent – fluctuation is present

If the inner table of the frontal sinus is eroded pulsation is present

Xray shows affected sinus larger than the opposite side,loss of scalloped
appearance in frontal

sinus

Ethmoid cells replaced by one cystic cavity

Treatment – External frontoethmoidectomy / FESS

60. Where do the sinuses drain?

Maxillary sinus drains in the posterior part of the infundibulum into the
middle meatus
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Frontal sinus drains into the middle meatus thru the frontonasal duct

Anterior ethmoid group drains into the middle meatus

Posterior ethmoid group drains into the superior meatus

Sphenoid sinus drains into the spheno ethmoidal recess

61. Which perforation produces whistling sound?

Small septal perforation

62. What is rhinolalia clausa?

Any mass or growth occluding the nasopharyngeal space producing

hyponasal voice e . g. adenoids

antrochoanal polyp

63. What is rhinolalia aperta?

Abnormal nasopharyngeal space or incompatability of the soft palate which

fails to approximate

the nasopharyngeal isthmus e.g., cleft palate,palatal paralysis

64. Why do you get epistaxis in DNS?

Mucosa over the deviated part of septum is exposed to the drying effects of
air currents leading to

formation of crusts which when removed can cause bleeding

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65. Why do you get anosmia in DNS?

Failure of inspired air reaching the olfactory area

66. What is avulsion of nasal polyp?

Removal of polyp along with its ostia

67. How is the vidian nerve formed?What is the importance of the nerve?

Lacrimatory nucleus → nervus intermedius → geniculate ganglion →

greater superficial

petrosal nerve →joined by sympathetic branches from plexus surrounding

Internal Carotid artery

(deep petrosal nerve)→Vidian Nerve or nerve of the pterygoid canal

→sphenopalatine ganglion

→zygomatic and lacrimal branches supplies the lacrimal glands and also
glands in the palate and

nose

Controls the autonomic functions of the nose

Vidian neurectomy can help in the treatment of vasomotor rhinitis

68. What is the dangerous area of face?

It includes upper lip, nasal tip and its surrounding area. Infection in this area can
spread to cavernous sinus through anterior facial or angular veins

69. What is rhinolith?

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Stone like calcareous deposits found inside the nasal cavity

They may also show tentacles

Chiefly made of phosphates and carbonates of calcium and magnesium

These salts have been found to be deposited around a nucleus which could be
inspissated mucous,

blood clot or a small foreign body

On probing the presence of a stony hard structure[gritty sensation]

Removal – piecemeal,Caldwell-Luc or lateral rhinotomy

70. What is CSF Rhinorrhea?

Leakage of CSF from the nose

71. What are the functions of the paranasal sinuses?

Air conditioning of respiratory air Help in resonance of voice

Lightening of weight of skull bones Thermal insulation of orbit

Help in symmetrical growth of orbit

72. Which bones develop osteitis and which bones develop osteomyelitis?

Osteitis occurs in compact or ivory bone like the floor of the frontal sinus
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Osteomyelitis occurs in the diploeic bone like the anterior wall of the frontal
sinus and the maxillary alveolus

73. What is oroantral fistula?

A communication between the antrum and oral cavity

May occur following dental extraction (second premolar and first molar- upper),

Caldwell Luc surgery, maxillary carcinoma

74. What is inverted papilloma?

Also known as Ringertz tumour

It is so named because microscopically neoplastic epithelium grows

towards the underlying stroma

Seen on the lateral wall of nose

Has a tendency for recurrence and malignant transformation

75. What is office headache or vacuum headache?

Headache in frontal sinusitis shows a characteristic periodicity. It comes on

waking up in the

morning, gradually increases ,reaches its peak in the midday and then starts
subsiding.

76. What are the regions where headache occurs in sinusitis?

Maxillary sinus - Infraorbital pain

Frontal sinus – Supraorbital pain

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Ethmoid sinus – Pain over the bridge of the nose and between the eyes

Sphenoid sinus – Occipital,vertical or retro orbital pain

77. What is the dangerous area of nose?

Olfactory area because infection can spread from the nose intracranially through
the pia-arachnoid

sheath of the olfactory nerve through the cribriform plate of the ethmoid

78. What is septal spur?

Sharp angulation occurring at the junction of septal cartilage with the ethmoid or
vomer

79. What is Rhinophyma?

Also known as potato nose, caused by the hypertrophy of sebaceous glands

80. What is Sampter’s triad?

Asthma, aspirin sensitivity along with nasal polyposis

81. What is Kartagener’s syndrome?

Bronchiectasis, sinusitis,situs inversus and ciliary dyskinesia

82. What is Young’s syndrome?

Nasal polyposis,bronchiectasis,sinusitis and azoospermia

83. Why do you get altered perception of smell in atrophic rhinitis?

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Crusts may be present in the olfactory area

Atrophy of the mucosa

Damage to the nerve endings

84. What is rhinosporidiosis?

Fibromyxomatous structure caused by infection with fungal

infection ,Rhinosporidium seeberi

Appears as multiple nodules or leaf shaped with rounded or dentate margins

Bleeding polypus,friable resembling like strawberry with a grayish undersurface

studded with sporangia showing white dots

85. How will you differentiate a polyp from a hypertrophied turbinate?

Turbinate is sensitive to touch,firm in concictency,cannot be probed all around

Polyp is insensitive to touch,soft in consistency and can be probed all around

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THROAT
1. What is the function of the tonsils and adenoids?

Defence mechanism – production of lymphocytes and plasma cells

Guards the oropharynx by filtering the infection from spreading to the

aerodigestive tract -POLICEMAN

2. What are differences between tonsils and adenoids?

Adenoids
Tonsils

Single midline structure in the nasopharynx Paired bilateral

structure in oropharynx

Capsule is absent Capsule is present

Lined by pseudostratified ciliated columnar epithelium Lined by non

keratinizing squamous epithelium

No crypts,has longitudinal ridges and furrows Numerous crypts

are present

Drains to the Retropharyngeal lymph node Drains to the

jugulo digastric or Wood’s node

3. What is Waldeyer’s ring?

Collection of subepithelial lymphoid tissue

Inner ring – adenoids, tubal tonsils, palatine tonsils and lingual tonsils

Outer ring – submental, submandibular, facial, upper deep cervical and

retropharyngeal nodes
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4. What is the difference between tonsil and lymph node?

Tonsil – subepithelial lymphoid tissue, no afferent only efferent

Lymph node has both afferent and efferent

Tonsil is partly capsulated and has crypts

Lymph node is encapsulated and has a cortical and medullary differentiation

5. What are the structures forming the bed of tonsil?

Loose areolar tissue

Pharyngobasilar fascia

Superior constrictor muscle

Paratonsillar vein

Buccopharyngeal membrane

6. What is Passavant’s ridge?

Mucosal elevation produced by the palatopharyngeus muscle at the level of

the nasopharyngeal

Isthmus, prevents regurgitation of food from the oropharynx into the

nasopharynx

7. What are the muscles forming the anterior and posterior pillars?
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Anterior pillar- palatoglossus muscle

Posterior pillar – palatopharyngeus muscle

8. What will happen if you damage the pillars during surgery?

Anterior pillar damage can lead to asymmetry

Posterior pillar injury can lead to velopharyngeal insufficiency

9. What is Adenoid facies?

Open mouth and mouth breathing Pinched nostrils

Crowded teeth High arched palate

Loss of nasolabial folds Rhinolalia clausa

Pectus excavatum Underslung mandible

Hypoplasia of maxilla Rounded shoulders

Vacant expression

10. What are the cardinal signs of chronic tonsillitis?

Flushing of the anterior pillars

Hypertrophied tonsils

Posterior pillar is not visible

Extrusion of cheesy material on pressure over the tonsils using two tongue
depressors

Enlarged non tender jugulodigastric lymph node also known as Wood’s node
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11. What is Irwin Moore’s sign?

Extrusion of cheesy material on pressure over the tonsils using two tongue
depressors

12. What are the types of Chronic Tonsillitis?

Chronic parenchymatous, chronic follicular and chronic fibrotic

13. What is the DD for a patch or ulcer over the tonsils?

Apthous angina

Monocytic angina

Vincent’s angina

Agranulocytic angina

Leukemic angina

14. What organism causes Infectious Mononucleosis? What are the other
diseases caused by that

organism in ENT?

Epstein-Barr virus

Also causes Nasopharyngeal Carcinoma and Burkitt’s lymphoma

Diagnosed by Paul-Bunnell test

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15. What causes Vincent’s angina?

Symbiotic process between spirochaete Borrelia vincenti (sp. Denticola) and

gram negative fusiform

Bacilli

16. What are the investigations you do for a patient before tonsillectomy?

Blood hemoglobin RBC count

Total leucocyte count Differential count

Bleeding time Clotting time

Platelet count Blood glucose

Blood urea Chest X ray

Blood grouping and Rh typing ECG

17. What is the blood supply of the tonsil?

Arterial supply from

Tonsillar branch of the Facial artery

Branch from the ascending pharyngeal artery

Descending palatine artery a branch from the maxillary artery

Ascending palatine branch of facial artery

Dorsalis linguae arteries

Venous drainage is thru the paratonsillar vein to the common facial vein
and pharyngeal plexus
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18. What is Eagle’s Syndrome?

Elongated styloid process

Ossification of the stylohyoid ligament pressing on the tonsillar bed and the
glossopharyngeal nerve

Can cause referred otalgia

19. What are the indications for tonsillectomy?

Recurrent attacks of acute tonsillitis (more than 6 episodes per year in a

young child or 2-3 per year

in an adult

Chronic tonsillitis

One attack of peritonsillitis/peritonsillar abscess

Tonsillar hypertrophy obstructing respiration or deglutition

Diphtheria carrier state

Unilateral tonsillar enlargement

Unexplained cervical adenitis

Benign tumors of the tonsil like papilloma

Tonsillolith/Tonsillar cyst

Approach to elongated styloid process and glossopharyngeal nerve

Enlarged tonsils causing snoring and OSA

OTHER INDICATIONS
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Focal infections like CSOM, OME and Rhinosinusitis associated with tonsillar
infection

Rheumatic heart disease

Acute glomerulonephritis

Failure to thrive

20. What are the contra indications for tonsillectomy?

Aneurysm or abnormal vasculature of tonsil

Epidemic of polio

Acute tonsillitis

Age below 3 years

Bleeding diathesis

Uncontrolled DM and HT

21. What are the methods of tonsillectomy?

COLD METHODS

Guillotine Dissection and snare

Cryosurgery Harmonic scalpel

HOT METHODS

Coablation Laser

Electrocautery Radiofrequency

22. What are the complications of tonsillectomy?

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Haemorrhage

Aspiration pneumonia/collapse of lung

Injury to teeth, lips, the anterior and posterior pillars

23. What is reactionary hemorrhage? What are the causes?

Bleeding occurring during the first 24 hours after surgery

It occurs due to slippage of ligature

Regaining of the normal blood pressure leading to opening of collapsed

vessels leading to bleeding

Dislodgement of clot

Clot sitting on the vessel and preventing it from contracting

24. What is secondary hemorrhage? What are the causes?

Bleeding occurring within 5-10 days

Due to infection

25. What is the important contraindication for adenoidectomy?

Presence of cleft palate even submucous cleft as it can lead to rhinolalia

aperta

26. What is quinsy?

Cellulitis and abscess formation between the tonsillar capsule and tonsillar
bed
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27. What are the clinical features in quinsy?

Presence of severe pain, odynophagia,trismus and restricted neck

movements

Tonsil is congested

Soft palate is edematous on the affected side

Uvula is pushed to the opposite side

Enlarged tender JD node

28. Where will you incise a peritonsillar abscess?

The most prominent site of bulge

A line is drawn from the base of the uvula horizontally to the last upper
molar tooth and a vertical

line from the anterior pillar.Incision is made superolateral to the

intersection of these two lines

29. What is abscess or hot tonsillectomy?

Tonsillectomy is done at the time of an acute attack of quinsy

Advantage is tonsil is already separated from the tonsillar bed and plane of
dissection is easy

Disadvantage is it can lead to excessive hemorrhage or

aspiration,dissemination of infection leading

to bacteremia and septicemia

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30. What is cold or interval tonsillectomy?

Tonsillectomy is done 4-6 weeks after an acute attack of quinsy after incision
and drainage and

adequate antibiotic treatment

31. Why do you get abdominal pain during acute tonsillitis?

Due to mesenteric adenitis

32. How will you differentiate between acute membranous tonsillitis and
diphtheritic tonsillitis?

Epidemic of diphtheria is present

Toxic complications present

The membrane not only covers the tonsil but also extends to the uvula, soft
palate

It is adherent , peeling is difficult and produces bleeding

Membranous tonsillitis is confined to the tonsils and can be removed easily

33. What are the branches of the external carotid artery?

Superior thyroid artery Occipital artery

Lingual artery Posterior auricular artery

Ascending pharyngeal artery Internal maxillary artery

Facial artery Superficial temporal artery

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34. Why is stone formation common in the submandibular duct?

Mixed salivary gland /mostly mucous secretion

It drains against gravity

The lingual nerve hooks around the Wharton’s duct

35. How is the tongue divided into anterior two thirds and posterior one third?

By the circumvallate papillae

36. What are the characteristics of inflammatory, tuberculous and malignant

lymph node?

Inflammatory – soft,smooth , tender mobile usually solitary

Tuberculous – multiple, matted, firm, puckering of skin may be present

Malignancy – hard in consistency,may be mobile or fixed to deeper

structures usually the carotid

sheath

37. Why left recurrent laryngeal nerve is more prone for palsy?

Because it has a long course in the neck and thorax

It hooks around the ductus/ligamentum arteriosum

38. What is Semon’s law?

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In all progressive organic lesions of the recurrent laryngeal nerve the

abductors are the first to be

paralysed followed by the adductors and on spontaneous recovery the

reverse occurs.

This is because the abductors are phylogenetically newer

39. What is steeple sign?

It is a radiological sign seen in xray AP view of neck due to ALTB or croup

due to subglottic edema

and narrowing of subglottic region

40. What is thumb sign?

Radiological sign seen in acute epiglotittis on lateral view of X ray of neck –

swollen epiglottis

41. What is stridor?

Is a noisy breathing resulting from narrowing of airway at the level of larynx

or below the larynx

42. What is stretor?

Stretor is the noisy breathing due to narrowing of airway above the larynx.e.g.,
hypertrophied adenotonsillitis
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43. What are the differences between IDL and direct laryngoscopy?

S.No

INDIRECT LARYNGOSCOPY

DIRECT LARYNGOSCOPY

There is foreshortening in A.P.diameter

There is no foreshortening

True and false cords appear to be in contact with each other

True and false cords are separated by ventricle

Inverted mirror image is seen

There is no inverted image (infact direct visualization of the structures

Vocal cords look flat and white with sharp free margin

Vocal cords are slightly rounded and faintly pink in colour

The movement of vocal cords is seen better

Movement is seen only in local anaesthesia

The under surface of vocal cords is not seen

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The under surface of vocal cords is not seen in this procedure also, but some idea
of under surface is gained by pressing the vocal cord of the opposite side by the
blades of laryngoscope

Ventricle is not seen

Ventricle is seen by pressing the false cords

It is an OPD procedure

It is done in operation theatre.

44. What are the differences between vocal cord palsy and ankylosis of
cricoarytenoid joint?

In vocal cord palsy the Antero posterior diameter is shortened.

Arytenoids fall forwards and downwards

Bowing of the vocal cord is present

Flickering of vocal cords during phonation is seen

In ankylosis , the arytenoid is prominent.

Length of the vocal cord is maintained.

The cord appears tense

45. Why glottic carcinoma has a good prognosis?

Patient comes early to the doctor because of hoarseness of voice

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Lack of subepithelial lymphatics

Has fibroelastic tissue which prevents the growth from spreading for a
considerable duration of time

Responds well to radiotherapy

46. What are the structures you see on IDL scopy?

Epiglottis Valleculae

Median and lateral glossoepiglottic folds Aryepiglottic folds

Arytenoid cartilages True and false vocal

cords

Pyriform fossae

47. What is Bocca’s sign?

Side to side laryngeal movements over the underlying vertebral column

produces laryngeal crepitus.

Absence of this crepitus in post cricoid growth is Bocca’s sign

48. What is Ortner’s syndrome?

Left recurrent laryngeal nerve palsy due to pressure by enlarged left atrium in
mitral stenosis

49. What is odynophagia?

Painful swallowing
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50. What is absolute dysphagia?

When the patient has difficulty in swallowing even saliva

51. Why do you get trismus in quinsy?

Due to spasm of the muscles of mastication

52. What is Patterson Brown Kelley syndrome?

Achlorhydria, koilonychia, glossitis, cheilitis, iron deficiency

anaemia,splenomegaly and post cricoid

Web,premalignant condition

Also known as Plummer Vinson syndrome or Sideropenic dysphagia

53. What are the causes for unilateral tonsillar enlargement?

Intratonsillar causes – tonsillolith,tonsillar cyst,peritonsillar abscess,foreign bodies,

tumors of the

tonsil

Extra tonsillar causes – carotid artery aneurysm,parapharyngeal

abscess,parapharyngeal tumours,

deep lobe of parotid gland tumors

54. What are the different positions of the vocal cord?

Median – midline – during phonation

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Paramedian – 1.5 mm from midline – recurrent laryngeal nerve palsy

Intermediate or cadaveric – 3.5 mm from midline – both recurrent and external

laryngeal nerves are

paralysed

Partial abduction - 7 mm from midline

Full abduction – 9.5 mm from midline

55. How will you know if a foreign body coin is in the airway or food passage?

If an Xray AP and lateral view of the soft tissues of the neck is taken, if the coin is
at the level of cricopharynx or cervical esophagus the FB will be in the coronal
position

But in the laynx and subglottic region it will be in the sagittal position

56. What is laryngomalacia?

Congenital condition

Weak supraglottic framework which collapses during inspiration and produces

noisy breathing or

stridor

Especially during exertion, crying or superadded infections

Omega shaped epiglottis

Short aryepiglottic fold

Loose ,lax mucosa with high sensitivity

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57. What are the differences between adult and infant larynx?

Size – smaller in infants

Shape – funnel shaped due to omega shaped epiglottis

Cartilage is softer in infants

Superiorly placed

Straighter in infants

Highly Sensitive

Subglottis is narrow

58. What is keratosis pharyngis?

Yellowish white horny outgrowths of cornified epithelial cells formed by

hypertrophy and

Keratinisation of epithelium involving the tonsils,posterior pharyngeal

wall,lateral pharyngeal

wall,lingual tonsils and larynx

59. Which parts of the larynx are covered by squamous epithelium?

Vocal cord, upper part of the aryepiglottic fold, interarytenoid region, lingual
surface of epiglottis

60. What are the advantages of LASER tonsillectomy?

Quicker healing

Less operative time

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Less blood loss

61. What is Rose position?

Tonsillectomy position where the patient lies supine with extension at the atlanto
occipital joint and flexion at the cervical vertebra

62. What is Killian’s dehiscence?

A weak area in the posterior pharyngeal wall between the thyropharyngeus and
cricopharyngeus muscles

Zenker’s diverticulum develops here

63. What is the crypta magna?

Largest intra tonsillar crypt lying near the upper pole

Represents a remnant of the second pharyngeal pouch

64. What is Ludwig’s angina?

Infection of the submandibular space following periodontal disease

65. Which are the hidden areas of malignancy in ENT?

Fossa of Rossenmuller

Pyriform fossa

Retromolar trigone
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66. What is the Sinus of Morgagni ?

Potential space between the skull base and the upper border of the superior
constrictor muscle.

Transmits the Eustachian tube, levator and tensor palate muscles along with the
ascending pharyngeal artery

67. What are the parts of the laryngopharynx?

Pyriform sinus,post cricoid region and posterior pharyngeal wall

68. What are the levels of lymph nodes of the Head and neck?

I Submental and submandibular nodes

II Upper jugular nodes

III Middle jugular nodes

IV Lower jugular nodes

V Posterior triangle

VI Prelaryngeal,paratracheal and pretracheal nodes

VII Superior mediastinal nodes

69. What are the predisposing factors for oral malignancy?

8S

Smoking Syphilis
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Spices Sharp tooth

Submucous fibrosis Sideropenic dysphagia

Sepsis Spirit

70. What are the actions of the intrinsic muscles of the larynx?

Posterior cricoarytenoid – abduction

Lateral cricoarytenoid , interarytenoid, cricothyroid and thyroarytenoid –

adduction

Cricothyroid,thyroarytenoid and vocalis – tensors

71. What is the reason for the laryngeal prominence in males?

In males the thyroid notch is at an angle of 90° while in females it is at an angle of

120°

72. What is the length of the vocal cord?

In adult male 22 mm adult female 19-20 mm

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73. What is the mechanism of action of cryosurgery?

Cryosurgery means surgery by freezing

When a gas under high pressure is suddenly allowed to expand its temperature
falls,so the cryoprobe allows a compressed gas to escape thru a narrow tip
producing the tip temperature around or more than -70° C which leds to tissue
death

Gases used liquid N2, nitrous oxide or CO2

Formation of intracellular ice crystals leading to swelling and rupture of cells

Intracellular dehydration

Toxic concentration of electrolytes and alteration of cellular pH

Denaturation of cellular proteins

Derangement of cellular respiration and metabolism

Microthrombus in capillaries and local ischemia

74. What is carcinoma in situ?

Intraepithelial carcinoma with an intact basement membrane or without

breaching the basement membrane

75. What is neoplasm?

Purposeless, perverted, progressive growth of tissue which exceeds and is unco-

ordinated or unassociated with that of the normal tissue and exists in the same
excessive manner even after cessation of stimuli which invoked the response.

76. How will you identify a non opaque foreign body?

By fluoroscopy
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77. How will you a suspect a foreign body inhalation in children?

A well, normally playing child suddenly develops choking, respiratory distress,

unexplained repeated cough, wheezing and sometimes cyanosis

78. Why is foreign body more common in the right main bronchus?

Angulation of Right main bronchus to the tracheal line is less

The carina is situated slightly towards the left

The right main bronchus is wide, so more air current passes

79. What are the types of obstruction in trachea bronchial tree?

That which allows inspiration but no expiration – ball valve- emphysema

That which causes complete obstruction- collapse of lung

That which allows both inspiration and expiration

80. What is the length of esophagus?

From the upper incisor to the Gastro esophageal junction in adults 40 cms

From the incisors to cricopharynx – 15 cm

From the cricopharyngeal junction to the gastro esophageal junction – 25 cms

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So the length of the esophagoscope used should be more than 40 cms

81. What are the normal anatomical constrictions in the esophagus where
foreign body can lodge in the esophagus?

At the level of cricopharynx

At the level of arch of aorta

At the level where the left main bronchus crosses

At the Gastro-esophageal junction

82. What is the difference between oesophagoscopy and bronchoscopy?

Oesophagoscope is bigger and longer in size

In bronchoscope side holes are present for ventilation of remaining bronchioles

83. Why vegetable foreign body is more dangerous?

Because it is hygroscopic in nature and can swell

Releases vegetable oils which is irritant and toxic

84. What are the indications for tracheostomy?

Airway obstruction

Secretions retained in the laryngotracheal tree

Inhalation of fluids into the trachea

Respiratory insufficiency (pulmonary,circulatory, neuromuscular diseases)

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85.What are the advantages of Tracheostomy?

a) It relieves the upper airway obstruction.

b) It decreases the amount of dead space (30-50%)

c) It provides access to clean the tracheobronchial tree.

d) It protects against aspiration.

e) It reduces the resistance of airflow and increases total compliance and

alveolar ventilation.

f) Helps in intermittent positive pressure ventilation.

g) Induction of anaesthesia