Textbook of Ear, Nose and Throat Diseases Mohammad Maqbool, Suhail Maqbool
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1Textbook of Ear, Nose and Throat Diseases2
3Textbook of Ear, Nose and Throat Diseases
Eleventh Edition
Mohammad Maqbool MBBS DLO MS FICS Ex-Professor and Head Department of Otorhinolaryngology Government Medical College Srinagar, J & K Suhail Maqbool MBBS MS Assistant Consultant Department of ORL King Fahad Medical City KSA
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: 32558559
Fax: +91-11-23276490, +91-11-23245683
Branches
Textbook of Ear, Nose and Throat Diseases
© 2007, Mohammad Maqbool, Suhail Maqbool
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition : 1982
Second Edition : 1984
Third Edition : 1986
Fourth Edition: 1988
Fifth Edition : 1991
Sixth Edition : 1993
Seventh Edition : 1996
Eighth Edition: 1998
Ninth Edition : 2000
Tenth Edition : 2003
Eleventh Edition: 2007
9788184480818
Typeset at JPBMP typesetting unit
Printed at Gopsons Paper Ltd, Noida
5This Edition dedicated to the original Author—a teacher to many, a guide to many more and to me all that and a loving father.6
7Foreword
Dear Reader,
The eleventh edition of the Textbook of Ear, Nose and Throat Diseases is an excellent overview for medical students and the general practitioners. It is a comprehensive review of many of the specific ENT problems which trouble patients.
ENT problems form a large segment of general practitioner's patient evaluation and treatment. These doctors are the primary level of medical care.
Many physician groups form the secondary level of ENT practice and they are capable of proper evaluation and general surgical treatment of many disorders. These secondary level specialists will also sometimes refer to yet more highly trained, tertiary ENT sub-specialists who have become very skilled in a variety of relatively rare and challenging issues.
Our hope and belief is that this compact volume, as it has throughout the history of its publication and evolution, will continue to contribute to the knowledge of the wider medical community, so that ENT-specific problems can be rapidly and accurately identified and these patients either treated by their primary care providers, or appropriately referred.
Dr William F House
House Ear Institute
LA California
USA8
9Preface to the Eleventh Edition
Through the grace of almighty God and the continuous appreciation of previous editions by the vast number of medical fraternities from all over the country, the eleventh edition is in the hands of the readers.
Efforts have been made to make this textbook more informative and update.
A new Chapter on Headache has been added. A few new topics such as Neck masses, Tumours of Thyroid, Anthrax, etc. have also been incorporated. I am sure that the students both undergraduate and postgraduate, interns and general practitioners, all will be benefitted. Any constructive and healthy criticism to make this textbook more informative will be highly appreciated.
I am highly thankful to my ex-students and colleagues Dr Rafiq Ahmad and Dr Qazi Imtiaz for their deep interest in the script and additions in the book.
Thanks are due to Shri Jitendar P Vij, Chairman and Managing Director, MrTarun Duneja (General Manager, Publishing) and Mr PS Ghuman (Senior Production Manager) of M/s Jaypee Brothers Medical Publishers Pvt. Ltd., New Delhi for their kind cooperation.
Thanks are also due to Dr William F House for writing a foreword to this edition.
Mohammad Maqbool
Suhail Maqbool10
11Preface to the First Edition
Though there are quite a few books on otorhinolaryngology now available in the country, omission of some important topics or common conditions is noticed in most of these books. As such, a student or a clinician feels handicapped and has to waste a lot of time in looking from book to book for a particular topic or information. A humble effort has been made to prepare a comprehensive Textbook of Ear, Nose and Throat Diseases which would provide all the necessary details and conception to the reader. I hope and pray that all the readers of this textbook, undergraduate and postgraduate students, academicians, and general practitioners will be benefitted.
I owe personal thanks to my departmental colleagues particularly to DrAb.Majid, Dr Ghulam Jeelani and Dr Rafiq Ahmad for their constant interest and contribution to the text.
I must particularly thank Shri Jitendar P Vij of M/s Jaypee Brothers Medical Publishers Pvt. Ltd., New Delhi for his help and cooperation. I would feel grateful for any suggestions and healthy criticism from readers.
Mohammad Maqbool
12Introduction  
PRELIMINARY CONSIDERATIONS IN EXAMINATION
 
History Taking
Before proceeding to the examination of a patient, a detailed and proper history taking is a must. The relevant points to be noted may vary from one organ to another, hence are described at the beginning of each section.
The examination room should be reasonably large and noise free.
Most of the ear, nose and throat areas lend themselves to direct visualisation and palpation but a beam of light is needed for proper visualisation of the inside of the cavities.
Hands should be free for any manipulation. This is achieved, if a beam of light is reflected by a head mirror or head light. Usually the head mirror is used. The head light serves the same purpose in the operation theatre.
 
Head Mirror
This consists of a concave mirror on a head-band with a double box joint. The head mirror should be light as it is worn for long periods of time and may cause headache. The purpose of the double box joint is to enable the mirror to be as close to the examiner's eye as possible. The centre of the mirror has a hole about 2 cm in diameter.
The focal length of the head mirror is generally 8 to 9 inches (25 cm). It is the distance at which the light reflected by the mirror is sharply focussed and looks brightest. It is also the distance where most people can see and read clearly.
The head mirror is worn in such a way that the mirror is placed just in front of the right eye (in right handed persons). The examiner looks through the hole in the mirror and thus binocular vision is retained.
 
Light Source
The light is provided from an ordinary lamp fixed in a metallic container with a big convex lens and fitted on a movable arm which slides on a rod with a firm base (bull's eye lamp) or a revolving light source provided with ENT treatment unit (). This light source is kept behind and at the level of the patient's left ear. Light from this source is reflected by the head mirror worn by the examiner.13
Fig. I.1: ENT treatment unit
Fig. I.2: Mother holding child for examination
 
Position of the Patient
The patient should remain comfortably seated. Young children usually do not permit the examination in this position and need assistance. The assistant sits in front of the examiner and holds the child in his/her lap (). The legs of the child are held in-between the thighs of the assistant. One hand of the assistant holds the child's hands across his chest while the other hand stabilises the child's head.
 
Position of the Examiner
The examiner sits in front of the patient on a stool or revolving chair (). The legs of the examiner should be on the right side of the patient's legs.
Fig. I.3: Position of the patient for ENT examination
Fig. I.4: Common instruments used in ENT outdoor examination
 
Examination Equipment
The following are the instruments routinely used for ENT examination ().
  1. Tongue depressor
  2. Nasal specula
  3. Ear specula
  4. Holm's sprayer
  5. Laryngeal mirrors
  6. Postnasal mirrors
  7. Seigle's speculum
  8. Eustachian catheter14
  9. Ear forceps
  10. Nasal forceps
  11. Tuning forks
  12. Probes
  13. Ear syringe
  14. Auroscope.
Besides, a sterilizer, Cheatle's forceps, spirit lamp and few small labelled bottles containing the commonly used solutions, paints and ointments are also needed.
 
Suction Apparatus
A suction apparatus with suction tubes and catheters of various sizes is very helpful for cleaning the discharges to allow proper examination. It is also used for removing wax from the ears of the patients who have wax along with CSOM, where water should not be syringed in.