Diseases of Ear, Nose & Throat Mohan Bansal
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1DISEASES OF EAR, NOSE AND THROAT2
3DISEASES OF EAR, NOSE THROAT AND THROAT: Head and Neck Surgery
Mohan Bansal MS PhD FICS FACS Honorary Professor, Otorhinolaryngology Faculty of Medical Sciences Charotar University of Science and Technology (CHARUSAT) Changa, Anand, Gujarat, India Consultant, Ear, Nose, Throat, Head and Neck Surgeon Anand, Gujarat
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This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Diseases of Ear, Nose and Throat
First Edition: 2013
9789350259436
Printed at
5DEDICATED TO
Almighty Lord, my parents, teachers, family, patients and students
Shri Ramakrishna Paramhansa
He indeed is blessed, in whom all the qualities of head and heart are fully developed and evenly balanced. He acquits himself admirably well in whatever position he may be placed. He is full of guileless faith and love for God, and yet his dealings with others leave nothing to be desired. When he is engaged in worldly affairs, he is a thorough man of business. In the assembly of the learned, he establishes his claims as a man of superior learning, and in debates, he shows wonderful powers of reasoning. To his parents, he is obedient and affectionate; to his relations and friends, he is loving and sweet; to his neighbors, he is kind and sympathetic and always ready to do goods; to his wife, he is the god of love. Such a man is indeed perfect.
Holy Mother Sri Sarada Devi
If you want peace, do not find fault with others. Rather see your own faults. Learn to make the world your own. No one is stranger, my child; the whole world is your own.
Swami Vivekananda
We are responsible for what we are, and whatever we wish ourselves to be, we have the power to make ourselves. If what we are now has been the result of our own past actions, it certainly follows that whatever we wish to be in future can be produced by our present actions. Man is man, so long as he is struggling to rise above nature, and this nature is both internal and external.
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7PREFACE
As long as I live, I learn.
• Bhagwan Shri Ramakrishna Dev •
Diseases of Ear, Nose and Throat, which represents Otorhinolaryngology Head and Neck Surgery in all of its diversity, is created to fill the need of contemporary definitive book. The reader will find boxes, tables, flow charts, line diagrams and photographs, which serve to enhance learning. The book is comprehensive and of broader scope and is designed for students, residents and practitioners alike. It offers a balanced presentation of content and emphasizes the practical features of clinical diagnosis and patient management. The students will like the simplicity, directness and clarity. Each chapter includes clear, compelling, and up-to-date discussions and expertly executed and generously sized art. The brevity, conciseness, readable format and easy accessibility of key information will facilitate efficient use in any practice setting. Each page is carefully laid out to place related text, figures, and tables near one another to minimize the need for page turning. To provide an overview, each chapter begins with the list of its content and ends with Further Reading section. Each chapter has Clinical Highlights section for the quick revision of the students. This section has been especially prepared for answering frequently asked MCQs, short-answer questions and oral/viva questions. The Appendix contains Top 101 Clinical Secrets and Problem-Oriented Cases which will be of immense use and interest to the readers.
I would like to acknowledge my parents, late Shri Ramchandra and Smt Kalawati Devi Bansal, for enabling me to survive comfortably during my seemingly endless years of education. My family has unswervingly endorsed the time required for this mission, so heartfelt love and thanks go to my wife, Sushma, as well as our children Tejal and Mohit and his wife Astha. My loyal assistant for the last 10 years, Tejal Patel, has provided amounts of all-round care to cover for my time. I wish to thank my professor friends who spared their valuable time in reviewing the chapters.
The process of learning is truly life-long. Creating this text allows me to continue to become invigorated and inspired by otolaryngology. I hope that my quest to document significant and up-to-date information has been successful. My sincere hope is that readers, everywhere, will benefit from this book. I invite readers and educators to send their suggestions so that I can include them in the next edition. The structure, content, and production values of this book will be shaped by its relationship with educators and readers.
Mohan Bansal
(mohanbansal@yahoo.com)
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9ACKNOWLEDGMENTS
For this book Diseases of Ear, Nose and Throat, I have enjoyed the opportunity of collaborating with a group of dedicated and talented professionals. I would like to recognize and thank the members of the book team, who indeed worked hard, to bring this book to you. Shri Jitendar P Vij (Chairman and Managing Director), Jaypee Brothers Medical Publishers, illuminated the path for this book with his creative ideas and dedication. The insights and skills of Dr Richa Saxena (Editor-in-Chief) helped in polishing this book to best meet the needs of students and faculty alike. Mr Ankit Vij (Managing Director), the young and dynamic leader, took personal interest and laid out each page of the book to achieve the best possible placement of text, figures, and other elements. The suggestions from Mr Saket Budhiraja (Director-Sales and Marketing) were very practical and meaningful. Mr Tarun Duneja (Director- Publishing) demonstrated his untiring expertise during each step of the production process. I would like to thank Ms Sunita Katla (Publishing Manager) for her efforts towards the finalisation of the book. I would also like to thank Mr KK Raman (Production Manager), Ms Samina Khan (PA to Director-Publishing), Mr Amit Rai (Editor), Mr Ashutosh Srivastava (Assistant Editor) and Mr Kapil Dev Sharma (DTP Operator) for their work with efficiency. Ms Seema Dogra's (Cover Designer) and Mr Sumit Kumar's (Graphic Designer) artistic ability, organizational skills, attention to detail and understanding of illustration preferences greatly enhance the visual appeal and style of figures. They are consummate professionals whose efforts I truly appreciate. Tejal Patel, my assistant, shepherded the manuscript and electronic files. Sushma coordinated the development of many supplements that support this text. Dr Rimpal Chauhan, Chandani, Priti, Falguni, Rina, Rashmi, Tejal, Bimal and Hansika, my students, have collaborated on the illustrations for this book. The PG seminars, Journal Club meetings and case discussion at PSMC, Karamsad, Anand, Gujarat, are very enriching. So I am thankful to Prof Ravi Tiwari, Prof Girish Mishra, Prof Yojana Sharma, Dr Hiren Soni, Dr Siddharth Shah, Dr Nimesh Patel and PG students for their valuable and meaningful discussions. I feel immense pleasure to express my heartfelt emotions to my PhD guide Prof Vikas Sinha (Prof, ENT, and Dean, MP Shah Medical College, Jamnagar) and Prof Nitin Nagarkar (Govt Medical College, Chandigarh) and faculties of BJMC, Ahmedabad, Prof R Vishwakarma, Prof Bela J Prajapati, Dr Neena H Bhalodiya, Dr BK Kedia, Dr Kalpesh Patel, and Dr Divang Gupta, Dr Shaun and Dr Shashank for their kind cooperation and friendly help.
Under the GSE program of Rotary Foundation, I visited some of the best medical centers in the USA including the Mayo Hospital with my friend Prof Ranjan Aiyar. I appreciate his whole-hearted support. I am happy to express my thanks to my friend Prof Mohan Jagade with whom I received the Garnett Passé and Rodney William Memorial Foundation, International Educational Scholarship for attending the 16th World Congress of ORL, Head and Neck Surgery, in Australia.
I would like to express my feelings of gratitude to my MS (ENT) teachers of Rajasthan especially Late Prof P Chatterji, Prof NK Soni, Prof JP Gupta, Prof AS Bapna, Prof AK Gupta, Prof AK Singhal, Prof Ajit Singhji, and Prof Prakash Mishra.
I wish to especially thank several of my academic colleagues for their helpful contribution to this book. I am grateful to the dedicated educators who have contributed to the quality material that accompanies this text: Prof Swati Shah, Prof Amit Goyal, Dr AS Solanki, Dr Ritesh Prajapati, Dr Jayesh Patel, Dr Jaydeep Doshi and Dr Suhail Amin Patigaroo.
REVIEWERS
The chapters were emailed to the following otolaryngology professors. Majority of them generously provided their time and expertise and reviewed the chapters. I am extremely grateful to them. Their insightful suggestions for improvement helped me maintain book's accuracy and clarity. Their names are acknowledged in the following list: