Practical ENT Vikas Sinha
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abductor muscle, bulk of 85
Abductor paralysis, unilateral 86
Abscess
Cittelli's 33
extradural 33
intratonsillar 73
Luc's 33
parapharyngeal 72, 73
peritonsillar 71
pharyngeal 33
postauricular 33
site of 72
subdural 33
subperiosteal 33
temporal lobe 33
zygomatic 33
Absolute bone conduction test 11, 23
Accidental high-neck injuries 86
Accidental trauma 85
Achalasia cardia 116
Acoustic neuroma 160
Acquired cholesteatoma 31
Adenocarcinoma 69
Adenoid 41, 75, 75t
chronic enlargement of 75
curette 123, 123f
enlargement of 74
facies 75
hypertrophy 113f
retention cyst of 75
Adenoidectomy 123
indications 123
steps 123
Air
cells 26
conduction hearing aids 25
Allergen detection test 39
Allergic rhinitis 38
Allergic salute 39
Altitude, high 41
Alveolectomy 166
Anastomosis 208f
Aneurysm 93
Angular stomatitis 2
Ankyloglossia 61
Anosmia 3, 39
Anterior ethmoidal artery 40
ligation of 44
Anterior nasal
discharge 74
pack, procedure for 42
Anterior triangle 98
Anticoagulants 41
Antihelix, absence of 11
Antilogy 81
Antral mucosa 183
Antral puncture washout 142
Antrochoanal polyp 41, 53, 53t, 113f
Antrum identification 125
Aortic aneurysm 85
Aphthous ulcers 60, 63
Apple-core appearance 116, 116f
Aryepiglottic folds 79
Arytenoids 79
Asch's forceps 182, 182f
Aspergillus niger 60
Aspirin 41
Atelectasis 19
Atrophic rhinitis 1, 41, 50
Attic perforation 16, 16f, 203f
Audiogram 153
interpretation of 152
Audiology 150
room 151
Audiometry 24
room 151
Auditory canal, external 10, 14
Aural metallic syringe 192, 192f
Aural toilet 26, 28
Auricular nerve, posterior 107
Auscultation 97, 102
Autophony 5, 9
Axonotmesis 109
B
Bacterial endocarditis, subacute 72
Bald tongue 61
Ballenger's swivel knife 184, 184f
Barany noise instrument 191, 191f
Bartholin's duct 68
Basal meningitis 86
Bat ear 11
Bekesy self-recording audiometry 24
Bell's palsy 110
Bell's phenomenon 110
Betadine 143
Bill's bar 106
Bird beak, appearance of 116
Bleeding 55
Blood stained discharge 6, 36
Blunt tracheal hook 195, 195f
Bone
applied anatomy of 163
conduction 22
Bony septum 106
Box type joint 179f
Boyce's position 140
Boyer space 89
Boyle's blade 173
Boyle-Davis mouth gag 121, 173, 173f
Brainstem-evoked response audiometry 24, 158
Branchial fistula 93
Branchial sinus 93
Broad-spectrum antibiotics 27, 28
Broders’ classification 91
Bronchoscope 140f
Bronchoscopy 139
procedure 140
Bronchus
carcinoma of 85
right main 141
Bulbar paralysis 85
Bull's eye lamp 10, 171
Burkitt lymphoma 215f
Burkitt's tonsil artery forcep 175, 175f
C
Cacosmia 39
Caldwell-Luc operation 44, 163, 164
Caloric tests, types of 161
Calorimetry 160
Canfield's operation 164
Carcinoma 65
nose 41
secondary 93
stage of 62
tongue
clinical types of 63
sites of 63
Carcinomatous ulcer 63
Carhart's notch 154, 154f
Carotid artery, external ligation of 44
Carotid body tumor 93
Carotid triangle 99
inferior 99
Cartwheel appearance 11
Cauterization 42
Cell seeker 186, 186f
Central perforation 16, 16f, 203f
Central vertigo 162
Cerebrospinal fluid 3
otorrhea 3
Cervical adenitis, suppurative 72
Cervical esophagus, carcinoma of 85
Cervical rib 94
Cervical spondylosis 8
Cheek 65, 66, 70
nibbling 65
Chest, anteroposterior view of 115
Chevalier Jackson's
bronchoscope 194, 194f
esophageal speculum 193, 193f
laryngoscope 142, 142f
metallic tube 195, 196f
tube 135f
Chewing movement 8
Child tracheostomy 136, 137
Cholesteatoma 31
congenital 31
formation, stage of 32f
types of 31
Cholesterol granuloma 31
Chorea 72
Chronaxy 85
Circumferential incision 130f
Citelli's punch forceps 181, 181f
Cochlear deafness 25, 25t
Cochlear implant 25
Cold caloric test 160f
Cold compression 42
Cold spatula test 45, 46f
Collaural fistulae 14
Color 6, 16
Commando operation 166
Commissure laryngoscope, anterior 142f, 194, 194f
Concave mirror 172
Concentration 74
Conductive deafness 1, 23, 24, 24t, 152, 159
Condylectomy 166
Confrontation test 105
Congestion 11, 18
Consent
before surgery 117
document 118
refusal of 118
Conversation test 24
Coralization 17
Correct aseptic surgical procedure, rules of 143
Cortical evoked response audiometry 158
Cortical mastoidectomy 124
Cracks 60
Cranial nerves, examination of 104
Crescent's sign 56, 113f
Cricoid hook 195, 195f
Cricopharynx 115
Cricothyrotomy 136
Crust 53
falling of 37
Cuff
inflation of 133
polyvinyl chloride tube 135f
Curves, classification of 156
Cyst
branchial 93
dental 67
dermoid 93
mucous retention 67
nasoalveolar 67
nasolabial 67
nasopalatine 67
periapical 67
radicular 67
thyroglossal 101, 101f, 103
tonsillar 73
Cystic hygroma 93, 94
D
Dalrymple's sign 103
Darrier's line 39
Deafness 3, 5, 79
alteration of 7
degree of 7
fluctuation of 7
mixed 152
types of 152
Denis Browne's tonsil holding forcep 174, 174f
Dental ulcer 60, 63
against sharp tooth, chronic 63
Depressed nasal bridge 45
Deviated nasal septum 211
C-shaped 211f
Deviated nose 45
Diabetes 2
Diagnostic nasal endoscopy 145
Digastric triangle 98
Direct laryngoscopy 80, 80t, 193, 193f
procedure of 142
Direct spread 32
Discharge 5, 6, 52
character of 36
Displacement method 27
Doyen's mouth gag 177, 177f
Draffin's bipod metallic stand 174, 174f
Drill with burr 188, 188f
Duct 68
Dundas grant air caloric test 161
Dysphagia 2
Dysphonia plicae ventricularis 87
E
Ear
canal, syringing of 149f
case 225
discharge 5
dressing forceps 190
drop 147
examination of 5, 10
foreign bodies in 15
left 153f155f
method of 171
examination of 171f
middle 151
normal 159, 159f
nose and throat
operations in 119
procedures in 145
topical medications into 147
right 172f
surgery, instruments for 185
swab 27, 28
Electrogustometry 110
Electroneurography 110
Endolymphatic hydrops 162
Epidermoid cholesteatoma 31
Epiglottis 77
Epistaxis 40, 41
artery of 40
causes of 41
management of 42, 45
Epstein pearls 67
Erythroplakia 65
Esophagoscope 138f, 192, 192f
Esophagoscopy 137
complication 139
contraindications 138, 140
indications 137
procedure 138
Esophagus
barium swallow of 116
carcinoma of 85
instrument for 192
Ethmoidal artery, posterior 41
Ethmoidal neuralgia, anterior 37
Ethmoidal polyp 53, 53t
Ethmoidectomy approach, external 44
Eustachian tube 19
catheterization 19, 20
Eve's tonsillar snare 175, 175f
Exophthalmos 103
Exostoses 14
Eyeball, protrusion of 103
F
Face, dangerous area of 46, 46f, 209f
Facial artery, tonsillar branch of 121
Facial asymmetry 9
Facial nerve 20, 104, 106, 107f, 124
classification on 109
electrodiagnostic tests of 110
examination of 11, 20
paralysis 3, 5, 9, 21, 33
causes of 108
Facial pain 65
Fagge aural forceps 190, 190f
Fallopian canal 107
False antrum 125
False Rinne's negative 22
Farabeuf's mastoid periosteal elevator 185, 185f
Fever 5, 9
Fexofenadine 27
Fibroid tonsillitis, chronic 72
Fissure 60
Fistula test 11, 20
Fixed cord 87, 87t
Flat tympanogram 157f
Follicular type, acute 71
Footplate, ankylosis of 1
Foramen
lacerum 167
ovale 167
rotundum 167
spinosum 167
Forceps space 139
Forehead mirror 172, 173f
Foreign bodies
in ear, nose and throat 146, 147
laryngopharyngeal 197
living 146
non-living 146
Foul smelling discharge 6
Fracture nasal bone 114
Freer's elevator 180, 180f
Frog face deformity 45
Frontal sinus 58
palpation of 58f
Fuller metallic tube 195, 196f
Fuller tube 135f
Functional aphonia 86
Functional endoscopic sinus surgery 51, 54, 183
Functional voice problems 87
Fungal infection 2
Fungus 14
Furunculosis 13
edema 13t
G
Gag reflex 111
Gardiner brown thumb rest tuning fork 22
Geographical tongue 61
Gilette space 74
Glegg's aural snare 179, 179f, 187, 187f
Glomerulonephritis, acute 72
Glomus jugulare tumor 85
Glossitis 2
chronic superficial 62, 63
Glottic cancer 90
Glottic chink 79
Glottis 88, 90
Godlee's mallet 191, 191f
Golding-Wood approach 163
Gradenigo's syndrome 33
Gradual deafness 7
Granulation 11, 18
removal of 28
tissue 28
Greater palatine artery, terminal branch of 40
Griesinger sign 10
Grommet 30, 30f
Grubber's ear speculum 187f
Gum 65, 70
hyperplasia 65
Guttman's sign 102
H
Habermann's theory 32
Hairy leukoplakia 3
Hallpike-Fitzgerald bithermal caloric test 160, 161
Hand scrub technique 145
Hard palate 70
Harmonic scalpel 120
Hartman's nasal forceps 180f
Hartman's tuning fork 22
Headache 5, 9, 37, 74
Hearing
level, normal 153f
theories of 151
Hearing aid 24, 25
bone conduction 25
implantable 25
programmable digital 25
Hearing loss
neural 159f
noise-induced 155
sensorineural 154, 154f
sensory 159f
Helmholtz theory 151
Hemangioma 41, 79
Hemimandibulectomy 166
Hemophilia 41
Heterosmia 39
Higginson's rubber syringe 184, 184f
High-arch palate 75
High-pitched tinnitus 9
Hodgkin's disease 41, 85
Horner's syndromes 102
Hot caloric test 160f
Howarth nasal raspatory 181, 181f
Hutchinsonian teeth 65
Hyperacusis 110
Hyperosmia 39
Hypertension 2, 40, 41
Hypertrophy, stage of 62
Hypochromic microcytic anemia 2
Hypoglossal canal 167
Hypophyseal fossa 113
Hyposmia 39
I
Impedance audiogram 24, 156
Incision, site of 130
Incudostapedial joint 11, 18
Infection
chronic 119
spread of 32
Inflammatory swellings 93
Influenza 41
Informed consent 117
Intensity 150
Interarytenoids area 79
Intermittent positive pressure respiration 196
Internal auditory meatus 167
Internal maxillary artery, ligation of 44
Intubation 136
Itching 38
J
Jackson's sign 80
Jansen Middleton's double action bone nibbling forceps 180f
Jenkin's mastoid
chisel 186, 186f
gouge 186, 186f
Jenning's mouth gag 178, 178f
Jobson Horne's probe with ring curette 191, 191f
Joffroy's sign 103
Jugular foramen 167
Jugulodigastric lymph nodes 99
Juvenile multiple papilloma 78t
Juvenile nasopharyngeal angiofibroma 1, 41, 45, 54, 56, 209f
Juvenile papilloma 82, 83f
K
Keratosis obturans 15
Kidney tray 148
Kiesselbach's plexus 40
Killian's elevator 180, 181f
Killian's gouge 179, 179f
Killian's self-retaining nasal speculum 181, 181f
Kobrak method 161
Koilonychia 2
Korner's meatoplasty 126f
Korner's septum 125
L
Labial artery, superior 40
Labyrinthitis 33
Lack's tongue depressor 71, 71f, 177, 177f
Lacrimation 110
Lahey's method 101
Laimer's triangle 139
Laryngeal compartments 89
Laryngeal crepitus 76
Laryngeal forceps 197, 197f
Laryngeal indications 131
Laryngeal mirror 197, 197f
Laryngeal papilloma 82
types of 82
Laryngeal spaces 89
Laryngoscopy 141
indirect 76, 76f, 77f, 80, 80t, 197
Laryngotomy 136
Larynx
anterior part of 77
carcinoma of 90, 91
examination of 76
functions of 90
hidden areas of 92
instrument for 192
lymphatic drainage of 88
muscles of 87
nerve supply of 88
position of 102
posterior part of 77
premalignant conditions of 92
tuberculosis of 85
Lateral sinus thrombosis 33
Lederman's classification 59, 59f
Left atrium, enlargement of 85
Left peritonsillar abscess, incision of 73f
Left recurrent laryngeal nerve paralysis, causes of 85
Lempert's endaural speculum 188, 188f
Lempert's mastoidectomy curette 186, 186f
Leprosy 41, 49
Leukemia 41
Leukoplakia 62, 65
stage of 62
Levocetirizine 27
Light, cone of 11, 17
Linthicum test 161
Little's area 40, 40f
Liver disease 41
Local antibiotic ear drops 27
Local decongestant nasal drops 27
Loudness 150
recruitment 159
Lower air passage, protection of 90
Lymph node 62, 94
examination of 4f
groups of 96
levels 96f
multiple 94
M
Macewen's mastoid curette 186, 186f
Macewen's triangle 164, 165
Macroglossia 60
Magauran's plate 174, 174f
Maggots 55
Malignancy 85, 116
Malleus, handle of 11, 17
Mandible 166
Marginal perforation 16, 16f, 203f
Masking 152
Mass 54
Mastoid
air cells 125
antrum 165
process 165
retractor 185
Mastoidectomy 124
Mastoiditis 13, 13t, 32
acute 26, 124
Maxilla 163
Maxillary antrum 142
Maxillary artery 142
Maxillary sinus 58
carcinoma of 41, 58
haziness of 112t
palpation of 57f
right 112f
Maxillary sinusitis, chronic 75
Meatoplasty 126
types of 126
Mediastinal lymphadenopathy 85
Mendelian law 3
Meniere's disease 8, 20, 154, 160, 162
Meningitis 33
Mental lethargy 75
Mentoplasty 166
Metallic ear speculum 187
Metaplasia theory 32
Metastatic glandular enlargement 86
Microlaryngeal surgery 81, 82
Middle ear
mucosa 17
pressure, normal 156, 156f
Middle meatus 51
Midline swellings 97
Mild-conductive deafness 153f
Mini tracheostomy 136
Minimal caloric test 161
Mitral stenosis 85
Mobility 61, 102
Möebius sign 103
Mollison's self-retaining hemostatic mastoid retractor 185f
Mollison's tonsil dissector 175, 175f
Morgagni sinus 65
Mosher's dictum 136
Motor function 106, 107
Mouth
cyst of 67
floor of 65, 66, 70
Mucosa, color of 52
Multiple primary malignancies 99
Muscular triangle 99
Musical sound 150
Myeloma, multiple 41
Myringo puncture 130
Myringotomy 130, 189
indications 130
N
Nasal allergy 38
Nasal and sinus surgery, instruments for 178
Nasal bone, fracture of 114f
Nasal cavity 43f, 50
Nasal discharge 36
Nasal dressing forceps 179
Nasal endoscopes 54
Nasal injury 45
Nasal obstruction 36
bilateral 37
Nasal pack
posterior 43
ribbon gauze 42
Nasal septum 47
medial wall of 47f
Nasopharyngeal carcinoma 41, 85
Nasopharynx 44f, 113
posterior wall of 113f
X-ray of 113, 113t
Neck 96f
anteroposterior view of 115
examination of 93
incision 44
lateral soft tissue X-ray of 115
lymphatic chain of 95f
triangles of 98, 98f
Negus’ curved tonsil artery forceps 176, 176f
Nerve
abducent 104
accessory 104, 111
glossopharyngeal 104, 111
hypoglossal 104, 111
oculomotor 104
olfactory 104
optic 104, 105
trigeminal 104, 105
trochlear 104
valley of 165
vestibulocochlear 104, 111
Neuropraxia 109
Neurotmesis 109
Nicotine stomatitis 66
Nocturnal cough 74
Noisy respiration 74
Noncuffed tracheostomy tube 196f
Nose
broadening of 45
case 227
danger area of 46
drop 148
examination of 36, 45, 228
granulomatous disease of 49
irritation of 38
itching of 38
pinching of 42
surgical anatomy of 42
telangiectasis of 41
X-ray of 114
Nursing care 133
Nystagmus 161
degrees of 161
types of 161
O
Ocular nystagmus 161
Ohngren's classification 58, 59f
Olfactory agnosia 39
Olfactory bulb and tract 166
Operation theater 143
Ophthalmic artery, branch of 40
Optic foramen 166
Oral cavity
carcinoma of 3
examination of 60
Oral submucous fibrosis 3, 65
Orbital fissure, superior 166
Organ donation, consent for 118
Osler-Rendu disease 41
Osmophobia 39
Osteolytic lesion 114f
Osteophytes 8
Otitic hydrocephalus 33
Otitis externa, malignant 15
Otitis media 29, 157
acute 13, 13t, 72
suppurative 189
adhesive 19
atticoantral type of 26, 28
classification of 29, 29t
nonsuppurative 30
recurrent acute 75
safe type 34, 34t
secretory 30
tubotympanic type of 26
unsafe type 34, 34t
Otoacoustic emissions 158
Otomicroscopic examination 34
Otosclerosis 1, 3
Otoscopic examination 10, 172, 172f
Outer hair cell 159
Overlay technique 129
P
Pack bulla, posterior 44f
Pain 5, 8, 81, 102
nature of 8
site of 8
Palate 64, 66, 70
Palpation 57, 58f, 66, 69, 94, 101
Papillae 61
Papillary cystadenoma lymphomatosum 69
Papilloma 41
adult onset 82, 83, 83f
multiple 78
Paraglottic space 89
Paralysis, bilateral
abductor 86
adductor 86
complete 84, 86
incomplete 84, 86
Paralysis, unilateral
complete 84, 86
incomplete 84, 86
Paralyzed cord 87, 87t
Paranasal sinuses
examination of 36, 45
X-ray of 112, 113
Parosmia 39
Parotid
duct 68, 69
gland 68
surgery 109
tumors 69
Paroxysmal positional nystagmus, benign 162
Paroxysmal sneezing 38
Paroxysmal vertigo, benign positional 8
Pars flaccida retraction 19
Pars tensa retraction 18
Patch test 127
Pemberton's sign 101
Percutaneous tracheostomy 136
Perennial allergic rhinitis 38
Perforation 16
margin of 17
shape of 17
site of 17
size of 10
types of 16
Perilabyrinthine air cells 124
Peripheral neuritis 85, 86
Peripheral vertigo 162
Perisinus air cell 124
Permanent perforation 17
Petrositis 33
Phantosmia 39
Pharyngeal wall, posterior 74
Pharynx, examination of 70
Phonation 90
Phonophobia 110
Physiological nystagmus 161
Pillar retractor, anterior 175, 175f
Pinna 10, 11, 11f
erection of 12
protrusion of 10, 12
size of 11
Pitch 150
Plester's type mastoid retractor 185
Plester-Jansen self-retaining hemostatic mastoid retractor 185f
Plica semilunaris 122
Plotting, symbols for 152
Plummer-Vinson syndrome 2, 63
Poliomyelitis, epidemic of 120
Politzer myringotome 189f
Politzer's method 19, 20
Polyp 11, 18, 28, 53
Polyphasic motor unit potential 110
Polyvinyl chloride 135
material 196
Positive patch test 127
Postaural Wilde's incision 125f
Post-auricular
region 10, 12
sulcus 10, 12
Postcricoid
area 79
carcinoma 3
web formation 2
Posterior triangle 99
Pre-auricular region 12
Preepiglottic space 89
Pressure, high 41
Prominent Darwin tubercle 11
Pterygopalatine fossa 44
Pulmonary causes 132
Pure tone audiometry 24, 152
Purpura 41
Pus 55
Pyriform fossa 80
Q
Quantitative nerve excitability test 110
Quinine 3
Quinsy 71, 72
R
Radial incision 130f
Radical mastoidectomy 125
modified 126
Radical neck dissection 85, 86
Radioallergosorbent test 39
Radiography 26
Ranula 67
Rat tail appearance 116, 116f
Recurrent laryngeal nerve
paralysis, causes of right 85
right 88f
Red glazed tongue, stage of 62
Reinke's space 89
Renal failure 41
Respiration 90
Retraction pocket 11, 18
Retrocochlear deafness 25, 25t
Retrocochlear lesion 159
Retromolar trigone 65, 70
Retropharyngeal abscess
acute 74f
chronic 74f
Retropharyngeal nodes 95
Rheumatic fever 72
Rhinitis
acute 41
chronic 41
Rhinolalia aperta 64
Rhinolalia clausa 64
Rhinoplasty 163
Rhinorrhea 3, 38
Rhinoscleroma 2
Rhinoscopy
anterior 45, 46
posterior 45, 55, 56f
Rhinosporidiosis 2, 41
Rhinosporidium 2
Riedel's thyroiditis 102
Rinne's test 11, 22
Rose's position, advantage of 120
Ruedi's theory 32
Rutherford's telephone theory 151
S
Sade's classification 18
Salicylates 3
Saliva flow test 69
Salivary flow rate 108, 110
Salivary glands 68
Salt and pepper appearance 56
Santorini fissure 15
Schirmer's test 108, 110
Schwabach test 23
Schwartze's operation 124
Screw type joint 180f
Scrotal tongue 60
Seasonal allergic rhinitis 38
Secretomotor function 108
Seddon classification 109
Segmental mandibulectomy 166
Semon's law 84
exception of 85
Sensorineural deafness 23, 24, 24t, 152
congenital 3
Sensorineural hearing loss, high-frequency 155f
Sensory function 106, 108
Sepsis 62
Septal deformity 48
Septal deviation 48
Septal dislocation 48, 48f, 210f
Septal perforation 49
Septal spur 48, 48f, 210f
Septic foci 27
Septoplasty 49, 50, 50t
steps of 49
Septum, submucous resection of 50, 50t
Serrated and grooved jaw 180f
Sessile papilloma 63
Siebenmann's meatoplasty 126, 126f
Siegel's pneumatic ear speculum 20, 189, 190f
Singer's nodules 78
Sinus, examination of 57
Skin 94
allergy test 39
overlying 100
preparation 144
Skull
base of 166
lateral view of 113
Sleep apnea 75
Smell 6
disturbances of 39
Sneezing 37
Snellen's chart 105
Snoring 39
Soft palate 70
Solitary papilloma 78, 78t
Sound 150
distortion of 7
Speech
audiograms 159f
audiometry 24, 158
detection threshold 159
discrimination score 159
impaired 75
reception threshold 159
therapy 81, 82
Sphenoid 166
sinuses 166
Sphenopalatine artery, septal branch of 40
Spinal accessory 95
Spine of Henle 165
Spirit 62
S-shaped deviated nasal septum 211f
St Clair Thomson's
adenoid curette with cage 176, 176f
long-bladed nasal speculum 178, 178f
posterior rhinoscopic mirror 184, 184f
Stapedial reflex 110
Stellwag's sign 103
Stensen's duct 65, 68, 69
Sternomastoid tumor 93
Subdural air cells 124
Subglottic cancer 91
Subglottis 88, 90
Subjective audiometry 24
Submandibular gland 69
swelling 68
Submandibular salivary gland 93
Submental triangle 98
Submucous fibrosis 64
Subperiosteal mastoid abscess, acute 13f
Subtotal perforation 16, 16f, 203f
Sudden deafness 7
Suppurative otitis media 32
acute 9, 29
complications of 32
Supraglottic cancer 90
Supraglottis 88, 90
Suprameatal spine 165
Suprameatal triangle 164, 165f
Surgery 28
Swelling 61, 68, 93, 94, 97
congenital 45
examination of 4
Syphilis 41, 49, 62, 63
congenital 65
Syphilitic ulcer 63
Systemic antihistamines 27
T
Tachycardia 103
Taste 110
Teeth 65, 70
Temporal bone 164
fracture of 3
Tenderness 13, 102
Therapeutic indication 139, 141
Thermal trauma 41
Throat
case 229
examination of 70
Thudicum's nasal speculum 46, 172f, 178, 178f
Thumb sign 77
Thyroglossal fistula 101, 103
Thyroid
strom 103
surgery 85
thrill 102
Thyroid gland
carcinoma of 85
enlargement of 103
examination of 100
excluding 93
Thyroplasty 92
Tilley's antral
harpoon 183, 183f
rosette burr 183, 183f
Tilley's nasal forceps 179f
Tilley-Lichtwitz trocar and cannula 183, 183f
Tinnitus 1, 5, 8, 9
bilateral 9
subjective 9
types of 9
unilateral 9
Tongue 60, 61, 66, 70
base of 80
depressor 45, 173, 173f
use of 70
lymphatic drainage of 62, 62f
ulcers of 63
Tonsil 71, 75, 75t
and throat surgery, instruments for 173
arterial supply of 121, 122f, 219f
bed of 122
chronic enlargement of 120
examination of 70
relationship of 122
removal of normal 120
venous drainage of 122
Tonsillar position 121
Tonsillectomy 119
contraindications of 120
indications 119
for unilateral 120
methods of 120
steps of 121
Tonsillitis
acute 71
cardinal signs of 72
chronic 71, 72
complications of 72
Tonsillolith 73
Topognostic tests 110
Torus mandibularis 67
Torus palatinus 67
Tos's classification 19
Toxic goiter, primary 103
Toynbee's ear speculum 187f
Toynbee's test 19
Trachea
instrument for 192
position of 102
Tracheal incision 133
Tracheobronchial indications 131
Tracheobronchial toilet 131
Tracheostomy 131, 135, 136
adult 136, 136t, 137
child 136, 136t
complications of 134
functions of 132
procedure of 133
sequelae of 135
sites of 132
types of 132
Tracheostomy tube 195
cuffed 196
noncuffed 196
Tracheotomy
adult 137t
child 137t
consent for 118
Trautmann myringotome 189f
Travelling wave theory of Bekesy 151
Treacher Collins’ syndrome 12
Tremor 103
Trigeminal nerve over skin of face, supply of 106f
Triple S triangle 108
Trocar and cannula 143f
Trotter's triad 64
Trousseau's tracheal dilator 197, 197f
Tube
fixation of 133
size of 136
types of 135, 135f
Tuberculosis 2, 41, 49, 85
Tuberculous ulcer 60, 63
Tumor, node, metastasis classification 91
Tuning fork test 11, 21, 22f
series of 23
Turbinates 51
Tympanic membrane 10, 15
different quadrants of 204f
mobility of 11, 18
quadrant of 11, 18
retraction 18
right 15f
types of perforation in 203f
Tympanogram, normal 156, 156f
Tympanometry 110, 156
pressure, negative 157, 157f
Tympanoplasty 27, 127
grafts used for 128
prerequisites for 127
techniques of 129, 129f
types of 127, 128f
Tympanosclerosis 19
U
Ulcer 61, 63
malignant 60
Underlay technique 129
Unusual high peak 157f
Upper lobe 141
V
Vagal tumors 86
Vagus nerve 104, 111
paralysis, causes of 85
Vallecula sign 80
Valsalva's method 19
Vascular tumor 79
Vasomotor rhinitis 37
Ventricular folds 77
Vertebral artery, compression of 8
Vertigo 5, 79, 162
absence of 7
causes 162
presence of 7
types of 7
Vestibular neuronitis 8
Vestibular nystagmus 161
Visual acuity 105
Visual field 105
Vitamin
C deficiency 41
K 41
Vocal cord 78
paralysis 84
position of 79, 79f
Vocal fatigue 81
Vocal folds 77
Vocal nodule 78, 80, 81f
Vocal polyp 81, 82f
Voice, hoarseness of 81
von Bezold's abscess 33
von Graefe's sign 103
W
Waldeyer's ring 97, 97f
Walsham's forceps 182, 182f
Warthin's tumor 69
Watery discharge 6
Wavelength 150
Wax 14, 148
removal 149f
position for 149f
syringing of 148
Weber's test 11, 23
Wegener's granuloma 64
Wet bubbly nose 74
Wever volley theory 151
Wharton's duct 65, 68, 69
Wilde aural forceps 190f
Wilde's forceps 190
Wilde's incision 108, 124, 125
Wildermuth ear 11
Wittmaack's theory 31
Woake's eustachian catheter 182, 182f
Wool test 133
Y
Yankauer nasopharyngoscope 176, 176f
Yankauer pharyngeal suction tube 177, 177f
Z
Zygomatic air cells 124
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Chapter Notes

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History Taking in ENTChapter 1

  1. NAME: Name is asked:
    • For the identification of the patient
    • For developing rapport with the patient
    • For maintaining the record of the patient.
  2. AGE: Certain diseases are common in certain age groups like:
    • Presbycusis is common in old age (It is the condition in which bilateral high-frequency sensorineural hearing loss occurs.)
    • Atrophic rhinitis and otosclerosis are more common at puberty.
  3. SEX: Certain diseases are common in particular sex like:
    • Juvenile nasopharyngeal angiofibroma (JNAF) is exclusively found in males
    • Atrophic rhinitis and otosclerosis are more common in females.
      (Otosclerosis causes ankylosis of footplate of stapes and causes conductive deafness and tinnitus. It is treated medically by sodium fluoride and surgically by stapedectomy.)
  4. CASTE: Certain castes have certain type of diseases like:
    • Bodhya community (Mahar) of Vidarbha region of India has more incidence of sickle cell anemia, hence epistaxis is more common
    • Sindhis and Bhanushalis of Saurashtra region have more incidence of thalassemia major and have more episodes of epistaxis and bleeding disorder.
  5. RELIGION: Because of consanguineous marriage in Muslims, the incidence of congenital sensorineural deafness is more.2
  6. OCCUPATION:
    • Vocal nodules are more common in hawkers and in children who scream a lot
    • Septal perforation is more common in nickel, chromium and arsenic workers
    • Sensorineural hearing loss (especially at 4000 Hz) is more common in people who are exposed to constant loud noise like mill workers, persons staying near railway tracks or airport
    • Laryngocele was believed to be more common in trumpet blowers.
      (Laryngocele is the enlargement of saccule. It may be of external, internal or mixed variety.)
  7. ADDRESS: Certain diseases have more geographical predilection:
    • Rhinosporidiosis is very common in Jharkhand, Chattisgarh, Madhya Pradesh and West Bengal states of India
      • Rhinosporidiosis is a fungal infection caused by the Rhinosporidium seeberi and kinealyi. It is more common in those who take bath in pond where cattles also have bath. It spreads by the dust from the dung of infected cows and cattle. The treatment is surgical excision.
    • Rhinoscleroma is endemic in Northern part of India.
      • Rhinoscleroma is a progressive granulomatous disease caused by Klebsiella rhinoscleromatis. Histologically, it has Mikulicz cell containing Frisch bacilli. The end result of this disease is painless stenosis of vestibule and nose. It is treated by the surgical excision of stenotic lesion.
    • Plummer Vinson syndrome is very common in central part of Gujarat India.
      • Plummer Vinson syndrome consists of dysphagia, hypochromic microcytic anemia, glossitis, angular stomatitis and koilonychia. The complication of this syndrome is postcricoid web formation.
  8. PAST HISTORY: Enquire about previous history of:
    • Diseases like diabetes, tuberculosis and hypertension. All these may have bearing on the present state of disease like in untreated or active tuberculosis, there may be associated tuberculous otitis media or laryngeal tuberculosis. In untreated or uncontrolled diabetes, the chances of infection are very high.3
    • Drugs: Certain drugs are toxic to ear like streptomycin is vestibulo-toxic while dihydrostreptomycin is cochleo-toxic. Quinine or salicylates cause tinnitus in the ear.
    • Postnatal jaundice may cause deafness due to the deposition of conjugated bilirubin in brainstem nuclei.
    • Head injury: Fracture of cribriform plate may cause anosmia or cerebrospinal fluid (CSF) rhinorrhea. Fracture of temporal bone may cause deafness, facial nerve palsy or CSF otorrhea.
  9. PERSONAL HISTORY:
    • Smoking may lead to carcinoma larynx
    • Tobacco and Gutkha chewing may cause carcinoma of oral cavity and oral submucous fibrosis (OSMF)
    • Postcricoid carcinoma is more common in cigar smokers
    • Senile degenerative changes of inner ear are early in heavy smokers and heavy alcoholics.
  10. FAMILY HISTORY: To know the hereditary cause of deafness like:
    • Otosclerosis is an autosomal dominant disease
    • Congenital sensorineural deafness in children is directly related with Mendelian law.
      Mendelian law states that when two hybrids (people with normal hearing but carrying deafness) marry, then deaf children must follow.
  11. SOCIAL HISTORY: Unsafe sexual contact may lead to AIDS (Hairy leukoplakia of oral cavity is highly suggestive of AIDS).
  12. GENERAL EXAMINATION:
    • Examine pulse, blood pressure, cyanosis, clubbing, anemia, jaundice and the lymph nodes
    • Hypertension may cause epistaxis, cyanosis is present in advanced laryngeal and bronchial malignancy, clubbing is present in bronchial carcinoma, anemia is present in recurrent epistaxis.
    • Examination of lymph nodes: Make the patient comfortably seated on the chair (examiner stands behind the patient), flex the neck of the patient slightly and start palpating on both sides systematically and 4symmetrically, starting with submental, submandibular, jugulodigastric, juguloomohyoid, preauricular, postauricular, occipital, and the vertical chain of lymph nodes at carotid region, etc. Palpate on both the sides of neck even if lesion is unilateral (Fig. 1).
      zoom view
      Fig. 1: Examination of lymph nodes.
    • Examination of swelling
      Examine the swelling under following headings: Number, site, size, shape, surface, margin, mobility, skin over the swelling, mobility of skin over the swelling, consistency, temperature, fluctuation, illumination test, etc.