Diseases of Ear, Nose and Throat with Head and Neck Surgery Mohan Bansal
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table
A
Abbe-Estlander flap 441
Abducent nerve 124f
palsy, left 124f
Abductor laryngeal injections 543
Abductor spasmodic dysphonia 541
Abscess 494, 598
acute retropharyngeal 599
chronic retropharyngeal 600
deep neck spaces for 595f
dental 307
extradural 241, 334
intratonsillar 459
meatal 236, 239
parapharyngeal 236, 239, 457, 603
perisinus 244
peritonsillar 457, 518, 598, 599f, 603, 631
pharyngomaxillary 599
postauricular 236, 239
pretracheal space 600, 600f
prevertebral space 600
retropharyngeal 236, 239, 518, 600f
septal 364, 365f
subdural 241
subperiosteal 333
zygomatic 236, 239, 240f
Absidia 102
Absolute bone conduction test 151
Acanthamoeba 110
Acetic acid solution 99
Acetylcholine muscarinic receptor antagonist 276
Achalasia 452
Acid
fast
bacilli 93, 520
smears 424
fumes 328
phosphatase 229
Acidosis, metabolic 695
Acini, types of 53
Acinic cell
carcinoma 431, 433
tumors 428
Acne rosacea 307
Acoustic coupling pathways 24f
Acoustic neuroma 144, 170, 299, 300, 300f, 303, 608, 679
staging of 302
Acoustic reflex 155
pathways 156f
Acoustic rhinometry 313
Acoustic therapies, examples of 143b
Acoustic trauma 172
Acquired cholesteatoma, pathogenesis of 228
Acquired immune deficiency syndrome 106, 446, 707
Actinic cheilitis 409, 441
Actinomyces 93, 602
bovis 425
israelii 91, 138, 425
naeslundii 425
Actinomycosis 122, 425, 568, 602
Acyclovir 104, 105, 287
Adams-Stokes disease 250
Adductor laryngeal injections 543
Adductor spasmodic dysphonia 541
Adenitis syndrome 414
Adenocarcinoma 392, 427, 431, 500, 575
follicular 588, 591
papillary 587, 591
Adenohypophysis 477, 712
Adenoid 49, 59t, 67, 214, 313, 460
blood supply 59
curette 634
cystic carcinoma 392, 396, 427, 430, 433, 471
facies 460, 462
functions of 58, 62
hypertrophied 461f
hypertrophy 48, 462, 632
lymphatic drainage 59
nonsurgical treatment of 635
Adenoidectomy 221, 222, 358, 632634, 654, 709
endoscopic 634
indications of 636
instruments of 656f
Adenoiditis, purulent 632
Adenolymphoma 429
Adenoma 584, 586
follicular 587
non-functioning 628
sebaceous 293
Adenotonsillar disease 455
Adenotonsillar hypertrophy, chronic 460, 461
Adenotonsillectomy 461, 462, 631, 635, 655
instruments of 656f
Adenovirus 103
Adiadochokinesia 257
Adipose tissue 81
Adrenaline 618, 698
Adrenocorticotropic hormone secreting adenomas 628
Adriamycin 689
Adult supraglottitis 518
Aerodigestive tract 58
Aero-otitis media 223, 605
Agger nasi cells 36, 41, 42, 675f
Agoraphobia 276
Agranulocytosis 417, 457
Air bone gap 151, 164
Air passages, foreign bodies of 560
Airborne external irritants 48
Airway 369, 709
breathing and circulation 369
devices 663, 663f
difficulty 695
fire, management of 697
maintenance of 369
management, immediate 696
nasopharyngeal 663, 663f, 696
obstruction 460
acute 513
chronic 514
severity of 511
Alae nasi movements 310
Alar division 82
Alar fascia 595
Alcohol 407
abuse 409, 695
fast bacilli 93
Alexander's dysplasia 179
Alexander's law 252, 252f
Alexia 538
Alkaline
nasal
douche 346
irrigation 340
phosphatase 342
reflux 545
Allergen 350
elimination of 266
Allergic fungal rhinosinusitis 345
Allergic responses
immediate 351
late 351
types of 351
Allergic rhinitis 38, 306, 331, 347, 348, 350, 352, 353b, 355f, 357, 357t, 708
aria, classification of 352f
diagnosis of 350
medicines for 355t
seasonal 351
surgical treatment of 360
Allergic rhinosinusitis 327, 332t
Allergy 232, 348, 365
evaluation 330
management of 221
salute 352
testing 214
Alport's syndrome 186
Alternaria 102, 110, 345
Alveolar ridge 441
Alveoli 52
Alveolus
lower 52
upper 52
Amalgam tattoo 418
treatment 418
Amantadine 104
Ambulatory 24-hours esophageal pH recording 452
Ameloblastoma 395, 436
malignant 395
transformation 436
origin 436
treatment 436
American Joint Committee on Cancer 431t, 480
of Carcinoma Nasal Cavity, Maxillary and Ethmoid Sinuses 389t
Amethocaine 698
Amide 698
Amikacin 172, 179
Amines, tricyclic 273
Aminoglycoside 98
antibiotics 172
caution 98
intratympanic injections of 267
ototoxicity 177
side effects 98
spectrum 98
Aminopenicillins 96
Amitriptyline 128, 273
Ammonia 48, 310, 315, 328
Amoxicillin 96, 222, 709
Amphetamine 276
Amphotericin B 102
Ampicillin 96, 597, 709
Ample history 369
Amyloid tumors 526
Analgesics 129
Analog hearing aids 191
Anaphylaxis 349
management 349
Anaplastic carcinoma, tumors nodal metastasis (TNM) staging for 590
Ancillary laboratory testing 184
Androgen receptor 682
Anemia 245, 322
immune hemolytic 350
sideropenic 485
Anesthesia 692
general 693, 699
local 698
regional 699
topical 506, 698
total intravenous 693
Aneurysm 567
intracranial 125
Anginosus-Milleri group 92
Angioedema 352, 360
Angiofibroma 336, 385, 668
nasopharyngeal 472f, 476
Angiogenesis 681
Angiotensin-converting enzyme 341
Angle fracture 378f
Angle's classification 377
Angular cheilitis 111, 412
Ankyloglossia 408, 418
Anomia 538
Anosmia 306, 311, 708
common causes of 311
postinfluenzal 311
Anotia 199
Anoxia 179
Anroth's sign 714
Anti-allergic treatment 330
Antibiotics 90, 94
antipseudomonal 207
bactericidal 98
bacteriostatic 98
resistance 457
patterns 708
sensitivity testing 95
side effect of 90
Antibodies 425
antimicrosomal 88
Anticancer drugs, chemotherapy toxicity of 688
Anticholinergic agents 356
Anticoagulation therapy 245
Antidepressants 129
Antidiphtheric serum 458
Antiemetics 276
Antiepileptic 143
drugs 273
Antifungal
agents 344
inhibit cell wall glucan synthesis 102
therapy 102
treatment 102t, 103
Anti-herpes treatment 105
Antihistamines 276, 326, 355, 468
oral 355
Anti-IgE antibody therapy 356
Antimicrobials 100
adverse effects of 99
agents 95
Antineutrophilic cytoplasmic antibody 339
Anti-phagocytic bacterial structures 100
Antipseudomonal penicillins 96
Antireflux
surgery 495
therapy 495
Antiretroviral 109t
therapy 104
Antiseptics, nonspecific 99
Antithyroid 87
drugs 582
Antitubercular drugs 99
Anti-tumor necrosis factor 127
Antiviral 104, 105
Antral lavage 621
Antral puncture 327, 331, 620
anesthesia and position 620
complications 621
contraindications 620
indications 620
instruments 620
technique 620
Antral sign 472, 476
Antral wash 314
Antrochoanal polyp 335t, 336, 336f, 337, 337f, 666f, 668, 670
specimen of 336f
Antrostomy, intranasal 331, 622
Antrum irrigation 621f
Antrum puncture 329, 621f, 651
instruments 651f
Anxiolytics 129
Aortic arch 64, 643, 714
Apgar score 181
Aphasia 538
amnesic 538
conduction 538
fluent 538
global 538
mixed 538
nominal 538
nonfluent 538
sensory 538
total 538
visual 538
Aphonia 534
functional 539, 543
hysterical 539
Aphthous ulcers 111, 120f, 416f, 457, 458
major 416f
minor 415f
Apical lung tumor 712
Apnea hypopnea index 463, 469
Apnea index 463
Aponeurosis, pharyngeal 56
Apoptosis 681
Appetite 7, 48
Aqueduct of vestibule, opening of 15
Aquino's sign 303
Arches
branchial 21f, 65, 65f
zygomatic 84, 375
Areca nut, chewing of 407
Argon laser 702, 706
Armored tubes 662
Arnold's nerve 5
Arnold-Chiari malformation 251, 712
Arousal index 463
Arousal test 183
Arterial dissection 140
Arterial embolization 323
Arterial ligation 324
Arteriovenous malformations 139, 577
Arteritis, temporal 126
Artery 38f
ethmoidal 324
external carotid 14, 81, 324
maxillary 14, 324
posterior auricular 14
Arthralgia 290
Artificial larynx 552
Aryepiglottic fold mass 404f, 546f
Arytenoid 508
cartilages 69
processes, movement of 73f
vocal processes of 71
Arytenoidectomy 533
Asch's forceps 372, 373, 373f, 651f
Ashai technique 552
Aspergillus 102, 110
flavus 345
fumigatus 102, 345
niger 101, 204, 209
species 346
Aspiration 514, 534, 535
common causes of 512
congenital problems of 558
cytology 385
Aspirin 127
Astemizole 356
Asthma 350, 352, 357t, 364, 495
Asynergia 257
Ataxia, ipsilateral 244
Ataxic gait 116
Atelectasis 215, 225, 561
Atelectatic ear 605, 606
Atherosclerosis 140
Atlantoaxial dislocation 636
causes of 636
Atovaquone 109
Atracurium 694
Atresia 559
correction of 367
isolated 202
Atresiaplasty 202
Atrium 34
Atrophic scar 213
Attic cholesteatoma 229, 612
Attic compartments 12
Atticotomy 231
Audiogram 142, 173f, 230, 233, 248
charting, symbols used in 152t
format of 146f
free-field aided 185f
Ménière's disease 265f
otosclerosis 164f
Audiology 146
Audiometric zero 147
Audiometry
free-field play 184f
impedance 155, 155f, 165, 167
Auditory
aphasia 538
artery, internal 20
brainstem
implant 197
response 156, 182
canal, internal 20, 20f, 299, 299f, 675f
fatigue 159
function 134
hallucination 139
meatus, internal 2
nerve 26
neural pathways 21
neurons, efferent 29
neuropathy spectrum disorder 183
oral communication 186
pathways, ascending 22t
placode 21
rehabilitation 185
response cradle 183
steady state response 158, 182
training 188
vesicle 21
Aural speculum 133
Aural syringe 206, 646
Auricle 5, 20
cartilage 6
disorders of 198
external features of 5f
hematoma of 200
incisura terminalis 5
keloid of 295
nerve supply 5
Auricular nerve, greater 5
Autoantibodies 705
testing for 432
Autoeczematization 708
Autoimmune disease 285, 414, 582
Autonomic nervous system 37
Awake flexible laryngoscopy 559
Axonotmesis 282
Azithromycin 98
Azoles 102
Aztreonam 96
B
B canal wall-up procedures 607
Bacillus
gram-negative 93
proteus 218, 244
pyocyneous 218
Baclofen 127
Bacteria 90
anaerobic 422
Gram-negative 90t, 91t
microaerophilic 93
pathogenic 92
potentially pathogenic 92
Bacterial
cell wall synthesis, inhibitors of 96
endocarditis, subacute 457
parotitis, acute 402
protein synthesis, inhibitors of 97
rhinosinusitis, acute 326, 337, 708
Bacteriotherapy 90
Bacteroides fragilis 93, 96, 227, 596
Balance disorders 248
Ballenger's swivel knife 654, 654f
Ballet's sign 714
Balloon dilators 496
Bannwarth's syndrome 290
Barany's noise box 150, 646
Barium esophagography 450
Barium swallow 450f, 451f, 452, 486, 493, 493f, 496499, 499f, 500, 500f
modified 451, 535
Barotrauma 218, 327
Barrett's esophagus 495
Bartolomeo Eustachi 8
Bartonella henselae 425
Basal cell
carcinoma 295, 309f, 320
hyperplasia 229f
theory 229
nevus syndrome 395
Basal skull fractures 288
Basilar membrane 16, 264
Bat ear 198, 209
Batten graft 315
Battle's sign 288, 292
B-cell lymphoma 104
Beahr's triangle, boundaries of 87
Becker's sign 714
Behavior observation audiometry 183, 184f, 184t
Behçet's syndrome 414, 415
Bell's facial palsy, right side 286f
Bell's palsy 104, 136, 286, 287, 292
Bell's phenomenon 286, 292
Benign paroxysmal positional vertigo 167, 259, 261f, 289
Bent and Kuhn classification 42
Benzodiazepines 143, 273
Berry's ligament 87
Berry's sign 714
Beta-adrenergic blockers 582
Beta-lactamase inhibitors 90, 95, 96, 100
Betel, chewing of 407
Bezold's abscess 236, 239, 240f, 246
Bezold's sign 714
Bicellular reserve cell theory 428
Bifid uvula 449f
Bill's bar 20, 292
Bill's island 28
Binaural tests 149
Bing test 149, 151
Biopsy 138, 297, 314, 475, 500, 654, 712
laryngeal 521
scrapings of 343
Bipolaris 102, 345
Bird-beak sign 714
Birkett tonsil artery forceps 658f
Birth injuries 179
Biscuit-type lesion 163
Bite-appliance therapy 129
Bithermal caloric test 256f
Björk flap 556
Black-colored tongue 400f
Blakesley and Takahashi ethmoid forceps 652
Bleeding 230
Bleomycin 689, 690, 691
Blepharospasm 291
Blindness 538
Blink reflex 301
Blom-Singer prosthesis 552
Blood
borne infection 268
brain barrier 100
culture 518
disorders 417
dyscrasias 458
loss 708
classification of 370
tests 248, 498
transfusion of 107
vessels 321
Blow-out fracture 375
types of 375
Blunt probe 646
Bocca's sign 600
Body equilibrium, maintenance of 27
Body mass index 465
Boerhaave's syndrome 491, 501
Bone
conduction 159
hearing aid 185, 189
destruction of 229
erosion 236
ethmoid 40, 42f
forceps 652
frontal 40, 371
marrow 589
examination 457
maxillary 38
remodeling of 163
removal of 624
Bone-anchored hearing aid 192, 192f
parts 192f
processor 192f
system 192
Bony cochlea, cut section of 16f
Bony fallopian canal 283
Bony labyrinth 15, 29, 163
Bordetella pertussis 91, 93, 518
Boric acid 99
Borrelia burgdorferi 92, 94, 263
Borrelia vincenti 94
Botulinum toxin
injection 498
therapy 543
Boyer, pre-epiglottic space of 71
Boyle-Davis mouth gag 633, 633f, 655, 656f, 657f
Brachytherapy 684
Brain
abscess 236, 243
rupture 243f
toxoplasmosis of 108
Brainstem 21, 275, 301
evoked response audiometry 141, 156, 157, 157f, 157t, 159, 177, 182, 186, 275, 301
implant 197
lower 302
Branchial apparatus 65, 65f
Branchial arches, derivatives of 65f
Branchial cleft
anomalies, tracts of 576
cyst 576
second 576
sinus, second 576
Branchial sinus 576, 577f
Branchio-oto-renal syndrome 181
Branhamella catarrhalis 218
Broad-spectrum coverage 95
Broca's aphasia 538
Brodmann's area 22
Brompheniramine 355
Bronchi 76, 703
development of 74
Bronchial foreign bodies 561, 562
Bronchial obstruction, types of 561f
Bronchiectasis 48
Bronchitis, asthmatic 712
Bronchoalveolar lavage 341
Bronchoesophagoscopy instruments 661f
Bronchopneumonia 534
Bronchopulmonary segments 76, 76f, 77f
Bronchoscope 642, 659, 660, 660f
proximal end of Storz 660f
size of 660
ventilating 513
Bronchoscopy 501, 513, 559, 639, 704
biopsy 641, 709
flexible 641
foreign body removal forceps 661
rigid 639641
types 639
Bronchospasm 351
Brook's tumor 712
Brown's sign 303
Broyle's ligament 70, 78
Brudzinski's sign 242
Bruit 120
Bryce's sign 527
Buccal fat pad 445
Buccal mucosa 52, 398, 441f
carcinoma 399f
malignancy 444f, 445f
stage III T2N1M0 carcinoma of 446
Bulbous nasal tip, correction of 627
Bull's eye lamp 116, 117f
Bulla ethmoidalis 35
Bupivacaine 698
Burkitt's lymphoma 104
Burning mouth syndrome 419
Burns, corrosive 491
C
Cable graft 291
Cacosmia 306
Cadaveric larynx, sagittal section of 70f
Caffeine 248
Calcitonin 87, 590
serum 572
Calcium channel blockers 273
Caldwell-Luc approach 337
Caldwell-Luc operation 49, 331, 379, 621, 622f, 630, 652654
Caloric test 254, 255f, 266, 301
Canal ampulla
lateral 279
posterior 279
superior 279
Canal wall-down
mastoidectomy, disadvantages of 612
procedure 231, 231t
Canal wall-up
mastoidectomy, disadvantages of 612
procedure 231, 231t
Canal, atresia of 20
Canalithiasis 259, 260
Cancer
anaplastic 586, 588
ethmoidal 396
glottic 549
head and neck 84, 545, 681
laryngeal 549, 709
laryngopharynx, spread of 71
larynx
and hypopharynx, stage grouping for 548
spread of 71
maxilla 379
medullary 586
nose and paranasal sinuses, staging of 390t
oropharyngeal 478
papillary 586
phobia 448
prevention of 691
staging 431t
subglottic 551
subsites of 51
supraglottic 545, 550
tongue 446
Candida albicans 101, 204, 497
Candidiasis 101, 108, 111, 411, 412
chronic hyperplastic 438
chronic hypertrophic 411
Canine fossa antrostomy 622, 622f
Capsofungin 102
Carbamazepine 127, 143
Carbapenems 96
Carbenicillin 96
Carbimazole 582
Carbon dioxide 702
laser 703, 714
Carbonic anhydrase inhibitor 273
Carboplatin 689691
Carcinoembryonic antigen 572
Carcinogenesis, multi-hit theory of 681
Carcinoma 298f, 401f, 441f, 445f
anaplastic 588, 591
base of tongue 61, 449, 480
buccal mucosa 444, 445f, 445f
esophagus 500, 709
tumors nodal metastasis (TNM) classification of 501b
floor of mouth 443
gingiva 441
glottic 71, 550f
glottis 552
hard palate 120f, 445
hypopharynx 485
in situ 549
larynx 546f, 547f, 552
lips 440, 441f
lymphoepithelial 431, 479
maxillary sinus 387f
medullary 591
middle ear 297, 303
mucoepidermoid 430
nasopharyngeal 59, 473, 474f
nasopharynx 477
of laryngopharynx, AJCC cancer staging and UICC TNM classification of 487t
of larynx, AJCC cancer staging and UICC TNM classification of 547t
oral
cavity 437
tongue 441
oropharyngeal 478, 479
postcricoid 488, 500f
posterior pharyngeal wall 482
pyriform sinus 487
retromolar trigone 446
right tonsil 574f
sinonasal undifferentiated 390
soft palate 482
supraglottic larynx 120f, 545f
thyroid
staging of 590
treatment of 590
tip of tongue 442f
tongue 442f, 443f
tonsil 481
undifferentiated 431
vocal cord, irradiated case of 505f
Cardiac achalasia 451, 498, 501
radiological findings of 498
Cardiac failure 290
Cardiac valvular disease 631
Cardiopulmonary responses 48
Cardiospasm 451
Carhart's notch 164, 167
Carhart's tone decay test 153
Carina, posterior spur of 76f
Caroticotympanic nerves 11
Carotid 81
angiography 472
artery 81, 87f, 570
common 81
internal 14, 483, 595
blowout 86
body tumors 119, 567, 575, 576
sheath 82
infections 597
triangle 709
swellings 566, 572
Cartilage 32, 68, 69f
auricular 28
implant 534
incision of 624
lower lateral 32, 314f
removal of 624
types of 68
Cartilaginous external auditory canal, skin of 6f
Cartilaginous tumor, laryngeal 529
Cart-wheel sign 219
Cat scratch disease 425
Catecholamines 297
Caudal septal deviation 34, 35, 362, 363f
Cauliflower ear 209
Causative fungi 345
Cavernous sinus 45f, 334f, 337, 628
thrombophlebitis/infection 337
thrombosis 49, 245, 333, 334, 334t
Cavum minor 613
Cefotaxime 328
Cefoxitin 597
Ceftriaxone 100, 220, 597
Celiac disease 414
Cells
frontoethmoid 42
infraorbital 42
marginal 14
mediated immune process 407
of Hensen 18
perisinus 14
wall 99
zygomatic 14, 609
Cellulitis 204, 316, 621
Cementoma 386
Central auditory
pathways 22f
tests 149
Central sleep apnea 464
Central vestibular
connections 22
disorders 271, 272b
lesions, features of 254
system 26
Cephalometric radiogram, lateral 469
Cephalosporins 90, 96, 707
Cerebellar
abscess 243, 244
artery
anteroinferior 274, 292
occlusion, posterior inferior 277
posteroinferior 274
superior 274
hemisphere 257, 274
infarction 274
isolated 274
tests 257
Cerebellopontine angle 20, 299, 300f
boundaries of 299
lesions 283
relations of 299
tumor 142, 249, 285, 300f, 302
Cerebellum 243, 275, 301
Cerebral
abscess 243
edema 86
Cerebrospinal fluid 16f, 137, 275, 342, 379
composition of 17t
leak 620
localization of 380
persistent 289
otorrhea 289
rhinorrhea 289, 379, 380, 380t, 382
tracers 380, 380t
Cerebrovascular disease 125, 249
Cerebrum 22, 48, 243
cortical veins of 242
Ceruminoma 294
Cervical
abscess 457
adenopathy 109
causes 109
cancer, invasive 108
chain, transverse 83
esophageal rupture 491
esophagotomy 494
esophagus 64, 88f, 500f
perforation of 491
examination 565
fascia 81
superficial 81
thin superficial 594
lymph node 61f, 84, 458, 504
involvement 391
level of 84, 85b
palpation of 567f
lymphadenitis
acute 578, 580f
tuberculous 579, 579f
lymphadenopathy 519, 598
lymphangioma 577
nodal metastases 474
node
anterior 84
fine-needle aspiration cytology of 475
superficial lateral 83
pleura 81, 592
rib 580
spinal cord lesion 712
spine 453
immobilization 708
tuberculosis of 600
X-ray of 136, 600
spondylosis 126
sympathetic trunk 570
symptoms 565
trachea 80
vertigo 277
Cetrizine 356
Chalk writing stick 381f
Chandler classification 333t
Charge syndrome 712
Chassaignac's triangle 81
Cheek retractor 655
Chemodectoma 296, 575
Chemoprevention 691
Chemoradiation 86, 690
induced dysphagia, preventing measures of 454
Chemosis 245
Chemotherapeutic
agents 689t
therapy 684
Chemotherapy 590, 680, 686, 688
adjuvant 690, 691
anterior 690f
antituberculous 579
biological factors 688
concomitant 686
induction 686, 690f
intra-arterial 691
palliative 688
phases of drug evaluation 688
posterior 690
principles 688
prognostic factors 688
systemic 475
Cherubism 396
Chest pain, noncardiac 494
Chevalier Jackson's esophageal speculum 662f
Chevalier Jackson's tracheostomy tube 663
Chevallet fracture 362, 362f
Chisels 653
Chlamydiaceae 92
Chlamydiae 94
Chlamydophilia
pneumoniae 94
psittaci 94
trachomatis 94
Chloramphenicol 98, 100
Chloroquin 171, 179
Chlorpheniramine 355
Choanae 31
Choanal atresia 312, 367, 668
bilateral 310
Choanal polyp 312, 313
Cholesteatoma 138, 224, 226, 227, 230, 232, 234, 243, 244, 249, 708
acquired 228
primary 226
congenital 165, 228, 230, 708
pathogenesis of 229f
primary 234
acquired 228, 230
secondary acquired 228, 230
spread of 229
structure 228, 228f
surgical treatment 231
types of 228, 228b
Cholesterol granuloma 230
Chondritis 201, 204, 209
Chondrodermatitis nodularis chronica helicis 201
Chondroma 385, 528
common sites 385
treatment 385
Chondrosarcoma 392
Chorda tympani 280
nerve 11, 167
Chordoma 470, 471, 712
nasopharyngeal 477
Chorioretinitis 107
Choristoma 470
Chraniopharyngioma 470
Chrysomya 381
Churg-Strauss syndrome 335, 339, 342
Chyle leak 86
Cicatricial pemphigoid 412
Cilastatin 597
Ciliary
beat, rate of 49
biphasic beats 47
dyskinesia syndrome, primary 330
Ciprofloxacin 95
Circumvallate papillae 449
Cisplatin 172, 689, 691
Cisplatinum 690
Citelli's abscess 236, 239
Citelli's angle 28
Clarithromycin 109
Claussen butterfly chart 257f
Clavulanate 222, 597
Clavulanic acid 96
Cleft lip 362, 712
congenital 33
Cleft palate 67, 214, 362, 449, 712
submucous 449, 460, 714
Clegg's nasal snare 654f
Clemastine 355
Clindamycin 98, 109
Clivus 628
Clonazepam 143, 273
Clostridium
botulinum 91
difficile 91
tetani 91
Clotrimazole 102
Coblation 636
Cocaine 698, 699
Cocal nodules, bilateral 449f, 524f
Coccidiomycosis 108
Cochlea 16, 29
aqueduct of 16
develops 21
Cochlear basal turn 179
Cochlear canal, structure of 17f
Cochlear duct 16
pushing Reissner's membrane 264f
Cochlear dysfunction 140
Cochlear hair cells 25
Cochlear implant 165, 186, 188, 193, 195, 197
candidates, evaluation of 195
surgery
early of 196t
late complications of 196t
Cochlear microphonics 25, 26, 29, 156
Cochlear nerve 21
Cochlear nucleus 29
Cochlear recess 15
Cochleopalpebral reflex 183
Cochleosacculotomy 266
Cognitive behavior therapy 144
Cold ablation 636
Cold abscess 566f, 568, 579, 579f
left side 119f
ruptured 121f
Cold air caloric test 255
Cold dissection 634
Collagen disease, localized 407
Collagen vascular disorders 407
Collagenase 229
Collar stud abscess 579
Collaural fistula 202
Collet-Sicard syndrome 474
Colliculus, inferior 21
Colloid nodule 586
Coloboma 199
Columellar septum 34
Combined modality
therapy 690
treatment 685
Commissure laryngoscope, anterior 660f
Common cold 326, 337, 456
Compartment nodes, anterior 84
Complete blood count 108, 353, 597
Complex sound 146
Comprehensive Tinnitus Management Program 143b
Concha bullosa 35
Conchotome 658
uses 658
Condylar fractures 378, 603, 673f, 708
Confrontation test 244
Coniotomy 557
Connexin 26 mutation 185
Consciousness, level of 243
Constitutional signs 424
Constrictor muscles, middle and inferior 67
Conus elasticus 70
Conventional radiology
larynx 667
neck 667
pharynx 667
temporal bone 665
Cor pulmonale 460, 462
Cord virulence factor 100
Core biopsy 585
Cormack and Lehane classification 697
Cormack, grades of 697f
Coronavirus 103, 456
Corti, organ of 16, 18, 25, 25f
Cortical mastoidectomy 238, 240, 608
cavity 609f
steps of 610
Corticobulbar tract 538
Corticosteroids 356, 411
short-course of 417
systemic 433
Corynebacterium diphtheriae 90, 93, 458
Coryza 326
Costen's syndrome 144, 712
Co-trimoxazole 97
Cottle mallet 648f
Cottle test 310, 314, 315f
Cotton swabs injury 209
Cotton-wool test 310
Cough 504, 510, 534, 554
painful 554
reflex 75
Cowden's syndrome 584
Coxsackie virus infections 456
Cranial bones 2
Cranial fossa
anterior 379
middle 46, 303, 379
Cranial nerve 5, 66t, 135, 595
examination of 122
involvement 387
palsies 296
tests of 123t
Craniocervical junction disorders 272
Craniofacial growth abnormalities 460
Craniopharyngioma 59
Creamy ear discharge 236
Crepitus
laryngeal 489
presence of 597
Cresylate 99
Cribriform plate 676f
lateral edge of 35
Cricoarytenoid joint 563
arthrodesis of 534
Cricoarytenoid muscle, posterior 78
Cricoid 69
cartilage 64, 78, 80
arch of 70
level of 88
split 513
Cricoidectomy, subperichondrial 534
Cricopharyngeal
myotomy 499
spasm 497
sphincter 643
Cricothyroid
joint 563
membrane 70, 513
muscle 73f
paralysis, causes of 533
spaces 75
Cricothyroidotomy 564
Cricothyrotomy 70, 555f, 557, 562
emergency 513
Cricotracheal membrane 69
Cricovocal membrane 69
upper edge of 71
Cristae 19, 19f
Crocodile scissors and forceps 651
Crocodile tears 285
Cromolyn 356
sodium 360
Crooked nose 32f, 318
S shaped 318f
Croton oil 714
Crowe-Beck test 245
Crus commune 16
Cryosurgery 358, 704, 705, 706
Crypta magna 62
Cryptococcal meningitis 109
Cryptococcosis 108
Cryptotia 199
C-shaped deformity 362
Cuneiform cartilage 69
Cup ear deformity 198
examples of 199f
Cupula 19, 19f
Cupulolithiasis 259
Curvularia 102, 345
Cushing's syndrome 116
Cutaneous horn 294
Cyanosis 115
Cyberknife stereotactic surgery 686
Cyclophosphamide 689
Cylindroma 430
Cystadenoma lymphomatosum, papillary 429
Cystic fibrosis 330, 335, 337
tests for 312
transmembrane regulator gene 312
Cysts 200, 200f, 293, 307, 309
branchial 65, 567, 576
dental 307
dentigerous 395
ductal 526
fissural 394
follicular 395
involving nasal cavity 394f
mucous 483
nasoalveolar 319
periapical 395
saccular 526
sebaceous 5, 118, 293, 578f
Cytomegalovirus 109, 179, 450, 456, 497
congenital 184
retinitis 108
Cytoplasmic membrane 99
Cytotoxic drugs 171, 433
D
Da Vinci surgical Robotics system 706
Dacryocystorhinostomy, endoscopic 652
Dalrymple's sign 571, 571f, 712
Danger space 707
Danger triangle area 33
Dapsone 109
Darwin's tubercle, prominence of 199
Deaf and dumb 185, 708
Deaf, education and vocation of 186
Deafness 343, 387
Decibel (dB) 147, 151, 159
scale 147
Decongestants
nasal 355
oral 326, 355
topical 309, 326, 623
Deep cervical fascia 81
three layers of 82f
Deep cervical internal jugular chain 85
Deep lateral cervical nodes 83
Deep neck space
classification of 595b
infections 594
complications of 598
infrahyoid 595
suprahyoid 595
Deep retraction pockets 226, 612
Deferoxamine 171
Deficient mastoid pneumatisation, theories of 13
Dehydration 421, 705
Deiter's cells 18
Delphian node 71, 78, 84
Delta sign 245
Demarquay's sign 545
Demyelinating plaque 275
Denis Browne tonsil holding forceps 657f
Dental caries 438
Dental erosions 494
Depression 453
Dermabrasion infection 714
Dermatitis
contact 204
postauricular 133f
Dermatomyositis 407
Dermoid 307
cyst 293, 307, 437, 449, 567, 578
common sites of 118
sublingual 437
submental 437
types of 437
Desferioxamine 171
Desloratadine 356
Diabetes 208f
mellitus 285
Diaphragm 64
Diaphragma sellae 628
Dichotic test 149
Didanosine 109
Diffuse esophageal spasm 452, 497
Digastric muscle 13
Digastric ridge 13, 281
DiGeorge sequence 65, 712
Dihydroergotamine 126
Dilutional thrombocytopenia 695
Diphenhydramine 355
Diphtheria 457, 458t, 518
Diphtheritic croup 516
Diphtheroid 340
Diplopia 246, 370, 582
vertical 274
Direct immunofluorescence examination 412
Direct laryngoscopy 509, 559, 637
Discoid lupus erythematosus 411, 438
Discrimination test 159
Disequilibrium 249
Dislocation, anterior 362
Disorders of voice 538
aphonia 538
diplophonia 538
dysphonia 538
phonasthenia 538
puberphonia 538
rhinolalia 538
Distal thromboembolism 245
Distant metastases 475, 501, 590
Distraction techniques 183
Diverticula 491
Diverticulum
esophageal 501
hypopharyngeal 453
Dix-Hallpike examination 708
Dix-Hallpike maneuver 258
modified 254
Dix-Hallpike test 253, 254f, 260, 261
interpretation 254
method 253
Dizziness 249, 269
causes of 260t
pathophysiology of 28
psychophysiologic 248
Docetaxel 689
Dohlman's procedure 499
Donaldson's line 28
Dorsal hump 627
Dorsum of tongue
lobular capillary hemangioma of 435f
midline exophytic growth 435f
white patches on 400f
Double ring sign 380, 714
Down's syndrome 214, 461, 635, 635, 699
Doyen's mouth gag 655, 655f
Doyen-Jansen mouth gag 655f
Draffin bipod 655, 657f
Drainage, venous 14, 20, 62
Dressing forceps 646
Drooling 404
acute 404
anterior 404
chronic 404
classification 404
examination 405
history 405
management 405
Drop attacks 264
Drowsiness 236
Drugs 321, 351, 707
Dry perforation 226
Dry vermilion 51
D-tubocurarine 694
Duct, incision of 427
Dysarthria 538
Dysdiadokokinesia 244
Dyshormonogenesis 581
Dyskeratosis congenita 438
Dysmetria 257, 713
Dysphagia 438, 449, 450, 452, 456, 493, 499, 504, 510, 599, 602
causes of 453b
esophageal 452
expressive 538
fatal complication of 453
lusoria 453f, 454
medications aggravating 454
oropharyngeal 452, 454
receptive 538
sensory 538
sideropenic 438
Dysphonia 510
plica ventricularis 508, 539, 543
spasmodic 541
ventricular 539
Dysplasia 410
fibrous 385f, 396
Dyssomnia 463
Dystrophia myotonica 285
E
Eagle's syndrome 62, 136, 483
Ear 110, 460, 702, 703
anatomy of 1, 4
and cerebellopontine angle, tumors of 293
buds injury 209
carcinoma 295
congenital defects of 21
development of 20, 21t, 29
developmental anatomy of 21
discharge 148, 230
examination of 131, 132t
external 110
fluids, inner 17
fullness 148
hardening of 162
inner 21
internal 15
maggots 203, 209
microforceps 649f
microsurgery 648
instruments 609f
middle 110
nerve supply of 135f
nose and throat
common complaints of 115t
diseases 102
pain 236, 237
physiology of 1
polyp 139, 227f, 296
removal of 233
pus 242
speculum 646
insertion 133f
surgery bone cutting instruments 648f
surgery instruments 648f, 649f
retractors 648f
syringing 206, 206f, 207f
three parts of 5
Earache 134, 286, 456
post-tonsillectomy 636
Eardrum, motion of 24f
Earwax 206, 209
Ecchymosis, periorbital 373
Echinocandins 102
Ectoderm 21
Ectopic
parathyroid 65
thyroid 66
tissue 88
Edema 582
facial 86
inflammatory 333
Edentulous mandible, fracture of 379
Eikenella corrodens 597
Elastic cartilages 78
Electrical tests 283, 284t
Electrocochleography 156
Electrogustometry 284, 301
Electrolytes, serum 597
Electromagnetic mode, transverse 701
Electromagnetic spectrum 683t
Electromyography 283
laryngeal 509, 533
Electroneurography 283
Electroneuronography 284
Electronic nose 380
Electro-olfactogram 312
Elevators 653
Elimination tests 354
Embryology 65
Emphysema
obstructive 561
subcutaneous 620
surgical 504
Empty nose syndrome 366
Empyema 241, 329
Encephalocele, extranasal 318
Enchondral layer 163
Endaural incision 5
Endaural speculum 648
Endemic cretinism 581
Endobronchial mass lesion 641f
Endoderm 21
Endolymph 15, 17, 29
composition of 17t
flow of 27
impaired absorption of 263
movement of 19
overaccumulation of 264
Endolymphatic
duct 17
hydrops 263, 289
delayed 267
sac 17, 29
decompression 266
surgery, types of 266
systems 16f
Endomeatal spines 6
Endonasal septoplasty, limitations of 625
Endoneurium 292
Endophlebitis 244
Endoscope 134f, 659, 660
care of 112
ninety-degree 506
position 506
Endoscopic
pituitary adenomectomy, steps of 629
septoplasty 625
sinus surgery 331, 333, 386, 617, 623, 624, 653
instruments of 651f, 652f
major complications of 620t
minor complications of 620t
skull base surgery 629
supraglottic findings classification 540
Endoscopy 475, 497, 504, 637
Endotracheal intubation 367, 554, 564
complications of 697
Endotracheal tube 664, 695
appropriate size 697
fire, laser-induced 704
size of 664
specialized 664
Endowrist technology 706
End-to-end anastomosis 291
Enophthalmos 370
Enterobacteriaceae 93
Environmental theory 225
Enzyme 47
Enzyme-linked immunosorbent assay (ELISA) 107, 354
Eosinophilia 358, 360
Ephedrine 276
Epidermal growth factor receptor 681
Epidermal necrolysis, toxic 416
Epiglottis 69
Epiglottitis 516, 517f
acute 511, 517t, 522
Epiglottopexy 534
Epileptic fits 244
Epinephrine 698
Epineurium 282
Epiphora 286, 373
Epirubicin 690
Epistaxis 33, 306, 320, 361, 460
anterior 322, 322t
balloon 324f
causes 321
diffuse 322
digitorum 321
evaluation 321
home care of 322b
investigations 322
pertinent anatomy 320
posterior 322, 322t, 708
recurrent 623
sites of 321
treatment 322
Epithelial
carcinoma, WHO classification of 474t
hair cells, sensory 19
ingrowth theories 229f
layer, outer 7
Epithelioma 118, 320
Epithelium, olfactory 36
Epitympanum 8
compartments of 12
Epoetin alfa 109
Epstein-Barr virus 103, 104, 263, 340, 426, 428
infection 477
Epulis
congenital 436
granulomatosa 436
Epworth sleepiness scale 466, 467
Ergotamine tartarate 126
Ertapenem 96
Erysipelas 201, 201f
Erythema multiforme 416
Erythematous candidiasis
acute 412
chronic 412
Erythrocyte sedimentation rate 342, 589
Erythroleukoplakia 409, 444
lesion, pre-existing 44f
Erythromycin 90, 98, 171
Erythroplakia 409, 410, 438
tongue 410f
Erythropoietin 109
Escherichia coli 91, 93, 227, 243, 244, 340, 601, 709
Esophageal
diseases 491b
injury 564
corrosive 492t
lumen, narrowed 493
manometry 451
perforation 643, 710
speech 552
sphincter
lower 64, 490
upper 64, 451, 643, 490
Esophagitis
candidal 111
infectious 497
pill-induced 494
Esophagogastric angle 65
Esophagogastroduodenoscopy
endoscopy 495
flexible 493
Esophagogram 451
Esophagoscope 642, 660, 661f
Esophagoscopy 452, 497, 500, 641t, 642, 644, 709, 710
flexible 643, 644f
instruments for 642
procedure of 643f
rigid 493, 642
transnasal 644
Esophagotomy, transthoracic 494
Esophagus 63, 64f, 451f, 490, 492, 570
abdominal 64
anatomy of 50
benign neoplasm of 499
constrictions 64
disorders of 490
esophageal sphincters 64
evaluation of 450
face 66
long part of 450
lymphatic drainage 64
nerve supply 64
palate 67
perforation of 490, 494, 643
pharyngeal apparatus 65
physiology of 50
short part of 450
structure 64
thyroid gland 66
tongue 66
Esthesioneuroblastoma 689
staging systems for 392
Estradiol nasal spray 341
Ethambutol 90, 99, 109
Ethmoid
anterior 311
bone, small thin lamina of 36
sinus, malignancy of 391
sinusitis, acute 315
Ethmoidal artery, anterior 620
Ethmoidal cells, posterior 43, 49
Ethmoidal infundibulum
lowest part of 39
medial wall of 36
posterior part of 39
Ethmoidal nerve syndrome, anterior 306
Ethmoidal neuralgia, anterior 306, 366
Ethmoidal polyps, bilateral 335
Ethmoidectomy
anterior 619
external 331, 337, 630
intranasal 331, 337
posterior 619
transantral 337
Etidocaine 698
Eustachian catheter and politzer bag 647
Eustachian tube 134, 155, 164, 211, 212t, 216, 218, 232, 610f
abnormally patent 142
anatomy 210, 211f
cartilaginous part of 211f
catheterization 134, 213, 222
closure of 610
disorders of 210
dysfunction 161, 708
endoscopy 212
instruments 648f
mucosa of 211
nasopharyngeal opening of 213
obstruction 214, 477
patulous 215, 216
pharyngeal opening of 59
physiology 211f, 212
tests 213
Evan's blue dye test, modified 535
Eve's tonsil snare 657, 657f
method of application 657
Ewald's law 252
Exophthalmos 315, 476, 571f, 582
malignant 582
treatment of 582
Exophytic lesions 444
Exostoses 294, 294t
Exserohilum 102
External auditory canal 2, 6, 20, 23, 24, 28, 131, 133, 133f, 135, 137, 139f, 148, 161, 232f, 266, 297, 298t
atresia of 202
cholesteatoma of 205t
congenital disorders of 202
disorders 139
exostosis of 303
furuncle of 238t
nerve supply of 7f
nevus of 133f
primary cholesteatoma of 205
straightens 133f
trauma of 202
External beam radiotherapy, postoperative 591
External ear 4
benign tumors of 293
development of 21f
diseases of 198, 199t
malignant tumors of 295
External nasal valve, collapse of 314
External nose 307, 308, 320, 341
anatomy of 32
cadaveric dissection of 32f
diseases of 33, 316
epithelioma of 320
structure 32f
swelling 308f
tumors of 318
External surface of mandible, structure of 377f
Extracorporeal shock wave lithotripsy 427
Eye 275, 290
and orbit 387
movements, classes of 250f
protection of 703
signs 582
Eyeball 391
displacement of 373
Eyelid
inflammatory edema of 333
motion, upper 281
F
Face
dangerous area of 33
disfigurement of 385f
Facial analysis 626t
Facial lacerations 371
Facial nerve 5, 7, 9, 10f, 135, 281, 299, 301, 371, 708, 709
branches of 280f
course of 279
decompression, surgical 287
disorders 278
extracranial course 279
greater petrosal branch of 31
hyperkinetic disorders of 291
injuries of 285
intracranial course 279
intratemporal course 279, 279f
landmarks 285
monitoring, intraoperative 290
motor nucleus of 279
nucleus 279f
palsy 156, 234, 281
complication of 285
grading 281t
iatrogenic 292
left 125f
surgical treatment of 291
paralysis 241
bilateral 285
causes of 285
regeneration 282
segment of 29, 292
supplies 292
surgical
exploration of 708f
landmarks 54, 280
topographical lesions of 284f
transmastoid exposure of 291f
tumors of 285
Facial nodes 83
Facial numbness 387
Facial pain 127
atypical 128
Facial palsy 208f, 224, 281
causes of 285b
clinical evaluation of 281
left side 219f
lower half left 283f
recurrent 287
upper motor neuron 292
Facial paralysis
lower motor neuron 282
recurrent 292
upper motor neuron 282
Facial plastic surgery 713
Facial recess 9, 10f
boundaries of 610
opening of 10f
tympanotomy 281
Facial ridge 611
lowering of 611
Facial skin 121f
Facial swelling 387
Facial trauma 371, 708
Facultative anaerobic rods 90, 91, 100
Fallopian canal 2, 279
False cords 70
Famciclovir 104
Familial distal myopathy, progressive 285
Farabeuf periosteum elevator 650f
Fascia
buccopharyngeal 57, 82, 598
prevertebral 595
superficial 567f
Fasciitis 567f
Fat-graft myringoplasty 614
Fatigue 687
Fatty acids, polyunsaturated 428
Faucial arch, carcinoma in 482
Faucial diphtheria 458, 462
Faucial tonsil 60
Fenestra cochlea 9, 16
Fenestra vestibuli 9, 15
Fenestration operation 253
Fergusson suction tube 648f
Fetal hypothyroidism 580
Fever 236, 456
exanthematous 218, 515
pharyngoconjunctival 456, 462
Fexofenadine 356
Fiberoptic bronchoscope
advantages 640
types of 640
Fiberoptic exploration 269
Fibroelastic membrane, laryngeal 70f
Fibroma 523
Fibrosis 232
submucous 409, 438, 449
Fibrous bands, surgical incision of 408
Fibrous dysplasia, juvenile aggressive type of 396
Fick and Cody tack procedures 267
Filgrastim 109
Fine needle aspiration cytology 121, 393, 401, 404, 424, 475
reports of 585b
Finger nose test 244
First arch syndrome 65
Fisch's classification 472
Fisch's staging system 297f
Fissula ante fenestram 163
Fissured tongue 418, 418f
acquired 418
congenital 418
Fissures 309, 396
of Santorini 6
Fistula 66, 88, 121, 576
branchial 65, 568
chronic 379
etiological classification of 122
evaluation of 122
external 121
internal 121
large 379
oronasal 399f
perilymphatic 167, 237, 250, 253, 269
postauricular 234
sign 268
test 230, 253, 258, 269
false-negative 253
false-positive 253
interpretation 253
method 253
principle 253
types of 121
Fitzgerald-Hallpike bithermal caloric test 255, 258
Flavor 398, 709
Flexible fiberoptic bronchoscopy 640
Flexion, ipsilateral 80
Floor of mouth
examination of 52
inferior surface of 52f
Flucloxacillin 96
Fluconazole 102, 105
Flucytosine 102
Fluid, free amino acid content of 269
Fluorescein, intrathecal 380
Fluorescent in situ hybridization 681
Fluoride 433
Fluoroscopy 498
Foley's catheter 323, 324f
Folinic acid 109
Follicular tonsillitis, acute 458t
Food hypersensitivity 414
Footplate fenestra 166f
Foramen cecum 88
Foramen lacerum 43
Foramen of Huschke 7, 28
Foramen ovale 43
Foramen rotundum 43
Foramen spinosum 43
Forced duction test 375
Forceps delivery 285
Fordyce's spots 412, 419
Foreign bodies 122, 138, 381f, 492
nature of 560
of ear 202
removal 562
respiratory passage 518
risk factors 492
throat 501
upper esophagus 668f
Foscarnet 109
Fossa of Rosenmüller 58, 59, 211
Foul-smelling discharge 233, 306, 379
Fovea ethmoidalis 676f
Fowler's alternate binaural loudness balance test 153
Fractionated CO2 laser 703
Fracture 373f
comminuted 361, 372f
impacted 372f
impure blow-out 375
Le Fort classification of 376f
mandibular 378, 379, 382, 708
multiple pieces of 361
parasymphyseal 378f
posterior wall 371
subcondylar 378f
three sites of 374f
Fraser test 269
Frazier water protocol 454
Free radial forearm flap 445
Freer's double-ended elevator 653f
Frenzel glass 258
Frenzel maneuver 216
Frequency spectrum 158
Frey's syndrome 11, 285, 431, 433
Friedman tongue positions 465
Frisch bacillus 521
Frontal cyst, congenital 118f
Frontal sinus
malignancy of 391
tenderness of 311f
trephination of 331
Frontal sinusitis, acute 315
Frontoethmoidectomy, external 331
Frontosphenoethmoidectomy 331
Frostbite 5, 200
Fukuda test 714
Fuller's bivalved tracheostomy tube 662
Fulminant sinusitis, acute 102
Fungal infection 330, 458
Fungal sinusitis 337
acute invasive 344
allergic 102, 335
chronic hypertrophic 345
invasive 102
noninvasive 102, 346
Fungi 101
Fungiform papilloma 386
Fungus balls 345
Furred tongue 400f
Furstenberger's sign 636
Furuncle 307, 309, 317
nose 118f
treatment 317
Furunculosis 205
Fusidic acid 98
Fusiform bacilli 457
Fusobacterium necrophorum 93, 597
G
Gabapentin 127, 128
Gait and tandem walking 255
Galen's anastomosis 74, 78
Gallium scanning 341, 589
Galvanic test 255
Gamma knife surgery 302
Ganciclovir 104, 109
Gardner's syndrome 584
Gastric junction, esophageal 451f
Gastritis, atrophic 488
Gastroesophageal reflux 65, 485, 545
disease 115, 330, 450, 490, 494, 504
Gastroesophageal sphincter 65
Gastrointestinal tract 593
Gastroscope, flexible 644f
Gastrostomy 496
Gelle's test 149, 151, 159
Gene 681
Geniculate body, medial 26
Geniculate ganglion 292
Genioplasty, advancement 469
Gentamicin 98, 172, 179, 267
Gerlach tonsil 216
Germ theory 350
Giant cell arteritis 127
Gifford's sign 714
Gingivae 52
Gingival involvement 413
Gingivitis 111
marginal 413
Gingivolabial sulcus 394f, 444f
Gingivostomatitis, herpetic 413, 413f
Ginkgo biloba 143
Gland
normal 403
pituitary 45f
submandibular 80, 403
Glandular tissue 403
Glioma 385, 396
extranasal 319
Globus hystericus pharyngeus 499
Glomerulonephritis, acute 457
Glomus tumors 139, 140, 296, 303, 575
blood supply of 296
Glomus tympanicum 296, 303
Glossectomy, partial midline 469
Glottic chink 74, 78, 531, 536
Glottic closure 534
types of 509f
Glottic gap 508
keyhole appearance of 540f
Glottic insufficiency 511, 539
Glottis 71
anteroposterior length of 71
Gluck-Sorenson's incision 85
Glucose-6-phosphate dehydrogenase, deficiency of 100
Glutamate receptor antagonists 143
Glycerol test 265
Glycopeptides 97
Goiter 568, 569f, 570f
development, stages of 583
simple 583
toxic 571f, 589f
nodular 581
Goitrogens 581
Goose's foot 280
Gradenigo's syndrome 240, 246
Gradenigo's triad 708
Grafts 614, 615
Granular cell tumor 436
Granulation 232, 234
histopathology of 234
tissue 230
Granuloma 525
contact 525f
eosinophilic 417
nonhealing midline 339
traumatic 417
Granulomatous disorders 407
Graves’ disease 88, 581
Graves’ ophthalmopathy 582
Great vessels, abnormal 453f
Greenstick fracture 372f
Griesinger's sign 245, 246
Grisel syndrome 598
Griseofulvin 102
Grommet testing 155
Group A beta-hemolytic streptococci 92, 457, 709
Growth hormone-secreting adenomas 628
Guedel oropharyngeal airway 663f
Guillain-Barré syndrome 285, 554
Gums 52, 398, 399
Gutzmann's pressure test 543
H
Habenula perforata 166
Haemophilus influenzae 91, 93, 180, 218, 223, 242, 422, 515, 517, 601, 709
Hair cells 18, 19f
functions of 25
inner 18, 18t, 25
outer 18, 18t, 25
Hair dye and alcohol intake 428
Hair follicles 6
Hairy leukoplakia 111, 111f
oral 410
tongue 399f
Hairy tongue 418
Hajek lip retractor 655, 655f
Half Somersault maneuver 261
Halitosis 449
Haller cells 42
Halmagyi head thrust test 253
Halo sign 714
Hamartoma 470
Hammer 653
Hand, foot and mouth disease 414, 419
Handicap, degree of 152
Handkerchief sign 714
Hansen's disease 521
Hard palate 52, 394f, 398, 399
hemangioma 399f
Harmonic scalpel 632, 636
Hartmann's dressing forceps 646
Hartmann's ear forceps serrated and cupped jaws 649f
Hartmann's eustachian catheter 648f
Hartmann's nasal forceps 647f
Hartmann's speculum 648f
Hashimoto's disease 88
Hashimoto's thyroiditis 589f
Hay fever 352
Hayes-Martin maneuver 427
Head and neck, lymph nodes of 83, 84f
Head
coronal section of 31, 31f
impulse test 253
movement, plane of 26t
of malleus, attic fixation of 165
sagittal section of 58f
Headache 122, 124t, 130, 135, 236, 243, 251, 306, 329
cluster 126
common causes of 126t
contact point 127
cough 127
depression 126
disorder, international classification of 124, 125t
diurnal 130
severe 237, 246
sinus 70, 124, 127
suboccipital 244
tension-type 125
vacuum 130
Head-Shake test 253
Hearing
assessment, methods of 183b
conservative nonvestibular ablative surgery 266
ear 176
impairment 176t, 178
level 147
physiology of 23, 23f
screening test of 158
speech 176t
threshold of 157
Hearing aids 136, 155, 185, 188, 188f, 190, 197
air conduction 188
behind-the-ear 188f
digital 191
hybrid 191
implantable 188, 191, 192
Hearing evaluation 145
methods of 149
need of 148
Hearing handicap 177t
degree of 176
Hearing loss 230, 233, 301
acquired 179
bilateral
predominantly low-frequency conductive 164f
severe-to-profound 184t
symmetrical sensorineural 175f
causes of 148
chronic 223
classification of 160
cochlear 301t
conductive 148, 151, 152, 160, 161t, 162t, 164, 167, 707
causes of 161b, 162fc
degree of 148, 151, 152, 175
different types of 160b
ear sensorineural 111
etiology of 179
familial progressive sensorineural 175
fluctuating 177, 289
genetic 180, 180t
sensorineural 175
maximum conductive 159
mild 179, 708
mixed 148, 152
noise-induced 24, 172, 173f, 177
nonorganic 176
nonsyndromic congenital 181
retrocochlear 159, 301, 301t
sensorineural 140, 148, 151, 152, 154, 160, 161t, 168, 169fc, 171, 173f, 174f, 175, 181fc, 224, 265f, 707
severe 157f
mixed 153f
severity of 148, 152
sudden 275
idiopathic sensorineural 705
sensorineural 105, 173, 177
types of 147, 148, 152, 159
unilateral sensorineural 159
WHO classification 176t
Hearing tests 183, 233
different types of 149b
Heartburn 65, 450
Heerfordt's syndrome 285, 290
Heimlich's maneuver 562, 562f
Heister mouth gag 655f
Helicotrema 16
Heller's operation, modified 498
Hemangioma 293, 386, 430, 433, 435, 482, 483, 528, 560
adult 528
capillary 293, 386
cavernous 293, 386, 528
infantile 528
oral 435
subglottic 559
tongue 435f
Hemangiopericytoma 386, 471
Hematolymphoid tumors 446
Hematoma
and airway impairment 592
epidural 713
extradural 713
perichondrial 201f, 209
septal 361, 364, 708
Hematopoietic-stimulating factors 109
Hemifacial spasm 291
Hemithyroidectomy 549, 590
Hemolysis 92
Hemolytic streptococci 515
Hemoptysis 510
Hemorrhage 584
intracranial 179
significant 421
Hemostasis 634
Hemotympanum 209
Hennebert's sign 170, 253, 258, 264, 708
Hennebert's symptom 714
Hepatitis, granulomatous 99
Hepatocellular damage 99
Hereditary theory 224
Herpangina 414, 456, 462
Herpes labialis 413, 414f
Herpes lesions, healed 121f
Herpes simplex 497
Infection
primary 413
recurrent 413
secondary 413
stomatitis 111
type 1 184
virus 103, 104, 263, 413, 456
Herpes zoster 307
oticus 136, 207, 249, 287
Herpetiform 415, 416f
Heschl's gyrus 29
Heymann turbinectomy scissors 653
Hiatus hernia 453, 491, 496
paraesophageal 496
rolling 496
sliding 496
Hiatus semilunaris 36, 49
Higginson's syringe 621f, 651, 651f
Highly active antiretroviral therapy 109, 112
Hires 90k cochlear implant 194f
Histamine 348
Histoplasma capsulatum 343
Histoplasmosis 343
Hitzelberger's sign 7, 301
Ho's triangle 84
Hoarseness 510, 514, 524, 539
of voice 509, 558
causes of 510t
Holman-Miller sign 472, 476
Homonymous hemianopia, contralateral 244
Hondousa sign 679
Hopkins telescope/sinuscope 651
Horner's syndrome 474, 570, 597, 599, 713
Hot tonsillectomy 598
House-Brackmann system 281, 281t
House-dieter very fine malleus nipper 649f
Howarth's nasal raspatory elevator 654f
Howarth's operation 331
Human herpes simplex virus 413
Human immunodeficiency virus 106, 112, 419, 426, 707
oral manifestations of 112, 415
Human papillomavirus 103, 104, 438, 479, 545, 681
Hump nose 317
Hurd tonsil needle 657
Hürthle cell adenoma 587, 589
Hutchinson's teeth 177, 343
Hyaline cartilages 78
Hybrid cochlear implant device 193
Hydration 687
Hydroxyzine 355
Hygiene hypothesis 350
Hygroma, cystic 577
Hyoepiglottic ligament 69
Hyoid
bone, greater cornu of 80
myotomy 469
Hyperacusis 144, 286
Hyperbaric oxygen therapy 174, 207, 705
Hypercalcemia 500, 593
common clinical features 593
Hyperemic
decalcification 238
laryngitis, chronic 519
Hyperfunctional disorders 531, 538
Hyperkeratosis, frictionally-induced 409
Hypermotility disorder 491
Hypernasality 541
Hyperosmia 306
Hyperparathyroidism 592
primary 592
secondary 593
tertiary 593
Hyperplastic
candidiasis 409, 411
goiter, diffuse 583
Hypersalivation 404
Hypersensitivity
antibody-mediated 349
immune complex-mediated 350
mechanism, types of 349
T-cell-mediated 350
Hypertension
benign intracranial 126
pulmonary 460
Hyperthermia, malignant 695
Hyperthyroidism 581
clinical features of 582t
Hypertrophic rhinitis, compensatory 366
Hypertrophied turbinates 335, 336, 365
Hyperventilation 257, 276
Hyphema 370
Hypnotherapy 144
Hypofunctional disorders 530
Hypoglossal facial anastomosis 291
Hypomotility disorders 491
Hyponasality 541
Hypopharyngeal cancer, sites of 486f
Hypopharynx 65, 480, 690
malignant tumors of 485
structure of 62f
tumor size 548
Hypophysectomy 623
Hypopnea 463
Hyposmia 306, 311, 616
Hypotension, orthostatic 257
Hypothalamic disease 581
Hypothyroidism 263, 285, 569, 575f, 580, 592, 713
adult 581
clinical features of 581t
etiological classification of 581b
infantile 580
Hypotympanum 8
Hypoxic cell sensitizers 684
Hyrtl's fissure 237
I
Ice-cream cone sign 714
Idiopathic endolymphatic hydrops 263
Idiopathic facial pain, persistent 128
Ifosfamide 689
IgE antibody, in vitro tests of 354
IgE mediated hypersensitivity 349
I-gel laryngeal airway 663f
Imidazoles 102
Imipenem 597
Immotile cilia syndrome 48, 337
Immunity 107
cell-mediated 349
humoral 348
Immunoglobulins 47
serum 348
Immunologic mechanism, types of 349
Immunology 348
Immunosuppressive therapy 339
Incidental sinus opacification 617
Incision, submandibular 80
Incus 11
Indigo carmine test 312
Indinavir, side effects of 109, 112
Induction chemotherapy, role of 690
trials of 690t
Infantile hemangioma, treatment of 560
Infections 351
acute 321, 515, 516
bacterial 458
chronic 458
deep neck sources of 596
dental 327, 601
source of 233
superadded 353
Infectious respiratory obstruction, causes of 516
Inferior constrictor muscle, cricopharyngeal parts of 499f
Inferior turbinate, submucous diathermy of 357
Inflammation, meningeal 268
Inflation deflation test 155, 214
Influenza 103
neuraminidase inhibitors 104
vaccination 104
virus 103
Infra-auricular nodes 15
Infraglottic larynx 70
Infrahyoid epiglottic tumors 550
Infranuclear lesions 538
Infrapyramidal recess 9
Infratemporal fossa 54, 390, 472
Infundibulum, ethmoidal 34f, 36, 49
Ingestion, caustic 492, 501, 709
Injury
inadvertent 130
life-threatening 369, 708
Inner ear congenital deformities, types of 179
Inspiratory air flow 47f
Intense pulsed light laser 703
Intensity 147
Interferon gamma release assay 521
Interleukin 342
Intermaxillary segment 67
Internal
auditory canal, content of 299
capsule, sublentiform part of 22
jugular vein, ligation of 245
laryngeal trauma, causes of 563
nose
anatomy of 33
linings of 36
Intersinus septum 43
Intracranial
hypertension, idiopathic 125
tension, raised 243, 244, 301
Intranasal
anatomy, evaluation of 305
provocation test 354
Intraoral herpes simplex, recurrent 414, 416
Intravenous fluids and electrolytes 492
Intrinsic sleep disorder, types of 463
Intubation 492, 708
granuloma 526
Invagination theory 228
Iodine, dietary deficiency of 583
Iodized salt 584
Ipratropium bromide nasal spray 326
Ipsilateral nystagmus, causes of 258
Iron
deficiency anemia 438
oral 497
syrup, ingestion of 400f
Irritation
fibroma 436
treatment 436
meningeal 242
Irwin Moore's sign 636
Ischemic attack, transient 273
Isoniazid 90, 95, 99
Isthmus 6, 592
nasopharyngeal 59
oropharyngeal 60
Itching 306
Itraconazole 102
J
Jackson's dictum 561
Jacobson's nerve 8, 11, 144
Jansen's self-retaining mastoid retractor 650f
Jansen-Middleton double action bone nibbling forceps 653f
Jargon aphasia 538
Jarjavay fracture 361, 362f
Jaundice 115
neonatal 179
Jaw 383, 468
masses, classification of 393t
opening exercises 408
swellings 393, 708
management of 393
thrust 696, 696f
Jellinger's sign 714
Jenkin's mastoid gouge 650f
Jennings mouth gag 655
Jervell and Lange-Nielsen syndrome 180
Jet ventilation 696f
Jobson Horne probe 647, 647f
Joffroy's sign 571, 571f
Joints 69
cricoarytenoid 69
cricothyroid 69
dislocation of 563
Joll's triangle 86
Jugular bulb 13
Jugular chain, anterior 84
Jugular foramen 2
syndrome 297, 474, 475, 713
Jugular fossa, dehiscent roof of 8
Jugular nodes
upper 38
and middle 63f
Jugular vein, ipsilateral 142
Jugular wall 8
Jugulodigastric nodes 574
Juvenile multiple papilloma 528t
Juvenile nasopharyngeal angiofibroma 471, 709
Radkowski classification of 472f
Juvenile papillomas 527
Juxtavisceral chain 83, 84
K
Kallmann syndrome 312
Kanamycin 172
Kaposi sarcoma 108110, 112, 435, 446
Kartagener's syndrome 48, 335, 337
Kashima operation 533
Keloid 133f, 209
after postauricular mastoid surgery 295f
recurrent 295f
Keratitis, exposure 285
Keratoacanthoma 118f, 294
Keratoconjunctivitis 433
sicca 432
Keratocyst, odontogenic 395
Keratosis 526
obturans 205, 205t
pharyngitis 459, 462
Kernig's sign 242
Keros classification 41, 43f, 620
Kerrison bone punch 653f
Ketoconazole 102
Kidney
disease 321
trouble 115
Kiesselbach's plexus 37, 320, 324
Killian's dehiscence 57, 67, 499f
Killian's elevator 653f
Killian's gouge bayonet shaped 654f
Killian's incision 624
Killian's long-bladed nasal speculum 653f, 654f
Killian's polyp 336
Killian-Jamieson's space 67
Kinesin 713
Kinocilia face striola 20, 27
Kissing tonsils 465f
Klebsiella 243
ozaenae 340
pneumoniae 91
rhinoscleromatis 93, 346, 521
Klestadt's cyst 319
Klippel-Feil syndrome 186
Knudson two-hit 681
Kobrak test, modified 255
Kocher's test 570
Koilonychia 488
Korner's septum 14, 28
Krause's ear snare 649f
Krause's nodes 475, 477
Kuttner's tumor 424
L
Labyrinth 15
blood supply of 20
concussion of 292
development of 22f
hyperactive 257f
perilymphatic 163
Labyrinthectomy 267
Labyrinthine 20
aplasia 179
disorders 271
fistula 236, 253, 267, 268
wall 9
Labyrinthitis 170, 224, 241
bacterial 170
purulent 251
serous 236, 268
suppurative 236, 268
Lacerations, corneal 370
Lack's l-shaped tongue depressor 647
Lacrimal glands, secretomotor pathway of 12f
Lacrimation, gustatory 285
Lactate dehydrogenase 589
Lahey's method 570f
Lamier Hackemann's space 67
Lamina papyracea 35, 36f, 41
Lamina propria, superficial layer of 508
Lancefield grouping antisera 92
Language, development of 186
Laryngeal cancer
incidence of 544
treatment of 545
Laryngeal disorders 504, 510t
congenital 558
Laryngeal framework 69f
surgery 534, 535
Laryngeal hygiene 639
Laryngeal infections
etiology of 515
risk factors of 515
Laryngeal inlet 73
Laryngeal lesions, congenital 709
Laryngeal malignancies 546
Laryngeal mask airway 663f, 664, 696
Laryngeal mirror 504, 646, 647
warming 505f
Laryngeal muscles, intrinsic 72t
Laryngeal nerve 86, 592
external 74, 86
inferior 78
internal 63, 74
left recurrent 74
paralysis
bilateral recurrent 533
bilateral superior 533
unilateral recurrent 532
unilateral superior 533
recurrent 74, 87, 530, 532, 534, 570
right recurrent 74
superior 74, 530
Laryngeal opening, sphincteric closure of 75
Laryngeal paralysis
causes of 531
classification of 531
Laryngeal reconstruction, single-stage 513
Laryngeal reinnervation procedures 535
Laryngeal spaces 78
Laryngeal surgery, conservation 549
Laryngeal symptoms 503
Laryngeal syphilis 521
Laryngeal trauma 563f, 564
danger of 564
Laryngeal videoendoscopy 507
Laryngeal web 559, 564
Laryngectomy
partial
frontolateral 549
horizontal 549
total 534, 549
Laryngitis
acute 519
atrophic 340, 520
chronic
hypertrophic 519
nonspecific 519, 520t
hyperplastic 519
sicca 520
Laryngocele 70, 527, 529
external 529
mixed type 527f
Laryngoesophageal
cleft 560
reflux 494
Laryngomalacia 534, 558, 559, 564, 709
Laryngopharyngeal
carcinoma, common sites of 63
packing 634
reflux 495, 504, 520, 709
complications of 709
symptoms of 709
Laryngopharynx 62, 88f, 450, 465, 504, 643
communications 63
CT scan of 678f
examination of 504b
functions 63
hypopharyngeal diverticulum 63
hypopharynx subsites 63
lymphatic drainage 63
posterior view of 62f, 486f
pyriform sinus of 60
sagittal section of 63f
subsites of 71f
Laryngoplasty, medialization 534, 540
Laryngopyocele 527
Laryngoscopes 659
Laryngoscopic instruments 659f
Laryngoscopy 647f, 709
endoscopic 540f
flexible 469, 639, 709
indirect 449, 493, 504, 505f
Laryngotomy 557
Laryngotracheal
injuries, Schaefer's classification of 564t
trauma 562, 564
Laryngotracheitis 516
Laryngotracheobronchitis 517t
acute 516, 518, 522, 561
Laryngotracheobronchoscopy 513
Laryngovideostroboscopy 540
Larynx 64, 465, 504, 690, 702, 703
anatomy of 68
benign tumors of 523, 524t
cavity of 70
classification benign tumors of 523
congenital lesions of 558
coronal section of 71f
development of 74
dimension of 78
edema of 522
embryological development of 74t
examination of 504b
growth of 75
height of 508
hidden areas of 78
infection of 515, 516t
inlet of 70
intrinsic muscles of 73f
malignancy of 547
malignant tumors of 544
motor nerve supply of 78
movements of 504
mucous membrane of 71
muscles of 72
narrowest part of 71
nerve supply of 73
neurological disorders of 530
paramedian section of 56f
parts of 508
physiology of 68
position of 508
sagittal section of 63f, 70f
structure of 508
supraglottic malignancy of 551f
systemic diseases of 516t
tuberculosis of 511, 520
verrucous carcinoma of 549
widening of 504
Laser 358, 700702
ablative 703
advantages of 703
control of 701
cordectomy, endoscopic 533
disadvantages of 703
energies, uses of 701
nonablative 703
resurfacing 703
surgery 624, 700
tissue effect 701
Lasix test 267
Lateral cartilages
upper 32, 314f
and lower 32f
Lateral sinus
of Grunwald 36
thrombophlebitis 244
Laugier's sign 714
Law's view 665
Le Fort classification 382
Le Fort fractures 376
Lederman's classification 388, 389f
Lee Silverman voice therapy 543
Legionella 110
pneumophila 91
Leiomyoma 500, 501
Lemierre's syndrome 245, 597
Lempert's curette 650f
Lempert's endaural
retractor 650
speculum 649f
Lempert's fenestration operation 165
Leprosy 285, 343, 521
Lermoyez attack 264
Lesions 443
lower lip 441
pituitary fossa 628
tongue 407, 418
Lesser alar 32
Leucovorin 689, 691
Leudet's sign 714
Leukemia 299, 322, 417, 419, 457
Leukocyte count 421
Leukoedema 409
Leukoplakia 409, 438, 443, 526
buccal mucosa 409f
candidal 411
erosive 409
homogeneous 409
lip 441
nodular 409
oral 409
thin 409
tongue anterior two-thirds lateral margin 410f
Leukotriene 349
modifiers 356
Levator palpabri superioris, paralysis of 124f
Levator veli palatini muscle 59, 211
Levobupivacaine 698
Levocetrizine 356
Lhermitte's sign 687
Lichen planus 438
bullous 411
erosive 411
erythematous 411
oral 411
Lichtwitz cannula 621f, 651
Lichtwitz trocar 621f, 651f
Lidocaine 143, 698
Ligaments 69, 69f
Light house sign 714
Lignocaine 618, 698
Limen nasi 34
Linea alba 409
Linea temporalis 13
Linezolid 99
Lingual thyroid 87, 449, 704
Lingual tonsillar abscess 459
Lingual tonsils 58, 60
diseases of 459
Lipoflavinoids 143
Lipomas 118, 523, 576
Lips 51, 398
blood supply 52
carcinoma of 52
epithelium 51
lower 398
lymphatic drainage 52
parts 51
philtrum, upper 391f
protection of 643
reading 188
upper 398
vermilion border 51
Little's area 320
Liver disease 321
Lobar bronchi 77
Lobar segmental bronchi 77
Lobectomy 590
Lobule, abnormalities of 199
Local lesion, types of 474
Long-face syndrome 460, 462
Loop diuretics 171
Lop ear deformity 198
examples of 199f
Loratadine 356
Loud sounds 161
Loudness 147
discomfort level 147
Low-set ears 133, 199
Luc's abscess 236, 239
Luc's forceps 654, 654f
Lucae mallet 648f
Ludwig's angina 600, 601f, 603
Lumbar puncture 244
Lungs 77
development of 74
Lupus 521
pernio 341
vulgaris 342
Luschka pouch 476, 477
Lyme disease 92, 263, 285, 290
useful diagnosis of 99
Lymph nodes 15, 86, 457
chains draining hypopharynx 63f
metastases 440, 442
of neck, examination of 566
parapharyngeal 59, 61
postfacial 53
prefacial 53
regional 480, 501, 548
submandibular 38
Lymphadenitis, acute 578f
Lymphadenopathic form 425
Lymphadenopathy 290
benign 670
inflammatory noninfectious 580
regional 590
submandibular 580f
Lymphangioma 430, 436
Lymphatic disorders 703
Lymphatic drainage 38, 71
of ear 15, 15t
supraglottic 71
Lymphatic malformations 577
Lymphatic metastases 61, 71, 444, 474
Lymphocytic thyroiditis, chronic 581
Lymphocytosis syndrome, diffuse infiltrative 433
Lymphoepithelial lesion, benign 424
Lymphoma 109, 432, 446, 449, 471, 479, 482, 575, 586, 588, 591, 689
extranodal 575, 593
Lymphonodular pharyngitis, acute 456
Lymphosarcoma 567
Lymphoscintigraphy 86
Lynch operation 331
Lyre's sign 576
M
Macewen's curette and cell seeker 650, 650f
Macewen's triangle 3f, 4, 13f, 28, 609, 609f
boundaries of 13
Macrolides 95, 98, 356
Macrotia 199
Macula 19
Magauran's plate 657f
Maggots nose 381
Magnetic resonance
angiography 672
imaging 671
Malignant tumors
high-grade 404
of nasopharynx, AJCC cancer staging and UICC TNM classification of 476t
of oropharynx, AJCC cancer staging and UICC TNM classification of 480t
tumors nodal metastasis (TNM) classification of 431t
Mallampati oral view, four classes of 697f
Mallet 653
Malleus head fixation 179
Mallory-Weiss syndrome 492
Mandible 377
fractures, Dingman's classification of 378f
inner surface of 377f
Mandibular
fracture, orthopantomogram of 378f
skeletal deficiency 469
Maneuver building positive pressure 213
Manometry 497
Mantoux test 424
Marcus Gunn pupil 713
Marfan's syndrome 465
Mass 387
in nose 362
Masseter muscle 595
rigidity 696
Mast cell
sensitized 348t
stabilizers 356
Masticator space abscess 398f, 602, 602f
Masticatory muscles 128
Mastoid 3, 80, 119f, 648
abscesses, types of 239f
air cells 13, 14
removal of 609
antrum 13, 14, 28, 607f, 609f
and air cells, ventilation of 225
identification of 609
cells 13
curette 650
exposure of 609
gouges 650
nodes 83
pneumatization 224
process 55
segment 285
self-retaining retractors 649
suction tips 650
surgeries 605, 611, 615
tenderness 238
three types of 13f
tip 28
removal of 610
types of 13
wall 9
X-ray of 225f
Mastoidectomy 220, 234, 241, 607, 610, 653
types of 607, 607b
Mastoiditis 234
acute 7, 237, 238t
coalescent 237, 246
left ear masked 239f
masked 239
Maxilla
osteomyelitis of 334
pyriform notch of 314f
T3N0M0 squamous cell carcinoma of 396
Maxillary artery, internal 46
Maxillary sinus 38, 45, 49, 310, 311, 328f, 331, 394f, 666f, 670f, 677f
bilateral 330f
left 337f
malignancy of 387f, 390
opens ostium of 35f
ostium of 39
tenderness of 311f
Maxillary sinusitis 315, 630
Maxillectomy 391
inferior 391
medial 391, 473
postoperative complications of 391
total 391
Maxillofacial bones, different 369f
Maxillofacial region, injuries of 368
Maxillofacial trauma 368
Maximal stimulation test 283
McGovern's technique 367
M-cresyl acetate 99
Measles 456
Meatal antrostomy, inferior 49, 621, 651
Meatoplasty 611
Meatus
inferior 33
superior 33
Meckel's cartilage 21f
Med-el cochlear implant 195f
Medial canthal tendon disruption, signs of 373
Median palatal cysts 394
Mediastinal nodes, upper 590
Mediastinum tumor, superior 532
Medullary disorders 531
Medullary infarction, lateral 274
Medullary syndrome, lateral 277
Medullary thyroid carcinoma 588
types of 588b
Melanoacanthosis 118f
Melanoma 418, 446, 471
auricle 295
malignant 392
nose 320
Melanotic macules 417
Melkersson's syndrome 287
Melkersson-Rosenthal syndrome 292, 398, 418
Membranes 69
Membranous labyrinth 16, 17f, 162, 289, 675f
rupture of 289
Ménière's disease 17, 26, 142, 144, 148, 153, 170, 248250, 253, 258, 260, 263, 264f, 267
bilateral 266
classification of 265
diagnosis of 265
Ménière's syndrome 263, 265
Meniett device therapy 266
Meningioma 302, 386
extracranial 386
intracranial 386
Meningitis 185, 242, 289
bacterial 99
neonatal 179
Meningococcal vaccine, conjugate serogroup C 93
Meningococcus 93
Meningoencephalocele 318
extranasal 385
intranasal 385
Meniscal displacement 129
Mepivacaine 698
Mesna 689
Mesoderm 21
Mesothorium 387
Mesotympanum 8
compartments of 12
Messerklinger technique 618
Metaiodobenzylguanidine 589
Metaplasia 307
Metastatic neck nodes 84, 566f, 575, 709
secondary 120f, 505f
Metastatic nodes, secondary 567
Methemoglobinemia 698
Methicillin-resistant -5 Staphylococcus aureus 92
Methotrexate 127, 266, 689, 690, 691
Methylene blue dye 214
Metronidazole 97, 597
Michel aplasia 179, 186
Microcystic lymphatic malformations 577
Microflora, normal 92
Micrognathia 512
Microlaryngeal surgery 704
Microlaryngoscopy 509, 513, 526f, 637
Microorganism 95
Microsurgery instruments 651
Microtia 199, 200f
Middle ear 8, 21, 23, 135, 161, 605
and mastoid, tumors of 296, 296b
atelectasis 224, 225
boundaries of 8
cleft 280
ventilation pathway of 212
debridement of 611
development of 21f
dimension of 28
effusion 217, 223, 267
endoscopy 212
fluid 148
infection 364, 632
inflation of 222
malignancy of 139
medial wall of 10f
mucosa 11, 232
neoplasms of 296
nerve supply of 11, 144
ossicles 11
parts of 8, 8f, 9f
polyps 139
relations of 8
symptoms 448
Migraine 124, 125, 126, 248, 249, 271, 276, 277
basilar 272
nonspecific 272
specific 272
Migration theory 229
Migratory glossitis 418
Mikulicz's cells 346
Mikulicz's disease 424, 432, 433
Millian's ear sign 209, 615, 714
Minerals 408
Minimal alveolar anesthetic concentration 693
Minor salivary glands 56
tumor 446, 479
common sites of 52
Mitochondria 99
Mitomycin 689
Mitomycin-C 691
Mivacurium 694
Möebius sign 571, 571f
Möebius syndrome 285, 290
Molecular biology 410
Molecular cytogenetics 681
Molecular techniques 681
Mollison's self-retaining hemostatic mastoid retractor 649f
Mollison's tonsil dissector 656
Molluscum contagiosum 107
Mondini dysplasia 179
Mondini malformation 186
Moniliasis 411
Monoamine oxidase 115
Monobactams 96
Mononuclear inflammatory cells 229
Mononucleosis, infectious 285, 456, 457, 462, 709
Monosomy 428
Monostotic fibrous dysplasia 385
Monotic test 149
Montgomery tube 713
Moraxella catarrhalis 91, 93, 218, 223
Moro's reflex 183
Morphine 128
Motility disorders 491
Motility studies 499
Motion awareness 23
Motion sickness 275, 276
Motor aphasia 538
Motor fibers, branchial 278
Motor paralysis, contralateral 244
Mouth
breathing 363
care 687
commissure of 52
floor of 52, 398, 399, 401f
gags 655, 655f
paramedian section of 56
retractors, types of 655f
vestibule of 398
Mucocele 328, 333, 428, 436
frontoethmoidal 333
maxillary 333
Mucociliary flow, measurement of 312
Mucoid ear discharge, causes of 138
Mucoid impaction 641f
Mucoperiosteal flap 622
Mucormycosis 110, 346
Mucosa 49, 76
Mucosal melanotic macule 417
Mucosal melanotic nevi 418
Mucosotropic virus 438
Mucous membrane 56
pemphigoid 412
Mucous pooling 508
Mucous retention cyst 436f, 483
Mucous transport time 312
Mucus, blob of 336
Muller's maneuver 465, 469
Muller's muscles 713
Mulliken and Glowacki classification 293, 577
Multicellular theory 428
Multidrug therapy 95
Multinodular goiter, recurrent 575f
Multiple endocrine neoplasia syndrome 588, 588b
Multiple juvenile laryngeal papillomatosis 529
Multiple sleep latency test 466
Multisensory disturbances 272
Multisensory imbalance 275, 708
Mumps 103, 104, 402, 420
complications of 433
Mural thrombus 244
Murmurs 120
Muscles 534
constrictor 57f
extraocular 713
extrinsic 73
intratympanic 11
intrinsic 73
muccinator 82
palatal 713
palatopharyngeus 57
relaxant 129
depolarizing 694
tension dysphonia 511, 540
Muscular branches 280
Muscular coat 57
Muscular division 82
Muscular layer 64
Muscular lesions 538
Mutation 681
falsetto voice 539
Myalgia 290
Myasthenia gravis 554
Mycobacteria 93
atypical 93
Mycobacterial cervicofacial infections 424
Mycobacterial disease, tuberculous 424
Mycobacteriosis 108
Mycobacterium
avium 108
intracellulare 424
kansasii 424
disease 108
leprae 90, 343, 521
scrofulaceum 342, 424
szulgai 343
tuberculosis 90, 93, 94, 100, 108, 424
xenopi 343
Mycoplasma pneumoniae 91, 94
Myelitis
partial transverse 275
transverse 687
Myer-Cotton grading system 559
Mylohyoid muscle, removal of 55f
Myoblastoma 436
Myoclonus 140, 142, 542
branchial 542
palatal 139, 140
Myogenic disorders 128
Myotomes 66t
Myringitis
bullosa 207
granular 138, 207
Myringoplasty 612, 614
graft materials 614
mid-lay technique 614
overlay 615f
technique 614
techniques 614
underlay technique 614
Myringosclerosis 607
Myringotomy 162, 220, 222, 238, 291, 605, 606, 649, 649f, 704
incisions 605f
Myxedema 581
atrophic 581
pretibial 582
primary 581
N
Nadolol 582
Naffzigger's sign 714
Naphazoline 356
Narcotics 129
Nares, atresia of 318
Nasal airflow 47f
during inspiration, main current of 49
Nasal allergy 218
Nasal anticholinergics 355
Nasal antihistamines spray 355
Nasal balloon 323
Nasal bone 32f, 319f, 371, 372f
bilateral fracture of 372f
fracture 318f
closed reduction of 373f
unilateral fracture of 372f
X-ray of 318f, 373f
Nasal breathing 324f
Nasal brushing 314
Nasal cannula 513
Nasal cautery 322
Nasal cavity 31, 313, 389, 666f
anterosuperior part of 37
examination of 309
floor of 445f
lateral wall of 33, 33f, 58f
left 363f
nerve supply of 37
patency of 310
Nasal chromones 355
Nasal continuous positive airway pressure 468
Nasal crusting 306
Nasal cycle 46
Nasal decongestant 331
drops 329
Nasal deformity
classification of 372
grading of 372
Nasal dermoid 319f, 385
Nasal diphtheria 306
Nasal discharge 306, 310, 329, 460
bilateral 306
Nasal dorsum, depressed 317
Nasal douche 382
Nasal endoscope, rigid 212, 448
Nasal endoscopy 330
diagnostic 617
examination 327
Nasal examination 305
Nasal findings 341
Nasal flaring 315
Nasal flow, peak inspiratory 314
Nasal fracture
patterns 371, 372f
reduction forceps 651
Nasal furuncle 308f
Nasal glands, secretomotor pathway of 12f
Nasal gouges 654
Nasal mastocytosis 335
Nasal mucosa, scrapings of 343
Nasal musculature 33
Nasal myiasis 381, 382
Nasal obstruction 47, 306, 310312, 460, 704
bilateral 312
causes of 312, 313fc, 336, 623
chronic 48
measurement of 313
unilateral 312
Nasal packing
anterior 323
posterior 323, 323f, 324f
Nasal polyp 335, 335f, 366, 366t
Nasal pruritus 352
Nasal regurgitation 379, 449
Nasal root 319f
Nasal secretions 380, 380t
Nasal septal bleeding, persistent 324
Nasal septum 34, 38f, 49, 361, 677f
blood supply of 37f
deviated 306, 362, 367
types of 363f
fracture 361
types of 362f
of cadaver 35f
perforation of 365
structure of 35f
submucous resection of 623
surgery 623, 654
types 361
Nasal skin 33
Nasal smear 353, 521
Nasal speculum 309f, 653
Nasal spine, anterior 34, 363f
Nasal steroids spray 355
Nasal stuffiness
bilateral 352
factors relieving 365
Nasal surgery 652f, 654
endoscopic 633
Nasal swabs 314
Nasal symptoms 305, 341
Nasal synechia 366, 366f
Nasal temperature 47, 49
Nasal tip
support mechanisms for 627
upward rotation of 627
Nasal topical ipratropium bromide 356
Nasal valve 34, 312, 314f
disorders 314, 627
external 314, 314f
internal 314, 314f
Nasal vestibule 342
furuncle of 317f
skin of 36
Nasal vestibulitis 317, 317f
Nasal vibrissae filter coarse particles 47
Nasogastric feeding 713
Nasolabial cyst 119f, 307, 319
left side 319f
right side 309f
Nasolacrimal duct 49
Nasomaxillary buttress, medial 376
Nasomaxillary complex 376, 376f
Nasomaxillary skin 309f
Naso-orbital ethmoid 373
fractures, Markowitz classification of 374
Nasopharyngeal bursa 58
Nasopharyngeal disorders, symptoms of 447
Nasopharyngeal structures 448b
Nasopharyngolaryngoscopy 506
flexible 465, 448, 507f, 513, 639
Nasopharynx 31, 58, 58f, 64, 110, 125, 135, 213, 447, 468, 656, 690
benign tumors of 470
boundaries 58
digital examination 448
endoscopy 448
examination 447, 448b
functions of 59
infection of 213
malignant tumors of 471
tumors of 470
Natural killer cells 349
Near-total thyroidectomy 590
Nebulized l-epinephrine 513
Neck 465, 565, 589
anatomy of 79
CT scan of 546f, 678f
diagnostic tests 568
dissection 84, 86
classification of 85b
elective 86, 88
extended 85, 86
modified 86
selective 85, 86, 88
infections, superficial 594
lateral view of 667
lipoma 576f
management of 440
mass 573, 580
common 566t
congenital 576
congenital midline 578
node
metastasis 390, 481f
regions 4f
secondary 679
physical examination 565
posteroanterior view of 668
sagittal section of 82f
surface anatomy of 80f
swelling 387, 574
mid-line 572
triangles of 71f, 81
ultrasonography 422, 568f
Necrotic nodes 678f
Necrotizing fasciitis 602
Needlestick injury 111
Negus artery forceps 657
Negus knot tyer 658, 658f
Neisseria
gonorrhoeae 91, 93
meningitidis 91, 93, 180
Neoadjuvant chemotherapy 690
Neodymium:yttrium-aluminum-garnet laser 702
Neomycin 172
Neonatal facial palsy, causes of 285
Neonatal suppurative parotitis 423
Neoplasms 110, 119, 138, 335, 403, 491
benign 491, 499
high-grade 403
histogenesis of 428
malignant 491
odontogenic 436
sinonasal malignant 387
Nerve 38f
accessory 712
auriculotemporal 5, 7, 8
conduction velocity 283
excitability test 283, 286
fiber
cross-section of 282f
longitudinal section of 282f
glossopharyngeal 8, 62, 135, 713
graft 291
hearing loss 153
injury
correlation of degree of 284t
pathophysiology of 281
peripheral 282f
intratympanic 11
muscle implant 533
of Galen 530
olfactory 31, 37, 48, 311
palsy, left oculomotor 124f
posterior auricular 280
sensory 81
structure 282f
trigeminal 31, 37, 135, 277, 714
Nervous system 290
Netilmycin 172
Neural pathways 21
Neuralgia
glossopharyngeal 128, 136, 713
postherpetic 128
trigeminal 127, 714
Neurilemmoma 523, 576
Neuritis
acute vestibular 262
peripheral 311
Neuroblastoma, olfactory 392
Neurodermatitis 209
Neuroepithelium, sensory 19
Neurofibroma 294, 385, 523
Neurofibromatosis, multiple 300f
Neurohypophysis 713
Neuromuscular electrical stimulation 454
Neuromuscular junction disorders 531
Neuropraxia 281, 282
Neurotmesis 282
Neutron radiations 683
Neutropenia, cyclical 417
Neutrophil count 417
Nicotine stomatitis 412
Nicroflora, nasopharyngeal 92t
Nissen fundoplication 495
Nitrous oxide 693, 695
Nocardia asteroides 90
Nodes
malignant 670
postauricular 83
pretracheal 84
sublingual 84
submandibular 83
submental 83
Nodule
autonomous 587
dominant 587
malignant 587
toxic 581
Noise 147
exposure 141
trauma 172
Nonairflow rhinitis 359
Nonallergic rhinitis 347, 358
etiological classification of 359t
types of 358
Nongroup A beta-hemolytic streptococcal infection 456
Non-Hodgkin's lymphoma 110
Noninflammatory parotid swellings 428, 433
Non-neoplastic thyroid swellings, classification of 583b
Non-nucleoside reverse transcriptase inhibitors 109
Nonproductive cough, common causes of 494
Nonrecurrent-recurrent laryngeal nerve 78
Nonresorbable vaseline gauze strip 323f
Nonsteroidal immunosuppressant 266
Nontopical sprue 414
Nontuberculous mycobacteria 90, 342
cervical lymphadenitis 579
Nontuberculous mycobacterial disease 424
Normal barium swallow of
lower esophagus 450f
upper esophagus 450f
Normal sternocleidomastoid muscle, echogenicity of 403f
Nose and paranasal sinuses 135, 314, 676f, 677f
anatomy of 30
axial section of 42
coronal section of 35f, 40f
CT scan plain coronal section 670f
physiology of 30
tumors of 384t, 673
Nose 465, 666, 468, 702, 703, 705
anatomy of 32
bleeding polyp of 396
block 351
blood supply of 36
boil of 317
dangerous area of 37
deviated 318
dorsum of 317f, 319f
floor of 309
functional examination of 308
infection of 213
osteocartilaginous framework of 32
paramedian section of 56
paranasal sinuses, operations of 616
patency of 310f
physical examination of 308
physiology of 46
rhinosporidiosis polyp, right 344f
sinuses, examination of 308b
solitary plasmacytoma of 386
supratip depression deformity of 32
tip of 118f
tumors of 383, 384
vestibule of 34
wart of 320
Notice board pin bronchus 668f
Nuclear palsy 282
Nuclei 123t
Nucleic acid synthesis, inhibitors of 97
Nucleoside
analog 104
reverse transcriptase inhibitors 109
Nucleus
5 cochlear implant 194f
solitarius 713
upper part of 279f
Nutcracker esophagus 498
Nutrition 687
Nystagmus 26, 251, 255f, 257, 258f, 264
ageotropic 260
contralateral 258
degree of 252, 252f
downbeating 708
eliciting 251
geotropic 260, 261
optokinetic 252
peripheral vestibular 252
spontaneous 244, 251, 274
Nystatin 102, 105
O
Obesity-hypoventilation syndrome 463
Obliterated postauricular sulcus 133
Obliterative lesion 163
Obstructive disorders 426
Obstructive sleep apnea 364, 460, 461, 463, 464, 465b, 467, 467fc, 468b, 469, 704
complications of 466
diagnosis of 465
evaluation of 465
factors aggravating 464, 464b
nonsurgical treatment of 467
pathophysiology of 464
severity of 466
surgical treatment of 468
symptoms of 465b
syndrome 449, 463, 464
treatment of 468t
Occipital nodes 83
Oculo-oro-genital syndrome 415
Oculopalatal myoclonus 542
Odontogenic tumor, adenomatoid 396
Odynophagia 415, 449, 450, 510, 520
Office laryngoscopy 507
Ohngren's classification 388, 389f
Ohngren's line 396
Olfaction 48
Olfactory bulb 48, 311
volume 312
Olfactory disorders 311
Olfactory receptor cells 48
Olfactory tests 311
Olfactory tract 48
Olivary complex, superior 29
Olivary nucleus, superior 21
Omega sign 714
Omeprazole 495
Omohyoid, inferior belly of 81
Oncocytic
carcinoma 589
papilloma 386
tumors 428
Oncocytoma 430, 523
Oncogenes 681
Onodi cells 43, 49
Open book-splayed fracture 372f
Open mastoid cavity otorrhea 138
Ophthalmoplegia 245, 582
internuclear 713
Optic foramen 43
Optimum discrimination score 154
Oral cancer
AJCC cancer staging and UICC TNM classification of 439t
evaluation of 401
examination 401
history 401
imaging 401
Oral cavity 51, 51b, 111, 125, 135, 397, 465, 677f, 690, 702, 703
anatomy of 50
benign tumors of 434
cancer of 86, 439, 439t
common cancers of 444
dysgeusia 397
examination of 398b, 399f
excessive salivation 397
neoplasms of 434
pain 397
physiology of 50
premalignant conditions of 438
subsites of 51f, 438
symptoms 397
tongue depressor 399
trismus 398
tumors of 434, 435b
xerostomia 397
Oral lesions, drug-induced 417
Oral mucosal lesions 406, 407b, 416
Oral submucous fibrosis 407, 408f, 442f
management of 408b
Oral thrush 412, 709
Oral ulcerations, drug-induced aphthous-type 414
Orbit 375
apex of 46
Orbital abscess 333
Orbital apex 40
syndrome 333
Orbital blowout fractures 708
Orbital cellulitis 333, 334t
Orbital compartment syndrome 375
Orbital complications
clinical features 333
diagnosis 333
treatment 333
Orbital fissure
superior 43
syndrome 333
Orbital foramen, superior 390, 396
Orbital hematoma 373, 620
Orbital injury 621
Organ of Corti, structure of 18f
Organ preservation 691
therapy 551, 691, 710
Oroantral fistula 379, 379f, 382, 397
Orodental fistula 382
Orolabial herpes 413
Oropharyngeal
airway 663f, 664, 696
dysfunctions 416
structures 448f
symptoms 449b
Oropharynx 59, 64, 125, 135, 336f, 439t, 448, 465, 480, 504, 677f, 690, 702, 703
and hypopharynx, stage grouping for 480
bimanual palpation of 481f
boundaries 60
cancer 439
treatment of 480
communications 60
CT scan of 678f
dorsum of 53f
examination of 399f, 449
functions of 61
lymphatic drainage 61
palpation of 449
structure of 60f
subsites of 51f, 71
symptoms 448
tumors of 478
Orthodontic procedures 460
Orthopantomogram 129, 668, 669f
Orthopantomography 393
Ortner's syndrome 532, 536
Oseltamivir 104
Osler-Weber-Rendu disease 324
Osseous spiral lamina 16
Ossicles 11, 28, 161
destruction of 614
disruption 148
fixation 148, 614
lever action of 24
Ossicular
chain 24, 232
discontinuity 165
diseases 161
disorders 161
erosion 224
necrosis 230
reconstruction 615f
rotation, axis of 29
Ossiculoplasty 612, 614
Osteitis 237, 334
Osteoclastic resorption 238
Osteogenesis imperfecta 163, 165
Osteoma 294, 294f, 294t, 385, 396
Osteomeatal complex 35, 35f
cadaveric dissection of 34f
diseases of 35
level of 35f
Osteomyelitis 334
mandibular 122
sinus of mandible 568
skull base 207
Osteoplastic flap operation 331
Ostium
accessory 39
maxillary 34f
Ostmann's pad of fat 211
Otalgia 134, 135f, 144
causes of 135b, 137fc
primary 135
secondary 135
Otic capsule 21, 29
disruption 288, 289
sparing 289
Otic labyrinth 162
Otitic
barotrauma 223
hydrocephalus 236, 245
Otitis externa 136, 138, 203
acute 203, 603
allergic 203
bullous 207
chronic 203
complications of 204
granular 204
hemorrhagic 207
left ear malignant 208f
malignant 207, 209
microorganisms 203
treatment 203, 708
Otitis media 9, 185, 217, 605, 606
acute 96, 105, 138, 217, 218, 220fc, 223, 235, 241, 243, 244, 457, 605, 606
suppurative 138, 219f
adhesive 165, 224, 225
chronic suppurative 138, 139, 205f, 224, 226, 226f, 241, 612
complicated 236
healed chronic 226
hemorrhagic 221
intracranial complications of 135
left ear healed 232f
postvaccination 218
recurrent acute 220
serous 165, 353
suppurative 235, 236, 291
complications of 235, 236b, 236f
intracranial complications of 236
syphilitic 234
tubercular 233
tubotympanic chronic suppurative 232f
unilateral 475
with effusion 222f, 224, 248
Otoacoustic emissions 25, 157, 159, 182
Otoendoscopy 230
Otogenic brain abscess 243
Otogenic sigmoid sinus 125
Otolaryngology 701
Otolith organs 19
macula of 19f
Otolithic membrane 20
Otomastoiditis, chronic 224
Otomycosis 101, 102, 204, 209
left ear 205f
Otoplasty 200
Otorhinolaryngology 114
mycotic diseases of 101
Robotic surgery in 706
Otorhinorrhea 379, 380
Otorrhea 136, 607
causes of 137b
persistence of 237
Otosclerosis 24, 160, 162, 164, 165, 167, 614, 707
Otosclerotic lesions, types of 163
Otoscope 133, 134f, 646
uses of 133
Otoscopy 8, 23f, 133, 208, 219f
pneumatic 183, 222, 707
Ototoxic agents
action of 171t
list of 171b
Ototoxic drugs 170, 177, 179
Ototoxicity 97, 99, 171, 171f
Audiology Protocols of American Academy of Audiology 172
early features of 172
Otrivin 220
Outer hair cells, disorders of 157
Oval open esophagoscope 661
Overtones 147, 159
Oxazolidinones 99
Oxygen concentration 695
Oxyhemoglobin saturation, degree of 466
Oxymetazoline 220, 356, 618
P
P-24 antigen 108
Pachydermia laryngis 519, 522
Paget's disease 165
Pain 493
sensitive structures 124t
Palatal disorders 218
Palatine tonsils 58, 59f, 61
Palatoglossal arch 60
Palatopharyngeal arch 61
Pallor 245
Palpating deep cervical nodes, method of 567f
Palpebral fissure, narrowing of 373
Palsy, palatal 208f
Pancuronium 694
Pancytopenia 417
Panfacial fractures 376
Panorex oral view 597
Pansinusitis 328f
Papilledema 242, 582
Papilloma 118, 294, 309, 320, 434, 482
adult-onset 527
clinical features 320, 435, 483
cylindrical 386
exophytic 386
inverted 386, 396
lesion 482
site 482
treatment 320, 435, 483
Papova virus 529
Paracusis willisii 148, 161, 164
Paradoxical middle turbinate 35
Paraganglioma 296, 303, 470, 709
Para-glottic space 71
Parainfluenza virus 103, 104, 456
Paralysis, unilateral 533
Paranasal sinuses 310, 331, 337f, 383, 384, 666
anatomy of 38
blood supply of 45t
development of 46, 46t
examination of 308, 308b
growth of 46t
malignancy of 396
mucous membrane of 44
nerve supplies of 45t
opening of 34f
physiology of 48
plain CT scan of 330f
X-ray of 328f, 340, 667f
Parapharyngeal mass, CT scan of 483f
Parapharyngeal space 595
Parasympathetic preganglionic secretomotor fibers 278
Parathyroid 573
glands 88, 88f, 592
inferior 592
superior 592
tumors 592
Paratracheal nodes 84
Parenteral iron 497
Parenteral streptomycin 266
Parkinson's disease 543
Parkinsonism 116
Parosmia 306, 311
Parotid abscess 120f, 422
left side 422f
Parotid duct, opening of 398
Parotid gland 53, 281, 371, 430f, 669f
anteromedial surface of 54f
lymphoepithelial cysts of 110
surgery 54
swelling
acute 423f
tail of 429f
Parotid nodes 83
Parotid relations 292
Parotid swelling
bilateral 402
left 402f
non-neoplastic 428
Parotid tumor 55, 433
axial view 429f
Parotidectomy, superficial 433
Parotitis 136
acute 603
recurrent 423
Pars superior, development of 21
Partial ossicular replacement prosthesis 614
Partial syndrome 274
Partial upper airway obstruction 517f
Passavant's ridge 59, 67
Pasteurellaceae 91
Paterson-Brown-Kelly syndrome 485, 496
Paterson-Kelly syndrome 438
Paul Dudley White's winking ear lobe sign 714
Pectoralis major muscle flap 443
Pediatric
airway, Robotic surgery in 706
epiglottitis 514, 517, 517f
masses 336
rhinosinusitis 46, 331
Pehane laryngoscopic view 697f
Pemphigus vulgaris 412
Pendred syndrome 180, 186, 581
Penetration aspiration scale 535
Penicillin 95, 96
allergy 707
augmented 96
G 90, 100
resistant Staphylococcus aureus 422
Penicillinase-resistant penicillins 96
Pentamidine 109
Peptidoglycan 100
Percutaneous dilational tracheostomy 558, 558f
Perennial allergic rhinitis 352
Perez bacillus 340
Perichondritis 201, 201f, 204, 209
Pericranial tenderness 125
Periesophageal cellulitis 494
Perigeniculate ganglion area 284
Perilabyrinthine cells 14
Perilymph 15, 17, 29
composition of 17t
Perineural intracranial spread 38
Perineurium 282
Perinuclear antineutrophilic cytoplasmic antibody 339
Periodic falls 417
Periodontitis 111
Periosteum
elevator 654
inflammation of 237
Periostitis, acute 237
Periotic labyrinth 163
Peripheral T-cell neoplasm 339, 340, 340t
Peripheral vestibular
disorders 259, 260b
pathology of 19
lesions, features of 254
nystagmus 251
system 26
Peripheral vestibulopathy, acute 274
Peritonsillar space 62, 595
Peritonsillitis 598
Perpendicular plate, fracture of 372f
Perphenazine 128
Persistent idiopathic facial pain, treatment of 128
Pes anserinus 280
Petrosal nerve, greater 280, 292
Petrositis 224, 240
Petrosquamous suture 6
Petrotympanic suture 3
Petrous apex lesions 302
Petrous apicitis 240
Petrous process, posterior surface of 4f
Peutz-Jegher's syndrome 713
Pharyngeal arches 65, 66t, 713
Pharyngeal artery, ascending 14
Pharyngeal bursa, infection of 476
Pharyngeal bursitis 476
Pharyngeal constrictor 82
Pharyngeal examination 130, 447, 709
Pharyngeal injuries 564
Pharyngeal mass 673f
posterior 483f
Pharyngeal pouch 57, 65f
and grooves 65, 66t
Pharyngeal space 57
lateral 595, 599
Pharyngeal wall 56, 57f
posterior 61, 449
Pharyngitis 455, 456
atrophic 340
bacterial 455
irritative 455
tonsillitis, membranous 457
treatment 456
Pharyngobasilar fascia 56
Pharyngoesophageal junction 64
Pharyngomaxillary space 595
Pharynx 56, 687
anatomy of 50
culture 518
evaluation of 447
lateral view of 57f
paramedian section of 56
physiology of 50
sagittal section, structure of 60f
Phelps sign 297, 303
Phenol 714
Phenylephrine 356, 618
Phenytoin 127
Philtrum 67
Phlebectasias 436
Phobic postural vertigo 276
Phonasthenia 539, 543
Phonatory glottis 78
Phonetically balanced words 159
Phonomicrosurgery 528
Phonosurgery 535
Phosphoinositide 3-kinase 681
Photodynamic therapy 704
Photons, high-energy 683t
Picket-Fence graph of temperature 246
Pickwickian syndrome 463465
classic obesity-related 461
Pierre-Robin sequence 65
Pierre-Robin syndrome 512
Pillar 449
retractor, anterior 656
Pinna 4, 23, 28
avulsion of 200
development of 21f
protrusion of 133
retraction of 133
upper part of 200f
Piperacillin 96, 597
Pituitary adenomas, classification of 628
Pituitary disease 581
Pituitary fossa 45f
surgery 652
Pituitary thyroid axis 572
Pituitary tissue, residual 628
Pizzillo's method 569f
Pizzillo's technique 569f
Plasmacytoma 386, 471
Plastic surgery 703
Plastic whistle larynx 562f
Plate, ethmoid 34
Play audiometry 184
Pleomorphic adenoma 385, 403, 404, 428, 429f, 435, 470, 482, 483, 523
Plester retractor 2 × 2 prongs 648f
Plester-Jansen self-retaining hemostatic mastoid retractor 649f
Plummer-Vinson syndrome 409, 437, 438, 453, 485, 488, 496
Pneumatic dilatation, endoscopic 498
Pneumatization
frustration of 13
loss of 225
Pneumocephalus 630
Pneumococcal conjugate vaccine 218
Pneumococcal vaccines, conjugate 92
Pneumococcus 92
Pneumocystis
carinii 107
jiroveci 108
Pneumomediastinum 563
Pneumonia, bacterial 100
Pneumothorax 563
spontaneous 561
Pocket ear 199
Poliomyelitis 531
Politzer bag 213
Politzer test 213, 213f
Polyarteritis nodosa 285
Polychondritis 202, 365, 708
Polycyclic hydrocarbons 387
Polyenes 102
Polymerase chain reaction 103, 108, 425
Polymicrobial infections 95
Polymorphic reticulosis 339
Polymyositis 407
Polyotia 209
Polyp 230, 232
causes of 139b
common causes of 337
ethmoidal 335t, 337
formation 330f
multiple 139f
treatment of 337
Polypoid corditis 528
Polypoidal mass 344f
Polyposis, bilateral diffuse 525
Polysomnography 461
Polysomy 428
Polyvinyl chloride tubes 661
Pons, cut section of 156f
Poor lung function 551
Positive airway pressure, continuous 513
Positive pressure respiration, intermittent 554
Positron emission tomography 140, 672, 685
Postcricoid region, malignancy of 488f
Posterior ethmoidal cells, removal of 619
Posterior semicircular canal, occlusion of 262
Posterosuperior meatal wall, sagging of 238
Postlaryngeal crepitus 488f, 504
Postnasal
drip 329
mirror 647
pack 323f
Posture test 309
Postviral olfactory disorders 105
Pot's spine 600
Potassium
iodide 341
titanyl-phosphate 702
Potato tumor 308, 319
Pott's puffy tumor 334, 337
Povidone-iodine 99
Preauricular appendages 199f
Prednisone 126
Prelaryngeal node 84
Premalignant field defect 681
Presbycusis 175f
Presbylaryngis 76
Presbyosmia 306
Presyncope 250
Prevertebral fascia, alar division of 82
Prilocaine 698
eutectic mixture 698
Primaquine 109
Probe test 309
Processus cochleariformis 9, 280
Progressive disease, severe and rapidly 413
Prokinetic drugs 495
Prolactinomas 628
Proliferative verrucous leukoplakia 410
Proof puncture 621f
Propantheline bromide 266
Prophylactic antibiotics 289
Propranolol 582
Proptosis 245, 315, 476
Propylthiouracil 582
Prostaglandins 349
Protease inhibitor 112
Proteinosis, hereditary lipid 713
Proteolytic enzymes 229
Proteus mirabilis 91, 243
Proteus vulgaris 340
Proton pump inhibitor 495
failures of 452
Protympanum 8
Prussak's space 12, 13f, 28
Psammoma bodies 713
Pseudallescheria boydii 345
Pseudoephedrine 356
Pseudomembranous candidiasis, acute 411
Pseudomembranous colitis 99, 100
Pseudomonas 601
aeruginosa 91, 93, 209, 227, 243, 597
pyocynea 244
Pseudotumor 580
cerebri 144
Psittacosis 92
Psoriasis 101, 204
Psychogenic disorders 248
Pterygoid muscle, medial 595
Pterygoid process 43
Pterygomaxillary buttress, posterior 376
Pterygomaxillary fossa 390
Pterygopalatine 46
fossa 46, 677f
Ptosis 124f, 245
Puberphonia 539
Pug nose 373
Pull system 27
Pulsatile tinnitus 141, 142, 707
common causes of 142t
Pulsation sign 303
Pulsed positive pressure 266
Punches 652
Puncturing trachea 513
Pure blow-out fracture 375
Pure chondroma 385
Pure tone 146
audiogram 152f, 153f, 173
audiometry 151, 161, 164, 184
average 151
Purulent discharge 138, 306
Pus under tension 237
Push system 27
Putrid odor 306
Pyemic abscesses 245
Pyocele 333
Pyogenic granuloma 436
Pyogenic staphylococci 243
Pyramidal eminence 10f
Pyramidal signs 275
Pyrazinamide 90, 99
Pyriform fossa
cancer of 63, 489
mass, CT scan of 486f
tumor 71
Pyriform sinus 63
Pyrimethamine 109
Pyrosis 65, 450
Q
Q-tip injury 209
Quadrangular membrane 70
Queckenstedt's test 245
Quinine 179
toxicity 171
Quinolone 220
antibiotics 97
Quinsy 598, 603
abscess 598
forceps 658
incision and drainage of 658
R
Raccoon eyes 288
Radiant laser energy 700
properties of 701
Radiation
mucositis 417
postoperative 685
preoperative 685
radiotherapy sources of 683
spontaneous emission of 700
stimulated emission of 700
therapy, intensity-modulated 686
Radical mastoidectomy 610, 610f, 615
modified 240, 611
Radical maxillectomy 391
Radical neck dissection 84, 85, 85f, 88, 475
major postoperative complications of 86
modified 85
Radioactive iodine 584, 590, 691
contraindication of 685
Radiobiology 684
Radiofrequency surgery 704
Radionuclide cisternography 380
Radiotherapy 86, 680, 682, 686, 691
adjuvant 685
complications of 687
contraindications of 685
curative 685
external beam 590, 684
fractionation of 686
intraoperative 685
modes of 684
palliative 685
planning of 686
Ramsay Hunt syndrome 7, 207, 249, 287, 292
Ramus mandibularis 55
Ranitidine 495
Ranula 55, 436, 437f
treatment 437
Rapid strep tests 457
Rathke's pouch 58, 471, 477
Rat-tail sign 714
Recalcitrant rhinosinusitis 331
Recanalization 367
Rectus palsy
inferior 124f
left lateral 124f
medial 124f
superior 124f
Recurrent laryngeal nerve, paralysis of 533
Red lesions 407
Red man syndrome 97
Reflexes 209
nasopulmonary 48
Reflux
disease, nonerosive 495
esophagitis 495, 496
features of 496
laryngitis 494, 495, 709
Regenerative nodule 587
Reichert's cartilage 21f
Reinke's edema 72, 525, 528, 529
Reinke's space 72, 78, 525
Reissner's membrane 16
Reiter's syndrome 515
Respiration 46
Respiratory
acidosis 695
alkalosis 695
cilia 49
dead space 564
distress 493, 504, 551, 562, 709
disturbance index 463, 466
glottis 78
infection, upper 693
insufficiency 554
mucosa 36
muscles
paralysis of 554
spasm of 554
papillomatosis, recurrent 527
syncytial virus 103105
Retention cyst 60, 70, 395, 449
Reticular lichen planus 411
Retracted tympanic membrane 208
Retraction pockets 208, 215
Retroauricular sulcus, upper part of 118f
Retrobulbar neuritis 126
Retrocolumellar vein 320
Retrofacial cells 14
Retrolabyrinthine procedures 608
Retromolar trigone 52
Retronasal testing 312
Retropharyngeal lymph nodes, tuberculosis of 600
Retropharyngeal space 60, 595
forms anterior wall of 82
infection 457
Rhabdomyoma 523
Rhabdomyosarcoma 299, 392, 471, 477, 689
Rheumatic fever 457
Rh-hemolytic disease 350
Rhinitis 358
atrophic 311, 340, 341, 346, 347, 364
chronic 308
diphtheritic 328
emotional 358
gustatory 359
honeymoon 358
hormone-related 359
idiopathic 359
irritative 328
medicamentosa 360
occupational 359
sicca 341
work-related 359
Rhinogram 313
Rhinolalia aperta 541
Rhinolalia clausa 337, 460, 462, 474, 541
common causes of 460
Rhinolaryngoscopy, flexible transnasal 506
Rhinolith 381
Rhinomanometry 313
Rhinometry 313
Rhinophyma 33, 307, 319, 324, 704
Rhinoplasty 5, 373, 626
augmentation 324, 627
closed 626
complication of 34, 628
endonasal 626
open 626
Rhinorrhea 351, 352, 358
clinical diagnoses of 307fc
excessive 359
Rhinoscleroma 342, 346
Rhinoscope 448, 647f
Rhinoscopic mirror, posterior 310f
Rhinoscopy
anterior 308, 309, 309f, 329, 448
posterior 308, 310, 310f, 448
Rhinosinusitis 325, 335
acute 325, 326, 331, 332
bacterial 332t
chronic 48, 325, 329, 330, 330t, 332, 364
hyperplastic 330, 708
complications of 332, 332b
fungal 344
intraorbital extension of 333
recurrent 325, 364, 632
subacute 325
Rhinosporidiosis 102, 343, 346
Rhinosporidium seeberi 102, 343
life cycle of 343
Rhinotomy
extended lateral 473
lateral 386
Rhinovirus 103, 456
Rhizomucor 102
Rhizopus arrhizus 102
Rhizotomy, radiofrequency 128
Rhomboid glossitis, median 412
Ribavirin 104
Ribonucleic acid 340
Ribosomal RNA analysis 92
Rifampicin 95, 99
Rifampin 90
Right lower lobe bronchus 76f
Rigid esophagoscopy, instruments of 642f
Rigid transoral fiber-optic laryngoscopy 505
Rim fracture 375
Rima glottidis 71
Rimantadine 104
Ring sign 244, 714
Ringertz tumor 386, 396
Rinne test 134, 149, 150, 150f, 159, 161
Risus sardonicus 116
Ritonavir 109, 112
Robotic skull-base surgery 706
Robotic surgery, transoral 706
Rodent ulcer 307, 320
early 30f
Romberg's test 257
interpretations 257
method 257
Ropivacaine 698
Rose fever 352
Rose position 633f
Rose sinus douching cannula 651
Rosenbach's sign 714
Rosenthal's canal 16
Rotating chair test 27, 257
Rotation test 254, 255f
Round open esophagoscope 661
Round window 16
reflex 24
Rouviere's node 67
Roux cheek retractor 655f
Rubber tubes 662
Rubella, congenital 184
Rupatadine 356
Russell bodies 346
S
Sac 17
Saccades 252, 274
Saccharin
sodium test 312
solution 214
Saccular cyst
anterior 527
lateral 527
Saccular macula 27
Saccule 17, 19, 70
functions of 27
macula of 27
Saddle nose 317
Sade classification 225, 225f
Salicylates 171
Saline nasal douching 330
Saliva
dribbling of 286
drooling of 493
functions of 53
Salivary calculi 433
Salivary flow, submandibular 284
Salivary glands 53, 54f, 85, 135, 402, 403, 421, 672f
cancer 682, 689
disease
human immunodeficiency virus-associated 426
inflammatory 423
disorders of 420
excision of 427
major 431t
malignancy of 431, 709
neoplasms of 427
secretomotor pathway of 12f
sublingual 55
submandibular 55, 668
swelling 428
tumor 427, 427t, 428
Salivary malignancy
primary 428b
signs of 427
symptoms of 427
Salivary neoplasm 427, 575
nature of 427
Salivary type amylase, serum 421
Salpingopharyngeal fold 59
Salpingopharyngeus 57
Salvage neck dissection 86
Samter's triad 330, 335, 337
Sanguinaria 409
Sanjivani airway management oropharyngeal airway 663f
Santorini 69
Saprophytic fungal infection 345
Sarcoidosis 290, 341, 407, 433
Sarcomas 392, 479, 689
osteogenic 392
Sardana's approach 473
Sargramostim 109
Scala
media 16
tympani 16
vestibuli 16
Scalene nodes 84
Scaphoid fossae 199f
Scarlet fever 457
Scarpa's ganglion 22
Scattered calcification 679
Schatzki ring 496
Schaumann's bodies 713
Scheibe dysplasia 179
Schirmer's test 284, 284f, 301, 432
Schneiderian membrane 49
Schuller's view 666
Schwabach's test 134, 149, 151
Schwann cells 713
Schwannomas 385, 576
Schwartz sign 164, 167
Scleral lacerations 370
Scleroderma 407, 452, 498
Scleroma 521
Sclerosis 225f
multiple 249, 275, 277
Scope
holding of 643
lubrication of 643
Scopolamine 276
Scott Wilson tonsil scissors 657
Screamer's nodules 524
Screening test 255
Scrofula 579
Scutum 9
Seborrhea 204
Seborrheic dermatitis 101
Seborrheic keratosis, pigmented 118f
Secondary cardiac achalasia, causes of 498
Secretory glands, serous 47
Sedation endoscopy, drug-induced 466
Seddon classification of neural injury 281
Seeberi 102
Selective serotonin-reuptake inhibitors 273
Semicircular canal 15, 29, 258
ampulla of 279
cut section of 16f
dehiscence, superior 165, 269
superior 2
Semicircular duct 17
ampulla of 19f
Semon's law 532
Semont maneuver 261, 262f
Sensation level 147
Sensorineural hearing loss sudden, causes of 174b
Sentinel lymph node biopsy 86
Septal abscess, complications of 367
Septal cartilage 32, 34
caudal dislocation of 361
deficiency of 35
deformed 624
dislocates 363f
fracture of 667f
graft 623
junction of 362f
Septal fracture, closed reduction of 373f
Septal surgery 364, 653
instruments for 652f
Septoplasty 358, 366f, 623t, 624, 625f
endonasal 624
techniques 625f
Septorhinoplasty 373, 623, 624, 626
Septum 309
caudal deflection of 309
membranous 34
Sequelae, symptoms of 230
Sequestrum 122
Sermoid, simple 318
Serpentine-like fashion 100
Sesamoid 32
Sessions’ classification 472
Seventy-degree endoscope 506
Shea teflon piston 166f
Sheehy teflon ventilation tube 606f
Shepard teflon ventilation tube 606f
Shock
organ 263
thermal 705
Short increment sensitivity index test 153, 301
Short-tau inversion recovery 672
Shrapnell's membrane 7
Sialadenectomy 327
Sialadenitis 426
acute suppurative 421
bacterial 709
chronic 423
nonsuppurative acute 421
Sialadenosis 433
Sialoendoscopy 427
Sialogogues, systemic 433
Sialography, CT of 403
Sialolithiasis 426
Sialolithotomy, open 427
Sialometaplasia 430
Sialorrhea 404
Sibson's subpleural fascia 81
Siegel's examination 648f
Siegel's speculum 144, 151, 253, 647, 648
Siegelization 134, 222
Sigmoid sinus thrombosis 246
Silastic tubes 662
Silicone tubes 662
Simple cortical mastoidectomy 609f
Singer's complaints 524
Singer's nodules 524
Single axillary incision Robotic surgery 706
Sinonasal tract, adenocarcinoma of 396
Sinopulmonary disease 337
Sinus 121
and intrasinus abscess, obliteration of 244
causes of 122
ethmoidal 41, 42, 49, 310, 328f, 330f, 331, 389, 676f
evaluation of 122
frontal 40, 45, 49, 310, 311, 331, 371, 675f
intracranial venous 125
maxillary 676f
mucociliary clearance of 49
mucous drainage of 45
of Morgagni 59, 475, 477
opening of 122
operations 616
ostium 385
preauricular 122, 200, 200f, 209
surgery 651
functional endoscopic 35
tuberculous 568
tympani 9, 10f
ventilation of 48
Sinuscopy 330, 617
examination 617f
Sinusitis 96, 325
chronic 331
Sinusotomy, frontal 619
Sipple syndrome 588
Sisomycin 172
Situs inversus 48
Sjögren's syndrome 402, 404, 407, 421, 423, 424, 432, 433, 709
primary 432
secondary 432
Skeletal muscle 66t
relaxants 694
Skew deviation 274
Skin 702
cancers 440, 709
care 687
glands 6
lesions 342, 417
perioral 413f
piercing devices 107
protection of 703
reactions 687
after postoperative radiotherapy 687f
redness of 504
Skull, base of 36f, 630f
Slash tracheostomy 554
Sleep
apnea 47, 463, 464
mixed 464
architecture 466
disordered breathing 463
efficiency 466
nasendoscopy 466
patterns 464
Sluder's neuralgia 136, 306, 337, 714
Small atticoantrostomy 612
Small venules, progressive retrograde thrombophlebitis of 236
Smell 137, 311
disorders of 48
increased sense of 306
loss of 311
sense of 306, 310
Smoke, evacuation of 703
Smokeless tobacco 409
Smoking 407, 428
Smooth pursuit 252, 274
Snare method 634
Sneezing 47, 48, 306
paroxysms of 352
Snoring 251, 364, 449, 463, 704
causes of 469
management of 467fc, 468b
spouse syndrome 467
surgical treatment of 469
Sodium fluoride 167
Soft palate 449, 626t
retraction of 448
uvula of 120f
Soft rubber air bag 648f
Soft tissue
fullness 483f
injuries 371
neck
lateral view, X-ray of 461f, 483f, 493f, 561f
Solitary papilloma, adult 528t
Solitary thyroid nodule 584
Somatosounds 140
Sonotubometry 214
Sore throat 99, 449
Soreness and burning mouth 408
Sound 146
conduction of 23
during ear transmission, loss of 29
energy 159
frequency of 75
intensity of 75
level meter 147
localization 29
Space of mandible, abscess of 601, 601f
Spasms 285
Spatula test 310, 310f
Special sound-proof audiometry room 152f
Specific-IgE antibody tests 354
Spectrum 97
hypopharyngeal 493
penicillins 96
extended 95
Speech 179
audiometry 72f, 153, 184
uses of 154
banana 147
conservation 188
development of 186
different types of 147, 147t
discrimination score 154, 154t
disorder 538
types of 542
frequencies 159
reading 188
reception threshold 152, 154
recognition score 154
therapy 524, 534
Sphenoethmoidal
cells 43
mucocele 333
recess 34
Sphenoid bone 43, 44f
Sphenoid sinus 42, 43, 45f, 49, 329, 331, 652, 676f
depth of 43
malignancy of 392
neoplasms of 328
pneumatization 44
walls 45f
Sphenoid sinusotomy 619
Sphenoid, greater wing of 4f
Sphenopalatine 46
artery 320
endoscopic ligation of 324
ganglion 49
neuralgia 136
Spinal accessory
chain 83
nerve 86
Spinal nerves 135
Spinal nucleus 277
Spinosum 43
Spirochetes 92, 94
Splint therapy 129
Spondee words 159
Spontaneous nystagmus, presence of 251
Sporothrix schenckii 345
Spouse arousal syndrome 467
Spratt mastoid curette 648f
Spread, pathways of 236
Spreader grafts 315
Squama frontalis 40
Squamous anterior surface 2
Squamous cell 14
carcinoma 118, 121, 298t, 320, 384, 428, 431, 479, 481, 485, 500, 501, 689
auricle 295
esophagus 500, 709
external nose 320
paranasal sinuses 396
Squamous metaplasia theory 229
Squamous papilloma 385, 434, 470
Squamous posterior surface 2
S-shaped deformity 363
St Clair Thomson adenoid curette 658
with guard 658f
without guard 658f
St Clair Thomson long bladed nasal speculum 653f
Stahl's ear 199
Stankiewick's sign 620
Stapedectomy 162, 164, 165
lasers for 166
left ear 166f
Stapedial artery, persistent 167
Stapedial myoclonus 141
Stapedial otosclerosis 163
Stapedial reflex 284
Stapedius 11
muscle 28
Stapes fixation, congenital 165
Stapes footplate 615f
ankylosis of 614
fixation of 163
Staphylococci 90, 99
Staphylococcus aureus 90, 107, 218, 227, 515, 578, 598, 709
Static labyrinth 26
Stavudine 109
Steam inhalation 329
Stellwag's sign 571, 571f
Stenger test 177
Stenosis 138, 318
Stensen's duct 54
opening 423f
Stenver's view 666
Stereocilia, displacement of 27f
Sternocleidomastoid 3
muscle 80, 80f, 86, 240f
lower part of 669f
Sternomastoid
muscle 54
tumor 567, 580
Steroids 286, 287
contraindications of 287
intranasal 468
local 408
Stevens-Johnson syndrome 416
Stickler syndrome 181
Stigmata 181
Stomodeum, roof of 33
Streptococcal tonsillitis 456, 458t
Streptococci 92
Streptococcus
anginosus 92
haemolyticus 243
milleri 92
pneumoniae 90, 92, 180, 218, 223, 242, 243, 422, 515
pyogenes 90, 92, 218, 422, 455, 578, 598
viridans 90, 422
Streptogramins 99
Streptomycin 90, 99, 100, 172, 179, 267
ototoxicity 177
Stress 263
Stria vascularis 16, 17
Stridor 504, 511, 514, 539, 551
acute 511, 514
biphasic 511
causes of 512, 512b
congenital 464, 558, 560, 564
expiratory 464, 511
inspiratory 464, 488, 511
neonatal 534
sound of 512
Striola 19, 27
curvilinear shape of 27
Stroboscopic parameters 509t
Stroboscopy 508, 546
Strokes, cerebrovascular 248
Stuttering 542, 543
Stylalgia 483
Styloid process 4, 54, 714
Stylomandibular ligament 82, 429f
Stylomastoid foramen 29, 280f, 402
Subclavian artery, compression of 580
Subclavian steal syndrome 273
Subepithelial lymphoid tissue, collection of 59
Subglottic stenosis, congenital 559
Submandibular
abscess, acute 578f
duct, opening of 398
gland
deeper part of 55f
excision of 427
level of 678f
salivary glands, common disorders of 55
swellings, common 567
Submucosal vascular plexus 37
Substance abuse 409
Subtotal central perforation 219f, 226f
Succinylcholine 694
Sulbactam 597
Sulcus tubae 43
Sulcus vocalis 526, 540
Sulfadiazine 109
Sulfamethoxazole 109, 339
Sulfisoxazole 222
Sulfonamides 95, 97
Sulzberger's powder 99
Sumatriptan 126
Summer cold 352
Sun exposure, chronic 409
Sunderland classification 282, 282f
Superior constrictor muscle, upper border of 67
Superior laryngeal nerve, paralysis of 533
Supermarket syndrome 714
Supraclavicular nodes 83
Supraglottic tumors, lateral 71
Suprahyoid epiglottic tumors 550
Supraorbital cells 42
Supraorbital ridge 371
Suprapyramidal recess 9
Supratonsillar fossa 61
Supratubal recess 29
Surgery, pituitary 628
Suxamethonium 694
Swallowing
functional endoscopic evaluation of 452
physiology of 64
Sweat test 312
Sweating, gustatory 285, 431, 433
Sweet's syndrome 414
Swelling 117, 117t, 307, 449, 504
acute painful 402
benign 482
cheek 621
cystic 118f, 437f, 449
developmental 393
discrete 584
erythematous 201f
examination of 118
exophytic 118f
infectious 393
inflammatory 393
infratemporal fossa region 387f
nodular 118f
of external nose and vestibule, classification of 318
over mastoid region 238
parotid gland 427f
severe painful 602
submandibular 443
thyroglossal cyst 80
Swimmer's otitis externa 209
Synchronous second primary cancer 401
Synkinesis 285
Syphilis 92, 170, 184, 343, 346, 438, 449, 520t, 521
acquired 343
congenital 253, 343
Syringomyelia 251
Systemic diseases 330, 407, 421
nasal manifestation of 102, 338
Systemic inflammatory diseases 519
Systemic lupus erythematosus 407
Systemic sclerosis
diffuse 498
limited 498
progressive 498
T
Tachycardia 571, 695
Target sign 380
Taste 398, 709
buds 53, 419
sensation
diminished 286
neural pathways of 53f
sense of 398, 709
test 284
Taxanes 689
Taxotere 689
Tazobactam 597
Teapot sign 620
Tecastemizole 356
Tectorial membrane 18
Teeth 398, 399
protection of 643
Tegmen cells 14
Tegmen tympani 28
Teicoplanin 97
Telangiectasia, hereditary hemorrhagic 324
Telecanthus 373
Teletherapy 684
Temporal bone 2, 3f, 6f
air cells of 14f
contents 2
CT of 673, 710
fracture 209, 237, 287, 289, 290, 292, 708, 708f
clinical features of 708
longitudinal 289
management of 289
transverse 288
fungal infection of 204
imaging 185
longitudinal fracture of 292
magnetic resonance imaging 673, 710
neoplasms of 295
parts 2
pneumatization of 236, 674f
relations 2
squamous part of 2f, 6
transverse fractures of 292
Temporal gyrus, superior 22
Temporal lobe auditory cortex 26
Temporalis muscle 125
flap 445
Temporomandibular arthritis, acute 603
Temporomandibular disorders 128, 707
common causes of 129t
Temporomandibular dysfunction 129
Temporomandibular joint
disorder, surgical treatment of 707
dysfunction 136
Temporomandibular pain, criteria of 129
Tender jugular lymph nodes 245
Tendon reflexes, deep 242
Tensor tympani 11
muscle, canal of 9
Tensor veli palatine
contraction of 211f
function of 214
muscle 211
Teratomas 470, 476, 578
Terbinafine 102
active metabolite of 356
Tetanus 116
Tetracyclines 97, 100
Thalamus 22
Thoracic esophageal rupture 491
Thoracic esophagus 64
rupture of 491
Thoracolumbar vertebrae 475
Thorax 589
Thornwaldt's cyst 313, 477
Thornwaldt's disease 476
Thorotrast 387
Three semicircular canals, planes of 26f
Three-oz water swallow test 535
Throat pain 456
Thrombocytopenia 322
Thrombophlebitis 125, 242
Thrombus, extension of 244
Thudicum nasal speculum 309, 309f, 646
Thymic cyst 580
Thyroarytenoid muscle epithelium 508
Thyroglobulin 87, 590
antibodies 88
Thyroglossal cyst 66, 88, 119f, 449, 566, 568, 576, 577f, 709
Thyroglossal duct 88, 714
Thyroglossal fistula 568
Thyrohyoid membrane 69, 527f
Thyrohyoid spaces 75
Thyroid 69, 453, 573
adenoma 568
agenesis, congenital 581
angle 78
antibodies 88, 589
artery
inferior 87, 592
superior 86, 592
auscultation of 570f
autoantibodies 572
autoimmune disorders of 88
bruit 571
cancer 685
anaplastic 682
follicular 682
medullary 682
papillary 682
carcinoma
prognostic factors of 591
staging of 590
treatment of 590
cartilage 70f, 80, 120f, 563
cysts 586, 587
cytopathology, reporting 586
deficiency, mild type of 581
disorders 572t
enlargement 583
failure, severe type of 581
functions 572
test 572, 581, 582
thyrotoxicosis 572
gland 80, 86, 88, 568
anterior surface of 87f
disorders of 580
echogenicity of 669f
shape of 569f
IMA artery 87, 592
isthmus 555f
lamina 80
lymphoma 589
malignant tumors of 587, 589
medullary carcinoma of 685
multinodular goiter 180
neoplasms 575, 584
classification of 584b
nodules 119f, 584, 586, 587, 709
left lobe 587f
types of 586
palpation 570f
papillary carcinoma of 588f
parafollicular cells of 713
peroxidase 87
physiology of 87
posterior surface of 154f
scan 672f
stimulating hormone 87, 572t
surgery 591
types of 591
swelling 568, 569f
vein
inferior 592
middle 592
superior 592
Thyroidectomy 584
completion 590
subtotal 549, 584, 590
total 584, 590
Thyroiditis, autoimmune 581
Thyroplasty 535, 536
Thyrotoxicosis 581
primary 581
secondary 581, 582, 584
Thyrotropin 87
releasing hormone 87
Thyroxine 584
therapy 590
Tic 285
douloureux 127
Ticarcillin 96, 597
Tilley's antral burr 651
Tilley's dressing forceps 646
Tilley's harpoon 651
Tilley's nasal forceps 647f
Tinea versicolor 107
Tinnitus 139, 141, 144, 301, 542, 707
acoustic therapies 143
causes of 140b
classification of 139, 140b
drug-induced 140b
etiopathology of 140
evaluation 141
in acoustic neuromas 141
lifestyle changes 143
management program 143
matching 143
pharmacotherapy 143
pitch of 141
radiological imaging 142
relieving 144b
retraining therapy 144
salicylates-induced 140
severity of 141
subjective 707
surgical management 144
Tissue
damage, zones of 701
edema 351
injury, zones of 702f
vaporization, central area of 701
Tobacco, chewing of 407
Tobey-Ayer test 245
Tobramycin 172, 179
Tone decay test 265
Tongue 42, 398, 401f, 468, 714
base of 60, 449
base radiofrequency 469
bite during chewing food 400f
carcinoma of 53
depressor 399f
dorsum of 53f
extensive hemangioma of 435f
fibrillar twitching of 572f
geographical 418, 418f
glossitis involving bilateral margins of 400f
inferior surface of 52f
lesion 674f
lymphatic drainage 53
malignancy of 408f, 442f
musculature, deep 442f
neck node metastasis 53
parts 52
tie 418
Tonotopic gradient 25, 25f
Tonsil 449, 460, 574, 705
artery forceps 658
bed of 61f, 62
crypts of 61f, 449
dissection forceps 658
dissector and pillar retractor 657f
functions of 58, 62
holding forceps 655
knife 656
malignancy of 457, 481f, 482
membrane 449
nasopharyngeal 58
symmetry 449
unilateral enlargement of 482f
white patches on 457, 458b
Tonsillar
crypts 62
content of 62
cyst 459, 459f
hypertrophy, grading of 461
keratosis 458
pillar 449
anterior 481f
space, anterior 61
Tonsillectomy 60, 358, 631, 634, 634f, 654, 656
contraindications of 636
interval 598
Tonsillitis
acute 462, 632
chronic 450, 457, 631
membranous 457
recurrent 457, 631
Tonsillolingual sulcus 61
Tonsillolith 458, 459
Tonsillotomy 704
Topical isopropyl alcohol, topical 138
Topodiagnostic tests 284, 286
TORCH 184
Tornwaldt's disease 58
Torsional diplopia 274
Torticollis 580, 598
Torus 436
tubarius 59, 211
Total leukocyte count 457
Total ossicular replacement prosthesis 614
Tourette's syndrome 542
Towne's view 666
Toxic goiter, diffuse 581
Toxic shock syndrome 602
Toxicity, acute 689
Toxoplasma gondii 107
Toxoplasmosis 179, 425
congenital 184
Toynbee's maneuver 218
Toynbee's test 214
Trachea 76, 703
compression of 643
development of 74
Tracheal
cartilages 76
dilator 661
foreign body 561, 562
hook 661
blunt 662f
sharp 662f
obstructions, classification of 560
Tracheitis, bacterial 516, 517
Tracheobronchial tree 76f
anatomy of 68, 76
and larynx 78, 514, 644
physiology of 68
Tracheoesophageal fistula speech 552
Tracheo-innominate fistula 557
Tracheostome, narrowing of 549f
Tracheostomy 367, 492, 516, 533, 534, 536, 553, 555, 555f, 557, 661
advantages of 697
aims of 553
complications of 557, 557b
elective 554
emergency 513, 562
high 554
incisions for 555f
level and site of 554
low 554
mid 554
permanent 554
temporary 554
timings of 554
tube
classification of 662b
cuffed 663
extra length 661
metallic 662f
nonmetallic 662f, 663
placing 556
size of 663
types of 661
types of 554
Tracheotomy 553, 555, 709
Traditional screening tests 149
Tragal cartilage pointer 54
Tragus
absence of 199
sign 615
Transcervical surgery 706
Transcranial magnetic stimulation 144
Transglottic tumors 547
Transient-evoked otoacoustic emission 182
Transillumination test 315, 327
Translabyrinthine 608
cochleovestibular neurectomy 267
Transpalatine 473
Transtracheal jet ventilation 696
Trapezius
anterior border of 80
muscle 80
Trauma 458
Traumatic cerebrospinal fluid rhinorrhea, early 380
Traumatic disorders 200
Trautmann mastoid
chisel 648f
gouge 648f
Trautmann triangle 28
Traveling wave theory of von Bekesy 25
Treacher Collins syndrome 65
Trehalose dimycolate 100
Treponema pallidum 92, 94, 263
Triangular fibroelastic membrane 69
Triazoles 102
Trigeminal nerve
mandibular division of 121f
maxillary division of 46, 62
ophthalmic division of 46
Trimethoprim 97, 109, 222, 339
sulfamethoxazole plus metronidazole 597
Trimetrexate 109
Triple S triangle 279
Tripod fracture 374, 374f
Triptans 272
Trismus 387, 408, 603
acute
painful 603
painless 603
causes of 597, 603
chronic 603
indicating retromolar extension 387f
sequela 603
Trophic ulcers, deep 121
Trotter's sign 78, 488, 488f, 714
Trotter's syndrome 475, 477
Trotter's triad 474, 477
T-suppressor cells 349
Tubal blockage, acute 215
Tubal tonsils 58, 59
infected 59
Tube
physiology, vertical section of 211f
upper curvature of 661
Tubercular lesion, healed 121f
Tuberculin skin test 579
Tuberculosis 90, 342, 346, 449, 520, 520t
laryngeal 522
pulmonary 108
Tuboplasty, eustachian 215
Tubotympanic
disease 232
recess, endoderm of 21
Tuebingen ventilation tube 606f
Tullio's phenomenon 250, 263, 258, 268, 269, 708
Tumarkin, otolithic crises of 264
Tumors 313
adenomatoid 428
benign 393, 458
biology 681
epidermoid 428
exophytic 443
intracanalicular 300f, 301
intracranial 126, 311
intratympanic 296
malignant 118, 139, 393, 403, 478
mixed 427, 431
nodes and metastasis (TNM) 480
classification 389, 475, 590
staging 501
odontogenic 386
oropharyngeal 61f
parapharyngeal 483, 484, 576
pressing trigeminal nerve 300f
staging, primary 389t
suppressor
gene 681
protein 681
ventricle 71
Tuning fork 646
tests 134, 149, 150t, 159, 164, 230, 707
Tunnel of Corti 18
Turban epiglottis 521
Turbinates
level of 46
superior 33
Turbinectomy, inferior 358
Tympanic membrane 7, 7f, 9, 10f, 21, 23f, 24, 28, 133, 137, 138, 161, 167, 183, 207, 208f, 221, 233f, 607
anteroinferior quadrant of 232f
atelectasis of 208
atrophic 208
autograft 614
chronic perforation of 224
collagen-containing fibrous layer of 225
coupled motion of 24f
de-epithelialization of 138
denatured homograft 614
diseases of 198, 199t
dry traumatic rupture of 209
graft 615f
nerve supply of 144
perforation of 148, 209, 226f, 233, 238
retraction 226
four stages of 225f
right 11f
slight retraction of 225
thick 606
three layers of 8f
traumatic rupture of 209
ventral perforation of 232f
Tympanic plexus 11
Tympanocentesis 220
Tympanogram 156f, 167
types of 155t
Tympanomastoid
surgery 291
suture 54, 281, 294f
Tympanomeningeal hiatus 237, 246
Tympanometry 155, 165, 214, 222, 223
Tympanoplasty 5, 220, 231, 233, 234, 612, 613, 613f, 653, 693
complications of 614
types of 613, 613f, 613t
Tympanosclerosis 165, 208, 224, 232, 614
patch of 208f
Tympanosquamous suture 6
Tympanostomy tubes 222, 605, 606
types of 606
Tympanotomy, posterior 10f
Tympanum
dimension of 9f
six boundaries of 10f
Tyrosine-protein kinase kit 681
Tzanck cells 414
U
Ulcer 117, 117t, 408, 449, 568, 687
and inflammation, superficial 307
aphthous-like 415
contact 525, 529
corneal 582
examination of 120
nonhealing 442f
number of 415
site of 415
traumatic 417, 457
types of 415
Ulcerative
gingivitis, acute necrotizing 414
lesions 401, 407, 412
Umbrella graft 315
Unilateral blood-stained discharge, causes of 306, 381
Unilateral tonsil enlargement, causes of 632
Union for International Cancer Control 480
Universal Newborn Hearing Screening 182
University of Pittsburgh staging system 298t
Unterberger's test 257, 714
Upper airway
obstruction, management of 456
resistance syndrome 463, 464
Upper eyelid, spasm of 582
Uremia 285
Usher's syndrome 180, 186
Utricle 17, 19, 28, 258
functions 27
Utricular hair cells, bending of 27
Utricular macula 20, 27
Uveoparotid fever, triads of 290
Uvula 449
pointing sign 714
V
Vagal trunk, low 532
Vagus nerve 5, 7, 8, 74, 135, 208f, 531
Valacyclovir 104
Valganciclovir 109
Valleculae 60
Vallecular cyst 449
Valsalva
maneuver 134, 222, 253, 639, 709
test 213
Van der Hoeve syndrome 163, 167
Vancomycin 90, 97, 100, 597
Varicella
ischemia 286
lasers 703
lesions, congenital 560, 709
malformations 140
rings, congenital 512
stasis 705
tinnitus, surgical management of 144t
zoster virus 207, 287
Vasodilators 143, 266
Vasomotor
disturbance 263
rhinitis 358, 359
Vasovagal reflex 7
Vein, internal jugular 80, 81, 86, 87f
Venereal disease research laboratory 520
Venous hum 139, 142, 144
Venous pulsatile tinnitus 142
Ventilation tubes 606f
Ventricle of Morgagni 70, 78
Veria technique 196
advantages of 196
Vermis 257
Vernix, presence of 182
Verrucous carcinoma 444, 551
Vertebral angiography 302
Vertebrobasilar angiography 273
Vertical semicircular canals 253
Vertigo 127, 148, 164, 248251, 272, 275, 289
causes of 250t, 251t
central 708
differential diagnoses of 249t
musculoskeletal 277
pathophysiology of 28
peripheral 257, 708
spells 273, 708
types of 289
Vesicles 408
Vesiculobullous lesions 407, 412
Vestibular
anatomy 674f
aqueduct, enlarged 179
crest 15
disorders 258
evoked myogenic potentials 257, 302
folds 70
function tests 29, 258
hair cells 27f
loss
bilateral 28
complete bilateral 276
unilateral 28
nerve 22, 247
inferior 22
superior 22
neurectomy 262
complications of 267
neuritis 249
nuclei 22, 23
afferent and efferent connections of 23t
organs, hair cells of 19f
pathways 23f
receptors 26t
schwannoma surgery 20
symptoms, treatment of 272
system
diseases of 28
evaluation of 28
physiology of 26
Vestibule 15, 70, 307, 312
Vestibulocerebellar tract 23
Vestibulocervical reflex 27
Vestibulocochlear
ear 20
nerve 20, 299
Vestibulo-ocular reflex 23, 27, 253, 302
cancellation 253
Vestibulopathy, recurrent 267
Vestibulospinal
arc 302
reflex 27
tract 23
Vestibulotoxic drugs 177
Vibrotactile aids 186
Video laryngoscopy, flexible 507f
Vidian neurectomy 38, 358, 360, 623
Vinblastine 689691
Vinca alkaloids 689
Vincent's angina 414, 449, 457, 462
Vincristine 689, 690
Viral 428
culture 414, 497
infection 286, 416, 458
labyrinthitis 170
pathogens
immunoassay 103
tissue culture 103
pharyngitis 456
prodrome 421
rhinosinusitis 326, 327
serology 421
sialadenitis 709
Viruses 101, 103
vaccinations 105
Visceral division 82
Vision, blurring of 246
Visual disorders 248
Visual field defects 236
Visual reinforcement audiometry 183
Visual vestibular conflict 276
Vitamins 408
Vocal cord 71, 73
abducted 78, 506f
benign lesions of 528
cadaveric position of 531
epithelium of 78
fixed 532
fixity, causes of 532
full abduction of 531
length of 75t
lesions, removal of 528
mobility 488
nodules 529
palsy 74, 78, 532, 536
causes of 531
left 531, 532f
types of 531
paralysis, congenital 534, 559
paralyzed 534
paramedian position of 531
plication 534
position of 531
positions 531f
reason of 511
scars 526, 540
tensor of 78
tumors 71
Vocal fold 71
edges 508
functional divisions of 72
motions 508
mucosal disorders, non-neoplastic 523, 524
paralysis 530
structure of 72f
vascularity 508
Vocal nodules 524
Vocal polyp 524
Vocal rehabilitation, postlaryngectomy 552
Vocal tremor 541
Voice and speech 537
disorders 511, 537
classification of 538
phonation 537
resonance 538
Voice production, aerodynamic myoelastic theory of 75
Voice tests 149
Voice therapy 524, 540
Vomerine groove 34
Vomeronasal organ of Jacobson 48
von Graefe's sign 571, 571f
von Recklinghausen's disease 118, 300, 300f
von Troeltsch, anterior pouch of 13f, 28
Voriconazole 102
W
Waardenburg's syndrome 181, 186
Wagner and Grossman hypothesis 532
Waldeyer's ring 58, 58f, 67, 575
lymphoepithelium of 478
Wallenberg's syndrome 274, 277
Walsham's forceps 372, 373, 651, 651f
Warm normal saline 340
Warm saline 382
Warthin's tumor 402404, 427429, 430f
Warthin-Starry silver staining 425
Watery discharge 306
Waugh tonsil dissection forceps 658f
Wavelength, range of 683t
Wax granuloma 206
Wax softening agents 206
Weber's test 134, 149, 150, 151f, 159, 161
Weber-Ferguson incision 391f
Wegener's granulomatosis 285, 330, 338, 339f, 340, 340t, 365, 407
Wernicke's aphasia 538
Wernicke's encephalopathy 272
Western blot test 107
Wever and Lawrence report 24
Wharton's duct 405, 426
calculus 427f
Whiplash vertigo 277
Whirling vertigo 260
White-eyed blow-out fracture 375
Whitehead mouth gag with tongue depressor 655f
Whooping cough 518
Wickham's striae 411, 419
Wigand technique 619
Wilde's dressing forceps 646
Wilde's ear snare bayonet type 649f
Wilde's incision 607
Wildermuth ear 131, 199
Wolff-Chaikoff effect 87
Wood's sign 457, 636
Woodruff's plexus 320, 324
Word deafness 538
Worm theory 350
Wrisberg's cartilage 78
Wullstein retractor 648f
X
Xerostomia 111, 431, 433, 688
Xylocaine 126
spray, topical 506
Xylometazoline 220, 356
Y
Yankauer suction tube 657, 657f
Young's operation, modified 341
Young's syndrome 335
Z
Zalcitabine 109
Zanamivir 104
Zenker's diverticulum 57, 491, 499, 499f, 501
Zidovudine 109, 112
Ziehl-Neelsen stain 93
Zinc therapy 143
Zolmitriptan 126
Zygoma 54, 374
fracture, left 374f
×
Chapter Notes

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1Basic Sciences

Anatomy and Physiology of Ear1

Look at the anvil of a blacksmith—how it is hammered and beaten; yet it moves not from its place. Let men learn patience and endurance from it.
—Sri Ramakrishna Dev
TEMPORAL BONE
The temporal bone has an interesting multifaceted anatomy. The important structures present and their complicated anatomic interrelations make the temporal bone surgery a challenge.
  • Relations: It articulates with five cranial bones: parietal, sphenoid, occipital, zygomatic and mandible. This pyramidal-shaped bone forms part of the base and lateral side of skull (Fig. 1). The petrous part separates middle cranial fossa from the posterior cranial fossa.
  • Contents: It houses the hearing and vestibular organs. The important structures which pass through it include internal carotid artery, internal jugular vein, and facial nerve. So the temporal bone houses following structures:
    • ▸ Bony portion of external auditory canal (EAC)
    • ▸ Middle ear containing malleus, incus and stapes
    • ▸ Internal ear containing peripheral portions of auditory and vestibular system
    • ▸ Fallopian canal containing facial nerve
    • ▸ Osseous canal for the internal carotid artery
    • ▸ Bony covering for the sigmoid sinus and the jugular bulb.
      zoom view
      Fig. 1: Intracranial view of petrous and squamous parts of temporal bone
  • Parts: The five portions of temporal bones are referred to as separate bones and include:
    • ▸ Squamous
    • ▸ Petrous
    • ▸ Tympanic
    • ▸ Mastoid
    • ▸ Styloid process.
 
SQUAMOUS
It forms lateral wall of middle cranial fossa and roof of bony EAC. Its zygomatic process forms roof of the mandibular fossa (Fig. 2).
 
PETROUS
  • Anterior surface (Fig. 3): Posterior boundary of middle cranial fossa
    • ▸ Medially arcuate eminence of superior semicircular canal (SCC)
    • ▸ Laterally tegmen tympani and tegmen antri
    • ▸ Anteriorly canal for tensor tympani and eustachian tube
    • ▸ At apex depression for trigeminal ganglion
    • ▸ Foramina and sulci of greater and lesser superficial petrosal nerves.
  • Posterior surface (Fig. 4): Anterior boundary of posterior cranial fossa
    • ▸ Sulci for sigmoid sinus and superior petrosal and inferior petrosal sinuses
    • ▸ Internal auditory meatus (IAM): Facial and auditory nerves and labyrinthine vessels
    • ▸ Subarcuate artery depression lies superior and lateral to IAM
    • ▸ Operculum opening for vestibular aqueduct lies inferolateral to IAM
    • ▸ Jugular foramen is formed at the union of petrous and occipital bone.
  • Inferior surface (Fig. 5):
    • ▸ Opening for cochlear aqueduct at the superior-most limit of jugular foramen
    • ▸ Jugular fossa for the jugular bulb3
      zoom view
      Fig. 2: External (lateral) view of left temporal bone. Note the suprameatal (Macewen's) triangle
      zoom view
      Fig. 3: Anterosuperior inside view of left temporal bone. Note that some adjacent part of greater wing of sphenoid is also seen
    • ▸ Inferior foramen of carotid canal for internal carotid artery is situated anterior to jugular fossa and separated from it by a wedge of bone called keel
    • ▸ Tympanic canaliculus for tympanic branch (Jacobson's nerve) of glossopharyngeal nerve penetrates keel.
 
TYMPANIC
It forms anterior wall, floor and posterior wall of bony EAC, anterior wall and floor of middle ear and posterior part of mandibular fossa.
  • Two sutures in bony EAC: Anteriorly tympanosquamous and posteriorly tympanomastoid
  • Petrotympanic suture in middle ear through which chorda tympani nerve exits.
 
MASTOID
Sternocleidomastoid (SCM) muscle is inserted on mastoid tip. The posterior belly of digastric muscle is attached to the digastric sulcus that terminates anteriorly at the stylomastoid foramen.4
zoom view
Fig. 4: Posterior surface of petrous process of left temporal bone
zoom view
Fig. 5: Inferior view of left temporal bone. Note that some adjacent part of greater wing of sphenoid is also seen
Emissary vein draining into the sigmoid sinus travels through mastoid foramen. Mastoid antrum is situated deeper to Macewen's triangle.
 
STYLOID PROCESS
It is situated anterior to stylomastoid foramen and gives origin to three muscles (stylohyoid, styloglossus and stylopharyngeus) and attachment to two ligaments (stylohyoid and stylomandibular).
ANATOMY OF EAR
The ear is a complex organ. Its functional components, the hearing apparatus and balancing organ are situated in the temporal bone of skull. Ear has intimate relationship to the brain occupying middle and posterior cranial fossa, jugular bulb, sigmoid sinus, internal carotid artery and cranial nerve (CN) V, VI, VII, VIII, IX, X, XI and XII. For the sake of description, the ear is divided into three parts (Fig. 6):
  1. External ear
  2. Middle ear
  3. Internal ear.
 
EXTERNAL EAR
The external ear is divided into auricle (pinna) and external acoustic or auditory canal (EAC). The TM separates external ear from the middle ear.5
zoom view
Fig. 6: Three parts of the ear: external, middle and internal
 
Auricle
The auricle except its lobule is made up of (Figs 7 and 8) a framework of a single piece of yellow elastic cartilage (Fig. 8), which is covered with skin. The skin is adherent to the perichondrium on its lateral surface while it is comparatively loose on the medial surface. Epithelium is squamous keratinizing. Sebaceous glands and hair follicles are found in the subcutaneous tissue. Adipose tissue is present only in the lobule. There are various elevations and depressions, which can be seen on the lateral surface of pinna (Fig. 8).
  • Incisura terminalis: This area is devoid of cartilage and lies between the tragus and crus of the helix.
  • Nerve supply (Fig. 9):
    • Auriculotemporal nerve (CN V3): It is a branch of mandibular division of trigeminal nerve and supplies anterosuperior part of lateral surface of pinna, including tragus and crus of helix.
      zoom view
      Fig. 7: External features of auricle
    • Cranial nerve VII (facial nerve): It innervates the skin of concha and antihelix, lobule and mastoid.
    • Cranial nerve X (vagus nerve): Its auricular branch (Arnold's nerve) supplies to concha and postauricular skin.
    • Greater auricular nerve (C2,3): This nerve of cervical plexus supplies most of the medial surface of auricle and posterior part of lateral surface and the postauricular region.6
      zoom view
      Fig. 8: Auricle cartilage: external features
      zoom view
      Fig. 9: Nerve supply of right pinna. (A) Lateral surface; (B) Medial surfaceAbbreviation: CN, cranial nerve.
    • Lesser occipital nerve (C2): This nerve of cervical plexus supplies upper part of medial surface of auricle and postauricular region.
 
External Auditory Canal
  • Dimensions: EAC is 24 mm long and extends from the concha to the TM. Its anterior wall is 6 mm longer than the posterior wall. EAC is usually divided into two parts: (1) cartilaginous and (2) bony. Its outer one-third (8 mm) is cartilaginous and its inner two-thirds (16 mm) is bony.
  • Direction: EAC is “S” shaped and not straight. Its outer one-third cartilaginous part is directed upward, backward and medially while its inner two-thirds bony part is directed downward, forward and medially.
  • Cartilaginous EAC: It is a continuation of the cartilage that forms the framework of the pinna.
    zoom view
    Fig. 10: Skin of cartilaginous external auditory canal
    zoom view
    Fig. 11: Lateral view of temporal bone showing endomeatal spines and sutures
    • Skin glands: The skin of the cartilaginous canal (Fig. 10) is thick and contains ceruminous and pilosebaceous glands that secrete wax. The hydrophobic, slightly acidic (pH 6.0–6.5) cerumen is formed in this part of EAC.
  • Bony EAC: It is mainly formed by the tympanic portion of temporal bone but roof is formed by the squamous part of the temporal bone (Figs 2 and 11). In the anterosuperior region, squamous part articulates with tympanic bone (tympanosquamous suture). Inferiorly and medially squamous part joins with the lateral superior portion of the petrous bone (petrosquamous suture). Skin of the bony EAC is thin and continuous over the TM. Here the skin is devoid of subcutaneous layer, hair follicles, and ceruminous glands.
    • Isthmus: Approximately, 6 mm lateral to TM, bony EAC has a narrowing called the isthmus.7
    • Recess: Anteroinferior part of the deep bony meatus, medial to the isthmus has a recess, which is called the anterior recess.
    • Foramen of Huschke: In children and occasionally in adults, anteroinferior bony EAC may have a deficiency that is called as foramen of Huschke.
  • Relations of Bony EAC
    • Superior: Middle cranial fossa
    • Inferior: Parotid gland
    • Posterior: Mastoid antrum and air cells and the facial nerve
    • Anterior: Temporomandibular joint (TMJ)
    • Medial: Tympanic membrane
    • Lateral: Cartilaginous EAC.
  • Epithelial migration: The skin of EAC has a unique self-cleansing mechanism. This migratory process continues from the medial to lateral side. The sloughed epithelium is extruded out as a component of cerumen.
  • Nerve supply (Fig. 12):
    • Auriculotemporal nerve (CN V3): It is a branch of mandibular division of trigeminal nerve and supplies anterosuperior wall of EAC.
    • CN X (vagus nerve): Its auricular branch (Arnold's nerve) supplies to inferoposterior EAC.
    • CN VII (facial nerve): It innervates the skin of the mastoid and posterior EAC.
 
Tympanic Membrane (Fig. 13)
  • Dimensions: Its dimensions are: 9–10 mm height and 8–9 mm width. It is 0.1 mm thick.
  • Position: Tympanic membrane is a partition wall between the EAC and the middle ear. It is positioned obliquely. It forms angle of 55° with deep EAC. Its posterosuperior part is more lateral than its anteroinferior part.
    zoom view
    Fig. 12: Nerve supply of external auditory canal
    zoom view
    Fig. 13: Tympanic membrane showing attic, malleus handle, umbo, cone of light and structures of middle ear seen through it on otoscopy
  • Parts: Tympanic membrane consists of two parts: (1) pars tensa and (2) pars flaccida.
    • Pars tensa: It forms most of TM.
      • Annulus tympanicus: TM is thickened in the periphery and forms a fibrocartilaginous ring called the annulus tympanicus that fits in the tympanic sulcus.
      • Umbo: The central part of TM near the tip of malleus is tented inwards and is called the umbo.
      • Cone of light: A bright cone of light radiating from the tip of malleus to the periphery in the anteroinferior quadrant is usually seen during otoscopy.
    • Pars flaccida (Shrapnell's membrane): It is situated above the lateral process of malleus between the notch of Rivinus and the anterior and posterior malleal folds. It is not as tense as pars tensa and may appear little pinkish.
  • Structure: Tympanic membrane consists of the following three layers (Fig. 14):
    1. Outer epithelial layer: It is continuous with the EAC skin.8
      zoom view
      Fig. 14: Three layers of tympanic membrane
    2. Middle fibrous layer: It encloses the handle of malleus and consists of three types of fibers: radial, circular and parabolic. In comparison to pars tensa, this layer is very thin in pars flaccida and not organized into various fibers.
    3. Inner mucosal layer: It is continuous with the middle ear mucosa.
  • Otoscopy (Fig. 13): Normal TM is shiny and pearly gray in color. Its lateral surface is concave, which is more marked at the tip of malleus (umbo). Attic area lies above the lateral process of malleus and is slightly pinkish. Its transparency varies from person to person. Some middle ear structures can usually be seen through TM such as incudostapedial joint, round window (RW) and Eustachian tube.
  • Mobility (Seigalization): A normal TM is mobile. It can be tested with pneumatic otoscope or Siegel's speculum.
  • Nerve supply:
    • Auriculotemporal nerve (CN V3): It is a branch of mandibular division of trigeminal nerve and supplies anterior half of lateral surface of TM.
    • CN X (vagus nerve): Its auricular branch (Arnold's nerve) supplies to posterior half of lateral surface of TM.
    • CN IX (glossopharyngeal nerve): Its tympanic branch (Jacobson's nerve) supplies to medial surface of TM.
 
MIDDLE EAR
The middle ear cleft (Fig. 15), which is lined by mucous membrane and filled with air, consists of the middle ear, Eustachian tube, aditus ad antrum, mastoid antrum and mastoid air cells. Middle ear is a 1–2 cm3 air-filled cavity that houses ossicles (malleus, incus, stapes), muscles (tensor tympani, stapedius) and nerves (chorda tympani, tympanic plexus).
Relations of Middle Ear Cleft
  • Roof: Tegmen plate separates it from middle cranial fossa and its contents like meninges and temporal lobe of cerebrum.
    zoom view
    Fig. 15: Parts of middle ear cleft
  • Floor: Jugular bulb
  • Medial: Labyrinth. Lateral SCC lies posterosuperior to facial nerve.
  • Posterior: Sigmoid intracranial venous sinus
  • Anterior: Petrous part of internal carotid artery lying in carotid canal
  • Posteromedial: Posteromedial to mastoid air cells is situated cerebellum in the posterior cranial fossa.
  • Cranial nerves:
    • CN V and CN VI: They lie close to the apex of the petrous pyramid.
    • CN VII: The horizontal tympanic part is situated in the medial wall of middle ear, while vertical mastoid part runs between the middle ear and mastoid air cells system.
 
Parts of Middle Ear (Tympanum)
The dimensions of middle ear are shown in Figure 16. The tympanum (Fig. 17) is traditionally divided into three parts—mesotympanum, epitympanum and hypotympanum.
  1. Mesotympanum: This is the portion of middle ear that lies at the level of pars tensa.
  2. Epitympanum (attic): This is the portion of middle ear that lies above the level of pars tensa and medial to Shrapnell's membrane and the bony lateral attic wall.
  3. Hypotympanum: This is the portion of middle ear that lies below the level of pars tensa.
    • Protympanum: The portion of middle ear around the Eustachian tube opening is termed as protympanum.
 
Boundaries of Middle Ear (Fig. 18)
Middle ear has six boundaries: roof, floor, medial, lateral, anterior and posterior walls.
  1. Roof (tegmental wall): It is formed by tegmen tympani (a thin plate of bone), which extends posteriorly to form the roof of the aditus and antrum (tegmen antri). Tegmen tympani separates middle ear from the middle cranial fossa.
  2. Floor (jugular wall): A thin plate of temporal bone separates tympanic cavity from the jugular bulb.
    zoom view
    Fig. 16: Dimensions of tympanum
    zoom view
    Fig. 17: Parts of middle ear seen on coronal section
  3. Anterior (carotid wall): The anterior wall, a thin plate of bone, which separates the middle ear cavity from internal carotid artery, has following features:
    • Eustachian tube: It connects the middle ear with nasopharynx. It aerates and drains the middle ear. (Eustachian tube is discussed in detail in Chapter “Disorders of Eustachian Tube”).
    • Canal of tensor tympani muscle: It is situated in the roof of Eustachian tube.
    • ▸ Canal for chorda tympani nerve.
    • ▸ Attachment of anterior malleolar ligament.
  4. Posterior (mastoid wall): It lies close to the mastoid air cells and presents following structures:
    • Pyramid: It is a bony projection through the summit of which appears the tendon of the stapedius muscle that is inserted to the neck of stapes.
    • Aditus ad antrum: It is an opening through which mastoid antrum opens into the attic. It lies above the pyramid. Its relations are following:
      • Medial: Bony prominence of the horizontal SCC
      • Lateral: Fossa incudis (short process of incus lies and attached here).
      • Inferior: Fallopian canal for facial nerve
      • Superior: Tegmen antri.
    • Facial nerve: The vertical mastoid part of the fallopian canal for facial nerve runs in the posterior wall just behind and below the pyramid.
    • Facial recess or suprapyramidal recess (Fig. 19): This recess is a depression in the posterior wall lateral to the pyramid. Its boundaries are following:
      • Medial: Vertical part of CN VII
      • Lateral: Chorda tympani (branch of 7th CN) and tympanic annulus
      • Superior: Fossa incudis (short process of incus lies and attached here).
    • Sinus tympani or infrapyramidal recess: This deep recess lies medial to the pyramid. It is bounded by the bony ridges (subiculum below and the ponticulus above).
  5. Medial (labyrinthine wall) (Figs 21 and 22): It is formed by the lateral wall of labyrinth. It presents following structures:
    • Promontory: It is a bony bulge which is due to the basal coil of cochlea.
    • Oval window (fenestra vestibuli): The footplate of stapes is placed in this window.
    • Round window (fenestra cochleae): It is covered by the secondary TM.
    • Horizontal tympanic part of fallopian canal for facial nerve: It lies above the oval window.
    • Lateral SCC: It lies above the fallopian canal of facial nerve.
    • Processus cochleariformis: It is a hook-like projection, which lies anterior to the oval window. The tendon of tensor tympani takes a turn on this process and then is inserted on the neck of malleus.
  6. Lateral (membranous wall) (Fig. 23):
    • Tympanic membrane: Lateral wall is formed mainly by the TM. Some structures of the middle ear (such as long process of incus, incudostapedial joint, RW and Eustachian tube) can be seen through the normal semitransparent TM.
    • Scutum: An upper part of epitympanum is formed by outer bony attic wall called scutum.
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Fig. 18: Six boundaries of tympanum. Medial wall is seen through the tympanic membrane
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Fig. 19: Facial recess and sinus tympani relations with facial nerve and pyramidal eminence
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Fig. 20: Posterior tympanotomy. Structures of middle ear seen through the opening of facial recess
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Fig. 21: Medial wall of middle ear
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Fig. 22: Medial wall of middle ear cleft
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Fig. 23: Right tympanic membrane, ossicles and Eustachian tube seen from medial side
 
Ossicles
The ossicles (Fig. 24) conduct sound energy from the TM to the oval window. There are three middle ear ossicles—malleus, incus and stapes.
  1. Malleus (hammer): It consists of a head, neck, handle (manubrium), a lateral and an anterior process. It is the largest ossicle and measures 8 mm in length.
    • Head and neck: They lie in the attic.
    • Manubrium: It is embedded in the fibrous layer of the TM.
    • Lateral process: It appears as a knob-like projection on the outer surface of the TM and provides attachments to the anterior and posterior malleal folds.
  2. Incus (anvil): It consists of following parts:
    • Body and short process: They lie in the attic.
    • Long process: It hangs vertically and forms incudostapedial joint with the head of stapes.
  3. Stapes (stirrup): This smallest bone of body measures about 3.5 mm. It consists of head, neck, anterior and posterior crura and footplate. The footplate is positioned in the oval window by annular ligament.
 
Intratympanic Muscles
There are two middle ear muscles: tensor tympani and the stapedius.
  1. Tensor tympani: It runs above the Eustachian tube. Its tendon turns around the processus cochleariformis and passes laterally. It tenses the TM.
    • Origin: Bony tunnel above the osseous part of Eustachian tube.
    • Insertion: Just below the neck of malleus.
    • Nerve supply: It develops from the 1st branchial arch and is supplied by a branch of mandibular division of trigeminal nerve (CN V3).
  2. Stapedius: On contraction, it dampens the loud sounds and prevents noise trauma to the inner ear.
    • Origin: Conical cavity and canal within pyramid.
    • Insertion: It inserts to the neck stapes.
    • Nerve supply: It is developed from the second branchial arch and is supplied by nerve to stapedius of facial nerve.
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Fig. 24: Middle ear ossicles
  • Functions: Acoustic reflex protects ear from loud sounds.
    • Dampening of middle ear mechanics: Loud sounds (80 dB and above) cause contraction of stapedius that limits stapes movement.
    • Gain control mechanism: Acoustic reflex keeps cochlear input more constant and expands dynamic range.
    • Reduction in self-generated noise: Stapedius muscle contracts with chewing and vocalization.
 
Intratympanic Nerves (Fig. 25)
  • Tympanic plexus (nerve supply of middle ear): The tympanic nerve plexus, which lies on the promontory, supplies to the medial surface of the TM, tympanic cavity, mastoid air cells, and the bony Eustachian tube. It is formed by following nerves:
    • Tympanic branch (Jacobson) of glossopharyngeal: It carries secretomotor fibers to the parotid gland. The pathway of secretomotor fibers to the parotid gland consists of inferior salivary nucleus > CN IX > Jacobson's tympanic branch > Tympanic plexus > Lesser petrosal nerve > Otic ganglion > Auriculotemporal nerve > Parotid gland.
    • Sympathetic fibers: Caroticotympanic nerves come from the sympathetic plexus, which is present around the internal carotid artery.
  • Chorda tympani nerve: This branch of the facial nerve enters the middle ear through posterior canaliculus. It runs on the medial surface of the TM. It lies between the malleus and long process of incus, above the insertion of tensor tympani. It carries gustatory fibers from the anterior two-thirds of tongue and parasympathetic secretomotor fibers to the submaxillary and sublingual salivary glands.
 
Middle Ear Mucosa
Middle ear mucosa wraps ossicles, muscles, ligaments and nerves like peritoneum wraps various viscera in the abdomen. These mucosal folds divide the middle ear into various compartments. So, all the middle ear structures lie outside the mucous membrane.12
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Fig. 25: Nerves in relation with the middle ear. Note secretomotor pathway of salivary, lacrimal and nasal glands
Mucous membrane of the nasopharynx is continuous with that of the middle ear cleft.
Middle ear cavity is lined by ciliated columnar epithelium in its anterior and inferior part and mucosa changes to cuboidal type in the posterior part. Attic and mastoid air cells are lined by flat, nonciliated epithelium. Eustachian tube is lined by ciliated pseudostratified columnar epithelium with several mucous glands in the submucosa.
 
Compartments and Folds of Middle Ear (Figs 26 and 27)
Ossicles and their mucosal folds separate mesotympanum from epitympanum (attic).
  • Compartments of epitympanum:
    • Prussak's space: Its boundaries limit spread of cholesteatoma to other compartments.
      • Lateral: Membrana flaccida (Shrapnell's membrane)
      • Medial: Neck of malleus
      • Floor: Lateral process of malleus
      • Roof: Fibers of lateral malleolar ligament arising from neck of malleus and inserting along the rim of notch of Rivinus
    • Attic compartments: Transversely placed superior malleolar fold divides attic into two compartments—smaller anterior and larger posterior. The gap between the lateral malleolar fold and lateral incudal fold provides communication between Prussak's space and posterior attic compartment.
      • Anterior attic compartment
      • Posterior attic compartment: Superior incudal fold divides this space into following two divisions: medial and lateral spaces.
  • Compartments of mesotympanum: In the upper part of mesotympanum, there are following three compartments:
    • Inferior incudal space: Its boundaries are following:
      • Superior: Lateral incudal fold
      • Medial: Medial incudal fold
      • Lateral: Posterior malleolar fold extending from neck of malleus to posterosuperior margin of tympanic sulcus.
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        Fig. 26: Posterosuperior and lateral view of right tympanic cavity showing compartments and folds of middle ear (after Proctor)
      • Anterior: Interossicular fold that lies between long process of incus and upper two-thirds of handle of malleus.
    • Anterior pouch of von Troeltsch: It lies between the following boundaries:
      • Medial: Anterior malleolar fold extending from neck of malleus to anterosuperior margin of tympanic sulcus
      • Lateral: Portion of the TM anterior to handle of malleus
    • Posterior pouch of von Troeltsch: It is situated between the following boundaries:
      • Medial: Posterior malleolar fold extending from neck of malleus to posterosuperior margin of tympanic sulcus.
      • Lateral: Portion of the TM posterior to handle of malleus.
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Mastoid Antrum
This air-containing space (9 mm height, 14 mm width and 7 mm depth) is situated in the upper part of mastoid. Its boundaries are following:
  • Roof: It is formed by the tegmen antri, which separates mastoid antrum from the middle cranial fossa.
  • Lateral wall: It is formed by a 1.5 cm thick plate of squamous part of temporal bone which is marked on the lateral surface of mastoid by suprameatal (Macewen's) triangle (Figs 2 and 28). It is covered by postaural skin.
    • Boundaries of Macewen's triangle:
      • Linea temporalis (temporal line): A ridge of bone extending posteriorly from the zygomatic process (marking the lower margin of temporalis muscle and approximating the floor of middle cranial fossa)
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        Fig. 27: Prussak's space and anterior pouch of von Troeltsch
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        Fig. 28: Macewen's triangle. Surface landmark for mastoid antrum
      • EAC: Posterosuperior margin of EAC.
      • Tangent: A tangent to the posterior margin of EAC.
  • Medial wall: It is formed by the petrous bone and related to the:
    • ▸ Posterior SCC
    • ▸ Endolymphatic sac
    • ▸ Dura of posterior cranial fossa
  • Anterior: Anteriorly mastoid antrum communicates with the attic through the aditus ad antrum. Medial to lateral, the relations are following:
    • ▸ Facial nerve canal
    • ▸ Aditus ad antrum and facial recess lie between tympanum and mastoid antrum (see posterior wall of middle ear in the section of boundaries of middle ear)
    • ▸ Deep bony EAC
  • Posterior wall: It is formed by mastoid bone and communicates with mastoid air cells.
    • ▸ Sigmoid sinus curves downwards.
  • Floor: It is formed by mastoid bone and communicates with mastoid air cells. Other deeper relations from medial to lateral sides are:
    • ▸ Jugular bulb medial to facial canal
    • ▸ Digastric ridge gives origin to posterior belly of digastric muscle
    • ▸ Origin of SCM muscle.
 
Types of Mastoid (Fig. 29)
The mastoid consists of “honeycomb” air cells, which lie underneath the bony cortex. Depending on its development, three types of mastoid are described: cellular, diploic and acellular.
  • Cellular (well-pneumatized): Mastoid cells are well developed with thin intervening septa. Eighty percent people have pneumatized mastoids.
  • Diploic: Mainly there are marrow spaces with few air cells.
  • Acellular (sclerotic): There are neither cells nor marrow spaces.
 
Theories of Deficient Mastoid Pneumatization
  • Tumarkin: Failure of aeration of middle ear cleft that is the cause of “frustration of pneumatization”, results from the blockage of the Eustachian tube. It happens in patients with upper respiratory tract infections.
  • Diamond and Dahlberg: Different types of mastoids are the normal congenital variations.
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    Fig. 29: Three types of mastoid: Cellular, diploic and acellular
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  • Wittmack: Infantile otitis media interferes with normal absorption of diploic bone and leads to failure of pneumatization and dense mastoid bone. Evidence for this theory is lacking.
 
Mastoid Air Cells (Figs 30 to 32)
Mastoid antrum is present in all types of mastoids. It is the most constant mastoid air cell. In sclerotic mastoid, antrum is usually small and sigmoid sinus may be anteriorly positioned. In cases of mastoiditis, abscesses may form in these air cells and result in various types of intra- and extracranial complications For further details, see Chapter 20 “Complications of Suppurative Otitis Media”.
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Fig. 30: Air cells of temporal bone
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Fig. 31: X-ray mastoid left showing normal pneumatizationSource: Dr Jayesh Patel, Consultant Radiologist, Anand, Gujarat.
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Fig. 32: X-ray mastoid right showing partial loss of pneumatizationSource: Dr Jayesh Patel, Consultant Radiologist, Anand, Gujarat.
The mastoid air cells are traditionally divided into several groups, which include:
  • Zygomatic cells: In the root of zygoma.
  • Tegmen cells: In the tegmen tympani.
  • Perisinus cells: Present over the sinus plate.
  • Retrofacial cells: Present behind the fallopian canal of facial nerve.
  • Perilabyrinthine cells: They are located above, below and behind the labyrinth. The cells, which are present in the arch of superior SCC, may communicate with the petrous apex.
  • Peritubal: They are present around the Eustachian tube. These and the hypotympanic cells communicate with the petrous apex.
  • Tip cells: These large cells lie in the tip of mastoid, medial and lateral to the digastric ridge.
  • Marginal cells: These cells, which lie behind the sinus plate, may extend into the occipital bone.
  • Squamous cells: They lie in the squamous part of temporal bone.
 
Korner's Septum
Mastoid develops from the squamous and petrous parts of temporal bone. In some cases, petrosquamosal suture persists as a bony plate called Korner's septum, which separates superficial squamosal cells from the deep petrosal cells. During the mastoid surgery, Korner's septum causes difficulty in locating the antrum and the deeper cells.
 
Blood Supply
 
Arterial Supply
Following branches of external and internal carotid arteries supply blood to middle ear:
  • External carotid artery:
    • Maxillary artery:
      • Anterior tympanic artery: Major contributor
      • Middle meningeal artery
        • Petrosal branch
        • Superior tympanic artery: It traverses along the canal for tensor tympanic muscle.
      • Artery of pterygoid canal: Branch that runs along Eustachian tube.
    • Posterior auricular artery:
      • Stylomastoid artery: Major contributor
    • Ascending pharyngeal artery:
      • Tympanic branch
  • Internal carotid artery: Petrous part
    • Caroticotympanic branches.
 
Venous Drainage
Veins from the middle ear cleft drain into pterygoid venous plexus, superior petrosal sinus and sigmoid sinus.15
 
Lymphatic Drainage of Ear
The lymphatics of middle ear drain into retropharyngeal and parotid nodes. Eustachian tube lymphatics drain into retropharyngeal group of lymph nodes (Table 1). Internal ear does not have any lymphatics.
 
INTERNAL EAR
The internal ear (labyrinth), which has organs of both hearing and balance, is divided into bony and membranous labyrinth. The membranous labyrinth is filled with endolymph. Perilymph is filled in the space present between membranous and bony labyrinths.
 
Bony Labyrinth
Bony labyrinth (Fig. 33) consists of three parts: vestibule, semicircular canals (SCCs) and cochlea. The lateral wall of labyrinth is medial wall of middle ear. The medial wall of labyrinth is the lateral limit of IAC.
  • Vestibule: This central chamber of the labyrinth (5 mm) has following structures:
    • Lateral wall: It has oval window.
      • Oval window (Fenestra vestibuli): It lies in the lateral wall and is closed by footplate of stapes surrounded by annular ligament.
    • Medial wall (Fig. 34): It shows following structures:
      • Spherical recess: It is situated anteriorly and lodges the saccule. Perforations of maculae cribrosa media provide passage for fibers of inferior vestibular nerve.
      • Elliptical recess: It is situated posteriorly and lodges the utricle. The perforations of maculae cribrosa superior (Mike's dot) provide passage to nerve fibers that supply to utricle and ampulla of superior and lateral SCC.
      • Vestibular crest and cochlear recess: The spherical and elliptical recesses are separated from each other by vestibular crest. Inferiorly, vestibular crest splits to enclose cochlear recess for cochlear nerve fibers.
      • Opening of aqueduct of vestibule: It is present below the elliptical recess. Through this passes the endolymphatic duct.
    • Posterosuperior region:
      • Five openings of SCCs: They are present in the posterosuperior part of vestibule.
    • Anterior: Cochlea opens into the anterior region of vestibule.
  • Semicircular canals (Fig. 35): There are three SCCs: lateral (horizontal), posterior and superior (anterior). Each canal occupies two-thirds of a circle and has a diameter of 0.8 mm. They lie in planes at right angles to one another. Each canal has two ends: ampullated and nonampullated. All the three ampullated ends and nonampullated end of lateral SCC open independently and directly into the vestibule.
    • Superior SCC: It is 15–20 mm long and situated transverse to the axis of petrous part of temporal bone. Its anterolateral end is ampullated and opens in the superolateral part of vestibule.
    • Lateral SCC: It is 12–15 mm long and projects as a rounded bulge into the middle ear, aditus and antrum. It makes an angle of 30° with the horizontal plane. Its anterior end is ampullated and opens into the upper part of vestibule. The posterior nonampullated end opens into the lower part of vestibule below the orifice of crus commune.
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      Fig. 33: Bony labyrinth of left side. External features seen from lateral side
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      Fig. 34: Medial wall of left bony labyrinth seen from lateral side after the removal of its lateral wall
      TABLE 1   Lymphatic drainage of ear
      Lymph nodes
      Regions drained
      Preauricular and parotid nodes
      Auricle: Concha, tragus, fossa triangularis
      Cartilaginous external auditory canal
      Infra-auricular nodes
      Auricle: Lobule and antitragus
      Postauricular, deep cervical and spinal accessory nodes
      Auricle: Helix and antihelix
      Retropharyngeal nodes draining into upper deep cervical nodes
      Middle ear and Eustachian tube
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      Fig. 35: Cut section of semicircular canal
    • Posterior SCC: It is 18–22 mm long and situated parallel and close to the posterior surface of petrous part of temporal bone. Its lower end is ampullated and opens into the lower part of vestibule. Its upper limb joins the crus commune.
      • Crus commune: The nonampullated ends of posterior and superior canals join and form a crus commune (4 mm length), which then opens into the medial part of vestibule. So, the three SCCs open into the vestibule by five openings.
    • Cochlea (Figs 36 and 37): The bony cochlea, which is a coiled tube, looks like snail. Cochlear canal makes 2.5–2.75 turns round a central pyramid of bone called modiolus. The cochlear tube is 30 mm long. It is 5 mm from base to apex and 9 mm around its base.
      • Modiolus: The base of modiolus, which is directed towards internal acoustic meatus, transmits vessels and nerves to the cochlea. The apex lies medial to tensor tympani muscle.
      • Osseous spiral lamina: A thin plate of bone called osseous spiral lamina, winds spirally around the modiolus like the thread of a screw. This bony lamina gives attachment to the basilar membrane and divides the bony cochlear tube into three compartments: scala vestibuli, scala tympani and scala media (membranous cochlea).
      • Rosenthal's canal: The spiral ganglions are situated in Rosenthal's canal, which runs along the osseous spiral lamina.
      • Scala vestibuli: This upper-most channel is continuous with vestibule and closed at oval window by the stapes footplate.
      • Scala tympani: This lowermost channel is closed by secondary TM of RW.
      • Promontory: The promontory, a bony bulge in the medial wall of middle ear, represents the basal coil of cochlea.
      • Helicotrema: This opening is situated at the apex of