RAPID REVISION NOTES FOR ENT MBBS (Hardcopy)

Description

I. EAR

1. Anatomy & Physiology

• Divisions: External ear, middle ear, inner ear.
• Hearing Pathway: Sound transmission from tympanic membrane → ossicles → cochlea → auditory nerve → brain.
• Balance System: Vestibular apparatus, semicircular canals, otolith organs.

2. Common Ear Diseases

• Otitis Externa → Pain, swelling, ear discharge.
• Acute Otitis Media (AOM) → Middle ear infection, fever, bulging TM.
• Chronic Suppurative Otitis Media (CSOM)
  • Tubotympanic (Safe CSOM) → Central perforation, no complications.
  • Atticoantral (Unsafe CSOM) → Marginal perforation, cholesteatoma, risk of complications.
• Complications of CSOM → Mastoiditis, facial nerve palsy, labyrinthitis, brain abscess, lateral sinus thrombosis.
• Otosclerosis → Conductive hearing loss, Carhart’s notch, treated with stapedotomy.
• Meniere’s Disease → Triad: Vertigo, tinnitus, fluctuating SNHL.
• Acoustic Neuroma → Vestibular Schwannoma, progressive SNHL, diagnosed by MRI.
• Facial Nerve Palsy → Otogenic (due to CSOM, trauma), Bell’s palsy (idiopathic).

3. Hearing Tests & Management

• Tuning Fork Tests → Rinne’s, Weber’s, ABC.
• Pure Tone Audiometry (PTA) → Assesses hearing loss.
• Impedance Audiometry → Tympanometry for middle ear assessment.
• Management → Hearing aids, cochlear implants, tympanoplasty, mastoidectomy.

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II. NOSE & PARANASAL SINUSES

1. Anatomy & Functions

• Nasal septum → Divided by vomer and ethmoid.
• Turbinates → Superior, middle, inferior; function in air filtration and humidification.
• Paranasal Sinuses → Maxillary, Frontal, Ethmoid, Sphenoid.

2. Common Nasal Conditions

• Rhinitis → Acute (viral, bacterial), Allergic (IgE-mediated, seasonal, perennial).
• Sinusitis → Acute (<4 weeks) vs. Chronic (>12 weeks), presents with nasal blockage, headache, facial pain.
• Nasal Polyps → Associated with allergic rhinitis, Samter’s triad (Asthma, Aspirin sensitivity, Polyps).
• Epistaxis → Most common from Little’s area (Kiesselbach’s plexus).
• Deviated Nasal Septum (DNS) → May cause nasal obstruction, headache, recurrent sinusitis.
• Nasopharyngeal Angiofibroma → Adolescent males, recurrent epistaxis, vascular tumor.

3. Investigations & Management

• Nasal Endoscopy → For chronic sinusitis, nasal polyps.
• CT PNS → Best for sinus pathology.
• Management → Medical (nasal sprays, antihistamines), FESS (Functional Endoscopic Sinus Surgery), septoplasty, turbinate reduction.

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III. PHARYNX & LARYNX

1. Diseases of the Pharynx

• Tonsillitis → Acute (Group A Streptococcus), chronic (indication for tonsillectomy).
• Peritonsillar Abscess (Quinsy) → Unilateral swelling, trismus, requires drainage.
• Obstructive Sleep Apnea (OSA) → Snoring, daytime sleepiness, managed with CPAP or UPPP surgery.
• Pharyngeal Tumors → Squamous cell carcinoma, risk factors include smoking, alcohol.

2. Diseases of the Larynx

• Acute Laryngitis → Viral inflammation of vocal cords, hoarseness.
• Laryngotracheal Trauma → Hoarseness, airway compromise.
• Recurrent Laryngeal Nerve Palsy →
  • Unilateral → Hoarseness.
  • Bilateral → Stridor, requires tracheostomy.
• Laryngeal Cancer → Most common is squamous cell carcinoma, presents with progressive hoarseness.

3. Laryngeal & Pharyngeal Surgeries

• Tonsillectomy → Indications: ≥7 episodes/year, Quinsy, OSA.
• Tracheostomy → Emergency airway management.
• Microlaryngeal Surgery (MLS) → For vocal cord nodules, polyps.

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IV. HEAD & NECK

1. Neck Masses

• Midline → Thyroglossal Cyst (Moves with swallowing & tongue protrusion).
• Lateral → Branchial Cyst, Tuberculous Lymphadenitis, Metastatic Nodes.
• Goiter & Thyroid Disorders → Hypothyroidism, Hyperthyroidism, Thyroid Cancer.

2. Salivary Gland Diseases

• Sialadenitis → Infection, commonly affects the submandibular gland.
• Sialolithiasis → Salivary duct stones, submandibular gland most affected.
• Parotid Tumors →
  • Pleomorphic Adenoma (Most common benign).
  • Mucoepidermoid Carcinoma (Most common malignant).

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V. CLINICAL METHODS & INVESTIGATIONS

1. ENT Examination

• Otoscopic Examination → Assess TM, perforations, cholesteatoma.
• Nasal Endoscopy → For sinusitis, nasal polyps, tumors.
• Indirect Laryngoscopy → For vocal cord lesions, laryngeal cancer.

2. Imaging in ENT

• HRCT Temporal Bone → For CSOM, cholesteatoma, facial nerve pathology.
• MRI Brain & IAC (Internal Auditory Canal) → For vestibular schwannoma, SNHL.
• CT PNS (Paranasal Sinuses) → For sinusitis, nasal polyps, tumors.

3. Audiological Investigations

• Pure Tone Audiometry (PTA) → Degree and type of hearing loss.
• Impedance Audiometry (Tympanometry, Acoustic Reflexes) → Middle ear function.
• Brainstem Evoked Response Audiometry (BERA) → For retrocochlear pathology (e.g., Acoustic Neuroma).