ENT miscellaneous 2

• 1) autosomal
• 2) mitochondrial

• 1) dominant
• 2) recessive
• 3) Co-dominant ( semi- dominant)
• 4) X -linked ( can be dominant or recessive)

• 1) M ( mitosis)
• 2) G2 ( prepare to divide)

S ( DNA synthesis)

P53

• 1) Alkalating agents (nytrogen mustard)
• 2) heavy metals (cisplatin)
• 3) antimetabolites (Metotrexate)
• 4) cytotoxic antibiotics (Doxorubicine)
• 5) spindle poisons (Vinca)
• 6) Topoisomerase inhibitors (Etopocide)

Bone marrow suppression

• 1) Combination
• 2) Adjuvant
• 3) Neoadjuvant
• 4) Concurrent
• 5) Chemoprevention (retinoids)

60mm

30mm

• Nasocilliary
• Frontal
• Lacrimal

• I: slightly small but normal looking ear
• II: partial or hemi-ear
• III: peanut ear
• IV: anotia

• -Minor malformation (normal mastoid, OW, inner ear, CN VII, footplate)
• -Major malformation

• -Minor aplasia ( incomplete canalization)
• -Moderate: failed canalization of tympanic bone
• - Severe: complete abscence of EAC

• A: cartilaginous
• B: total canal
• C: Middle ear invlovement
• D: Inner ear, mastoid involvement

• Better outcome if anatomical structures exist:
• stapes: 2
• OW open 1
• middle ear space 1
• FN 1
• Malleus-incus complex 1
• Mastoid pneumatization 1
• Incus- stapes connection 1
• RW 1
• External ear 1

the line which passes through the inferior border of cricoid cartilage

1cm

4 weeks and 60 days respectively

when it drains less than 25ml/day of serous fluid

• 4-20million volts
• skin is relatively spared during RT

• conventional ( 30x2 Gy over 42 days)
• hypofraction
• hyperfraction
• acceleration
• split course

EARLY : bleeding, airway obstruction, increased intrecranial pressure, carotid sinus syndrome, nerve injury

INTERMEDIATE: pneumothorax, basal pulmonary collapse, bronchopneumonia, DVT, chylous fistula, seroma, skull base syndrome, infection, failure of skin healing, carotid artery rupture, flap failure, fistula

LATE: recurrence, mets, thyroid/parathyroid failure, parotid gland hypertrophy, lymphedema, hypertrophic scars, HIV,

• local
• systemic

• Autoimmune disease acute nonsyphilitic interstitial keratitis
• sensorineural hearing loss
• Medium- and large-vessel arteritis
• severe vertigonausea/ vomiting

• Transmitted in an autosomal-dominant fashion
• and consists of a constellation of findings, including
• (1) dystopia canthorum
• (lateral displacement of the medial canthi),
• (2) broad nasal root,
• (3) confluence of the medial portions of the eyebrows, (4) partial or total heterochromia iridis,
• (5) a white forelock
• (6) SNHL

• AD?
• Craniofacial synostosis
• syndactily
• crowding

Fissula ante fenestram

• Warthin's tumor

false positive fistula test in congenital syphilis and 25% of Meniere's disease.

• Thrmobosis of PICA (from basilar artery)
• vertigo, diplopia, dysphagia, hoarseness, horner's syn, sensory loss of ipsilat face and contralateral side of body, ataxia.

+ auricular crease

• synostosis (fusion of cervical vertebrae), brevicollis (short/absent neck) and low posterior hairline with many other associated malformations

acute utriculosaccular dysfunction causing sudden fall with no loss of conciousness. in 2-6 % on Meniere's disease.

• Verrucous (oral cavity)
• Hybrid verrucous
• Pseudosarcoma
• Basaloid SCC

posterior cricoarytenoid : videns VCs

• Locally invasive NPC:
• - Ipsilateral headache
• - unilateral soft palate palsy
• - CHL

pain over mastoid due to phlebitis of emissary vein after lateral sinus thrombophlebitis

Gadolinium enhanced MRI

• allergic granulomatous angiitis
• (in Nose: crusting, polyps)
• P-ANCA + in 70%
• phase I: Allergic rhinitis + Asthma
• phase II: Eosinophillic infiltrative + e. pneumonia
• phase III: systemic vasculitisi and granulation

• Coloboma
• Heart
• Atresia of choanna
• Retarded growth
• Genitalia problem
• Ear deformity

• Comonest ca of major salivary glands and minor ones in oral cavity (34%)
• mainly in parotid
• mage 45
• grading is important

• commonest malignant Ca of minor glands
• m=f
• 60th
• facial pain/paresis
• nerve spread
• infiltrative growth and slowly progressive behavior with recurrences and spread over a protracted course of many years

• subtypes:
• -cribriform
• -tubular
• -solid

• Low grade
• Almost always in parotid
• F>M 30th
• FNAC not very conclusive (similar to normal gland)
• 30% recurrence post op
• Recurrence up to many years later

AHI + respiratory effort related arousal (RERA)

upper airway resistance syndrome : exessive daylight somnolence without OSA

• Type I: collapse in retropalatal
• Type II: collapse in Retropalatal and retrolingual
• Type III: collapse in retrolingual

• 19-25 normal
• 26-30 overweight
• 30-40 obese
• >40 very obese

• MOPP ( mustagen, oncovin, procarbazine, prednisolone)
• ABVD (adriamycin, bleomycin, vinblastin, dacarbazine)

CHOP: (cyclophosphamide, adriamycin [hydroxy doxorubicin], vincristine [Oncovin], Prednisolone)

• allergy
• infection by H-influ
• vasomotor changes
• Due to Bernoli's law ( negative pressure increases in narrow areas when air flows through them)
• Plysaccaride changes in ground substance

cessation of airflow for >10sec

• Reduced airflow >30%, >10sec + >4% reduced SPO2
• or
• Reduced airflow >50%, >10sec + >3% reduced SPO2
• or
• ECG arousal

• Obstructive: throacoabd effort with reduced airflow
• Central: No throacoabd effort with reduced airflow
• Mixed: Ineffective and weak throacoabd effort

• carotid
• jugulotympanic
• vagal

• MEN IIA
• MEN IIB
• Neurofibromatosis type I
• Chromosome 2
• Living in high altitude ( carotid body tumor)

6%

• T1
• Tumor limited to the external auditory canal without bony erosion or evidence of soft tissue extension

• T2
• Tumor with limited external auditory canal bony erosion (not full-thickness) or radiographic finding consistent with limited (less than 0.5 cm) soft tissue involvement

• T3
• Tumor eroding the osseous external auditory canal (full-thickness) with limited (less than 0.5 cm) soft tissue involvement, or tumor involving middle ear or mastoid, or patients presenting with facial paralysis

• T4
• Tumor eroding the cochlea, petrous apex, medial wall of middle ear, carotid
• canal, jugular
• foramen or dura, or with extensive (greater than 0.5 cm) soft tissue involvement

Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)

Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement

Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the petrous apex

Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canalType

C2 tumor - Tumor invading the vertical portion of the carotid canal

Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal

Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter

Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter

Grade I refers to a small tumor involving the jugular bulb, middle ear, and mastoid;

Grade II is a tumor extending under the internal auditory canal;

Grade III is one extending into the petrous apex;

Grade IV is one extending beyond the petrous apex and into the clivus or infratemporal fossa.

Grades II, III, or IV may exhibit intracranial extension.

• A: small tumor on promontory
• B: Filling middle ear
• C:
• C1: from midle ear to mastoid
• C2: from middle ear to EAC
• C3: from middle ear to IAC

• homogenous
• nodular
• ulcerative

• edge of tobgue
• alveola

• marginal
• -horizontal
• -vertical
• pertial
• subtota
• total

• I: subepithelial
• II: subligamental
• III: Transmuscular
• IV: Total
• V: Extended
• -a: Contralat VC or ant commisure
• -b: arythenoid
• -c: subglottic
• -d: ventricle

• Cough
• dysphonia
• globus
• clearing throat

Hypopharynx Ca

• general (avoid cofeine, mint, late supper, oily food, keep head up while sleeping)
• medical (metoclopramide, H2 blockers, PPIs)
• surgical ( pull down LES into abd and fix)

• VCs don't open or close properly while breathing
• Wheezing, SOB ( not responding to bronchodilators)

LPR, cerebral/pontine problems

• profound SNHL
• Acute vertigo

• Serous: Toxic, viral
• Suppurative: bacterial
• Peri L: labyrinth fistula after mastoid surgery
• Para L: Vertigo/nystagmus in the prescence of CSOM

pain over the mastoid due to phlebitis of emissary veins after lateral sinus thrombophlebitis

• AICA
• Labyrinthine
• Superficial petrosal
• Stylomastoid

• Intracranial: 25mm
• Meatal: 8-10mm
• Labyrithine: 4mm
• Tympanic: 11mm
• Mastoid: 13mm
• Extracranial

idiopathic triad of:

• Facial nerve palsy
• Swelling of lips
• Fissured tongue

• Symptoms:
• dysphagia
• sore throat
• FB sensation in throat
• Referred otalgia
• for more than 2-4 months, in a heavy smoker/drinker
• Signs:
• Neck mass
• LOW
• hemoptysis
• hoarseness

• 20%
• 50%
• 65%

• 50% SCC
• 25% Adeno Ca
• 25% Undiff

• Overall: 90% from H&N
• 1,2,3: oral cavity, oropharynx
• 2,3,4: larynx
• 5: NPC
• supraclavicular: esophagus, lung, abdominal, pelvic

• I: small, localized, minimally attached to carotid
• II: partially surrounding vessel
• III: Complete encasing carotid

• Rising sun (TM)
• Brown's: siegelization: blanching
• Aquino's: Gentle pressure on ICA: blanching
• Audible bruit over mastoid

• Thyrosine (norepinephrine)
• Serotonin
• Vasomotor intestinal peptide

• Mucosa
• Meissner (sense)
• Submucosa
• Circumferential m.
• Auerbach (peristaltism)
• Longitudinal m.
• Adventitia

• Killian dehiscence
• Posteromedial, between Thyropharyngeus and cricopharyngeus m. ( two parts of Inferior Constrictor m.)
• Diverticulum of Zenker due to contacture of Cricopharyngeus and neuologic disturbance of pharynx in old men.

• Leimer's, dehiscence, between upper pole of vertical esophageal muscles

• UES:15cm from incisiors
• LMB: 24cm ( left main bronchus)
• LES: 40cm

Postauricular ecchymosis due to traumatic temporal bone fracture

• .From hyoid bone to suprasternal notch
• . pretracheal, paratracheal, precricoid, perithyroid

• Visceral mets
• Level IV

Yellow spots on buccal mucosa which are cebaceous glands.