1
Q
What is the most common congenital anomaly of the middle ear?
A
Fixation of stapes footplate
2
Q
What is preauricular sinus and its most common site?
A
Fusion defect of auricular tubercle; M/c site: Root of helix
3
Q
What is the embryological origin of the tragus and anterior helix?
A
1st pharyngeal arch (via Hillocks of His)
4
Q
Which structure is derived from the 1st pharyngeal cleft?
A
External Auditory Canal (EAC)
5
Q
What is the origin of the middle ear cavity, mastoid antrum, and eustachian tube?
A
1st pharyngeal pouch / Tubotympanic recess
6
Q
From which pharyngeal arches are the malleus/incus vs stapes suprastructure derived?
A
Malleus & Incus: 1st pharyngeal arch; Stapes suprastructure: 2nd pharyngeal arch
7
Q
The stapes footplate is derived from which structure?
A
Otic capsule (bony labyrinth)
8
Q
Name the three layers of the tympanic membrane and their germ layer origins
A
Outer (epithelial) - Ectoderm; Middle (fibrous) - Mesoderm; Inner (mucosal) - Endoderm
9
Q
What is microtia and what graft is used for pinna reconstruction?
A
Malformed/underdeveloped pinna; Graft: Autologous costal (rib) cartilage at age >6 years
10
Q
What is Korner’s septum and its clinical significance?
A
Persistent petrosquamosal suture; Can cause incomplete clearance of disease during mastoid surgery
11
Q
What is Scheibe aplasia?
A
Cochleosaccular dysplasia; M/c congenital abnormality of inner ear
12
Q
What characterizes Mondini aplasia?
A
Cochlea has only 1.5 turns (instead of normal 2.5 turns)
13
Q
What is Alexander aplasia and its audiological finding?
A
Defect in basal turn of cochlea; High frequency hearing loss
14
Q
What is Michel aplasia and why is it important?
A
Complete absence of bony and membranous labyrinth; Absolute C/I for cochlear implant
15
Q
What is the cymba conchae used as a landmark for?
A
Cartilaginous landmark for mastoid antrum
16
Q
What is incisura terminalis and its surgical significance?
A
Devoid of cartilage; Site of incision in endaural approach (Lempert’s incision)
17
Q
What is the total length of the EAC and its parts?
A
24 mm total; Outer 1/3rd (8mm) cartilaginous, Inner 2/3rd (16mm) bony
18
Q
What causes cauliflower ear and how is it managed?
A
Organized hematoma after trauma; Mx: Aspiration/drainage + contour dressing; Plastic surgery for established cases
19
Q
What is the M/c organism causing perichondritis and its treatment?
A
Pseudomonas; Treatment: Ciprofloxacin; Note: Spares lobule
20
Q
What is keratosis obturans and its associations?
A
Keratin collection with laminar onion skin arrangement; Associated with chronic sinusitis and bronchiectasis
21
Q
What causes diffuse otitis externa (swimmer’s ear)?
A
Pseudomonas; Treatment: Ciprofloxacin
22
Q
What is malignant otitis externa and who does it affect?
A
Skull base osteomyelitis d/t Pseudomonas; Seen in immunocompromised (diabetics); M/c complication: 7th nerve palsy
23
Q
What is the M/c cause of otomycosis and its appearance?
A
Aspergillus niger; Wet newspaper
24
Q
What is Ramsay Hunt syndrome?
A
Herpes zoster reactivation in geniculate ganglion causing facial nerve palsy with vesicles in EAC; Poor prognosis
25
What are the characteristics of the tympanic membrane?
Color: Pearly grey & translucent; Angle: 55° with horizontal; Effective vibratory area: 55 mm²
26
What is the most mobile part of the TM?
Pars flaccida (Shrapnell's membrane)
27
In which quadrant is the cone of light seen?
Antero-inferior quadrant
28
What causes tympanosclerosis?
Chronic inflammation of middle ear (CSOM, SOM) leading to calcification and hyalinization
29
Which segment of the facial nerve is M/c dehiscent?
Tympanic/Horizontal segment
30
What is the processus cochleariformis a landmark for?
1st genu of facial nerve; Tensor tympani takes lateral turn here
31
Which semicircular canal is M/c eroded by cholesteatoma?
Lateral semicircular canal
32
What structure is the M/c site for residual/recurrent cholesteatoma?
Sinus tympani (infra-pyramidal recess)
33
What are the boundaries of Prussak's space?
Laterally: Pars flaccida; Medially: Neck of malleus; Inferiorly: Lateral process of malleus; Significance: M/c site for retraction pocket and primary cholesteatoma
34
Which ossicle is largest and which is smallest?
Largest: Malleus; Smallest: Stapes
35
What is the M/c site of ossicular necrosis in otitis media?
Long/lenticular process of incus
36
What are the parts and length of the Eustachian tube in adults?
Bony (lateral 1/3rd: 12mm), Cartilage (medial 2/3rd: 24mm); Total: 36mm at 45° angle
37
Why are children more prone to middle ear infections?
ET is shorter (13-18mm), wider, more horizontal, and flaccid
38
What causes autophony with patulous ET?
Loss of Ostmann pad of fat
39
What are the sensory organs in the vestibular system?
Cristae in SCCs (rotational acceleration); Maculae in utricle/saccule (linear/gravitational acceleration & head tilt)
40
What frequency is detected at the basal vs apical cochlea?
Basal turn: High frequency; Apical turn: Low frequency (Traveling wave theory)
41
How do endolymph and perilymph differ in composition?
Endolymph: High K+ (similar to ICF), secreted by stria vascularis; Perilymph: High Na+ (similar to ECF), from CSF
42
What are the differences between inner and outer hair cells?
Inner: Single row, flask shape, less prone to damage, 90-95% afferent; Outer: 3-4 rows, cylindrical, more prone to damage, 80% efferent
43
What is the mnemonic for auditory pathway?
SLIM: Spiral ganglion → Lateral lemniscus → Inferior colliculus → Medial geniculate body → Auditory cortex (Area 41)
44
Where does crossover occur in the auditory pathway?
Through trapezoid body; 1st area of sound localization: Superior olivary complex
45
From which nerve does acoustic neuroma commonly arise?
Inferior vestibular nerve at Internal Acoustic Meatus
46
What are the boundaries of MacEwen's triangle?
Superior: Temporal line (MCF); Anterior: Posterosuperior border of bony EAC (facial nerve); Inferior: Tangent between other 2 lines (sigmoid sinus)
47
What is Donaldson's line used for?
Line through lateral SCC bisecting posterior SCC; Superior to it: Approach to posterior cranial fossa; Inferior to it: Approach to endolymphatic sac
48
What causes referred otalgia from Jacobson's nerve?
Pain from oropharynx, soft palate, tonsillar fossa, base of tongue (acute tonsillitis, peritonsillar abscess, Ca base of tongue/tonsils)
49
What is Arnold's nerve and its clinical significance?
Auricular branch of vagus (X); Supplies concha, floor & posterior wall of EAC; **Causes cough while cleaning ear**
50
What is the M/c organism and route of infection in ASOM?
Organism: Pneumococcus; Route: Eustachian tube
51
What is the cartwheel appearance of TM?
Seen in hyperemia/pre-suppuration stage of ASOM
52
What is the lighthouse sign in ASOM?
Pulsatile otorrhea in suppuration stage; Stage with maximum pain
53
In which quadrant is myringotomy performed?
Posteroinferior quadrant (J-shaped curvilinear incision); C/I in posterosuperior quadrant due to risk of 7th CN injury
54
What causes bullous myringitis?
Pneumococcus, Influenza virus, Mycoplasma pneumoniae; Serosanguinous discharge on rupture
55
What are the two types of CSOM?
Mucosal (Tubotympanic/Safe): Central perforation; Squamous (Atticoantral/Unsafe): Marginal perforation with cholesteatoma
56
What is the characteristic discharge in mucosal vs squamous CSOM?
Mucosal: Profuse, mucoid/mucopurulent, painless, non-foul smelling; Squamous: Scanty, purulent, foul-smelling, blood-tinged
57
What is the M/c graft used in myringoplasty?
Temporalis fascia
58
What are the types of Wullstein tympanoplasty?
Type I: Myringoplasty (malleus); Type II: Myringoincudopexy (incus); Type III: Myringostapedopexy (stapes)
59
What is Austin's classification based on?
Presence of malleus handle (M) and stapes suprastructure (S): Type A (M+,S+), B (M+,S-), C (M-,S+), D (M-,S-)
60
What is Wittmaack's invagination theory?
Primary acquired cholesteatoma forms through retraction pocket; M/c site: Pars flaccida/Prussak's space
61
What is Habermann's theory of cholesteatoma?
Secondary acquired cholesteatoma through marginal perforation; M/c cause: Acute necrotizing otitis media (β-hemolytic streptococci)
62
What are the differences between ICW and CWD mastoid surgery?
ICW: Opening through facial recess, limited visualization, chorda preserved, faster healing, higher recurrence; CWD: Complete wall removed, better visualization, chorda sacrificed, slower healing
63
What is the difference between radical and modified radical mastoidectomy?
Radical: Only stapes footplate preserved, ET closed, no tympanoplasty; Modified radical: Healthy mucosa/TM/ossicles preserved, tympanoplasty done
64
What are the signs of mastoiditis?
Fever, ear discharge, post-auricular edema/tenderness; O/E: Ironed out mastoid, reservoir sign, sagging of posterosuperior meatal wall
65
Name the abscesses following mastoiditis
Postauricular (M/c), Bezold abscess (SCM), Citelli abscess (posterior digastric/occipital), Luc's abscess (posterior EAC wall)
66
What is Gradenigo's triad in petrositis?
Retro-orbital pain (5th CN) + Diplopia (6th CN) + Ear discharge
67
What is the M/c brain abscess following otitis media?
Temporal lobe abscess; Features: Nominal aphasia, homonymous superior quadrantanopia, seizures, C/L hemiparesis
68
What are the signs of sigmoid sinus thrombosis?
Picket fence/hectic fever; Griesinger's sign (mastoid tenderness/edema); Tobey-Ayer test +; Crowe-Beck sign +; CT: Delta/empty triangle sign
69
What is the M/c intracranial complication of otitis media?
Meningitis
70
What are the features of tubercular otitis media?
Painless foul-smelling discharge, hearing loss out of proportion to symptoms, multiple TM perforations, pale granulation tissue
71
What frequencies are used in tuning fork tests?
512 Hz (preferred) > 256 Hz, 1024 Hz; Speech frequencies: 500, 1000, 2000 Hz
72
What is the mnemonic SOCS for Weber's test?
SNHL → Opposite side (better ear); CHL → Same side (diseased ear)
73
What is the minimum CHL for negative Rinne's test?
15-20 dB minimum; Maximum CHL detectable: 60 dB
74
What is Rinne's false negative?
BC > AC in severe SNHL (>70 dB loss)
75
Explain Rinne's test at different frequencies
256Hz-, 512Hz+, 1024Hz+ = 20-30 dB CHL; All negative = 45-60 dB CHL
76
What does Gelle's test assess?
Change in hearing with EAC pressure; Positive: Normal/SNHL; Negative (no change): Otosclerosis
77
What does Schwabach test assess?
Both conductive & sensorineural pathway; Shortened: SNHL; Lengthened: CHL
78
What are the audiogram symbols for right and left ears?
Right: Red color, O (AC unmasked), < (BC unmasked); Left: Blue color, X (AC unmasked), > (BC unmasked)
79
What is normal hearing threshold on PTA?
Up to 25 dB
80
What is Carhart's notch?
Dip in BC curve at 2000 Hz; Seen in Otosclerosis
81
What is acoustic dip?
Dip in AC & BC at 4000 Hz; Earliest feature of noise-induced hearing loss
82
What audiogram pattern is seen in Meniere's disease?
Upsloping audiogram (low frequency SNHL)
83
What causes downsloping audiogram?
NIHL, Ototoxicity, Presbycusis (high frequency HL first)
84
What is cookie bite audiogram?
U-shaped/mid-frequency hearing loss; Seen in congenital SNHL
85
What is WHO classification of hearing loss?
Slight: 26-40 dB; Moderate: 41-60 dB; Severe: 61-80 dB; Profound: ≥81 dB
86
What is the degree of hearing loss in different conditions?
TM perforation: 10-40 dB; Ossicular discontinuity with intact TM: 55 dB; Complete stapes footplate fixation: 60 dB
87
What are the components of impedance audiometry?
Tympanometry and Stapedial reflex; Uses 226/220 Hz; Objective test
88
What are the types of tympanogram curves?
Type A: Normal; As (sclerosis): ↓compliance (otosclerosis); Ad: ↑compliance (ossicular discontinuity); B: ↓pressure, ↓compliance (SOM); C: ↓pressure (early ET obstruction)
89
What is the pathway of stapedial reflex?
Afferent: Ipsilateral 8th nerve → Centre: Superior olivary complex → Efferent: Bilateral 7th nerve
90
What does decreased stapedial reflex threshold (<70 dB) indicate?
Sensory/Cochlear hearing loss with recruitment (abnormal perception of loud sounds)
91
What does BERA assess and its waveforms?
Auditory brainstem response (objective test); Wave I: Distal VIII nerve; Wave III: Cochlear nuclei; Wave V: Lateral lemniscus (largest/most consistent)
92
What are the uses of BERA in adults?
Best test for: Retrocochlear hearing loss (acoustic neuroma), Differentiating cochlear vs retrocochlear HL, Detecting malingering
93
What are the uses of BERA in neonates?
Best test to confirm HL in neonates/infants, Screen HL in ICU neonates, Determine hearing threshold
94
What does OAE assess?
Function of outer hair cells; OAE present: OHC, cochlea, middle ear normal; OAE absent (>30 dB HL): Refer for tympanometry & BERA
95
What is the screening test for neonatal hearing?
Transient evoked OAE (within 48 hrs, max 1 month); Distortion product OAE: Detects NIHL & ototoxicity
96
What is the 1-3-6 rule for neonatal hearing screening?
By 1 month: Screening; By 3 months: Referral tests; By 6 months: Rehabilitation with hearing aids
97
What is electrocochleography best test for?
Meniere's disease; SP/AP >45% indicates cochlear lesion
98
What is recruitment?
Feature of cochlear pathology; Abnormal increase in perception of loud sounds; SISI score 70-100% positive
99
What is the M/c cause of SOM in children vs adults?
Children: Adenoid hypertrophy; Adults: Nasopharyngeal carcinoma
100
What are the features of SOM in children?
B/L fluctuating painless HL, speech delay, snoring, adenoid facies (high arched palate, open mouth)
101
What is the confirmatory test for SOM?
Tympanometry showing Type B curve; 1st investigation in children
102
What is the surgical management of SOM?
Myringotomy + grommet/ventilation tube + adenoidectomy; Grommet placed in anteroinferior quadrant
103
What is Sade classification for TM retractions?
Stage 1: Retracted, not touching incus; Stage 2: Touches incus/IS joint; Stage 3: Atelectasis (touches promontory); Stage 4: Adhesive OM (adherent to promontory)
104
How to differentiate Sade Stage 3 and 4?
Siegelization/pneumatic otoscopy; Stage 3 mobile, Stage 4 adherent
105
What is otosclerosis and its site of origin?
Bone remodelling disease (AKA otospongiosis); Site: Fissula ante fenestram (enchondral layer of otic capsule) causing stapes footplate fixation
106
What are the clinical features of otosclerosis?
B/L progressive CHL, 20-30 yrs, F>>M, Paracusis willisii (hears better in noisy surroundings), aggravated by measles/pregnancy
107
What is Schwartz sign?
Flamingo pink TM in active otosclerosis due to increased vascularization
108
What is cochlear otosclerosis and its imaging finding?
Overgrowth towards inner ear causing mixed HL; HRCT: Halo/double ring sign (ring of lucency around cochlea)
109
What are the audiological findings in otosclerosis?
Rinne: B/L negative; Gelle: Negative; PTA: AB gap + Carhart's notch (2000 Hz); Tympanometry: As curve; Stapedial reflex: Absent
110
What is the treatment of otosclerosis?
Active (Schwartz sign+): Sodium fluoride; Mature: Stapedotomy + teflon piston (worse ear first); C/I: Only hearing ear
111
What is Van der Hoeve disease?
Osteogenesis imperfecta + Blue sclera + Otosclerosis
112
What is the safe noise exposure limit?
85 dB for 8 hours/day
113
What is the earliest finding in NIHL?
OHC damage; Early diagnosis: Distortion product OAE; PTA: Acoustic dip at 4000 Hz
114
What protection is better: ear muffs or plugs?
Ear muffs (40 dB protection) > Ear plugs (30 dB)
115
Which aminoglycosides are cochleotoxic vs vestibulotoxic?
Cochleotoxic: Neomycin > Kanamycin > Amikacin;
Vestibulotoxic: Streptomycin, Gentamicin
116
What is the mnemonic for ototoxic drugs?
A3 VCD: Aminoglycosides, Antimalarials, Analgesics, Vancomycin, Cytotoxic (Cisplatin), Diuretics
117
What is presbycusis?
Age-related HL (>50 years); Slowly progressive, B/L symmetrical; M/c: Neural type; PTA: Downsloping curve
118
What defines idiopathic sudden SNHL?
>30 dB SNHL, 3 continuous frequencies, over 3 days; Otologic emergency
119
What is the treatment of sudden SNHL?
Steroids (oral/transtympanic), Carbogen (5% CO2 + 95% O2), Hyperbaric O2; Non-recovering: CROS hearing aid/BAHA
120
Which canal is M/c involved in BPPV?
Posterior SCC > Horizontal > Anterior
121
What test diagnoses posterior canal BPPV?
Dix-Hallpike maneuver; Positive: Vertigo + vertical nystagmus with torsion towards ipsilateral side
122
What are the treatment maneuvers for posterior BPPV?
Epley's maneuver, Semont maneuver, Brandt-Daroff exercises
123
What test is for horizontal canal BPPV?
Supine roll test; Treatment: Gufoni maneuver, Barbecue roll
124
How to differentiate peripheral vs central nystagmus?
Peripheral: Latency+, limited duration, fatigable, fixed direction, disappears with fixation; Central: No latency, not limited, not fatigable, changing direction, persists with fixation
125
What are features of vestibular neuritis?
Sudden onset continuous vertigo (5-7 days) with spontaneous nystagmus; No hearing loss; Mx: Labyrinthine sedatives + vestibular rehab
126
What is the mnemonic for caloric test?
COWS: Cold → Opposite (hypoactive labyrinth); Warm → Same (hyperactive labyrinth)
127
What is the position for caloric test?
Supine with 30° head elevation; Tests lateral SCC
128
What is the triad of Meniere's disease?
Episodic vertigo (20 min-24 hrs) + Fluctuating low frequency SNHL + Tinnitus/aural fullness
129
What are the special features of Meniere's disease?
Tullio's phenomenon, Hennebert sign, Diplacusis, Recruitment, Tumarkin crisis (drop attacks)
130
What is the best test for Meniere's disease?
Electrocochleography: SP/AP >0.45; Also: Glycerol test (vertigo improves); SISI 70-100%
131
What is Lermoyez syndrome?
Reverse Meniere's: Hearing loss → Vertigo → Normal hearing
132
What is the stepwise management of Meniere's?
Medical: Salt/caffeine restriction, labyrinthine sedatives, diuretics, betahistine → Intractable: Transtympanic steroids/gentamicin, endolymphatic sac decompression, vestibular neurectomy → Hearing lost: Total labyrinthectomy
133
What are causes of perilymphatic fistula?
Cholesteatoma, barotrauma, surgeries (stapedotomy); C/f: Vertigo on straining, Tullio's phenomenon; Fistula test: Positive
134
What is SCCD (third window syndrome)?
Superior semicircular canal dehiscence; C/f: Vertigo + CHL + Enhanced BC sounds (autophony, pulsatile tinnitus); IOC: HRCT
135
What does VEMP test?
Cervical VEMP: Saccule via inferior vestibular nerve; Ocular VEMP: Superior vestibular nerve via VOR
136
What conditions have hyperactive VEMP?
Fistula, hypermobile footplate (congenital syphilis), SCCD, Meniere's disease
137
What is the M/c benign tumor of EAC?
Exostosis (surfer's ear): Multiple, sessile, B/L, deep EAC; Due to cold water entry
138
What is the difference between exostosis and osteoma?
Exostosis: Multiple, sessile, deep bony EAC; Osteoma: Single, lateral bony EAC
139
What is glomus tumor and its types?
M/c benign tumor of middle ear (paraganglioma); Glomus tympanicum (M/c): From tympanic plexus; Glomus jugulare: From jugular bulb
140
What are the signs of glomus tumor?
Pulsatile tinnitus + CHL; Aquino sign: Tinnitus disappears on carotid compression; Brown's sign: Pulsation on Siegelization; Rising sun/setting sun sign on otoscopy
141
What is the Fisch classification based on?
CECT based staging for glomus tumors: Type A (middle ear), B (mastoid), C1-3 (carotid canal), D1-2 (intracranial)
142
What is the management of glomus tumors?
Pre-op: Urinary VMA; <3 cm: Stereotactic radiosurgery/gamma knife; >3 cm: Surgical excision with pre-op embolization
143
What are features of acoustic neuroma?
M/c benign CP angle tumor; Origin: Vestibular nerve at IAM; Slow growing, no capsule
144
What is the earliest symptom of acoustic neuroma?
Tinnitus + U/L SNHL (cochlear nerve involvement); Vertigo usually absent (slow growing)
145
What is Hitselberger's sign?
Hypoesthesia in posterosuperior EAC due to facial nerve compression by acoustic neuroma
146
What are the audiometric findings in acoustic neuroma?
PTA: U/L or asymmetric SNHL; Speech audiometry: Poor discrimination, roll-over phenomenon; BERA: Best audiometric test (↑ I-V interval)
147
What is the best investigation for acoustic neuroma?
Gadolinium-enhanced MRI
148
What is ice cream cone appearance in acoustic neuroma?
Loosely placed tumor with cystic spaces; Bad prognosis; Requires excision
149
What are the segments of facial nerve in temporal bone?
Meatal (IAM) → Labyrinthine (shortest, narrowest) → Tympanic/Horizontal (M/c dehiscent) → Mastoid/Vertical (M/c injured in surgery)
150
What is the nerve supply to stapedius and its test?
Nerve to stapedius; Injury: Hyperacusis; Test: Stapedial reflex
151
What does chorda tympani supply?
Taste to anterior 2/3rd tongue + Salivation (sublingual, submandibular); Test: Electrogustometry
152
What is the M/c cause of Bell's palsy?
Idiopathic (HSV-1 in 60%); M/c site: Labyrinthine segment; Treatment: High-dose steroids + Acyclovir (if within 3 days)
153
What are differences between longitudinal vs transverse temporal bone fractures?
Longitudinal: Parallel, more common, lateral blow, TM perforation+, CHL, CSF otorrhea+; Transverse: Perpendicular, less common, occipital blow, no TM perf, SNHL, CSF rhinorrhea+, more facial palsy
154
What are complications of aberrant facial nerve regeneration?
Synkinesis (contraction of separate muscle groups), Crocodile tears (tearing during salivation), Frey syndrome (gustatory sweating)
155
What is BAHA and its indications?
Bone Anchored Hearing Aid; Age >5 yrs; Indications: Cannot use normal hearing aids (atresia, discharging ears, post-MRM), U/L deaf ear
156
What are the components of cochlear implant?
External: Microphone, speech processor, transmitter coil; Internal: Receiver stimulator, electrodes (placed in scala tympani via round window)
157
What are C/I for cochlear implant?
Michel aplasia, cochlear nerve lesions, central auditory lesions
158
What epithelium lines the nasal vestibule?
Stratified squamous keratinized epithelium
159
What epithelium lines the nasal cavity and sinuses?
Ciliated columnar pseudostratified epithelium (respiratory epithelium)
160
What epithelium lines the upper 1/3rd of nasal cavity?
Olfactory epithelium; Receives only 10-15% of inhaled air, increased by sniffing
161
Why is upper 1/3rd of nose called 'dangerous area'?
Contains olfactory epithelium; Direct connection to brain via cribriform plate
162
Which turbinate is the largest and an independent bone?
Inferior turbinate; Articulates with ethmoid (superiorly) and maxilla (laterally)
163
Which turbinate is part of ethmoid bone?
Middle turbinate
164
What is the M/c site of concha bullosa vs hypertrophic turbinate?
Concha bullosa: Middle turbinate
Hypertrophic turbinate: Inferior turbinate
165
What is concha bullosa?
Pneumatized turbinate;
M/c site: Middle turbinate; Resembles polyp on endoscopy
166
What drains into inferior meatus?
Nasolacrimal duct; Site: Junction of anterior 1/3rd & posterior 2/3rd of IT
167
What is the valve of nasolacrimal duct?
Valve of Hasner
168
What drains into middle meatus?
Anterior group of sinuses: Frontal, Anterior ethmoid, Maxillary (via osteomeatal complex)
169
What drains into superior meatus?
Posterior ethmoid sinus
170
What drains into sphenoethmoidal recess (SER)?
Sphenoid sinus
171
What is the first step of FESS/Infundibulotomy?
Uncinectomy
172
Which is the largest paranasal sinus?
Maxillary sinus (Antrum of Highmore); Capacity: 15 ml
173
Which sinus is earliest to develop and present at birth?
Maxillary sinus
174
Which sinus is M/c site of sinusitis in adults vs children?
Adults: Maxillary;
Children: Ethmoid
175
Which sinus causes M/c orbital complications in sinusitis?
Ethmoid sinus (d/t common venous drainage & lamina papyracea)
176
Which sinus is last to develop and absent at birth?
Frontal sinus;
Last seen on X-ray at 6 years
177
Which sinus is superior-most?
Frontal sinus
178
Which is the L/c sinus for sinusitis?
Sphenoid sinus
179
What is the M/c pneumatization type of sphenoid sinus?
Sellar type; Best for transsphenoidal hypophysectomy
180
What are the important relations of sphenoid sinus?
Optic nerve,
Internal carotid artery,
Pituitary gland
181
What are risk factors for maxillary sinusitis?
Extraction of 2nd premolar/1st molar (risk of oroantral fistula), dental infections
182
What is Agger nasi cell?
Anterior-most ethmoidal cell; Present in 90% population; May block frontal recess → Recurrent frontal sinusitis
183
What is Haller cell?
Located near floor of orbit/roof of maxillary sinus; Narrows maxillary sinus opening → Recurrent maxillary sinusitis
184
What is Onodi cell?
Posterior ethmoidal cell near sphenoid sinus; Relations: ICA, Optic nerve; Risk of injury during FESS
185
What is the most dreaded complication of FESS?
Optic nerve injury (due to Onodi cell proximity)
186
What is bulla ethmoidalis?
Most prominent anterior ethmoidal cell
187
What is fovea ethmoidalis?
Orbital plate extension of frontal bone; Forms roof of ethmoid sinus
188
What is Waters'/Occipitomental view position?
Nose-chin position; Mandible appears inverted 'U' shape; Shows frontal, anterior ethmoid, maxillary, sphenoid
189
What is Caldwell/Occipitofrontal view?
Nose-forehead position; Mandible appears straight; Best sinus seen: Frontal
190
Which X-ray view shows all sinuses including posterior ethmoid?
Lateral view
191
Pain over root of nose, medial and deep to eye - which sinusitis?
Ethmoid sinusitis; Pain increases with eye movements
192
Early morning pain/periodic 'office headache' - which sinusitis?
Frontal sinusitis
193
Pain over cheek and upper jaw - which sinusitis?
Maxillary sinusitis
194
Occipital headache - which sinusitis?
Sphenoid sinusitis
195
What defines acute vs chronic rhinosinusitis?
Acute: <12 weeks; Chronic: >12 weeks
196
What are the clinical features of rhinosinusitis?
Nasal obstruction + Nasal discharge + Facial pain + Hyposmia
197
What are M/c organisms causing acute bacterial rhinosinusitis?
Strep pneumoniae, H. influenzae, M. catarrhalis
198
What is TOC for chronic rhinosinusitis?
Steroid nasal spray;
Saline irrigation
Antibiotics in acute exacerbation
199
What is the IOC for chronic rhinosinusitis?
NCCT (Non-contrast CT)
200
When is FESS indicated in chronic rhinosinusitis?
If refractory to 1 month of medical management
201
What reduces synechiae formation after FESS?
Pack infused with Mitomycin C
202
What are features of preseptal cellulitis?
Involves only eyelid; Globe normal; Edema of eyelid
203
What are features of orbital cellulitis?
Chemosis, Proptosis, Restricted ocular movements, Decreased vision
204
What is seen in subperiosteal abscess?
Non-axial proptosis (orbit pushed out)
205
How to differentiate orbital cellulitis vs cavernous sinus thrombosis?
Cavernous has - Abrupt onset, U/L→B/L, CN involvement sequential (6→3→4), trigeminal paresthesia
206
What is Pott's puffy tumor?
Soft doughy swelling over forehead; Due to frontal bone osteomyelitis with subperiosteal abscess
207
What is superior orbital fissure syndrome?
CN III, IV, V1, VI involvement
208
What is orbital apex syndrome?
Superior orbital fissure syndrome + CN II involvement
209
M/c bone affected in osteomyelitis from sinusitis?
Adults: Frontal bone;
Children: Maxillary bone
210
M/c intracranial complication from sinusitis?
Subdural abscess > Brain abscess
211
M/c brain abscess following frontal sinusitis?
Frontal lobe abscess; Causes personality changes
212
What is mucocele?
Collection of secretions in sinus due to blocked drainage - causes cystic swelling and non-axial proptosis
213
What is pyocele?
Infected mucocele
214
What is the M/c organism causing fungal ball?
Aspergillus; Occurs in immunocompetent; M/c sinus: Maxillary
215
What is the endoscopy finding in fungal ball?
Cheesy/clay-like debris in middle meatus
216
What is CT finding in fungal sinusitis?
Double density sign (heterogeneous appearance due to metal entrapment)
217
Features of allergic fungal sinusitis ?
Occurs in immunocompetent + atopic (Type 1 hypersensitivity)
218
What is the M/c sinus involved in allergic fungal sinusitis?
Ethmoid sinus
219
What is the nasal discharge appearance in allergic fungal sinusitis?
Mucinous, peanut butter/axle-grease consistency
220
What are CT findings in allergic fungal sinusitis?
Double density sign + Sinus expansion → Bone erosion
221
What are the Bent and Kuhn criteria (major)?
Nasal polyps, Eosinophilic mucin, Type I hypersensitivity (↑IgE), CT: Hazy sinuses + heterogenous opacities, Positive fungal smear
222
What is treatment of allergic fungal sinusitis?
FESS followed by local steroids; Refractory: Post-op antifungal (Itraconazole)
223
What organisms cause acute invasive fungal sinusitis?
Mucormycosis: Rhizopus, Mucor; Invasive aspergillosis: Aspergillus fumigatus
224
What are endoscopy findings in invasive fungal sinusitis?
Black necrotic areas/anaesthetic areas
225
What is IOC for invasive fungal sinusitis?
Nasal smear/biopsy: Shows infarcts, angioinvasion, perineural invasion
226
What is treatment for mucormycosis? - MLA-B
Local debridement + Rx immunosuppression + IV Liposomal Amphotericin B
227
What is treatment for invasive aspergillosis?
Debridement + IV Voriconazole
228
Differentiate Aspergillus vs Mucor on histopathology
Aspergillus: Septate hyphae, branching at acute angles; Mucor: Ribbon-like aseptate hyphae, branching at right angles
229
What is the best investigation for nasal polyps?
NCCT
230
What is M/c cause of B/L nasal polyps in adults?
Allergy
231
What is Samter's triad/Aspirin-Exacerbated Respiratory Disease ?
Aspirin Exacerbated Respiratory Disease: Nasal polyposis + Asthma + Aspirin hypersensitivity; Non-allergic, non-IgE mediated
232
What is pathophysiology of Aspirin-Exacerbated Respiratory Disease?
Abnormal arachidonic acid metabolism; COX-1 > COX-2 inhibitors
233
What is treatment of Aspirin-Exacerbated Respiratory Disease?
Desensitization with aspirin + Symptomatic Rx with Montelukast
234
What is Churg-Strauss syndrome/EGPA?
Chronic Sinusitis + Adult onset asthma + Eosinophilia >10%
235
What is Young's syndrome?
Triad: Chronic sinusitis + Bronchiectasis + Infertility (obstructive azoospermia)
236
What causes B/L nasal polyps in children?
Cystic fibrosis/Mucoviscidosis, Kartagener's syndrome (PCD)
237
What is Kartagener's syndrome triad?
Situs inversus/Dextrocardia + Chronic sinusitis + Bronchiectasis (due to ciliary dyskinesia)
238
What is gold standard for PCD diagnosis?
Electron microscopy: Shows abnormal ciliary ultrastructure
239
What causes U/L nasal polyps?
Antrochoanal polyp (children/young), Allergic fungal sinusitis, Bacterial rhinosinusitis, Malignancy (elderly)
240
What is antrochoanal polyp?
U/L polyp growing from maxillary antrum towards choana; Seen in children/young
241
How to differentiate nasal polyp vs concha bullosa on probe test?
Polyp: No bleeding/pain, probe passes around; Concha: Bleeding/pain +, cannot pass probe around
242
How to identify meningoencephalocele (polypoidal mass in infant)?
Compressible, Transillumination +, Furstenberg test + (cry/cough increases mass size)
243
What are components of nasal septum (bony)?
Perpendicular plate of ethmoid, Vomer, Nasal crest of palatine bone, Nasal crest of maxilla, Nasal spine of frontal, Rostrum of sphenoid
244
What is the cartilaginous part of nasal septum?
Quadrangular/Quadrate cartilage; Supports lower 2/3rd of nose; Removal causes saddling
245
What is M/c nasal septal abnormality?
Deviated nasal septum (DNS)
246
What is M/c cause of DNS?
Birth trauma/Developmental abnormalities
247
What is paradoxical nasal obstruction in DNS?
Obstruction on side opposite to deviation due to compensatory turbinate hypertrophy (M/c: IT)
248
What is confirmatory investigation for DNS?
Nasal endoscopy
249
What is Cottle's test?
Cheek pulled upward and laterally; If obstruction decreases → DNS at nasal valve area
250
What is the surgery of choice for DNS?
Septoplasty (TOC); Not done in <17 years
251
What is difference between Septoplasty and SMR incisions?
Septoplasty: Freer's/Hemitransfixion incision (over caudal septal border); SMR: Killian's incision (1 cm above caudal border)
252
Why is septoplasty preferred over SMR?
Septoplasty: Only deviated part removed, mucoperichondral flap on one side, less complications; SMR: Most cartilage removed, flaps on both sides, more septal perforation/saddling risk
253
What is M/c facial fracture?
Nasal bone fracture
254
What is Class 1/Chevallet nasal bone fracture?
Vertical septum fracture; No or mild deformity
255
What is Class 2/Jarjaway nasal bone fracture?
Horizontal/C-shaped septum fracture; Gross deformity + Septal deviation
256
What is Class 3/Naso-orbito-ethmoid fracture?
Pig nose deformity; Fracture of nasal dorsum + perpendicular plate + cribriform plate + lamina papyracea; CSF rhinorrhea +
257
What is management of nasal bone # with deformity?
Early (<3 weeks): Wait for edema to decrease (5-7 days) → Closed reduction; Late (>3 weeks): Open rhinoplasty/septo-rhinoplasty
258
What forceps are used for nasal bone vs septum reduction?
Nasal bone: Walsham forceps; Septum: Asch's forceps
259
What is treatment of septal hematoma and its timing?
I&D within 72 hours; If not done → Septal necrosis, perforation, saddling, abscess
260
What is tripod fracture?
Zygomatic bone fracture at 3 suture sites: Zygomatico-frontal, Zygomatico-temporal, Zygomatico-maxillary
261
What are clinical features of zygomatic fracture?
Flattening of malar eminence, Anaesthesia over cheek (infraorbital nerve injury), Periorbital emphysema, Enophthalmos
262
What is blow-out fracture?
Fracture of inferior wall of orbit due to severe blow; Infraorbital nerve injury; CT: Tear drop sign (orbital fat protrusion into maxillary sinus)
263
What is Le Fort I/Guerin's fracture?
# parallel to palate (floor of nose + maxillary sinuses); X-ray: Floating palate/teeth; No CSF rhinorrhea
264
What is Le Fort II fracture?
Pyramidal #: Through maxillary sinus, infraorbital margin, lacrimal bone to root of nose; Hanging maxilla; CSF rhinorrhea +; Infraorbital nerve injury +
265
What is Le Fort III fracture?
Craniofacial dysjunction; CSF rhinorrhea +
266
What is M/c cause of CSF rhinorrhea?
Trauma
267
What is M/c site of # causing CSF rhinorrhea?
Anterior cranial fossa: Cribriform plate (lateral lamella)
268
What are clinical features of CSF rhinorrhea?
U/L watery nasal discharge (increases on leaning forward), Cannot sniff back, Handkerchief test: No stiffening, Reservoir sign +
269
What is Halo/Double ring/Target sign?
CSF forms clear ring around blood stain; Seen in CSF rhinorrhea
270
What is biochemical IOC for CSF rhinorrhea?
β2 transferrin + β trace protein positive
271
What is radiological IOC for CSF rhinorrhea?
HRCT to locate exact site of fracture
272
What tests assess active CSF leak?
MRI/CT cisternography, Intrathecal fluorescein
273
What is conservative management of CSF rhinorrhea?
Propped up position, Avoid straining, Stool softeners, Prophylactic antibiotics
274
When is surgery indicated for CSF rhinorrhea?
No resolution in 2 weeks; Endoscopic > Open repair
275
What is congenital anosmia and its association?
Inability to smell from birth; Associated with Kallman syndrome (hypogonadotropic hypogonadism)
276
What supplies sensation to tip of external nose?
External nasal nerve (branch of anterior ethmoidal)
277
What supplies upper part of external nose?
Infratrochlear nerve
278
What is the major sensory supply to nasal cavity?
Sphenopalatine/Nasopalatine nerves (from maxillary nerve via sphenopalatine foramen)
279
What supplies cheek and ala of nose?
Infraorbital nerve (from maxillary nerve via infraorbital foramen)
280
Where is sphenopalatine foramen located?
1 cm behind middle turbinate
281
What is composition of Vidian nerve?
GSPN (parasympathetic from facial nerve) + DPN (sympathetic from ICA plexus)
282
What is the pathway of Vidian nerve?
Via pterygoid canal → Relays in sphenopalatine ganglion (parasympathetic only)
283
What are functions of parasympathetic fibers via Vidian nerve?
Lacrimation, Vasodilatation, Nasal secretions, Palatine secretions
284
What is rhinoscopy finding in allergic vs vasomotor rhinitis?
Allergic: Pale/boggy mucosa; Vasomotor: Congested mucosa
285
What investigations differentiate allergic from vasomotor rhinitis?
Allergic: ↑IgE (RAST), Skin prick test +; Vasomotor: Normal IgE, Skin prick test -
286
What is treatment of allergic rhinitis?
Anti-allergics, Nasal steroid spray, Leukotriene inhibitors (Montelukast), Nasal decongestants (<7 days); If no improvement → Immunotherapy
287
What is treatment of refractory vasomotor rhinitis?
Intranasal steroids; If no improvement → Vidian neurectomy
288
What surgery for hypertrophied inferior turbinate (Mulberry appearance)?
Partial/Total turbinectomy
289
What is rhinitis medicamentosa?
Due to prolonged nasal decongestant use (>7 days) → Prolonged vasoconstriction → Ischemic changes in nose
290
What is treatment of rhinitis medicamentosa?
Stop decongestant use + Short course steroids (local nasal spray > systemic)
291
What are clinical features of atrophic rhinitis?
B/L excessive nasal crusts, B/L roomy nasal cavity, Foul smelling discharge, Merciful anosmia (patient unaware)
292
What causes primary atrophic rhinitis?
Unknown (M/c), Klebsiella ozaenae
293
What causes secondary atrophic rhinitis?
Granulomatous conditions, Tissue destructive surgery → Empty nose syndrome
294
What is treatment for crusts in atrophic rhinitis?
Alkaline nasal douche: Sodium chloride + Sodium bicarbonate + Sodium biborate (2:1:1 in distilled water)
295
What is Kemicetine solution and its contents?
Used to treat infection in atrophic rhinitis; Contents (mnemonic COPD): Chloramphenicol, Oestradiol, Propylene glycol, Vitamin D
296
What is Young's operation?
Complete closure of nasal cavity; For atrophic rhinitis
297
What is Modified Young's operation?
Nasal cavity closure with 3mm opening in center
298
What causes rhinoscleroma?
Klebsiella rhinoscleromatis (Frisch bacillus); Endemic to Asia & Africa
299
What are stages of rhinoscleroma?
1. Atrophic (crusting); 2. Granulomatous (hard woody nose); 3. Cicatricial (deformities like Hebra/Tapir nose)
300
What is seen on biopsy in rhinoscleroma?
Mikulicz cells (macrophages with phagocytosed bacilli), Russell bodies (plasma cells with eosinophilic inclusions)
301
What is DOC for rhinoscleroma?
Ciprofloxacin; Also: Streptomycin, Rifampicin, Tetracycline + Steroids (↓fibrosis)
302
Which part of septum perforates in granulomatous conditions vs syphilis?
All granulomatous: Cartilaginous part; Syphilis & GPA: Bony > Cartilaginous
303
What are ENT features of Granulomatosis with Polyangiitis (GPA)?
Serous otitis media, Strawberry gingiva, Septal perforation (bony); Ix: c-ANCA +, Biopsy: Necrotizing granulomatous vasculitis
304
What is nasal finding in TB?
Saddling + Perforation in cartilaginous septum; Biopsy: Caseating granulomas + AFB
305
What are apple jelly nodules?
Non-blanching brownish nodules seen in Lupus vulgaris
306
What are features of sarcoidosis in nose?
Strawberry nasal mucosa, Lupus pernio (violaceous nose affection); Biopsy: Non-caseating granulomas
307
What is Heerfordt's syndrome?
Uveoparotid fever (Sarcoidosis triad): B/L parotid enlargement + Facial nerve paralysis + Anterior uveitis
308
What is midline lethal granuloma?
T-cell/NK lymphoma; AKA Stewart's lymphoma; Associated with EBV; Causes destruction of midline structures
309
What is treatment of T-cell lymphoma of nose?
Radiotherapy ± Chemotherapy F/b Reconstruction of defect
310
What is the main artery of epistaxis and Little's area?
Sphenopalatine artery
311
What arteries form Kiesselbach's plexus?
Anterior ethmoidal A, Sphenopalatine A, Greater palatine A, Superior labial A (septal branches)
312
What is NOT part of Kiesselbach's plexus?
Posterior ethmoidal artery
313
Where is Little's area/Kiesselbach's plexus?
Anteroinferior part of nasal septum
314
What is Woodruff's plexus?
Venous plexus behind inferior turbinate
315
What happens if anterior ethmoidal artery is injured during FESS?
Orbital hematoma; Mx: Lynch Howarth incision + Ligation of anterior ethmoidal artery
316
What is nipple sign on CT?
Anterior ethmoidal notch; Entry point of anterior ethmoidal artery into nose
317
What is M/c site of epistaxis in children vs adults?
Children/Young: Little's area; Adults: Posterior epistaxis
318
What is M/c cause of epistaxis in children vs adults?
Children: Trauma (nose picking); Adults/Elderly: Idiopathic
319
What is M/c artery involved in epistaxis?
Sphenopalatine artery (both anterior + posterior)
320
What should you rule out in recurrent epistaxis in young male?
Juvenile nasopharyngeal angiofibroma
321
What is Trotter's/Hippocratic method?
First aid for epistaxis: Pinch nose tightly + Sit leaning forwards
322
What is sequence of management for epistaxis?
Trotter's method → Endoscopic cauterization (silver nitrate/bipolar) → Anterior nasal packing → Posterior nasal packing (Foley's catheter) → Ligation
323
What is order of arterial ligation for epistaxis?
TESPAL (Transnasal Endoscopic Sphenopalatine Artery Ligation) → Maxillary artery → ECA (neck) → Anterior ethmoidal artery
324
What is Caldwell-Luc procedure used for?
Maxillary artery ligation via sublabial incision (approach to pterygopalatine fossa)
325
What causes rhinosporidiosis?
Rhinosporidium seeberi (aquatic protozoa); Endemic: South India (Tamil Nadu); Seen in cattle breeders, farmers
326
What are features of rhinosporidiosis?
H/o bathing in ponds; Epistaxis, nasal obstruction, blood-tinged discharge; O/E: Strawberry/mulberry mass (polypoidal, vascular)
327
What is seen on HPE of rhinosporidiosis?
Sporangium filled with sporangiospores
328
What is treatment of rhinosporidiosis?
Wide excision of base + Cauterization F/b Dapsone (↓recurrence)
329
What is M/c benign tumor of nasal cavity?
Inverted papilloma (Ringertz tumor/Schneiderian papilloma/Transitional cell papilloma)
330
What causes inverted papilloma?
HPV; Features: Locally invasive, premalignant, recurrent
331
What is treatment of inverted papilloma?
Wide excision (Endoscopic > External approach)
332
What is M/c carcinoma of external nose?
Basal cell carcinoma (Rodent ulcer); HPE: Basophilic cell bundles + palisading nuclei
333
What is M/c carcinoma inside nasal cavity?
Squamous cell carcinoma (Nose picker's carcinoma)
334
What is M/c benign tumor of PNS?
Osteoma; M/c sinus: Frontal
335
What is fibrous dysplasia?
Normal bone replaced by fibrous tissue; Seen in young; M/c: Maxillary sinus; CT: Ground glass appearance
336
What is M/c malignant tumor of PNS?
Squamous cell carcinoma; M/c sinus: Maxillary
337
What carcinoma is associated with hardwood furniture industry?
Adenocarcinoma of ethmoid sinus (also carpenters)
338
What is esthesioneuroblastoma?
Olfactory neuroblastoma; Neuroendocrine tumor from olfactory mucosa; Highly vascular cherry-red polypoidal mass
339
What is Ohngren's line?
Line from root of nose to angle of mandible; Divides maxillary sinus into infrastructure (better prognosis) and suprastructure (bad prognosis)
340
What is juvenile nasopharyngeal angiofibroma?
Benign vascular tumor; Arises from sphenopalatine foramen; Seen in adolescent males with recurrent epistaxis
341
What is Holman Miller sign?
Pushing of posterior wall of antrum anteriorly on CT; Seen in JNA
342
What is rhinophyma?
Nasal elephantiasis/Potato nose; Middle-aged males; Due to long-standing acne rosacea (sebaceous gland hypertrophy); Rx: Wide skin excision
343
Nerve supplying motor function to most tongue muscles?
Hypoglossal nerve (CN XII). Exception: palatoglossus supplied by pharyngeal plexus.
344
Clinical sign of unilateral hypoglossal nerve palsy?
Tongue deviates toward the weaker side due to genioglossus action from normal side.
345
Main action of genioglossus?
Protrusion of tongue; deviation to the opposite side.
346
Which cranial nerves pass through the jugular foramen?
CN IX (glossopharyngeal), CN X (vagus), CN XI (accessory).
347
Sensory supply of anterior two-thirds of tongue (general sensation)?
Lingual nerve (branch of mandibular division of CN V).
348
Taste supply to anterior two-thirds of tongue?
Chorda tympani (branch of facial nerve, CN VII).
349
Sensory and taste supply of posterior one-third of tongue?
Glossopharyngeal nerve (CN IX) supplies both general sensation and taste.
350
Which nerve provides sensation to the base (posterior most) of tongue?
Vagus nerve (superior laryngeal branch/A... Arnold's branch involved in cough reflex).
351
Define Waldeyer's ring.
Ring of mucosa-associated lymphoid tissue (MALT) in nasopharynx and oropharynx: adenoids, tubal tonsils, palatine tonsils, lingual tonsils.
352
Boundaries of the pharynx (superior to inferior)?
Base of skull to lower border of cricoid cartilage.
353
Layers of pharyngeal fascia important clinically?
Pharyngobasilar (anterior) and buccopharyngeal (posterior) fasciae.
354
Epithelium type in oropharynx and hypopharynx?
Stratified squamous non-keratinized epithelium.
355
Epithelium type in nasopharynx?
Ciliated pseudostratified columnar epithelium.
356
Three longitudinal dilator muscles of pharynx?
Stylopharyngeus, salpingopharyngeus, palatopharyngeus.
357
Three circular constrictor muscles of pharynx?
Superior, middle, and inferior pharyngeal constrictors.
358
What is Killian's dehiscence and clinical significance?
A weak area between thyropharyngeus and cricopharyngeus (inferior constrictor); site of Zenker's (pharyngoesophageal) diverticulum (false diverticulum).
359
Most common side and population for Zenker's diverticulum?
Left side; common in elderly.
360
Typical presentation of Zenker's diverticulum?
Dysphagia, regurgitation, coughing, halitosis; Boyce's sign (gurgling on neck palpation).
361
Best initial investigation for suspected Zenker's diverticulum?
Barium swallow (lateral view).
362
Management options for Zenker's diverticulum?
Endoscopic stapling diverticulectomy or open excision for large diverticula; Dohlman's laser procedure.
363
Name the three key spaces/fascia posterior to pharynx (mnemonic BAP).
Buccopharyngeal fascia, Alar fascia, Prevertebral fascia.
364
What is the danger space and clinical importance?
Space between alar and prevertebral fascia allowing infection to spread to mediastinum causing mediastinitis/pericarditis.
365
Contents and lower extent of retropharyngeal space; common cause in children?
Contains Rouvière's nodes; extends down to ~T4; children—commonly due to acute suppurative lymphadenitis from nasopharyngeal infection.
366
Key X-ray lateral finding in retropharyngeal abscess?
Increased prevertebral soft tissue shadow (>7 mm at C2, >22 mm in adults), loss of cervical lordosis, possible air-fluid level.
367
First-line management of acute retropharyngeal abscess?
Airway protection, IV antibiotics, intra-oral incision and drainage; CT to differentiate from prevertebral abscess.
368
Location of peritonsillar (Quinsy) abscess?
Between palatine tonsil capsule and superior constrictor muscle (peritonsillar space).
369
Most common tonsillar crypt involved in adults predisposing to peritonsillar abscess?
Crypta magna (largest crypt) due to tonsillar atrophy.
370
Clinical features of peritonsillar abscess?
Severe sore throat, fever, odynophagia, muffled 'hot potato' voice, medial displacement of tonsil, trismus.
371
Management of peritonsillar abscess?
IV antibiotics, needle aspiration or incision & drainage; interval tonsillectomy after 6 weeks if indicated.
372
Parapharyngeal space other name and clinical importance?
Also called lateral pharyngeal or pharyngomaxillary space; potential site for abscess, neurogenic tumours, causes trismus and parotid/mandibular bulge.
373
Parapharyngeal space compartments and major neurovascular structures in post-styloid compartment?
Divided by styloid process into pre-styloid and post-styloid; post-styloid contains internal carotid artery, internal jugular vein, CN IX–XII, and sympathetic chain.
374
Site of incision for drainage of parapharyngeal abscess?
Incision 2–3 cm below angle of mandible (take care to avoid marginal mandibular nerve).
375
Anatomical compartments of submandibular space (related to Ludwig's angina)?
Sublingual compartment (above mylohyoid) and submaxillary/submandibular compartment (below mylohyoid).
376
Definition and main cause of Ludwig's angina?
Cellulitis of submandibular space (often bilateral) commonly due to infected lower molar teeth.
377
Key management priorities for Ludwig's angina?
Airway protection (may require tracheostomy), IV antibiotics, incision & drainage, dental extraction/caries management.
378
Where in nasopharynx are adenoids located?
At junction of roof and posterior wall of nasopharynx (nasopharyngeal tonsil).
379
Age-related growth pattern of adenoids?
Increase until ~6–7 years, plateau 7–12 years, atrophy after ~12 years.
380
Clinical features of adenoid hypertrophy?
Nasal obstruction, mouth breathing, adenoid facies, hyponasality (rhinolalia clausa), recurrent otitis media due to Eustachian tube blockage, sleep apnea.
381
Indications for adenoidectomy?
Sleep apnea, chronic serous otitis media (SOM), recurrent infections (AOM, sinusitis) unresponsive to medical therapy.
382
Important surgical complication associated with adenoidectomy (cervical spine)?
Grisel syndrome — non-traumatic atlanto-axial subluxation with neck stiffness and torticollis.
383
Angiofibroma key demographic and origin?
Benign, highly vascular tumor of adolescent males (pubertal) arising from sphenopalatine foramen/posterior nasal cavity.
384
Classic presentation of juvenile nasopharyngeal angiofibroma?
Unilateral nasal obstruction, recurrent epistaxis, rhinolalia clausa, possible proptosis or facial swelling (frog facies).
385
Investigation contraindication for angiofibroma?
Biopsy is contraindicated due to high vascularity—use endoscopy and imaging (CECT) and consider embolisation pre-op.
386
Preoperative step to reduce bleeding risk in angiofibroma surgery?
Preoperative embolization of feeding vessel(s), mainly branches of maxillary artery.
387
Most common carcinoma of nasopharynx and main risk factors?
Nasopharyngeal squamous cell carcinoma; risk factors: EBV infection, nitrosamine exposure (salted fish), genetic predisposition (endemic areas).
388
Most common site of nasopharyngeal carcinoma origin?
Fossa of Rosenmüller (lateral nasopharyngeal recess behind torus tubarius).
389
Common clinical feature that often presents in nasopharyngeal carcinoma?
Painless cervical lymphadenopathy (often first sign), unilateral serous otitis media, nasal obstruction.
390
Screening test suggestive of nasopharyngeal carcinoma?
Serology for EBV (IgA VCA, Early Antigen) — used for screening adjunctively.
391
First-line treatment for early-stage nasopharyngeal carcinoma?
Radiotherapy (NPC is radiosensitive); concurrent chemoradiation for advanced disease.
392
Main sensory supply to oropharynx?
Glossopharyngeal nerve (CN IX).
393
Developmental origin of palatine tonsils?
Derived from the 2nd pharyngeal pouch; crypta magna is remnant of the pouch.
394
Main arterial supply to palatine tonsil (single main vessel)?
Tonsillar branch of facial artery (main supply); also branches from ascending pharyngeal, ascending palatine, and lingual arteries.
395
Most common cause of acute tonsillitis?
Group A β-hemolytic Streptococcus (Streptococcus pyogenes) for bacterial; viruses also common.
396
Indications for tonsillectomy based on recurrent infections?
>3/year for 3 consecutive years, >5/year for 2 consecutive years, or >7 in a single year.
397
Name the bleeding vessel commonly implicated after tonsillectomy?
External palatine (paratonsillar) vein is common site of postoperative hemorrhage.
398
Differential diagnoses for membrane over tonsils (e.g., dirty grey membrane)?
Diphtheria, infectious mononucleosis, Vincent's angina, pseudomembranous candidiasis, trauma, neoplasia.
399
Characteristic features and management of diphtheria?
Dirty grey adherent membrane extending beyond tonsil that bleeds on removal; treat with antitoxin (after sensitivity) and antibiotics (beta-lactam/macrolide).
400
Main contraindication to throat swab biopsy in suspected angiofibroma?
Biopsy is contraindicated due to risk of life-threatening hemorrhage.
401
Two main types of tonsillectomy technique categories?
Cold methods (dissection & snare, microdebrider) and hot methods (cautery, coblation, laser).
402
Definition of peritonsillar space?
Space between tonsillar capsule and superior constrictor—site of peritonsillar abscess.
403
Pyriform fossa clinical significance?
Common site for foreign body lodgement and hypopharyngeal carcinoma; pain referred to ear via glossopharyngeal/internal laryngeal nerves.
404
Most common site of hypopharyngeal carcinoma?
Pyriform fossa (most common) and postcricoid area (associated with Plummer-Vinson syndrome).
405
Components of larynx classified by level?
Supraglottis (above true vocal cords), glottis (true vocal cords), subglottis (below true vocal cords).
406
Which laryngeal cartilage is a complete ring and common site for stenosis?
Cricoid cartilage (only complete ring).
407
Paired laryngeal cartilages?
Arytenoid, corniculate, and cuneiform cartilages.
408
Which laryngeal cartilage does not calcify?
Epiglottis (elastic cartilage—does not calcify).
409
Angle of thyroid cartilage in males vs females?
Males ~90°; females ~120° (accounting for Adam's apple prominence).
410
Two main membranes connecting larynx extrinsically to other structures?
Hyoepiglottic and thyrohyoid membranes; cricotracheal membrane connects cricoid to trachea.
411
Name of the ligament forming anterior thickening of conus elasticus?
Cricothyroid membrane (anterior thickening of conus elasticus).
412
Ventricle of larynx—location and significance?
Space between true and false vocal cords; contains the laryngeal saccule which can form laryngoceles if dilated.
413
Pre-epiglottic space (Boyer) clinical significance?
Potential route for supraglottic tumor spread and site dissected during surgery; bounded anteriorly by thyroid and thyrohyoid membrane.
414
What is Reinke's space
Submucosal space of true vocal cord — Reinke edema, polyps, nodules arise here.
415
Which intrinsic laryngeal muscle is the only abductor (the 'safety muscle')?
Posterior cricoarytenoid muscle (abducts the vocal cords).
416
Primary function of cricothyroid muscle?
Tensor/increases tension and pitch of vocal cords (innervated by external branch of superior laryngeal nerve).
417
Typical features and natural history of laryngomalacia?
Inspiratory stridor shortly after birth (worse supine, better prone); due to floppy supraglottic tissues; usually resolves by age 2.
418
Typical presentation of epiglottitis and key X-ray sign?
Acute onset fever, toxic appearance, severe odynophagia, drooling, muffled voice; lateral neck X-ray shows 'thumb sign'.
419
Typical presentation of croup (laryngotracheobronchitis) and X-ray sign?
Barking cough, hoarseness, inspiratory stridor in children; AP neck X-ray shows 'steeple sign'.
420
Management priorities for epiglottitis?
Secure airway (intubation if needed), IV antibiotics, IV fluids, steroids, nebulized adrenaline as supportive therapy.
421
Myer-Cotton grading—what does it classify?
Grading of subglottic stenosis (Grade I–IV based on percentage obstruction).
422
First-line definitive management for Grade IV congenital subglottic stenosis?
Cricotracheal resection with end-to-end anastomosis; may use stenting (Montgomery T-tube) and Mitomycin C adjunct.
423
Etiology and HPV types for juvenile recurrent respiratory papillomatosis?
HPV types 6 and 11 (low malignant potential); often transmitted during vaginal delivery.
424
Treatment to reduce recurrence of juvenile papillomatosis?
Microlaryngeal surgical excision (microdebrider preferred); adjuvant therapies include intralesional cidofovir, α-interferon, bevacizumab.
425
Presentation differences: vocal nodules vs polyps vs Reinke's edema?
Nodules: bilateral, small, at anterior 1/3 junction; polyps: unilateral, pedunculated;
Reinke's edema: bilateral diffuse swelling associated with smoking or reflux.
426
Procedural position used for direct laryngoscopy and microlaryngeal surgery
Flexion at cervical spine with extension at atlanto-occipital joint; pillow under shoulders (Called Chevalier Jackson or Boyce Position).
427
Utility of stroboscopy in laryngeal examination?
Visualizes mucosal wave of vocal cords in slow motion to detect subtle lesions and functional abnormalities.
428
Definition of spasmodic dysphonia and treatment?
Focal laryngeal dystonia with voice spasms during speech; treated with botulinum toxin injections into involved muscles.
429
Superior laryngeal nerve branches and their functions?
Internal branch (internal laryngeal nerve) provides sensory above vocal cords;
External branch supplies motor to cricothyroid muscle (tension/pitch).
430
Course difference between right and left recurrent laryngeal nerves?
Right loops around right subclavian artery; left loops under aortic arch—left RLN has longer intrathoracic course and higher risk of injury in mediastinal pathology.
431
Sensory supply of larynx above and below vocal cords?
Above vocal cords: internal branch of superior laryngeal nerve
below vocal cords: recurrent laryngeal nerve.
432
Commonest unilateral RLN palsy cause and commonest bilateral cause?
Unilateral often due to surgical trauma (thyroid surgery)
Bilateral RLN palsy commonly due to surgical trauma during thyroidectomy (total).
433
Presentation differences: unilateral vs bilateral vocal cord palsy?
Unilateral: hoarseness, breathy voice, aspiration risk
Bilateral (paramedian): stridor, respiratory compromise; voice may be preserved but airway is compromised.
434
Immediate management for bilateral complete vocal cord palsy with stridor?
Secure airway - may require tracheostomy
435
Types of Isshiki's thyroplasty and primary indications (Type I, II and III)?
Type I: medialisation for unilateral vocal cord paralysis
Type II: Lateralization of Vocal cords for B/L RLN palsy
Type III: shortening for puberphonia (lowers pitch).
436
Most common laryngeal cancer histology and major risk factors?
Squamous cell carcinoma; risk increased by smoking and male sex.
437
Early symptom of glottic carcinoma and why it's early?
Hoarseness is earliest symptom due to involvement of vocal cords which affects voice early and prompts early presentation.
438
Preferred imaging to detect laryngeal cartilage invasion?
MRI is investigation of choice for assessing cartilage erosion (best for soft tissue and cartilage).
439
Basic management options by stage for laryngeal carcinoma (T1–T4)?
T1–T2: transoral laser microsurgery (TLM) or radiotherapy;
T3: concurrent chemoradiation or surgery;
T4a: total laryngectomy + adjuvant radiotherapy;
unresectable T4b: palliative care.
440
List three methods of speech rehabilitation after total laryngectomy.
Oesophageal speech (phonation by air vibration), tracheoesophageal puncture & voice prosthesis (best), electrolarynx (external device).
441
What is a laryngocele and clinical sign on exam?
Air-filled dilation of laryngeal saccule; external swelling that expands with Valsalva
442
What is Bryce Sign
Laryngeal saccule produce hissing sound on compression (Bryce sign).
443
Principle of autofluorescence endoscopy in laryngeal lesions?
Normal mucosa fluoresces green
Neoplastic mucosa shows red-violet fluorescence
444
Narrow Band Imaging (NBI) helps detect what laryngeal change?
Neoangiogenesis and abnormal capillary patterns suggestive of malignancy.
445
Indications for tracheostomy (mnemonic from notes)?
Obstruction, mechanical ventilation, secretion removal/pulmonary toilet, Preventing aspiration in bilateral complete VC palsy (Occupy Most Seats...).
446
Preferred tracheostomy tube characteristics?
High-volume, low-pressure cuff to provide an airtight seal with minimal mucosal pressure.
447
Common complications of tracheostomy?
Immediate: bleeding, pneumothorax
Late: tracheal stenosis, tracheoesophageal fistula, infection, granulation tissue.
448
Most common age group and common foreign body types in airway foreign body?
Age 1–4 years; most common foreign bodies are nuts and peanuts.
449
First aid steps for choking (conscious adult with complete airway obstruction)?
Heimlich manoeuvre (abdominal thrusts) for conscious adult with universal choking sign; back blows and encourage coughing if partial obstruction and speaking.
450
Contraindications to Heimlich manoeuvre?
Infants <1 year (use back blows and chest thrusts)
Unconscious patient (start CPR)
Pregnancy/obesity (use chest thrusts instead of abdominal).
451
Definitive treatment for lodged airway foreign body when first aid fails?
Rigid bronchoscopy under general anesthesia for removal
452
Most common site of esophageal foreign body impaction?
At or just below the cricopharyngeal sphincter (upper esophageal sphincter).
453
Radiographic sign of button battery in esophagus on AP view?
Double density or halo sign; lateral view may show step-off at the edge
454
Most common site of Zenker's diverticulum (posterior vs lateral)?
Posterolateral outpouching through Killian’s dehiscence (posteriorly) — often left-sided.
455
Clinical mnemonic for structures passing in sinus of Morgagni between base of skull and superior constrictor?
''T A A L A'': Tensor veli palatini, Ascending pharyngeal artery, Ascending palatine artery, Levator veli palatini, Auditory (Eustachian) tube.
456
Main features on examination of laryngomalacia (flexibility of supraglottis)?
Omega-shaped epiglottis, short floppy aryepiglottic folds, prominent arytenoids, supraglottic redundancy on endoscopy.
457
Key differences between inspiratory, biphasic and expiratory stridor related to lesion site?
Inspiratory = supraglottic;
biphasic = glottic;
expiratory = intrathoracic airway obstruction (below trachea).
458
Thumb sign' and 'steeple sign' seen in which conditions?
Thumb sign on lateral neck X-ray = epiglottitis; Steeple sign on AP neck X-ray = croup (subglottic narrowing).
459
State one cause of failure of velopharyngeal closure after adenoidectomy?
Unmasking of velopharyngeal insufficiency due to cleft palate or pre-existing palatal dysfunction.
460
Which tonsillar lymph node receives lymphatic drainage from palatine tonsil?
Upper deep cervical (tonsillar) node.
461
Explain Boyce sign.
Gurgling sound on neck palpation in cases with Zenker's diverticulum (pouch filled with food).
462
Describe significance of Fosssa of Rosenmüller.
A recess behind torus tubarius in nasopharynx: common site of nasopharyngeal carcinoma.
463
Main motor supply to pharynx muscles?
Pharyngeal plexus (primarily pharyngeal branch of vagus nerve CN X) except stylopharyngeus which is supplied by glossopharyngeal nerve (CN IX).
464
Which diagnostic test differentiates retropharyngeal from prevertebral abscess?
CT scan of neck (contrast-enhanced) to define location and extent.
465
Common pathogens in acute tonsillitis and pseudomembranous tonsillitis?
Acute: Group A Streptococcus;
Pseudomembranous: diphtheria (Corynebacterium diphtheriae)
466
Typical complications of diphtheria
Respiratory obstruction (membrane), myocarditis with arrhythmias
467
Purpose of pre-op embolisation for angiofibroma?
To reduce intraoperative bleeding by occluding vascular supply (mainly from maxillary artery branches).
468
Common features suggesting malignant laryngeal lesion on contact endoscopy/NBI?
Disrupted mucosal fluorescence (red-violet on autofluorescence), irregular capillary patterns (NBI), pin-shaped/irregular vessels suggest malignancy.
469
Primary airway landmark for surgical cricothyrotomy?
Cricothyroid membrane (between thyroid and cricoid cartilages).
470
Recommended timing for interval tonsillectomy after peritonsillar abscess?
Approximately 6 weeks after acute episode if indicated (interval tonsillectomy).
471
Management of post-tonsillectomy hemorrhage (initial steps)?
Remove clots, apply pressure with gauze, cauterize bleeding points, ligate vessel if needed; IV fluids and possible return to OR for severe bleeds.
472
Describe 'rising tide' appearance in Zenker's diverticulum?
Visible rising of a food-filled pouch under the neck (swelling) that rises as the patient swallows or with palpation.
473
Which surgical procedure is contraindicated in juvenile recurrent respiratory papillomatosis?
Tracheostomy is generally contraindicated due to risk of distal spread of papillomas; intubation is preferred if airway needed.
474
Trotter's triad
Mandibular neuralgia
Palatal palsy
Conductive hearing loss due to serous otitis media.
475
Which ligament/space must be anesthetized before biopsy above the vocal cords?
Anesthetize at the thyrohyoid membrane targeting the internal branch of superior laryngeal nerve.
NEET-PG
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