ENT OSPE

Edition: 1.7

List of the Instruments

1. Metallic aural speculum
2. Tuning fork
3. Aural foreign body hook
4. Thudicum nasal speculum
5. Killian’s long bladed nasal speculum
6. Tilley’s nasal dressing forceps
7. Freer’s elevator
8. LUC’s forceps
9. Tilley’s Lichtwitz antral puncture trocar and cannula
10. Nasal foreign body hook
11. ANS pack
12. PNS pack
13. Metallic tongue depressor
14. Direct laryngoscope
15. Laryngeal mirror
16. PNS mirror
17. Rigid endoscope
18. Boyle Davis mouth gag with tongue blade
19. Tonsil dissector and anterior pillar retractor
20. Eve’s tonsilar snare
21. Negus hemostasis artery forceps
22. Knot pusher or knot tire
23. Tonsil holding forceps
24. Adenoid curette with cage
25. Mollison’s self retaining hemostatic mastoid retractor
26. PVC tracheostomy tube with cup
 Instruments for examination of ear
2. Tuning fork
PARTS:
1. Prongs
2. Shoulder
3. Stem
4. Base

USE/INDICATIONS:
It is used to do the clinical test of hearing.
FREQUENCIES:
Ideal: 512 Hz.
KEY POINTS TO BE REMEMBERED IN RINNE TEST:
1. Greetings, introduction, assurance.
2. Tuning fork is stuck at the junction of anterior 1/3rd and posterior 2/3rd
of the prongs at bony prominence of own body. eg – elbow, wrist, knee,
heal.
3. Prongs are placed parallel and 2cm away from the auricle.

- During Weber test, tuning fork can be placed on the vertex/forehead/root of

the nose or, on upper teeth.
INTERPRETATION:
Tests Normal Ear Conductive type of hearing Sensorineural type of hearing
loss loss
Rinne Rinne (+ve) Rinne (-ve) Rinne (+ve) but hears both of
AC>BC BC>AC them low.
Weber Central or equal Lateralized to the deaf ear Lateralized to good ear
ABC Equal Equal Reduced

3. Aural foreign body hook:

USE/INDICATIONS:
Removal of foreign body from ear.
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PRINCIPLE OF REMOVAL OF FOREIGN BODY:

1. Introduce the foreign body hook in the exter-
nal auditory canal superiorly and beyond the
foreign body.
2. Engage the foreign body in the angle of the
FB hook.
3. Pull the FB hook.

2
1. Metallic aural speculum:
USE/INDICATIONS:
1. Diagnostic:
a. To examine the deep part of the meatus,
b. To examine the postmastoidectomy cavity.
2. Therapeutic purpose:
a. Aural toileting,
b. Aural polypectomy,
c. Used in myringotomy, ossiculoplasty,
myringoplasty, tympanoplasty.

CONTRAINDICATIONS:
1. Any painful condition of the ear –
a. Furunculosis
b. Herpes Zoster otitis
c. Perichondritis

Q. WHY DEEP PART OF THE MEATUS IS EXAMINED?

- As superficial part is covered by speculum and that’s why external ear is first examined without speculum.

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 Instruments for examination of the nose
4. Thudicum nasal speculum:
USE/INDICATIONS:
1. Diagnostic:
a. To examine the anterior part of the nasal cavity (anterior
rhinoscopy).
b. To take biopsy from the nasal mass.
c. Diagnostic purpose of antral wash out.
2. Therapeutic:
a. Removal of the foreign body from the nasal cavity.
b. Submucosal resection (SMR) of the deviated portion of
the nasal septum.
c. Septoplasty
d. Therapeutic purpose of antral wash out.
e. Excision of rhinosporidiosis.

CONTRAINDICATIONS:
1. Any painful condition of the nose -
a. Furunculosis.
b. Vestibulitis.

STERILIZATION:
1. Autoclaving.
2. Boiling (from the boiling point to 30 minutes at 100℃).

PROCEDURE OF HOLDING AND EXAMINATION:

1. Greetings, introduction, assurance,
2. Light the headlight,
3. Place the speculum on the palm of right hand blades facing upward outwards,
4. With the index, middle and ring figure of the left hand take and hold the instrument properly with
the blades facing horizontally,
5. Examine each naris at one by one.

QUESTION TOPIC:
Nasal mass, epistaxis. Rajib Biswas | www.badhahin.com

4
5. Killian’s long bladed nasal speculum:
USE/INDICATIONS:
1. SMR operation.
2. Septoplasty.
3. Intranasal polypectomy.
4. Excision of the rhinosporidiosis.
5. Excision of the inverted papilloma.
6. Excision of any nasal mass.
7. Biopsy taking from nasal mass.

TYPES:
- Large, medium and small types.

ANESTHESIA:
It must be done under general anesthesia.
HOLDING:
With left hand.
+ RELATED QUESTIONS

6. Tilley’’s nasal dressing forceps:

USE/INDICATIONS:
1. To give ANS pack and to remove ANS
pack.
2. SMR operation (to remove the pieces of
bone or cartilage).
3. Septoplasty.
4. Intranasal polypectomy.
5. Excision of the rhinosporidiosis.
6. Excision of the inverted papilloma.

STERILIZATION:
1. Autoclaving.
1. Boiling (from the boiling point to 30 minutes at 100℃).

+ RELATED QUESTIONS Rajib Biswas | www.badhahin.com

7. Freer’’s elevator
USE/INDICATIONS:
To elevate the mucoperichondrium and
mucoperiosteum.

+ RELATED QUESTIONS

5
8. LUC’’s forceps:
USE/INDICATIONS:
1. SMR operation (to remove the pieces
of bone and cartilage).
2. Septoplasty (to remove the pieces of
bone and cartilage).
3. To take punch biopsy from nose, oral
cavity, ear.
4. In absence of tonsil holding forcep it
may be used in tonsillectomy opera-
tion.
5. Cald-Well LUC surgery
6. Septoplasty or SMR
7. Intranasal polypectomy
8. Removal of blood clot from tonsillar fossa after secondary hemorrhage due to tonsillectomy

STERILIZATION:
Chemical sterilization.
+ RELATED QUESTIONS

9. Tilley’’s Lichtwitz antral puncture trocar and cannula:

USE/INDICATIONS:
Used for antral wash out (or proof puncture) for:
1. Diagnostic:
a. To collect biopsy material from antrum in
case of suspected antral or sinonasal malig-
nancy.
b. To diagnose maxillary sinusitis.
2. Therapeutic:
a. Chronic maxillary sinusitis when medical
treatment failed.
b. Acute maxillary sinusitis under antibiotic cov-
erage.
c. In case of antrochoanal polyp where patient is
below 16 years after intranasal polypectomy. Rajib Biswas | www.badhahin.com

STERILIZATION:
Chemical sterilization.

+ RELATED QUESTIONS

6
10. Nasal foreign body hook:
USE/INDICATIONS:
To remove foreign body from nose.

11. ANS pack:

USE/INDICATIONS:
1. Uncontrolled epistaxis,
2. Septoplasty,
3. SMR operation,
4. Excision of the rhinosporidiosis,
5. Excision of the inverted papilloma

ANS WITH IMPREGNATED BIPP

B – Bismuth (Deodorant)
I – Iodoform (Local antibiotic)
P – Paraffin (Lubricant)
P – Paste
If BIPP is not available, then Neomycin ointment is given.
The pack is kept for 24 hours.

12. PNS pack:

USE/INDICATIONS:
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1. Uncontrolled epistaxis when ANS pack is failed,

2. Excision of nasopharyngeal angiofibroma,
3. After adenoidectomy

Introduced and impregnated with BIPP or neomycin followed

by ANS pack.
Antibiotic + Analgesic + Antihistamine+ Anti Ulcerant must
be given.

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 Instruments for oral cavity, throat and neck examination
13. Metallic tongue depressor:
PARTS:
1. Holding part (narrow): Used to hold the instrument (in right hand),
2. Depressor part (broad): Used to depress the anterior 2/3rd of the tongue.

USE/INDICATIONS:
1. Diagnostic:
a. To examine the vestibule and mouth cavity proper.
b. To do posterior rhinoscopy along with PNS mirror.
c. To take biopsy from any mass from any lesion of oral cavity.
2. Therapeutic:
a. Removal of foreign body from oral cavity – specially from oral cavity proper and oropharynx.
b. Incision and drainage of peritonsillar abscess/quinsy.
c. Used in tonsillectomy under local anesthesia (rare).

Q. WHY NOT USED IN THE POSTERIOR 1/3RD?

To avoid gag reflex.
- Any area supplied by glossopharyngeal nerve is a site for inducing gag reflex.
- The posterior 1/3rd is supplied by glossopharyngeal nerve but the anterior 2/3rd is not. So gag reflex
is present in posterior 1/3rd.

14. Rigid laryngoscope:

USE/INDICATIONS:
To do direct laryngoscopy.
INDICATIONS OF DIRECT LARYNGOSCOPY:
1. Diagnostic:
a. To asses, diagnosis and biopsy taking from the
lesion of the larynx and pharynx.
b. Diagnose the non-radiopaque foreign body of
the larynx and pharynx.
c. As part of panendoscopy in case of metastatic
cervical lymphadenopathy.
d. Prior to bronchoscopy for the apprentice.
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2. Therapeutic:
a. Exclusion of benign lesion.
b. Removal of foreign body.

+ RELATED QUESTIONS

8
15. Laryngeal mirror:
INDICATIONS:
Indirect laryngoscopy.
DIRECTIONS TO THE PATIENT:
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2. 12)&3 -). 1//।
3. ,)$4 1%/।
4. 555 ,&3/।

DIRECTION OF MIRROR:
Downwards.

+ RELATED QUESTIONS

16. PNS mirror:

INDICATIONS:
Posterior laryngoscopy.
DIRECTION OF MIRROR:
Upwards.

+ RELATED QUESTIONS

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9
 Instruments for tonsillectomy operation
18. Boyle Davis mouth gag with tongue blade:
PARTS:
1. Jaw piece: Retracts the upper jaw.
2. Tongue blade: Retracts the lower jaw and tongue.

USE/INDICATIONS:
1. Tonsillectomy operation.
2. Adenoidectomy operation.
3. Adenotonsillectomy operation.
4. Excision of nasopharyngeal angiofibroma per orally.
5. Antrochoanal polypectomy per orally.
6. Any operation of the palate, eg. Repair of cleft palate.

CONTRAINDICATIONS:
Any operation of the tongue.
STERILIZATION:
2. Autoclaving.
3. Boiling (from the boiling point to 30 minutes at 100℃).

19. Tonsil dissector and anterior pillar retractor:

USE/INDICATIONS:
1. Dissector end: It is used to dissect the palatine tonsil from its bed.
2. Retractor end: It is used to retract the anterior pillar during hae-
mostasis.

20. Eve’’’s tonsilar snare:

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USE/INDICATIONS:
It is used to separate the palatine tonsil at its lower pedi-
cle.

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21. Negus hemostasis artery forceps:
USE/INDICATIONS:
Used in hemostasis after tonsillectomy.

22. Knot pusher or knot tire:

USE/INDICATIONS:
It is used to knot the hemostatic point.

23. Tonsil holding forceps:

USE/INDICATIONS:
1. It is used to hold the palatine tonsil to pull it
medially during dissection method.
2. Excision of the nasopharyngeal angiofibroma.
3. Intranasal polypectomy.

STERILIZATION:
1. Autoclaving.
2. Boiling (from the boiling point to 30 minutes at 100℃).

24. Adenoid curette with cage:

INDICATIONS
1. Adenoidectomy

(St Clair Thomson adenoid curette with cage.)

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 Instruments for mastoidectomy operation
25. Mollison’’s self retaining hemostatic mastoid retractor:
USE/INDICATIONS:
Ear 1. Different type of mastoidectomy operation.
2. Myringoplasty.
3. Tympanoplasty.
4. Ossiculoplasty.
5. Cochlear implant.

Sculp: 6. Burr hole operation/craniotomy.

Nose: 7. Lateral rhinotomy.

Throat: 8. Laryngofissure.

Spinal cord: 9. Laminectomy.

STERILIZATION:
1. Autoclaving.
2. Boiling (from the boiling point to 30 minutes at 100℃).

Instruments for tracheostomy operation

26. PVC tracheostomy tube with cup:
USE/INDICATIONS:
Tracheostomy operation.
Cuff helps to keep the tube in situ.
ADVANTAGE:
1. Radiotherapy can be given.
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DISADVANTAGE:
1. Only one tube. So after blockage, tube has to be removed. So hamper in epithelialization.

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 Questions & Specimens
Q. What are the instruments required for ENT examination:
1. Light source
a. Head light
b. Chiron lamp with head mirror (Bull’s eye light source)
c. Torch light
2. Revolving chair,
3. Tongue depressor,
4. Posterior nasal space mirror,
5. Laryngeal mirror,
6. Thudicum nasal speculum,
7. Aural speculum,
8. Tuning fork.

Thyroid Gland
Q. Identify the specimen, how it is obtained and mention the identifying points.
Picture shows specimen of thyroid gland. It is obtained by total thyroidectomy.
IDENTIFYING POINTS:
1. ‘H’ shaped,
2. Two lobes connected by isthmus.

Q. What are the thyroid surgeries?

1. Hemithyroidectomy,
2. Lobectomy,
3. Subtotal thyroidectomy,
4. Near total thyroidectomy,
5. Total thyroidectomy,
6. Completion thyroidectomy.

Q. What are the indications of thyroid surgery?

1. Malignancy of thyroid gland,
2. Multinodular goiter,
3. Toxic thyroid after preparation in euthyroid stage,
4. Cosmetic purpose.

Q. What are the tests for thyroid swelling?

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Thyroid function tests:

1. Serum T3, T4, TSH
2. USG of thyroid gland
3. Thyroid scanning test – hot, cold
4. Radio-Iodine uptake test
5. X-ray neck lateral view
6. FNAC of the thyroid swelling
7. Histopathology of the operated mass.

- FNAC can be done in all cases except in follicular adenoma and follicular carcinoma – because they are in-
vestigated by cytology.

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Q. What are the complications of thyroid surgery?
1. Hemorrhage,
2. Hematoma,
3. Seroma,
4. Injury to the recurrent laryngeal nerve,
5. Hypothyroidism,
6. Hypoparathyroidism,
7. Thyroid storm/thyroid crisis,
8. Infection,
9. Wound gap/wound distance,
10. Hypertrophic/ugly scar.

Q. OTHER RELATED QUESTIONS:

Q. What are the midline swelling?
Q. What are the lateral to midline swelling?
Q. Goiter – Definition, classification.
Q. Classify – Thyroid swelling, thyroid neoplasm, thyroid malignancy.
Q. What are the investigations of thyroid swelling?
Q. What is the treatment of papillary carcinoma?

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 Thyroglossal Cyst

Mean age: 5.5 years.

Sex: Equal in both, some study shows male predominance.

Q. What are the clinical features and investigations of

thyroglossal cyst?
1. Painless lump in front of the neck,
2. Moves with deglutition,
3. Tongue sign positive,
4. Sometimes patient may present a painful lump.

INVESTIGATION:
1. FNAC
2. USG (confirmatory)

Q. What is the treatment of thyroglossal cyst?

Sistrunk’s operation under GA. It includes:
1. Excision of the cyst,
2. Excision of the duct,
3. Excision of the body of hyoid bone up to the core of tongue tissue.

RECURRENCE:
Chances of recurrence is very less, but recurs if there is any accessory duct.

Q. What are the complication of surgery:

1. Hemorrhage
2. Wound infection
3. Injury to the surrounding structures
4. Recurrence of disease

Q. OTHER RELATED QUESTIONS:

Define – Thyroglossal cyst, thyroglossal fistula.

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15
 Tonsillitis
Q. Identify the specimen.
Picture shows the specimen of palatine tonsil.
Q. How it is obtained?
By tonsillectomy operation.
Q. What are the identifying points?
1. Oval in shape,
2. Two surfaces – Lateral surface and medial surface,
3. Lateral surface contains crypts of tonsil,
4. Medical surface contains lining epithelium.

Q. What are the cardinal signs of chronic tonsillitis?

1. Both tonsils are enlarged or atrophied in size,
2. Anterior pillars are congested or red,
3. Inspisated pus comes out of the crypts of the tonsil when pressure given on anterior pillars. (The pus
without serum, it is found only from tonsil),
4. Jugulodigastric lymph nodes are enlarged or palpable but non tender.

Q. Why jugulodigastric lymph node?

1. They collect lymphatic drainage from palatine tonsil,
2. They are situated at the crossing point of internal jugular vein and posterior belly of digastric muscle,
3. It is situated ½ inch below and behind the angle of the mandible.

Q. What are the indications of tonsillectomy operation?

1. More than one attack of peritonsillarabscess – quinsy,
2. Chronic tonsillitis when medical treatment fails,
3. Recurrent attract of acute tonsillitis (3-4 attacks in a year for consecutive 2-3 years),
4. Hugely enlarged tonsil causing mechanical obstruction both in respiratory and food passage,
5. Unilateral enlargement of tonsil or ulcerated tonsil in case of suspected malignancy.
6. As a route
a. Glossopharyngeal neurectomy,
b. Removal of styloid process.
7. Focal lesion
a. Rheumatic fever,
b. Glomerulonephritis.
Q. What are the methods of tonsillectomy?
1. Guillotine method (obsoleted, atrophied tonsil is not suitable),
2. Dissection method or dissecting method,
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3. Cryo surgery (suitable for bleeding disorder patients, done by freezing under negative temperature),
4. Laser surgery,
5. Electrocauterization method,
6. Coblation method.

Q. What are the contraindications of tonsillectomy?

1. Bleeding disorder, eg. Hemophilia,
2. Acute tonsillitis or acute upper respiratory tract infection,
3. Endemic attack of poliomyelitis,
4. Hypertension,
5. Diabetes mellitus,
6. Status asthmaticus
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Q. What are the complications of tonsillectomy operation?
1. Hemorrhage.
2. Injury to the lip, uvula, posterior wall of pharynx, pillars.
3. Extraction of tooth.
4. Subluxation of the atlanto-occipital joint.
5. Acute suppurative otitis media.
6. Left tonsillar tissue in the tonsillar fossa – recurrence.

Q. What are the types of hemorrhage due to tonsillectomy operation?

1. Primary hemorrhage (during operation),
2. Reactionary hemorrhage (after completion of tonsillectomy till 24 hours),
3. Secondary hemorrhage (after 24 hours till healing)

Q. What are the cause of reactionary hemorrhage is tonsillectomy operation?

1. Failure of ligation,
2. Slipping of ligation,
3. Dislodgement of clot,
4. Vigorous cough,
5. Left tonsillar tissue,
6. Rise of blood pressure.

Q. What is tonsil?
Tonsils are subepithelial collection or aggregation of lymphoid tissue at the junction of upper aerodigestive
tract.
1. Nasopharyngeal tonsil,
2. Tubal tonsil,
3. Palatine tonsil (The tonsil),
4. Lingual tonsil.

Q. What are the difference between tonsil and lymph node?

Traits Tonsil Lymphoid tissue
Definition Subepithelial collection or aggregation Aggregation or collection of lymphoid
of lymphoid tissue at the junction of tissue anywhere in the body.
upper aerodigestive tract.
Capsule Absent or partially capsulated Encapsulated
Epithelial lining Present Absent
Crypts Present Absent
Histology Cannot be differentiated into cortex Can be differentiated into cortex and
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and medulla medulla

Afferent and efferent Efferent absent, afferent present Both present
channel
Growth chart Definite growth chart present No definite growth chart.

17
 Tympanic membrane
Q. Identify the specimen and what is your diagnosis?
Picture shows otoscopic view of magnified tympanic membrane.
DIAGNOSIS:
Central perforation.
Q. What are the parts of tympanic membrane?
1. Pars tensa and
2. Pars flaccid

Q. What are the causes of central perforation?

1. ASOM post perforative stage
2. TT variety of CSOM
3. Traumatic perforation (air or water pressure, explosion)

Q. What are the clinical features of central perfora-

tion?
Otorrhea, deafness, tinnitus, vertigo, headache, pain (not in CSOM).

Q. What is the treatment of central perforation?

1. Aural toileting
2. Topical eardrop containing antibiotic with steroid
3. Systemic antibiotic
4. Nasal decongestant
5. Avoidance of entry of water or nose blowing
6. Control of local and focal infection
7. Tympanoplasty

Q. What are the complications of treatment?

1. Injury to the chorda tympani nerve → Alteration of taste.
2. Facial nerve injury,
3. Perichondritis,
4. Wound gap,
5. Ugly scar.

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 X-Rays
Enlarged adenoid
Q. Identify the X-Ray.
Plain X-Ray soft tissue nasopharynx lateral view open mouth.
Q. Describe the findings.
Showing enlarged nasopharyngeal soft tissue
shadow narrowing the nasopharyngeal air column.
Q. What is your radiological diagnosis?
Moderately enlarged adenoid/adenoids.
Q. Mention 5 symptoms.
1. Nasal symptoms:
a. Bilateral nasal discharge,
b. Sinusitis → headache,
c. Rhinitis,
d. Anosmia.
2. Oral symptoms:
a. Mouth breathing,
b. Dry mouth,
c. Pharyngitis,
d. Tonsillitis,
e. Foul smelling breathing,
f. Dental caries,
g. Over crowding of upper incisor teeth,
h. High arched palate.
3. Aural symptoms:
a. Blockage of eustachian tube,
b. ASOM,
c. OME,
d. CSOM,
e. Hearing loss.
4. General symptoms:
a. Idiotic look,
b. Poor intelligence,
c. Adenoid facies.
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Q. What is the treatment of enlarged adenoids?

Possible treatment: Adenoidectomy under GA.
Q. What are the complications of adenoidectomy?
1. Hemorrhage,
2. Injury to the surrounding structure,
3. Temporomandibular joint dislocation/subluxation.

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 Maxillary sinusitis
Q. Identify the X-Ray.
Plain x-ray nose and paranasal sinuses occipitomental view.

Q. Describe the findings.

Showing haziness of the left maxillary antrum with
regular bony outline. Other sinuses are clear.

Q. What is your radiological diagnosis?

My radiological diagnosis is left sided maxillary sinusi-
tis.

Q. What are the differential diagnosis?

1. Antrochoanal polyp,
2. Antral cyst,
3. Thickened mucosa,
4. Hemoantrum (following any blow to the maxilla
e.g. RTA),
5. Sinonasal malignancy.

Q. What are the clinical features?

Headache, facial pain, nasal discharge, nasal obstruction, malaise, fever, body ache.

Q. What are the examination findings?

1. Exudates in the middle meatus,
2. Inflamed nasal mucosa,
3. Post nasal drip (trickling down of exudates through the posterior nasal space).

Q. What is the treatment of maxillary sinusitis? (principle of treatment)

1. Medical treatment
a. Antibiotic – tab. Ciprofloxacin 500 mg 12 hourly 7-10days (systemic broad spectrum antibi-
otic, usually second generation cephalosporin),
b. Antihistamine – tab. Chlorpheniramine maleate 4 mg 8 hourly 7-10 days,
c. Nasal decongestant – oxymetazoline or xylometazoline nasal drop 7-10 days,
d. Analgesic (if pain),
e. Steam inhalation.
2. Surgical treatment
a. Antral washout,
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b. Intranasal antrostomy,
c. Cald-Well LUC surgery,
d. FESS.

20
 Acute retropharyngeal abscess
Q. Identify the X-Ray.
Plain x-ray soft tissue neck lateral view.

Q. Describe the findings.

Showing hugely enlarged paravertebral soft tissue
shadow in the retropharyngeal space extending from the
skull base and merging with the chest; pushing the air col-
umn anteriorly with straightening of the cervical vertebral
column with no erosion or caries in the vertebral body.
There is no foreign body shadow within the paravertebral
soft tissue shadow.

Q. What is your radiological diagnosis?

My radiological diagnosis is acute retropharyngeal
abscess.

Q. What are the clinical features?

1. Dysphagia,
2. Stridor, croupy cough,
3. Torticollis,
4. Bulge in the posterior pharyngeal wall.

Q. What is the treatment of acute retropharyngeal abscess?

1. Incision and drainage per orally,
2. Systemic broad spectrum antibiotic,
3. Analgesic,
4. Diet: Soft and liquid diet.

Q. What is the site of incision and position of the patient?

1. Site of incision: Most bulging, fluctuating and dependent part without anesthesia by no. 15 BP blade.
2. Position of the patient: Supine with head end down

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21
 Cholesteatoma
Q. Identify the X-Ray.
Plain x-ray mastoids Towne’s view.

Q. Describe the findings.

Showing circular radiolucent area or a cavitary
lesion in the right mastoid region surrounded by
sclerosed bone and loss of normal honeycomb ap-
pearance.

Q. What is your radiological diagnosis?

So, my radiological diagnosis cholesteatoma in
the right mastoid or right sided cholesteatoma.

Q. What is the cause of cholesteatoma?

Atticoantral variety of CSOM.

Q. What is the treatment of cholestea-

toma?
Exploration of the mastoid by modified radical mastoidectomy.

Q. What are the types of mastoidectomy?

1. Simple/cortical/Schwartz operation,
2. Modified radical mastoidectomy,
3. Radical mastoidectomy.

Q. What are the complications of cholesteatoma?

1. Extracranial
a. Acute mastoiditis
b. Mastoid abscess
c. Facial nerve paralysis
d. Acute parotitis
e. Acute labyrinthitis
f. Lateral sinus thrombophlebitis
2. Intracranial
a. Extradural abscess
b. Subdural abscess
c. Meningitis
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d. Brain abscess
e. Otitic hydrocephalus

+ RELATED QUESTIONS

22
 Carcinoma esophagus
Q. Identify the X-Ray.
Contrast x-ray barium swallow esophagus.

Q. Describe the findings.

Showing proximal dilatation with irregular filling defect
(shouldering effect) ending in a rat tail appearance.

Q. What is your radiological diagnosis?

My radiological diagnosis is carcinoma middle third of
esophagus.

Q. How will you confirm your diagnosis?

By upper GIT endoscopic biopsy followed by histo-
pathological examination.

Q. What are the differential diagnosis?

1. Achalasia cardia
2. Benign stricture
3. Benign neoplasm

Q. What are the clinical features?

Rapidly progressing dysphagia (more in solid > liquid > absolute), anorexia, cachexia, anemia, retroster-
nal discomfort, cough, respiratory distress, hoarseness of voice.

Q. What are the risk factors of carcinoma esophagus?

1. Tobacco chewing and smoking
2. Alcohol
3. Hiatus hernia
4. Benign strictures
5. Cardiac achalasia
6. Diverticula
7. Plummer-Vinson syndrome

Q. What are the treatment modalities?

1. Surgery,
2. Chemotherapy and
3. Radiotherapy.
Rajib Biswas | www.badhahin.com

+ RELATED QUESTIONS

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 Achalasia cardia
Q. Identify the X-Ray.
Contrast X-ray barium swallow esophagus.

Q. Describe the findings.

Showing huge proximal dilatation and narrowing of the lower part looking like a pencil tip appearance.
The margin is regular.

Q. What is your radiological diagnosis?

My radiological diagnosis is achalasia cardia.

Q. What are the clinical features?

1. Rapidly progressive dysphagia (more in liquid than solid)
2. Sense of fullness
3. Vomiting
4. Dehydration

Q. How will you confirm your diagnosis?

Biopsy followed by histopathological examination showing absence of the ganglion cells in the myenteric
plexus.

Q. What is the treatment of achalasia cardia?

1. Surgical treatment
a. Cardiomyotomy or Heller’s operation.
b. Bougie dilatation or balloon dilatation
2. Medical treatment
a. Calcium channel blockers
b. Botulinum toxin

Rajib Biswas | www.badhahin.com

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 Audiogram

Conductive hearing loss:

1. Air conduction threshold increased and bone conduction threshold normal.
2. Air bone gap ≥ 10 dB.

Sensory hearing loss:

1. Both air and bone conduction threshold is increased,
2. Air and bone tracing are superimposed (or air bone gap < 10 dB)

Mixed:
1. Both air and bone conduction threshold increased,
3. Air bone gap ≥ 10 dB. Rajib Biswas | www.badhahin.com

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 Tympanogram

Causes of type B curve (B flat curve):

1. Otitis media with effusion,
2. Perforation of tympanic membrane due to
any cause – CSOM, traumatic rupture,
ASOM post perforation,
3. Thick tympanic membrane.

Causes of type C curve:

1. Eustachian tube blockage,
2. Retracted tympanic membrane,
3. Early stage of ASOM.

This note is primarily prepared by 1. Rajib Biswas 2. Md Mohiuddin 3. Nafis Rahman Purna 4. Md Ikbal Hossain 5. Nahid Badsha
Edition: 1.7
Be a contributor developing this note.
Send corrections or added topics at info@badhahin.com and find your name as a contributor on the next edition of this note.

Or, follow this link

Rajib Biswas | www.badhahin.com

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