Session Overview
1. Foreign Bodies & Emergencies
Disc Battery vs Coin
- Disc Battery: Emergency. Releases Alkali -> Perforation.
X-ray Sign: Double Ring Sign / Double Edge.
Rx: Urgent Rigid Bronchoscopy & Removal. - Coin: Single Edge.
2. Pharynx (Adenoid & Tonsil)
Adenoid Hypertrophy
- Clinical: Mouth breather, Adenoid Facies (Long face, Open mouth), Snoring.
Teeth: Crowding, High arch palate. - Glue Ear: Adenoid is the MC cause of Glue Ear (Secretory Otitis Media) in children.
Rx: Myringotomy with Grommet + Adenoidectomy.
Adenoidectomy
- Position: Rose Position (Neck Extension).
- Grisel Syndrome: "Grease on Chain"
Subluxation of Atlanto-Axial joint (C1-C2) due to overextension or infection.
Sx: Neck spasm/Torticollis post-op. Ix: MRI Neck. - Best Method: Coblation (Controlled Ablation). Less bleeding.
Tonsil & Infections
- Quinsy (Peritonsillar Abscess):
Triad: Trismus (Medial Pterygoid spasm), Hot Potato Voice, Uvula deviation to opposite side.
Note: No neck swelling (Neck swelling = Parapharyngeal Abscess). - Ludwig's Angina: Dental infection -> Chin swelling (Woody hard) + Trismus. Danger: Airway obstruction.
- Diphtheria: Bull Neck. Greyish-white membrane (Bleeds on removal). Extends beyond tonsil.
Tonsillectomy Hemorrhage
| Type | Time | Cause | Management |
|---|---|---|---|
| Primary | During surgery | - | Ligate vessel |
| Reactionary | Within 24 hrs | Slippage of Ligature (RE-actionary = RE-explore) | Start IV fluids -> Urgent Re-exploration |
| Secondary | 5-7 days | Sepsis (Eating Chips/Hard food) | Admit + IV Antibiotics |
3. Tumors of Nasopharynx
Juvenile Nasopharyngeal Angiofibroma (JNA)
- Patient: Adolescent Male (12-18y). Testosterone dependent.
- Symptoms: Profuse, Recurrent Epistaxis + Nasal Mass. Frog Face deformity.
- Pathology: Blood vessels LACK muscular coat -> Cannot contract -> Profuse bleeding.
- Diagnosis: Biopsy is CONTRAINDICATED. IOC: CECT.
Sign: Holman Miller Sign (Antral Sign) - Posterior wall of maxilla pushed forward. - Staging: Fisch Staging.
Nasopharyngeal Carcinoma (NPC)
- Patient: Chinese/Mongoloid race. Adult (50-70y).
- Etiology: EBV (Epstein Barr Virus).
- Site: Fossa of Rosenmuller (Above Eustachian tube).
- Clinical:
1. Metastatic Cervical Lymphadenopathy (MC presentation).
2. Unilateral Glu Ear (Adult). - Trotter's Triad (NPC):
Neuralgia (V nerve - pain)
Palatal Paralysis (X nerve)
Conductive Deafness (Glue ear) - Treatment: Radiotherapy (Chemo-radiation).
4. Nose & Paranasal Sinuses
Rhinosporidiosis
- Mnemonic: "SSS"
South India (Tamil Nadu)
Sea/Pond water (Bathing)
Studded/Strawberry Mass (Bleeding polyp). - Rx: Excision + Dapsone ("Rhino rides D").
CSF Rhinorrhea
- Site: Cribriform Plate (MC).
- Traumatic: Blood mixed CSF.
Signs: Target Sign / Halo Sign (on filter paper). - Confirm: Beta-2 Transferrin (Specific).
- Management: Conservative (Head elevation, Stool softeners). Surgery if fails.
Miscellaneous Nose
- Rhinoscleroma: Woody Hard Nose (North India). Micro: Mikulicz cells, Russell bodies.
- Atrophic Rhinitis (Ozaena): Crusts, Foul smell, Merciful Anosmia (Patient can't smell it). Rx: Young's Op.
- Choanal Atresia: Blue baby turns Pink on crying. Emergency. Rx: McGovern technique (Nipple).
- Pott's Puffy Tumor: "Popet" (Not a tumor). It is Osteomyelitis of Frontal Bone -> Subperiosteal abscess.
- X-rays:
Water's View: Drink Water (Chin touches plate). Best for Maxillary Sinus.
Caldwell View: Look in Well (Forehead touches plate). Best for Frontal/Ethmoid.
5. Larynx & Stridor
Anatomy & Cysts
- Cricoid: Only complete ring in airway.
- Vocal Cord Epithelium: Stratified Squamous (White color).
- Laryngocele: Trumpet blowers/Glass blowers. Air filled sac.
Sign: Bryce Sign (Gurgling sound on compression). - Reinke's Edema: Bilateral swelling.
Mnemonic: "S for Smoking, S for Stripping" (Treatment).
Pediatric Stridor
| Condition | Site | Sign/Symptom | X-ray |
|---|---|---|---|
| Laryngomalacia | Supraglottis | Inspiratory Stridor. Better in prone. | Omega Epiglottis |
| Acute Epiglottitis | Supraglottis | Drooling, Tripod pos, Toxic. | Thumb Sign |
| Croup (Laryngotracheitis) | Subglottis | Barking Cough, Biphasic Stridor. | Steeple Sign |
Vocal Cord Palsy & Thyroid Surgery
- Unilateral RLN Palsy: Cord in Median/Paramedian. Voice change.
- Bilateral RLN Palsy: Both cords Median. AIRWAY EMERGENCY immediately after extubation. Rx: Tracheostomy -> Later Type 2 Thyroplasty.
- SLN Palsy: Loss of high pitch (Singer's problem). Aspiration.
Thyroplasty Types
- Type 1 (MAD): Medialization (Adductor palsy).
- Type 2 (LAB): Lateralization (Abductor palsy).
- Type 3: Shortening (Relaxation). For Puberphonia (Male with high pitch).
Note: Puberphonia Rx: Gutsman Maneuver ("Have guts, man"). - Type 4: Tightening (Androphonia).
6. Ear & Audiometry
Audiograms & Tests
- Carhart's Notch: Dip at 2000Hz (Bone Conduction). Seen in Otosclerosis.
- Boiler's Notch (Acoustic Dip): Dip at 4000Hz. Noise Induced Hearing Loss.
- Presbycusis: Down-sloping curve (High freq loss). Bilateral.
- Meniere's: Low frequency loss (Rising curve).
- BERA Waves (E.COLI):
I: Eighth nerve (Distal)
II: Eighth nerve (Proximal)
III: Cochlear Nucleus
IV: Olivary Complex (Superior)
V: Lateral Lemniscus
VI: Inferior Colliculus
Clinical Signs
- Griesinger's Sign: Edema over mastoid (Lateral Sinus Thrombosis).
- Schwartze Sign: Flamingo Pink blush on promontory (Active Otosclerosis).
- Rising Sun Sign: Glomus Tumor (Red mass behind TM). Also Brown Sign (Pulsation stops on pressure) and Phelp's Sign (Bone erosion).
- Hennebert's Sign: False positive fistula sign (Syphilis/Meniere's).