ENT Lecture Notes

Nose Anatomy

• Lateral Wall of Nose: Includes turbinates:
  • Inferior turbinate
  • Middle turbinate
  • Superior turbinate
• Meatus: Spaces below turbinates:
  • Inferior meatus
  • Middle meatus
  • Superior meatus
• Sphenoethmoidal Recess: Area above the superior turbinate.
• Concha: Bony part of the turbinate; inferior concha covered with mucosa becomes the inferior turbinate.

Nasal Drainage Structures

• Drainage into Meatuses:
  • Inferior Meatus: Nasolacrimal duct
  • Middle Meatus: Maxillary sinus, frontal sinus, anterior ethmoid sinus
  • Sphenoethmoidal Recess: Sphenoid sinus

Surgical Considerations

• DCR (Dacryocystorhinostomy): Surgical opening made in the middle meatus.
• Endoscopic Techniques: Commonly used in ENT.

Sinus Development

• Sequence of development: Maxillary
• First sign: Maxillary sinus
• Last to develop: Frontal sinus
• Sinus at Birth: Maxillary and ethmoid present.

Coanal Atresia

• Bilateral Complete Coanal Atresia: Neonatal airway emergency; leads to cyanosis upon crying.
• Management: McGovern technique (wide-bore nipple).

External Nose Structure

• Composition: Nasal bones (upper part), cartilages (lower part).
• Cartilage Types: Upper lateral, lower lateral, lesser alar (sesamoid) cartilages.

Trauma Management

• Nasal Fractures:
  • No swelling: Immediate closed reduction
  • Swelling: Wait for seven days before reduction.
• Common Complications: CSF rhinorrhea, often associated with skull fractures.

CSF Rhinorrhea

• Common Site: Cribriform plate.
• Diagnosis: Beta-2 transferrin assay.
• Management: Conservative treatment first, then surgery if necessary.

Foreign Body in Nose

• Child with Unilateral Foul Smelling Discharge: Indicative of foreign body (e.g., button battery).

Atrophic Rhinitis

• Characteristics: Nasal crusting and bad odor; anosmia is present.
• Management: Alkaline nasal douching; modified Young's operation for surgery.

Rhinoscleroma

• Three Stages:
  1. Trophic stage (similar to atrophic rhinitis)
  2. Granulomatous stage (hard external nose)
  3. Fibrotic stage.

Rhinosporidiosis

• Location: South India; linked with pond water.
• Appearance: Strawberry-like nasal mass.
• Management: Surgical removal and post-surgery dapsone treatment.

Larynx Anatomy

• Cartilages: Thyroid, cricoid, epiglottis, arytenoids.
• Vocal Cords: True and false vocal cords; lined by different epithelial types.
• Laryngeal Innervation:
  • Sensory: Internal branch of superior laryngeal nerve
  • Motor: Recurrent laryngeal nerve (exception: cricothyroid muscle).

Vocal Cord Pathology

• Vocal Nodules: Result from vocal abuse; treated with voice rest and therapy.
• Laryngeal Cancer Staging: T1 (single structure), T2 (more than one), T3 (fixed vocal cords), T4 (invasion).

Otology

• Otosclerosis: Conductive hearing loss with a characteristic notch in audiograms (Carhart's Notch).
• Meniere's Disease: Low frequency hearing loss, episodic vertigo, tinnitus.
• Audiometry: Key for diagnosing hearing loss types.

Diagnosis and Management Techniques

• BPPV: Diagnosed with Dix-Hallpike maneuver, treated with Epley's maneuver.
• Audiograms: Used to define hearing loss types and levels.
• Implants:
  1. Cochlear implants for profound SNHL.
  2. Auditory brainstem implants for certain conditions.
  3. Bone-anchored hearing aids (BAHA) for atresia or malformation.

Important Points for Exams

• Coanal Atresia Management: Immediate airway intervention is critical in neonates.
• Chronic Ear Infections: Be aware of complications like cholesteatoma and their management strategies.
• Keep in Mind: Various conditions related to the nasal cavity and their surgical or medicinal interventions.