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  1. Acute epiglottitis in children is caused by Haemophilus influenzae type B. It produces a typical "Thumb sign" on lateral X-ray film. Ampicillin was considered the drug of choice but now many organisms have become resistant to it and ceftriaxone is preferred.
  2. Acute fulminant fungal sinusitis is an invasive sinusitis and is commonly seen in diabetics, HIV infected patients and transplant patients receiving chemotherapy for immunosuppression. Therapy in such cases should be urgent, aggressive surgical debridement and amphotericin-B.
  3. Acute laryngotracheobronchitis or croup is a viral infection caused by parainfluenzae type 1, 2, and sometimes 3. Critical area involved is subglottic larynx producing oedema with stridor and respiratory distress. X-ray (P.A. view) larynx shows typical "steeple sign" but X-rays are avoided as any manipulation may precipitate acute obstruction. Adenocarcinoma of ethmoid is mostly seen in those exposed to wood-dust.
  4. Adenoid facies, seen in adenoid hyperplasia, consists of crowded teeth, high-arched palate and underdeveloped pinched nostrils.
  5. Ammonia is not used to test sense of smell as it stimulates fibres of trigeminal nerve supplying the nose and not the olfactory ones.
  6. Angio-oedema. Deficiency of C1 esterase inhibitor causes angio-oedema. Deficiency of this inhibitor causes increased production of C1 esterase. This leads to anaphylatoxins which cause capillary permeability and oedema. Deficiency of C1 esterase inhibitor is an inherited condition.
  7. Area of adult tympanic membrane is 90 mm2, of which only 55 mm2 is functional. Area of stapes footplate is 3.2 mm2. Area ratio (or hydraulic ratio) is 17:1. According to other workers, functional area is 45 mm2 and area ratio 14:1.
  8. Axis of ossicular rotation passes between anterior process of malleus to short process of incus.
  9. Battle's sign is ecchymosis over the mastoid seen in fractures of temporal bone.
  10. Bell's phenomenon is seen in lower motor neuron paralysis of CN VII. The eyeball turns up and out when trying to close the eye.
  11. Bill's island. It is a thin plate of bone left on sigmoid sinus when it is to be retracted during surgery. It should be differentiated from Bill's bar.
  12. Blue drum is seen in hemotympanum (due to temporal bone fracture), glue ear, glomus tumour or hemangioma of middle ear.
  13. Broyle's ligament. Small ligament which connects both vocal cords at the anterior commissure to the thyroid cartilage.
  14. Bryce's sign. Seen in laryngocele. When the swelling is pressed, a gurgling sound is produced.
  15. Carcinoma of nasopharynx is caused, among other factors, by Epstein-Barr virus. Most common site of origin is fossa of Rosenmüller (pharyngeal recess). Most common histological variety is squamous cell carcinoma, and radiotherapy is the treatment of choice.
  16. Carhart's notch is seen in otosclerosis. Bone conduction curve shows maximum loss at 2000 Hz.
  17. CHARGE syndrome consists of Coloboma, Heart defects, choanal Atresia, Retarded growth, Genital hypoplasia and Ear anomalies.
  18. Choanal atresia is more often unilateral, more common in females (2:1), more often on the right side and more often bony than membranous (9: 1).
  19. Cochlea is a coiled tube making 2.5 to 2.75 turns. When straightened it measures 32 mm.
  20. Costen's syndrome is abnorn1ality of temporomandibular joint due to defective bite. It is characterised by otalgia, feeling of blocked ear, tinnitus and sometimes vertigo. Pain also radiates to frontal, parietal and occipital region.
  21. Donaldson's line passes through horizontal canal and bisects the posterior canal. It is landmark for endolymphatic sac which lies anterior and inferior to it (Fig. 76.-+)
  22. Dysphagia lusoria is due to compression of oesophagus by subclavian artery. I t occurs when right subclavian artery arises from thoracic aorta and passes in front of or behind the oesophagus.
  23. Elastic fibrocartilage is seen in pinna, epiglottis, corniculate, cuneiform cartilages and apices of the arytenoid cartilages. It does not undergo calcification. Hyaline cartilage is seen in thyroid, cricoid, and greater part of arytenoid cartilages. It undergoes calcification.
  24. Endolymph is produced by cells of stria vascularis of the cochlea and dark cells of the vestibular labyrinth. It is absorbed by endolymphatic sac.
  25. Eustachian tube is 36 mm long, one-third is bony and two thirds cartilaginous. Normally, it remains closed. Opening of the tube is an active process due to contraction of Tensor veli palatini muscle while closure is passive due to recoil of the cartilage.
  26. Exostosis of external auditory canal are multiple and usually associated with cold water swimming while osteoma of external canal is usually single and occurs at suture lines, e.g. tympanomastoid.
  27. External auditory canal of an adult is 24 mm in length. Outer one-third (8 mm) is cartilaginous and inner two thirds (16 mm) are bony.
  28. Fluctuating hearing loss is seen in otitis media with effusion (serous otitis media), Meniere's disease, perilymph fistula and malingering.
  29. Fluctuating hearing loss. It is seen in Meniere's disease, perilymph fistula, autoimmune disorder of inner ear and syphilitic labyrinthitis.
  30. Frenzel manoeuvre. It is used to open the eustachian tube and ventilate the middle ear by contracting muscles of the floor of mouth and pharynx while nose, mouth and glottis are closed. It is a little more difficult to learn than Valsalva manoeuvre.
  31. Galen's anastomosis. It is anastomosis between superior and recurrent laryngeal nerves.
  32. Gelle's test compares intensity of bone-conducted tuning fork sound without and with raising pressure on the tympanic membrane with Siegel's speculum. Normally, Celle's test is positive because intensity of hearing decreases when air pressure is raised in external auditory canal. In ossicular fixation or ossicular discontinuity, increased air pressure makes no changes in the sound intensity. (Celle's negative).
  33. Gradenigo's syndrome consists of (i) ear discharge (suppurative otitis media), (ii) diplopia (CN VI paralysis), and (iii) retro-orbital pain (CN V) involvement. It is due to petrositis-a complication of otitis media.
  34. Griesinger's sign is oedema over the mastoid and is seen in lateral sinus thrombosis. It is due to thrombosis of mastoid emissary vein impeding venous drainage and thus causing oedema over the mastoid.
  35. Gutmann's pressure test. It is done in puberphonia. Pressing on the thyroid prominence in a backward and downward direction relaxes the over stretched vocal cords and thus low-pitched voice can be produced.
  36. Hennebert's phenomenon. Dysequilibrium following nose blowing or lifting a heavy object. Seen in perilymph fistula (do not confuse with Hennebert's sign).
  37. Hennebert's sign is a positive fistula sign in the absence of fistula. Seen in congenital syphilis due to excessively utricular adhesions to stapes. Also seen in some cases of Meniere's disease.
  38. Hidden areas of the larynx include infrahyoid epiglottis, anterior commissure, subglottis, ventricle and apex of pyriform fossa.
  39. Horner's syndrome consists of ptosis, miosis (constriction of pupil), anhidrosis and enophthalmos due to paralysis of cervical sympathetics.
  40. Hyrtle's fissure, also called tympano meningeal hiatus, it is an embryonic remnant that connects CSF space to middle ear just anterior and inferior to the round window. It runs parallel to cochlear aqueduct. It can be the source of congenital CSF otorrhoea or meningitis from middle ear infections. Normally it gets obliterated.
  41. In any case of unilateral otitis media with effusion in an adult, rule out nasopharyngeal pathology especially the carcinoma.
  42. In Fitzgerald-Hallpike (bithermal caloric) test, thermal stimulation occurs in the horizontal semicircular canal. Cold water (30°C) causes nystagmus to the opposite side while warm water (44°C) to the same side. Remember COWS (Cold-Opposite- Warm-Same).
  43. Inverted papilloma or Ringertz tumour arises from the lateral wall of nose. It is characterised by squamous or transitional cell epithelium with fibrovascular stroma. Inward growth of epithelium towards stroma lends the name of inverted papilloma to it. It is associated with squamous cell carcinoma in 10-15% of patients.
  44. Jugular foramen syndrome is paralysis of CN IX, X and XI. It is seen in carcinoma nasopharynx, glomus jugulare, large acoustic neuroma or thrombophlebitis of jugular bulb.
  45. Kallmann syndrome is anosmia and congenital hypogonadism.
  46. Kartagener's syndrome consists of recurrent sinusitis, bronchiectasis and situs inversus. Ciliary motility is disturbed. Electron microscope shows absence of dyenin side arms in A-tubules.
  47. Korner's septum, sometimes seen during mastoid surgery, is a bony plate separating superficial squamous cells from the deeper petrosal air cells. Antrum lies deep to it.
  48. Krause's nodes are lymph nodes situated in the jugular foramen. Enlargement of these nodes compresses on CN IX, X and XI, causing jugular foramen syndrome.
  49. Larynx has three important spaces: pre-epiglottic, paraglottic and Reinke's. The first two are important because they are invaded by carcinoma arising in the laryngeal mucosa. Reinke's space is often affected by oedema and causes polypoid degeneration of vocal cords.
  50. Lermoyez syndrome is a variant of Meniere's disease. Patient first gets hearing loss and tinnitus. An attack of vertigo follows and relieves tinnitus and improves hearing.
  51. Lever ratio between the handle of malleus and the long process of incus is 1.3: 1.
  52. Lhermitte's sign. A rare sign seen after radiation of cervical spine. Electrical current-like sensation is felt in both arms, dorsal spine and both legs on flexing the neck.
  53. Lyre sign. It is splaying apart of internal and external carotid arteries on angiogram in cases of carotid body tumour of the neck.
  54. Malleus and incus are derived from the first arch. Stapes develops from second arch except its footplate and annular ligament which are derived from the otic capsule.
  55. Marcus Gunn pupil. This is due to interruption of afferent papillary pathway due to retrobulbar neuritis or any other optic nerve disease. When light is put on the diseased side, the pupils of both sides remain dilated but when the light is put on the healthy side it constricts both the pupils. In the latter case pupil on diseased side constricts due to consensual reflex because the efferent pathway on diseased side is normal. It is an important sign during endoscopic sinus surgery for any injury to the optic nerve.
  56. Mastoid antrum lies 12-15 mm deep from. the surface of suprameatal triangle in an adult. The thickness of the bone overlying the antrum is only 2 mm at birth and then increases at the rate of 1 mm per year.
  57. Mastoid tip does not develop till 2 years; hence postaural incision to open the nustoid before this age needs to be modified to avoid injury to the facial nerve.
  58. Michel aplasia. There is total lack of development of inner ear. It can be confused radiologically with labyrinthine ossification and can be distinguished by MRI which may show membranous labyrinth in the latter.
  59. Modiolus is the central bony axis of cochlea and measures 5 mm in length.
  60. Most common organism responsible for acute bacterial sinusitis is Strep. pneumoniae followed by H. infiuellzae. Anaerobic and mixed infections are seen in sinusitis of dental origin.
  61. Most common organisms in acute otitis media are Streptococcus pneumoniae, H. infiuenzae and Moraxella catarrhalis in decreasing order.
  62. Most common site for epistaxis (90%) is Little's area situated on anteroinferior part of nasal septum.
  63. Most common site of involvement in stapedial otosclerosis is located at the anterior edge of oval window in the area of fissula ante fenestram.
  64. Mouse-nibbled appearance of vocal cords is caused by tuberculosis.
  65. Mucormycosis is acute invasive fungal infection involving nose and paranasal sinuses, where fungal hyphae invade blood vessels causing ischaemic necrosis. Commonly involves lateral nasal walls and turbinates and quickly spreads to orbit, palate, face and cranium .. Treatment is surgical debridement and amphotericin-B.
  66. Muller's manoeuvre. Used to find the level and degree of obstruction in sleep-disordered breathing. It is performed while using flexible nasopharyngoscope. First the examiner sees the upper airways at rest and then during the time when patient makes maximal inspiratory effort with nose and mouth closed. Base of tongue, lateral pharyngeal wall and palate are examined for collapsibility and then rated from 0 (minimal collapse) to 4+ (complete collapse).
  67. Multiple juvenile laryngeal papillomatosis is a benign condition caused by human papilloma virus subtype 6 & 11.Treatment of choice is repeated excision with CO2 laser. Malignant change is uncommon unless radiation has been used as a mode of treatment.
  68. Nearly 80% of carcinomas involving paranasal sinuses are squamous cell. Maxillary sinus is the most frequently involved sinus. Other sites in decreasing order are nasal cavity, ethmoid sinuses, frontal and sphenoid Sill liS.
  69. Necrotising otitis externa, also called malignant otitis externa, is caused by pseudomonas infection in an elderly patient with diabetes.
  70. Node of Rouviere is the most superior node of the lateral group of retropharyngeal nodes.
  71. Noise-induced hearing loss shows a dip at 4000 Hz in air conduction curve of audiogram.
  72. Non-invasive forms of fungal sinusitis are (i) fungal ball and (ii) fungal allergic sinusitis presenting with polyps. They do not require antifungal treatment.
  73. Numbness in the posterosuperior meatal wall (supplied by CN VII) is seen in acoustic neuroma and is called Hitzelberger sign.
  74. Ortner's syndrome is paralysis of recurrent laryngeal nerve and cardiomegaly.
  75. Otic capsule-the so-caHed bony labyrinth ossifies from 14 centres. Ossification starts at 16th week and ends by 20-21st week of gestation.
  76. Paralysis of stapedial muscle (supplied by CN VII) causes hyperacusis or phonophobia.
  77. Patients with cleft palate have eustachian tube dysfunction and develop persistent otitis media with effusion and recurrent acute otitis media.
  78. Posterior cricoarytenoid is the only abductor muscle of the larynx. It IS supplied by recurrent laryngeal nerve.
  79. Pouch of Luschka. During development, notochord is attached to the endoderm in the area of nasopharynx producing an invagination pouch. Persistence of this pouch causes Thornwaldt's cyst which may get infected to form an abscess.
  80. Preoperative open biopsy. It is not done in an angiofibroma of nasopharynx, glomus tumour of the middle ear, carotid body tumour of the neck and parapharyngeal tumours which appear to be benign.
  81. Prussak's space lies medial to pars flaccida, lateral to the neck of malleus and above the lateral process of malleus. Anteriorly, posteriorly and superiorly, it is bounded by lateral malleal ligament. Posteriorly, it also has a gap through which the space communicates with epitympanum.
  82. Psammoma bodies. Found in papillary carcinoma of thyroid gland.
  83. Recruitment is an abnormal growth in loudness and is seen in cochlear lesions.
  84. Rhinophyma is due to hypertrophy of sebaceous glands of nasal tip. It is associated with acne rosacea.
  85. Rhinoscleroma is caused by a gram-negative coccobacillus-Klebsiella rhilloscleromatis. The disease passes through three stages-catarrhal, granulomatous and cicatricial. It causes woody infiltration of the upper lip. Other areas involved are larynx (subglottic region) and trachea leading to airway obstruction. Mikulicz' cells and Russell bodies are characteristically seen on histology.
  86. Risk factors associated with laryngeal cancer are smoking, use of alcohol, gastro-oesophageal reflux, exposure to wood-dust, asbestos and volatile chemicals, nitrogen mustard and previous ionising radiation. Genetic susceptibility also plays a great role.
  87. Risk factors associated with nasal and paranasal sinus malignancy are: wood dust, nickel and chromium plating industries, isopropyl oil, volatile hydrocarbons and smoking.
  88. Samter's triad consists of nasal polypi, bronchial asthma and aspirin sensitivity.
  89. Schaumann's bodies. Seen in sarcoid granuloma.
  90. Schneiderian membrane (mucosa). It is another name for respiratory mucosa of nose and consists of pseudostratified ciliated columnar cells.
  91. Schwartz sign is a pink reflex, seen through intact tympanic membrane, in the area of oval window. It indicates active otosclerosis usually during pregnancy.
  92. Sinudural angle, also called Citelli's angle, is situated between the sigmoid sinus and middle fossa dura plate.
  93. Sluder's neuralgia. It is characterised by neuralgic pain in lower half of face with nasal congestion, rhinorrhea and increased lacrimation. It is due to neuralgia of sphenopalatine ganglion.
  94. Solid angle is the area where three bony semicircular canals meet.
  95. Structures of ear fully formed by birth are: middle ear, malleus, incus, stapes, labyrinth and the cochlea.
  96. Tone decay, also called auditory fatigue, is change in auditory threshold when a continuous tone is presented to the ear. It is seen in acoustic neuroma and other retrocochlear lesions.
  97. Trautmann's triangle is bounded by the bony labyrinth anteriorly, sigmoid sinus posteriorly and the dura or superior petrosal sinus superiorly (Fig. 76.4).
  98. Treatment of choice for antrochoanal polyp in a child is functional endoscopic sinus surgery (FESS) or intranasal polypecton'ly. Caldwell-Luc operation is avoided.
  99. Trotter's (or Sinus of Morgagni) syndrome or triad is seen in nasopharyngeal carcinoma which spreads laterally to involve the sinus of Morgagni involving in mandibular nerve. It is characterised by:
    (i) Conductive hearing loss (due to eustachian tube obstruction).
    (ii) Ipsilateral immobility of soft palate.
    (iii) Neuralgic pain in the distribution of V3
     Trismus and preauricular fullness may be associated with the above.
  100. Tullio phenomenon. Loud sound produces vertigo. It is seen in congenital syphilis or when three functioning windows are present in the ear e.g. fistula of semicircular canal, fenestration operation in the presence of mobile footplate of stapes.
  101. Turban epiglottis is due to oedema and infiltration of the epiglottis and is caused by laryngeal tuberculosis.
  102.  Lupus-a form of tuberculosis, on the other hand, eats away and destroys the epiglottis.
  103. Tympanic membrane develops f1:om all the three germinal layers: ectoderm (outer epithelial layer) mesoderm (middle fibrous layer) and endoderm (inner mucosal layer) .
  104. Vertical and anteroposterior dimensions of middle ear are 15 mm each while transverse dimension is 2 11'111'1 at mesotympanum, 6 mm above at the epitympanum and 4 mm below in the hypotympanum. Thus, middle ear is the narrowest between the umbo and promontory.
  105. Vocal nodules occur at the junction of anterior with middle third of vocal cords as this is the maximum vibratory area during speech.
  106. Wallenberg syndrome (posterior inferior cerebellar artery syndrome) is due to thrombosis of posterior inferior cerebellar artery causing ischaemia of lateral part of medulla. It is characterised by:
    (i) Vertigo, nausea and vomiting
    (ii) Horner's syndrome
    (iii) Dysphagia
    (iv) Dysphonia
    (v) Ataxia with tendency to fall to the involved side
    (vi) Loss of pain and temperature sensation on same side of face and contralateral side of limbs.
  107. Wrisberg's cartilage. Another name for cuneiform cartilage situated in aryepiglottic fold. It is fibroelastic cartilage and does not undergo calcification.
  108. Woodruff's plexus. It is a plexus of veins situated inferior to posterior end of inferior turbinate. It is a site of posterior epistaxis in adults.

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