OTORHINOLARYNGOLOGY

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EAR

OTORHINOLARYNGOLOGY

CONTENTS
EAR ................................................................................................................................................................................ 5
DEVELOPMENT OF EAR ............................................................................................................................................. 5
ANATOMY OF EAR ..................................................................................................................................................... 5
PHYSIOLOGY OF EAR ................................................................................................................................................. 8
TESTS FOR HEARING.................................................................................................................................................. 9
HEARING LOSS......................................................................................................................................................... 11
OTOTOXICITY .......................................................................................................................................................... 12
MANAGEMENT OF HEARING LOSS ......................................................................................................................... 12
ASSESSMENT OF COCHLEAR AND VESTIBULAR FUNCTION .................................................................................... 13
DISEASES OF EXTERNAL EAR ................................................................................................................................... 14
FEATURES OF MIDDLE EAR DISEASES ..................................................................................................................... 15
MANAGEMENT OF MIDDLE EAR DISEASES ............................................................................................................. 17
MENIERES DISEASE ................................................................................................................................................ 18
OTOSCLEROSIS ........................................................................................................................................................ 19
FACIAL NERVE ......................................................................................................................................................... 20
BELLS PALSY ........................................................................................................................................................... 22
RAMSAY HUNT SYNDROME .................................................................................................................................... 22
CEREBELLOPONTINE ANGLE TUMORS .................................................................................................................... 22
GLOMUS TUMOR .................................................................................................................................................... 23
PIERRE ROBBIN SYNDROME .................................................................................................................................... 23
NOSE ........................................................................................................................................................................... 24
GENERAL FEATURES OF NOSE ................................................................................................................................. 24
ANATOMY OF NOSE ................................................................................................................................................ 24
PHYSIOLOGY OF NOSE ............................................................................................................................................ 25
CHOANAL ATRESIA .................................................................................................................................................. 26
RHINOLALIA............................................................................................................................................................. 26
CSF RHINORRHOEA ................................................................................................................................................. 26
Does NOT cause CSF Rhinorrhoea .............................................................................................................................. 26
DEVIATED NASAL SEPTUM ...................................................................................................................................... 26
GRANULOMATOUS DISEASES OF NOSE .................................................................................................................. 27
ALLERGIC RHINITIS .................................................................................................................................................. 28
ATROPHIC RHINITIS ................................................................................................................................................. 28

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OTORHINOLARYNGOLOGY

HYPERTROPHIC RHINITIS......................................................................................................................................... 28
EPISTAXIS ................................................................................................................................................................ 29
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA ...................................................................................................... 29
NASOPHARYNGEAL CARCINOMA ............................................................................................................................ 30
NASAL POLYPOSIS ................................................................................................................................................... 31
FOREIGN BODY IN NOSE ......................................................................................................................................... 31
PARANASAL SINUSES .................................................................................................................................................. 32
DEVELOPMENT OF PARANASAL SINUSES ............................................................................................................... 32
ANATOMY OF PARANASAL SINUSES ....................................................................................................................... 32
PHYSIOLOGY OF PARANASAL SINUSES.................................................................................................................... 33
SINUSITIS ................................................................................................................................................................. 33
MANAGEMENT OF SINUSITIS .................................................................................................................................. 34
SINONASAL TUMORS .............................................................................................................................................. 35
PHARYNX ..................................................................................................................................................................... 35
DEVELOPMENT OF PHARYNX .................................................................................................................................. 35
ANATOMY OF PHARYNX ......................................................................................................................................... 35
ZENKERS DIVERTICULUM ....................................................................................................................................... 36
PLUMMER VINSON SYNDROME .............................................................................................................................. 37
HEAD AND NECK SPACE INFLAMMATION ............................................................................................................... 37
ADENOID HYPERTROPHY ........................................................................................................................................ 37
ANATOMY OF TONSILS............................................................................................................................................ 38
TONSILLITIS AND QUINSY ........................................................................................................................................ 38
MANAGEMENT OF TONSILLITIS .............................................................................................................................. 39
ORAL CAVITY ............................................................................................................................................................... 39
GENERAL FEATURES OF ORAL CAVITY .................................................................................................................... 39
RANULA ................................................................................................................................................................... 40
VINCENTS ANGINA ................................................................................................................................................. 40
LUDWINGS ANGINA ............................................................................................................................................... 40
ORAL LESIONS, ORAL CYST, SINUS AND FISTULA .................................................................................................... 40
MAXILLOFACIAL INJURIES ....................................................................................................................................... 41
ANATOMY OF SALIVARY GLANDS ........................................................................................................................... 41
DISEASES OF SALIVARY GLANDS ............................................................................................................................. 42
MANAGEMENT OF SALIVARY GLAND DISEASES ..................................................................................................... 43
ANATOMY OF TONGUE ........................................................................................................................................... 44
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OTORHINOLARYNGOLOGY

MALIGNANCY OF TONGUE ...................................................................................................................................... 45

ANATOMY OF PALATE ............................................................................................................................................. 45
MALIGNANCY OF PALATE........................................................................................................................................ 45
CARCINOMA LIP ...................................................................................................................................................... 46
CARCINOMA CHEEK ................................................................................................................................................ 46
FEATURES OF CARCINOMA ORAL CAVITY ............................................................................................................... 46
MANAGEMENT OF CARCINOMA ORAL CAVITY ....................................................................................................... 47
LARYNX........................................................................................................................................................................ 47
DEVELOPMENT OF LARYNX ..................................................................................................................................... 47
ANATOMY OF LARYNX ............................................................................................................................................ 47
PHYSIOLOGY OF LARYNX ......................................................................................................................................... 49
STRIDOR .................................................................................................................................................................. 49
LARYNGOCELE ......................................................................................................................................................... 50
LARYNGOMALACIA ................................................................................................................................................. 50
VOCAL NODULE ....................................................................................................................................................... 50
LARYNGOSCOPY ...................................................................................................................................................... 50
EPIGLOTTITIS ........................................................................................................................................................... 50
LARYNGITIS ............................................................................................................................................................. 51
VOCAL CORD PARALYSIS ......................................................................................................................................... 51
DISEASES OF SPEECH ............................................................................................................................................... 52
DISEASES OF LARYNX .............................................................................................................................................. 53
TUMORS OF LARYNX ............................................................................................................................................... 53
FEATURES OF CARCINOMA LARYNX ....................................................................................................................... 53
DIAGNOSIS OF CARCINOMA LARYNX ...................................................................................................................... 54
MANAGEMENT OF CARCINOMA LARYNX ............................................................................................................... 54
TRACHEOSTOMY ..................................................................................................................................................... 55

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OTORHINOLARYNGOLOGY

KEY TO THIS DOCUMENT

Text in normal font Must read point.
Asked in any previous medical entrance
examinations
Text in bold font Point from Harrisons
text book of internal medicine 18th
edition
Text in italic font Can be read if
you are thorough with above two.

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EAR

OTORHINOLARYNGOLOGY

EAR
DEVELOPMENT OF EAR
Development of ear

Inner ear is completely formed by

Periauricular sinus
Pinna develops from
External auditory canal develops from
Contains all 3 components of embryonic disc
Germ layers in Tympanic membrane
Malleus and incus are derived from
Handle of malleus is derived from
Foot plate of stapes derived from
Foot plate of stapes from
Neuroectodermal origin
Only bone developing from neural
ectoderm
Skeletal element of second brachial arch
Third window effect
Eustachian tube develops from
Korner septum is the remnant of
MC congenital dysplasia
Bone NOT present at birth
NOT formed at birth
Mastoid process starts developing in
Attains adult size before birth
NOT attain adult size at birth

Eustachian tube opens at the level of inferior turbinate,

Pinna develops from cleft of first arch, Growth of inner
th
ear completed by 4 months
25 weeks
Improper fusion of auricular tubercles
st
nd
1 and 2 pharyngeal arch
First branchial cleft
Tympanic membrane
All the three
First arch
Meckels cartilage
Reichet cartilage
Otic capsule
Annular ligament of stapes, foot plate of
stapes
Foot plate of stapes
Stapes
Dehiscent semicircular canal
st
nd
1 and 2 pharyngeal pouch
Petrosquamous fissure
Schielbes dysplasia
Petrosquamous
Mastoid Process
nd
2 year
Ear ossicles
Maxillary antrum, mastoid antrum, mastoid process,
orbit
Mandible, Parietal

NOT a pneumatic bone

ANATOMY OF EAR
Ear lobule is made up of
Skin over Pinna is fixed loosely on
Cartilage is absent in pinna
Calcification of Pinna
Ceruminous glands in the ear are
Major part of skin of pinna is supplied by
Sensory supply of external auditory meatus
Nerve arising by two roots that surround
middle meningeal artery
Nerve supply of pinna

Elastic cartilage
Medial side
Above tragus
Addison disease, Ochronosis, Frost bite, Gout
Modified apocrine glands
Greater auricular
Auriculotemporal nerve
Auriculotemporal nerve
Vagus, Auriculotemporal nerve, Greater auricular nerve,

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OTORHINOLARYNGOLOGY

Sensory supply of pinna by

Does NOT give sensory supply to pinna
Dehiscence of anterior wall of EACC cause infection in
parotid gland via
Fissure of Santorini
Foramen of Huschke
Tympanomeningeal fissure
Ear cough is due to irritation of
Arnold nerve
Alderman nerve is a branch of
Nerve supply to auricle and external canal
Sensory supply of external auditory meatus by
External ear is NOT supplied by
Pars flaccida of tympanic membrane is called as
Pars flaccida lies between
Cone of light is due to
Cone of light
Nerve supply of tympanic membrane
Inner and Medial surface of tympanic membrane
Nerve supply of tympanic membrane
NOT true about tympanic membrane
Tympanic cavity
Distance between tympanic membrane and medial wall
of middle ear at the level of center is
Distance of promontry from tympanic membrane
Aditus is closely related to
Prussak space situated in
NOT a component of epitympanum
Narrowest part of middle ear
Middle ear communicates anteriorly with
Tegmen seperates middle ear from middle cranial fossa
by
Roof of middle ear is formed by
Tegmen tympani is formed by
Floor of middle ear cavity is related to
Floor of middle ear is related to
Promontry seen in middle ear is
Medial wall of middle ear
NOT a content of tympanic cavity
Tympanic plexus is formed by
Tympanic plexus is present in
Tympanic plexus is present in

lesser occipital nerve

Mandibular nerve
Tympanic branch of glossopharyngeal nerve
Fissure of santorini
Seen in cartilaginous part, associated with
parotid and superior mastoid infection
Anteroinferior part of bony canal
Hyrtls fissure
Arnolds nerve
Auricular branch of vagus nerve
Auricular branch of vagus nerve
Arnolds nerve, Auriculotemporal nerve, Lesser Occipital
nerve
Auriculotemporal nerve
Glossopharyngeal nerve, greater occipital nerve,
auditory nerve
Shrapnells membrane
Two malleolar folds
Handle of malleus
Anteroinferior
Auriculotemporal
Tympanic branch of glossopharyngeal nerve (Jacobson
nerve)
Auriculotemporal nerve, auricular branch of vagus,
glossopharyngeal nerve
Healed perforation has three layers
Malleus, Stapedius, Chorda tympani
2mm
2 mm
Lateral semicircular canal, short process
of incus, facial nerve
Epitympanum
Foot plate of stapes
Mesotympanum
Pharynx
Roof of middle ear
Tegmen tympani
Both petrous and squamous part
Jugular bulb
Internal jugular vein
Basal turn of cochlea
Round window, Oval window, Promontry
Posterior auricular nerve
Tympanic branch of glossopharyngeal nerve
Medial projection of middle ear cavity >> petrous part
of temporal bone
Promontory of middle ear

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OTORHINOLARYNGOLOGY
Sensory nerve supply of middle ear cavity is produced
by
Stapes foot plate cover
Smallest muscle in the body
Stapedius
Smallest bone
Processus cochleariformis is attached to
Toynbee muscle
Tensor tympani is attached to
Tensor tympani is supplied by
Innervations of tensor tympani muscle
Anterior wall of tympanic cavity contain
Muscle originating from pyramid of middle ear
Stapedius is supplied by
Superior Malleolar ligament connects
Anterior malleolar fold
Structure inferior to Sphenopetrosal Synchondrosis
Length of adult Eustachian tube
Elastic cartilage found in
Eustachian tube
Eustachian tube opens into middle ear cavity at
Eustachian tube opens into nasopharynx
Pharyngeal opening of Eustachian tube in
infant is at the same level of
Pressure difference between Middle ear and Eustachian
tube producing Tympanic membrane rupture
Swallowing movements open to
Eustachian tube
Toynbee test is for
Facial recess
Boundaries of facial recess

Facial recess is bounded medially by

Spine of henle
Suprameatal triangle is the external marker of
Mac Ewan triangle is land mark for
Anatomical landmark for facial nerve
NOT a boundary of Mac Ewan triangle
Inner ear anatomy
Inner ear is present in
Number of ossification centres in bony
labyrinth
Stereocilia & Kinocilium are seen in
Arcurate eminence of petrous temporal bone is caused
by
Horizontal semicircular canal

Glossopharyngeal nerve
Oval window
Stapedius
Asymmetric bipennate muscle
Stapes
Tendon of Tensor tympani
Tensor tympani
Neck of malleus
Trigeminal nerve
Mandibular nerve
Tensor tympani muscle
Stapedius
Facial nerve
Head of Malleus to roof of Epitympanum
Longer than posterior
Cartilaginous part of Auditory tube
36 mm
Auditory tube
rd
Inner 2/3 cartilaginous, opens during swallowing,
tensor palati opens it, higher elastin content in adults
Anterior wall
1 cm behind posterior end of inferior
turbinate
Tympanic opening
100 mm Hg
Tensor palate
Eustachian tube dysfunction
Posterior wall of middle ear
Vertical portion of facial nerve, fossa
incudis, chorda tympani branch of facial
nerve
Vertical part of facial nerve
Cancellous bone
Mastoid antrum
Mastoid antrum
Mastoid antrum
Promontry
Vestibule is the central chamber
Petrous part of temporal bone
14
Inner ear
Superior semicircular canal
Lateral

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OTORHINOLARYNGOLOGY
Lateral semicircular canal is related to
Singular nerve
Crus commune
Crus communae is formed by
Modiolus (apex) is directed
Organ of corti situated in
Organ of corti is situated on
Reissners membrane
Cochlear aqueduct connects
Infection of CNS spreads in inner ear through
More potential route for transmission of meningitis
NOT a route of spread of infection from middle ear
Ductus reunions connect
Blood supply to inner ear derived from
Labyrinthine artery is a branch of
Base of skull fracture causes rupture of
NOT a feature of basal skull fracture
Length of internal auditory canal
Vertical crest in internal auditory canal
VIII cranial nerve
Nerve of pterygoid canal
Endolymph is secreted by
Endolymph is secreted by
Volume of endolymph
High in Endolymph
Increase in K+ levels in ECF (ECF resembling ICF)
Extracellular fluid having high potassium and low
sodium
Endolymph is absorbed by
Endolymph is seen in
Endolymphatic duct connects
Endolymphatic duct drains in to
Membranous labyrinth floats in
Perilymph is
Perilymph contains
Perilymph around Organ of Corti drains into
Perilymph communicates with Subarachnoid space
through

Medial and posterior semicircular canal

Inferior vestibular nerve supplying posterior
semicircular canal
Cochlea
Non ampullated parts of posterior and
superior semicircular canal
Anterolateral inferior
Scala media, basilar membrane
Basilar membrane
Scala vestibuli
Internal ear with subarachnoid space
Cochlear aqueduct
Cochlear aqueduct
Lymphatics
Cochlear duct with saccule
Anterior inferior cerebellar artery
Anterior inferior cerebellar artery
Anterior inferior cerebellar artery
Severe epistaxis
1 cm
Bills bar
Balance, Equilibrium
Vidian nerve
Stria vascularis
Secretory cells of stria vascularis of cochlea
150 ml
K+
Endolymph
Endolymph
Endolymphatic sac in subdural space
Scala media
Scala media to subdural space
Sacculus
Perilymph
Ultrafiltrate of blood
Na+
Subarachnoid space
Aqueduct of Cochlea

PHYSIOLOGY OF EAR
Father of Otoneurology
Unit of frequency of sound
Speech frequencies
Area of Adult Tympanic Membrane

William House
Hertz
500 Hz, 1000 Hz, 2000 Hz
90 mm2 (17:1), 55 mm2 (14:1 Functional)
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