Hyperhidrosis

Hyperhidrosis or excessive sweating is believed to be secondary to over activity of the sympathetic nerves located in the chest cavity. Surgical treatment of hyperhidrosis involves interrupting the sympathetic nerves.
These nerves have 12 segments in the thoracic cavity from T1 to T12. This procedure is called endoscopic thoracic sympathectomy. In its different variations it is referred to as ETS, ETS-C, or ESB.
Sympathectomy is performed through small keyhole incisions in the underarm area under general anesthesia. The sympathetic nerves are then found in the thoracic cavity and are either cut, clamped or resected.
Sympathectomy can be achieved by various methods:
Sympathectomy by clamping or clipping (ETS-C / ESB)
In this method the sympathetic nerves are interrupted but not physically cut. This is accomplished by applying a titanium clip/clamp to the nerve. The pressure from the clamp interrupts the nerve signals through the sympathetic nerves. The sympathetic ganglia are not destroyed. The advantage of the method is the theoretical possibility of reconstructing the nerves in the future by removing the clamps.
Sympathectomy by cutting
In this method the sympathetic nerves are physically cut with scissors or electrocautery. The disadvantage of this method is that it is extremely difficult to reconstruct the sympathetic nerves in the future.
Sympathectomy by resecting the sympathetic nerves
Some surgeons prefer the removal of a segment of the sympathetic nerves. This method is effective in treating various forms of hyperhidrosis. However again it is extremely to reconstruct the sympathetic chain after this procedure.
The extent of sympathectomy
The extent or level of the endoscopic sympathetic blockade, ESB, varies according to the type of hyperhidrosis or facial blushing:
            Condition                         Level of ESB

            Facial Blushing                      T2
            Facial Sweating                T2 or T3
            Hand Sweating                 T3 or T4
            Underarm Sweating           T4 or T5

       

It is believed that by limiting the level of ESB to a specific segment of the sympathetic chain, compensatory sweating, the most common side effects of surgery, can be reduced.

Cystic Hygroma

A cystic hygroma is a growth that often occurs in the head and neck area. It is a birth defect.
Causes, incidence, and risk factors

A cystic hygroma occurs as the baby grows in the womb. It forms from pieces of material that carry fluid and white blood cells. This material is called embryonic lymphatic tissue.

After birth, a cystic hygroma usually looks like a soft bulge under the skin. The cyst may not be found at birth. It typically grows as the child grows. Sometimes it is not noticed until the child is older.
Symptoms

A common symptom is a neck growth. It may be found at birth, or discovered later in an infant after an upper respiratory tract infection.
Signs and tests

Sometimes, a cystic hygroma is seen when the baby is still in the womb using a pregnancy ultrasound. This can mean that the baby has a chromosomal problem or other birth defects.

The following tests may be done:

Chest x-ray

Ultrasound

CT scan

If the cystic hygroma is detected during a pregnancy ultrasound, other ultrasound tests or amniocentesis may be recommended.
Treatment

Treatment involves removing all of the abnormal tissue. However, cystic hygromas can often spread to other parts of the neck, making it impossible to remove all of the tissue.

Other treatments have been tried with only limited success. These include:

Chemotherapy medications

Injection of sclerosing medications

Radiation therapy

Steroids

Expectations (prognosis)

The outlook is good if surgery can totally remove the abnormal tissue. In cases where complete removal is not possible, the cystic hygroma commonly returns.

The outcome may also depend on what other chromosomal abnormalities or birth defects, if any, are present.
Complications

Complications may include:

Bleeding

Damage to structures in the neck caused by surgery

Infection

Return of the cystic hygroma

Mnemonics of ENT

Nasopharyngeal carcinoma: classic symptoms

NOSE:

Neck mass

Obstructed nasal passage

Serous otitis media externa

Epistaxis or discharge

Ear drops: direction to pull ear when instilling •For an grown UP it is UP.

• For a chilD it is Down.

SEQUELAE OF CSOM-

O-CART

Ossicular necrosis

Cholesterol granuloma

Atrophic tympanic membrane and atelactatic middle ear

Retraction pockets and cholesteatoma

Tympanosclerosis

D/D OF ACUTE TONSILLITIS

MADI LoVe MAT

M-membranous tosillitis

A-agranulocytosis

D-diphtheria

I-infectious mononucleosis

L-ludwig's angina

V-vincent's angina

M-malignancy

A-aphthous ulcer

T-tonsillar cleft

D/D of membrane over the tonsil

We Mainly Discuss At Length About Membrane In Tonsil

We - Vincent's angina

Mainly - Malignancy

Discuss - Diptheria

At - Agranulocytosis

Length - Leukemia

About - Apthous ulcers

Membrane - Membranous Tonsillitis

In - Infectious mononucleosis

Tonsil - Traumatic ulcer

indications of tympanoplasty-

ABCDES

A- age should be above 10yrs when sufficient resistance develops

B- benign (tubotympanic disease) can be corrected

C- conductive deafness can corrected

D- dry perforation gives best results

E- eustachian tube should be functioning properly

S- stapes should be mobile

Mneumonic dor D/D of membrane over tonsillitis:

M2-VIDAAL (form Widal test for Typhoid)

It is:

- Membranous tonsillitis

- Malignancy

- Vincent's angina

- Infectious mononucleosis

- Diptheria

- Apthous ulcers

- Agranulocytosis

- Ludwig's angina

Sequelae of Otitis media

SCALP COST

S-SNHL

C-Cholesteatoma

A-Atelectasis

L-Learning Disability

P-Perforation of TM

C-Conductive HL

O-Ossicular Necrosis

S-Speech Impairment

T-Tympanosclerosis

Treatment of atrophic rhinitis

(RAPE Young GirlS)

r-remove crust

a-antibiotic spray

pe-placental extact

s- supplement vit. A & D

y-youngs operation

g-glucose in glycerine

-girls-(femae more affected)

9 t's of otalgia

tonsil

tube( eustasian tube)

tics (glossopharyngeal)

trachea

thyroid

temporo mandibular joint

throat

tongue

teeth

(lower 4 are reffered causes)

Acute otitis media

Simple Harmonic Motion(SHM)
S-STRPTOCOCCUS PNEUM

H-H. INFLUENGE

M- M. CATARALLIS

Achalasia cardia- clinical features

DWRF-p

Dysphagia> more to liquid than solid (reverse seen in malignancy or stricture)

Weigit loss

Regurgitation of undigested food at ni8

retrosternal or epigastric Fullness after meals

pulmonary Symptoms due to repeated aspiration

ACHOO
A.......Autosomal dominant
C.......Compelling
H........Heli
O........Ophthalmic
O........Outburst

ACHOO ....This is a Autosomal dominant condition where patient involuntrily starts sneezing when he or she is exposed to brightlight and sunlight.




Clinical features of mumps
SOAP-
Salpingitis
Orchitis,Oophritis
Aseptic meningitis
Pancreatitis

Direction to which a ear should be pulled

PUL posterior upward laterally

FESS= INDICATIONS

"MERA FRCP"

M=MUCOCELE OF FRONTOETHMOID/SPHENOID SINUS

E=EPISTAXIS

R=RECURRENT ACUTE BAC. SINUSITIS

A= A C POLYP

F= FUNGAL SINUSITIS

R= REMOVAL OF FOREIGN BODY

C= CHRONIC BAC. SINUSITIS

P=POLYPOID RHINOSINUSITIS

G.E.R.D. diagnosis
24hour BEER
24 hour ambulatory ph monitoring
Bernstein's acid perforation test
Esophageal manometry
Endoscopy
Radionuclide study





Haemoptysis: causes
CAVITATES:
CHF
Airway disease, bronchiectasis
Vasculitis/ Vascular malformations
Infection (eg TB)
Trauma
Anticoagulation
Tumour
Embolism
Stomach




hypopharyngeal pouch




tom kidman cruise- old rated gossips.T of tom is for thyropharygeus,o of tom oblique fibres,k is for killian"s dehisense,c of cruise for cricopharyngeus.old people...da pouch. r of rated for regurgitation at nite,g of gossips for gurglin sound durin swallowin. calld da Boyce sign

Indications of cadwell luc

coffee board

c-chronic maxillary sinusitis

o-oroantral fistula

f-fungal sinusitis

f-foreign body of maxilla

e-ethmoidectomy

e-elevation of floor of orbit in orbital fracture

b-biopsy

o-opening of maxillary sinus for maxillary artery ligation

a-antrchoanal polyp

r-reduction of fracture maxilla

d-dental cyst

INTRA CRANIAL COMPLICATION OF OTITIS MEDIA

ESMOLol

E=EXTRADURAL ABSCESS

S=SUBDURAL ABSCESS

M=MENINGITIS

O=OTOGENIC BRAIN ABSCESS

L=LAT. SINUS THROMBOPHLEBITIS

LARYNX - ALL MUSCLES ACTIONS
A ridiculous story on this :)
{BIG CASE words r the clue}
an aircraft called ''larynx'' takes off wit ABhishek bachchan being the PILOT
[ABductors : Posterior cricoarytenoids] n inside the aircraft for the customers RELAXATION many TVs were put on [RELAX the vocal cords-->
T : Thyroarytenoids
V : Vocalis ] n as they watch the t v they see an AD on TRUE TENDER LOVE n CARE [ADductors-->
TRUE: TRansverse arytenoids
TENDER: Thyroarytenoids
LOVE: Lateral arytenoids
CARE: Cricothyroids ] but suddenly the situation gets TENSE wen they hear a CREAKY sound from outside [TENSE the cords-->
CREAKY: CRicothyroids] n there is an OPEN ANNOUNCEMENT to CLOSE ALL INLETS to the larynx (aircraft) as the TERRORISTS from outside were tryin to OPEN THE INLETS n intrude!
[OPEN: Oblique arytenoids
ANNOUNCEMENT: aryepiglotticus--> both CLOSE THE INLET OF larynx]
[TERRORISTS:Thyroepiglotticus--> OPEN THE INLET of larynx] !!!
n for the rest of story 'ABHISHEK HEIN NA' :)







LETs Sing a Poem (method of communication in laryngectomised patient)

L-lip peech
E-electrolarynx
T-transoral pneumatic device
(S)ing- blom-singer prothesis
(P)oem- panje prosthesis
-pen paper-writen language




nasal cycle is normally influenced by,
C-Climate
R-Respiration
E-Exercise
E-Emotions
P-Posture
E-Endocrine
D-Drugs

Causes of nasal septal perfortation

Lets Walk Through Another MRI

L= Lupus, Leprosy

W=Wegeners granulomatosis

T=Trauma

A=Abscess

M=Myiasis

R=Rhinolith

I=Idiopathic

Naso pharyngeal carcinoma(npc)
n -nitoso amine-salted fish
p-poly cyclic hydrocarbon-burning wood
c-vit c deficency diet
c-china -mc found in china




Direction of nasolacrimal:here is a really wonderful mnemonic 4 it....

LLB

L: Low=downwards

L: Laterally

B: backward





nso pharyngeal carcinoma (NPC)causeing trotters triad
NPC-trotters triad
N-neuralgia ipsilateral temporal(CN-5)
P-palatal paralysis(CN-x)
C-conductive deafeness

Order of paranasal sinuses

My maxillary

Extremely ethmoid

Sweet sphenoid

Friend frontal

HARD better after stapes surgery(selection of patient for stapes surgery)
H-hearing thresold 30 db or worse
A- air - bone gap 15 db
R-rinne negative for 256,512 Hz
D-discriminatoin speech score 60%
ref-dhigara 4th edn-p-88





Stapes surgery contraindication
COW TO MEN
C- young Children
O-Only hearing ear
W-Works in high construction,diving,air travels
T-Tympanic membrane perforation
O-Otitis externa
M-Meniers disease
E-Exostosis
N-works in Noisy surroundings

Symptoms of acute otitis media-

(A Full DPT Course)

A- autophony

Full- fullness sensation in ear

D- deafness

P- pain

T- tinnitus may be present

course- constitutional symptoms

Throat membrane
SUPER VCD (svcd)
s-streptococcus
v-Vincent angina
c-Candida(fungal)
d-diphtheria



types of thyroplasty:
I-medialization
II-lateralization
III-shortening
IV-lengthening

Men Like Short Lengths









TUNING FORK TESTS
THIS IS NOT EXACTLY A NEMONIC BUT A TRICK WHICH IS VERY USEFUL

WEBERS TEST IS LATERALISED TO WORSE SIDE IN CONDUCTIVE DEAFNESS-NO NEED TO MEMORISE IT-JUST CLOSE UR EAR FROM ONE SIDE N SPEAK OUT UR NAME,U WILL NEVER FORGET IT AGAIN.REVERSE IS TRUE FOR SNHL

causes of vertigo is to use the mnemonic AEIOU TIPS:

* A - alcohol

* E - epilepsy or exposure (heat stroke, hypothermia)

* I - insulin (diabetic emergency)

* O - overdose or oxygen deficiency (shortness of breath)

* U - uremia (toxins due to kidney failure)

* T - trauma (shock or head injury)

* I - infection

* P - psychosis or poisoning

* S – stroke

VERY SORRY TO GIRLS..............MY FATHER EAT BEAF N SOUP TO CEREMONIAL QUEEN"S PARTY....MNEMONICS

OTOTOXIC DRUGS MNEMONICS

VESTIBULOTOXIC........

VERY SORRY TO GIRLS

VE......VESTIBULOTOXIC

S.......STREPTOMYCIN

T ......TOBRAMICIN

G......GENTAMICIN

MY FATHER EAT BEAF N SOUP TO CEREMONIAL QUEEN"S PARTY.

M...........MARIJUANA,REST OF -micin drugs

F............FURASAMIDE

E..............ETHACRYNIC ACID

B ..........BUMATANIDE

N ....NITROGEN MUSTURD

S..............SALICYLATE

T.............TOBACCO

C...............CISPATIN,CO-POISONING

Q................QUININE

P................PROPANOLOL,PROPYLTHIOURACIL

Stridor may be-

1. Inspiratory (In case of LARYNX)

2. Biphasic (In case of TRACHEA)

3. Expiratory (In case of BRONCHI)

CHARGE SYNDROME
Coloboma
Heart defects
choanal Atresia
Retarded growth
Genital hypoplasia
Ear anomalies

Types of DNS (Deviated Nasal Septum)

'SCAN your nose'

• S -shaped deformity

• C -shaped deformity

• Anterior dislocation

• Nasal spur

Deviation may involve only the cartilage,bone or both. S -shaped deformity may cause bilateral nasal obstruction.

Recurrent laryngeal nerve injury

Recurrent laryngeal nerve injury can cause 'ABCD' (besides hoarsness of voice)

Aphonia

Bronchopneumonia (due to aspiration)

Cough (ineffective)

Dysphonia

Indications for Tonsillectomy

Tonsillectomy is indicated when a Tonsil 'HARMS'

Hypertrophy with hoarseness

Abscess (Peritonsillar - Quinsy)

Recurrent sore throat

Malignancy is suspected

Seizures (Febrile seizures due to Tonsillitis)

Otogenic Brain Abscess : stages



"INLET"

Stage of INvasion - headache, low grade fever, malaise and drowsiness
Stage of Localisation - formation of a capsule to localise the pus
Stage of Enlargment - zone of edema around the abscess, raised intracranial tension
Stage of Termination - ruptures into the ventricle or subarachnoid space

Tubercular otitis media : clinical features

5 P's

Painless ear discharge

Perforation

Profound hearing loss

Paralysis of face

Pale granulation

Rinne's test

NNN - Normally Rinne's test is Not Negative it's BACkwards test (Bone conduction better than Air Conduction)

Embryology of ear ossicles

Maleus and Incus forms from mesoderm of I arch

Stapes from Second arch.

Fluctuating hearing loss in . . .
"SPAM"
Syphilic labyrinthitis
Perilmph fistula
Autoimmune disorder of inner ear
Meniere's disease

Tonsils: Blood supply

'Love Father And Mother'

• Lingual artery

• Facial artery

• Ascending pharyngeal artery

• Maxillary artery

Little's area: Arteries

" LEGS "

• L - superior Labial artery

• E - anterior Ethmoidal artery

• G - Greater palatine artery

• S - Sphenopalatine artery

The four arteries anastamose at Little's area to form a vascular plexus called Kiesselbach's plexus.

Auditory Pathway

E.COLI-MA'

• Eighth nerve

• Cochlear nuclei

• Olivary complex

• Lateral lemniscus

• Inferior colliculus

• Medial geniculate body

• Auditory cortex

The area of cortex, concerned with hearing is Brodmann's area located in the Superior temporal gyrus.

Each ear is represented in both cerebral hemispheres.

Oropharyngeal cancers: aetiology

6 S's:
Smoking
Spicy food
Syphilis
Spirits [booze]
Sore tooth
Sepsis




causes of SNHL

1.Congenital
-Prenatal factors
-Paranatal factors

2.Acquired

Nakshatra Makes FANSI TOPS

Noise induced HL
Meniere's dz
Familial Prog HL
Ac. Neuroma
Noise Induce HL
Sudden HL
Infections
Trauma to labyrinth/ VIIITH nv
Ototoxic drugs
Presbyacusis
Systemic Dz.
5's' abSolute indications of tonsillectomy.
Sore throat (recurrent).
quinSy.
Suspected malignancy.
Seizure (febrile).
Speech affected due to hypertrophy of tonsil.



Menier's disease - symptoms

F..........fluctuating hearing loss
A ,.......aural fullness
T..........tinnitus
E..........episodic vertigo





skull fracture

tranSVerSe fracture - Seventh palsy Vertigo and Sensorineural hearing loss
lOngitudinal fracture - here O indicates OTORRHEA more common here...




TOWNE'S view is used to demonstrate-
"SIMLA"

Superior semicircular canal



Internal auditory meatus
Mastoid air cells









Laterl semicircular canal

Antrum




contraindications of stapedectomy-(I POD)
I-Infections in ext/middle ear
P-perforation should be closed first
O-only hearing ear is a contraindication
D-deafness (sensorineural)








COMPLICATIONS FOR CANAL WALL DOWN PROCEDURES
3 D's
Discharge
Deafness
Dizziness






Tumors of Cerebellopontine angle
' Angel GAMES'
• Acoustic neuroma (VIII th nerve tumor)
• Glomus tumor
• Arachnoid cyst
• Meningioma
• Epidermoid (cholesteatoma)
• Schwannoma of other Crainial nerves ( V, VII ,IX,X,XI)

Menier's disease

' VAST men'

• Vertigo

• Aural fullness

• Sensorineural hearing loss

• Tinnitus

In Meniere's disease/Endolymphatic hydrops the main pathology is distension of endolymphatic system due to increased volume of endolymph.Thus,there is distension of cochlear duct (scala media) and the saccule and to a lesser extent the utricle and semicircular canals.

Adductors of Vocal cord

Add TALC"

• Thyroarytenoid

• Transverse Arytenoid

• Lateral cricoarytenoid

• Cricothyroid

Think: Add TALC ie., Adductors are TALC.

Gradenigo's triad

"EAR"

• Ear discharge

• Abducens nerve palsy

• Retro-orbital pain (due to 5th nerve involvement)

Voice box: Components
"There are 3 Vs in your Voice box"


The structures as they appear in the sagittal section are
• Vestibular fold
• Ventricle
• Vocal fold