Essential One-Liners in ENT: Key Facts, Diagnoses & Treatments

• LEMPERT's ENDAURAL INCISION (type 2) begins at the incisura terminalis. The Most common site of origin of cholesteatoma is Prusssack's space 
• The site of exit of chorda tympani from the middle ear is canal of Huguier 
• Cartilaginous part of EAC is in the lateral 1/3rd and the bony part is in medial 2/3rd 
• Tympanic isthmus present 6 mm lateral to Tympanic Membrane, FB and wax get impacted here and their removal becomes difficult 
• Donaldson's line is the surgical landmark for the endolymphatic sac. It is a horizontal semicircular canal that bisects the posterior semicircular canal 
• Trautmann's triangle: key area for entry to posterior cranial fossa 

Boundaries:

Superiorly: superior petrosal sinus 

Posteriorly: sigmoid sinus 

Anteriorly: solid angle 

• Most common site for hidden/residual cholesteatoma—Infrapyramidal recess 

Embryology of the Ear: 

• Pinna-mesoderm of 1st and 2nd arch st 
• EAC-1st brachial cleft · Middle pouch of 1st and 2nd arch 
• Malleus, 1st arch of mesoderm 
• Incus, stapes superstructure, 2nd arch of mesoderm 
• Stapes footplate-otic capsule 
• Rinne's +ve: AC > BC [normal/SNHL] 
• Rime's -ve: BC>AC [CHL & severe SNHL]

Also read: Chronic Suppurative Otitis Media (CSOM): Symptoms & Treatment

Weber's Test 

• Lateralized to worst ear (CHL) 
• Lateralized to better ear (SNHL) 
• High-frequency audiometry (>8000 HL) is done on patients taking ototoxic drugs. 
• MRI findings of acoustic neuroma: ICE Cream cone appearance 
• BERA findings of acoustic neuroma: delayed appearance of wave 5.

Pure Tone Audiometry 

• Down sloping SNHL-Presbyacusis 
• Upsloping SNHL–Meniere's disease 
• 4000 HZ dip in Both AC & BC curve—Boilers notch, seen in Noise-induced Hearing loss 
• 2000 Hz dip only in BC curve – Carhartz notch, seen in osteoscleroma 

Tympanometry Curves

• A – normal 
• As – otosclerosis 
• Ad – discontinuity of ossicles 
• B – fluid 
• C – ET dysfunction 
• Gold standard for diagnosis of Menier's disease: electrocardiography SP/AP >30%

Also read: Glomus Tumor - Types, Clinical Features, Diagnosis

Malignant Otitis Externa 

• IOC for early diagnosis–Tc99 bone scan 
• The duration of antibiotic treatment is decided based on Ga67 scan 
• Myringotomy in ASOM: Curvilinear on posterior inferior quadrant 
• Myringotomy in SOM: Radial on antero inferior quadrant 
• Levenson's criteria: for congenital cholesteatoma 
• Radiological findings in acute mastoiditis: Clouding of mastoid air cells 

Gradenigo Syndrome 

• Persistent ear discharge 
• Retro-orbital pain 
• Diplopia 
• Syndrome associated with otosclerosis : Vander Hove syndrome 

TM Findings

• Air bubble behind TM, seen through it – SOM 
• Whitish mass behind intact TM – congenital cholesteatoma 
• Multiple perforation in pars tensa of TM – tubercular otitis media 
• Flamingo pink appearance of TM – Schwartz sign, +ve in otosclerosis 
• Whitish patch over TM – tympanosclerosis

Glomus Tumor

• Clinical signs
  • Rising sun appearance 
  • Browns sign 
• Radiological sign
  • Phelp's sign seen in CT 
  • Salt and pepper appearance is seen in MRI with contrast 

Also read: Essential Pediatric One-Liners: Key Facts and Conditions

Fitzgerld's Caloric Test Uses Temperatures Of 30 Degrees Celsius And 44 Degrees Celsius. 

• Cold water—opposite side nystagmus 
• Warm water, same side nystagmus 
• Dunda's grant apparatus is used in cold air caloric test, which is done in perforated TM 
• False +ve fistula test – this sign is called Hennebert's sign seen in o Congenital syphilis
  • Meneire's disease 
  • Hypermobile footplate of stapes 
• Dix HALLPIKE's MANEUVERE—diagnosis of BPPV 
• EPLEY's MANEUVERE—treatment of BPPV 
• Incision 1 cm behind retro auricular-William wilde post-aural incision 
• Incision done at the bony. Cartilaginous junction in EAC – LEMPERT's type 1 
• Incision done at the bony. Cartilaginous junction in EAC extended to incisura terminalis in type 2 LEMPERTS

Rhinology 

• Mulberry appearance of turbininate-hypertrophic rhinitis
  • Strawberry-like fleshy mass—rhinosporidiosis 
  • Strawberry-like nasal mucosa—sarcoidosis 
  • Greenish foul-smelling nasal mucosa—atrophic rhinitis 
  • Woody hard nose – rhinoscleroma 
• Target sign is seen in traumatic CSF rhinorrhea 
• Septoplasty is done for deviations anterior and posterior to Cottle's line, but SMR is only for deviations posterior to Cottle's line. 

Surgeries 

• Partial turbinectomy—hypertrophic rhinitis 
• Lautenslager's operation—atrophic rhinitis 
• Caldwell Luc's – maxillary sinus 
• FESS – all sinuses 

Also read: How to Prepare ENT for FMGE

X-rays for Sinuses 

• Caldwell view—frontal sinus 
• Water view—maxillary sinus 
• Lateral view—sphenoid sinus

Nodules

• Apple jelly nodules – lupus vulgaris 
• Woody hard nodules – rhinoscleroma 
• Gumma's – syphilis 
• Mid facial destruction – T cell granuloma 

One-liners

• Facial fracture with CSF rhinorrhea—Lefort type 3 fracture 
• Most common site for traumatic CSF leak—cribriform plate of ethmoid 
• Diagnostic IOC for CSF leak—beta 2 transferrin 
• IOC for localizing the defect—CT scan 
• IOC to localize acute CSF leak—CT cisternography 
• Most common sinus to be affected in adults: maxillary sinus 
• Most common sinus to be affected in children: ethmoidal sinus 
• Least common sinus to be affected: sphenoid 
• Most common complication of sinusitis: orbital injury 
• Most common dreaded complication of FESS-ICA injury 
• Most common artery to bleed after FESS—sphenopalatine artery 
• Most common bacteria causing acute sinusitis: Streptococcus pneumonia 
• Most common bacteria causing chronic sinusitis – mixed infection 
• Most common cause of fungal ssinusitis is aspergillosis 
• Periodic headache is seen in frontal sinusitis 
• Kuhn's criteria is used for AFRS

Also read: Understanding Microbial Staining and Sterilization Methods

Throat

• Passavant's ridge is formed by the palatopharyngeus. The sinus of Morgagni lies between the base of the skull and the superior constrictor. 
• Luschka's tonsil is adenoid. 
• Gerlach tonsil is tubal tonsil 
• Ranula: Swelling in the floor of the mouth that arises from the sublingual Salivary gland , transillumination test +ve 
• Nasopharyngeal angiofibroma is Ttestosterone-ependent , Seen in young males, mean age – 14

Clinical features 

• Repeated episodes of epistaxis 
• Nasal obstruction 
• Bone erosion of the greater wing of sphenoid Treatment 
• Embolization and then surgical excision Absolute indications of tonsillectomy 
• OSA 
• CA of tonsil

• Anterior bowing of posterior wall of the maxillary sinus—Hollman Miller's sign 
• DODD's sign: Antrochoanal polyp 

Narrowing of Subglottic Airway: 

• Subglottic stenosis
  • If diameter <4mm in full-term 
  • <3 mm in preterm 
• Omega-shaped epiglottis – laryngomalacia 
• Stridor increases in crying (laryngomalacia, epiglottis) 
• Stridor decreases on crying – choanal atresia 
• KASHIMA's operation – done in bilateral RLN palsy, in which 1 arytenoid and 1/3rd of the vocal cord are removed
• Thyroplasty types
  • Medialization 
  • Lateralization 
  • Shortening 
  • Lengthening 
• Tracheostomy types
  • Between 2nd and 3rd trachea - mid tracheostomy 
  • Above 2nd – high tracheostomy 
  • Below 3rd – low tracheostomy 
  • Best management for inhaled FB in an infant – bronchoscopy 
• Most common complication of tracheostomy – surgical emphysema 

Also read: Important One-Liners in Ophthalmology

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