Showing posts with label Otolaryngology. Show all posts
Showing posts with label Otolaryngology. Show all posts

Tuesday, February 9, 2021

Ear Syringing


REQUIREMENTS:   Water (temperature being as close to body temperature as possible), kidney tray, Simpson’s aural syringe/ 50 ml syringe attached to 16-18 gauze needle or pulsating water device, towel (if available)


  • Examine the ear. 

(Do not irrigate if there is: severe pain, recent trauma or surgery or a dry perforation of tympanic membrane, inability of patient to sit upright, organic foreign body in the ear, opening into mastoid, severe otitis externa, history of middle ear disease, ear surgery, inner ear problems [vertigo] or radiation in the area) 

  • Ask patient to sit upright. 

  • Hold the pinna backwards and upwards in adults and backwards in children to straighten the ear canal.

  • Keep a towel on the shoulder. 

  • Use a kidney dish to catch solution.

  • While irrigating direct the syringe towards the ear canal, postero-superiorly.  

  • Apply firm and constant pressure to the syringe.

  • Dry mop the ear and check it again to see if everything is out.  


Written by our guest author - Abhineet Desai

Illustration by Devi Bavishi












Monday, June 8, 2020


Hello Everybody!

Let us quickly review the different curves of a tympanogram. 

The following are the yypes of curves in you'll see on a tympanogram:

Type A – Normal pressure and normal compliance in normal ear.

Type As – Reduced compliance (‘s’ means stiffness leading to reduced compliance) and normal pressure.

  • Seen in
    • Otosclerosis or other ossicular fixation
    • Tympanosclerosis
Type Ad – Increased compliance (‘d’ means discontinuity leading to increased mobility) and normal pressure.
  • Seen in
    • Ossicular discontinuity
    • Thin and lax TM


Type B – Flat or dome shaped graph i.e. reduced compliance.

Seen in case of:Serous otitis media.

Thick tympanic membrane.

Type C – Normal compliance but negative pressure due to eustachian tube obstruction.

  • Seen in case of:
    • Retracted tympanic membrane,
    • Early stages before collection of fluid in middle ear.

Hope this was helpful. 

Let's Learn Together! 
Dr. Medha Vyas 

Sunday, November 17, 2019

Cardiovocal syndrome - Ortner syndrome

In 1897, Norbert Ortner described hoarseness caused by recurrent laryngeal nerve paralysis in patients with a large left atrium due to mitral valve stenosis.

Saturday, September 28, 2019

Quinsy Complication

This post is written by Sweta Senthil.
I don't know why she targeted me to make this mnemonic but it makes sense to remember the complication of Quinsy.

So mnemonic is "OJAS Pee"

Edema of larynx
Jugular Vein Thrombosis
Abscess of Lung/Pneumonitis
Septicemia, Spontaneous hemorrhage
Parapharyngeal Abscess

That's it!

Wednesday, March 13, 2019

Types of Sphenoid Sinues.

Hello Guy's!

Here's a sneak peek into the world of Neurosurgery!

In cases of Pituitary Adenomas, the general surgical approach is a TransNasal TransSphenoidal Approach for the excision of the lesion.

To know the type of sphenoid sinus is an important step in the pre-operative planning for the surgery. It also helps in estimating the site where we are most likely to encounter the tumor and the pituitary gland.

Hamburger classified 3 types of pneumatization based on its relationship to the sella turcica.

1)Conchal (rudimentary or absent sphenoid sinus)

2)Presellar (a posterior sphenoid sinus wall that is separated from sella by thick bone).

3)Sellar (a posterior sphenoid sinus wall that is adjacent to sella).

That's all for now... Time to Scrub.

Let's learn Together!

~Medha Vyas.

Saturday, November 17, 2018

Zebra series: Lemierre's syndrome

Hello everyone!

Let's talk about Lemierre's syndrome today.

Lemierre's syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal jugular vein after infection of the oropharynx. The predominant pathogen is a gram-negative anaerobic bacillus, Fusobacterium necrophorum.

That's the Zebra for the day!


Sunday, October 28, 2018

Facebook:ENT X-rays part - 1


Which is the last sinus to appear radiologically on X-ray?
1) Maxillary sinus
2) Ethmoid sinus
3) Sphenoid sinus
4) Frontal sinus

Answer with detail explanation through blog in 12 hours.

So, this post is regarding our Facebook page question on ENT X-rays.
Correct answer is Option 4- Frontal sinus.

Let's get into some details and all of them are potential one liner questions.

Order of development of Paranasal sinus is
Maxillary > Ethmoid > Sphenoid > Frontal

I remember this order with mnemonic - "MESs Food"

Maxillary sinus and (Anterior) Ethmoid sinus are present at birth.
Maxillary sinus appears at 4-5 months of age radiologically.
(Anterior) Ethmoid appears at 1 year of age radiologically.

Sphenoid sinus: Development start at 2nd or 3rd year after birth and continues till adulthood. Making it last sinus to complete development.
It appears radiologically after 4 year of birth.

Frontal sinus: Development starts after 4 year of birth and completed at 13-14 years of age.
It appears radiologically after 6 years of birth.

Happy learning :)

-That's all

-Demotional bloke.

Sunday, October 7, 2018

Question: Caloric test


Q) Caloric test was done on right side with cold water and eyes were moved to opposite side. Which of the following correspond to interpretation of nystagmus in this test?
1) Eyes moves slowly to right
2) Eyes moves slowly to left
3) ‎Eyes moves rapidly to left
4) ‎Eyes moves rapidly to right
Answer in 24 hours with explanation of Caloric test.

Wednesday, September 19, 2018

Question: Rhinoscleroma


Which of the following feature(s) of rhinoscleroma is/are true except:-
1) Atrophy of nasal mucosa
2) Caused by fungus
3) Treatment by antifungal drug
4) Caused by bacteria
5) Causative organism may be cultured from biopsy material

Answer in 24 hours!

So correct options are option 2 and option 3.

Rhinoscleroma is bacterial chronic granulomatous infection caused by Klebsiella rhinoscleromatis or Frisch bacillus.

Mode of transmission
Not unknown

Starts in the nose and extend upto naso-pharynx, larynx, trachea and bronchi.

Clinical features:

1) Atrophic stage:
Foul-smelling prurulent nasal discharge and crusting.

2) Granulomatous stage:
"Woody nose" feel is seen in lower part of nose and upper lip. Nodules are painless and non-ulcerative.

3) Cicatrical stage:
Distortion of upper lip, adhesion in the nose, nasopharynx and stenosis of subglottis.

 Presence of Mikulciz cells and Russell bodies 

1) Mikulicz cells: Macrophages containing central nuclues and vacuolated cytoplasm along with bacilli.

2) Russell bodies: Homogeneous eosinophilic inclusion bodies found in plasma cells.

Streptomycin and tetracycline given for 4-6 weeks and repeated.

Question: Rhinosporidiosis.

In rhinosporidiosis, the following is true:-
1) Fungal granuloma
2) Grayish mass
3) Surgery is the treatment
4) Radiotherapy is treatment
Answer in 24 hours!

Correct option is 3 - Surgery is the treatment.

Let's know more about rhinosporidiosis.
It is a chronic granulomatous disease caused by "Rhinosporidium seeberi" affecting both humans and animals. Earlier it was considered to be fungal in origin but now it is considered to be Aquatic protozoa.

Life cycle: It occurs in three stages.

1) Trophic stage: In this stage, the individual cell is called as trophocyte.
It has following features
-One chitinous wall
-Clear cytoplasm
-Nucleus along with nucleolus
Now trophocyte starts dividing and froms a colony. This colony is packed inside a sac called as "Sporangium". The trophocyte inside is called as "Endospores"

2) Sporangium stage:

Sporangium, unlike earlier stage is lined by two membranes
-Outer Chitinous
-Inner Cellulose layer

3) Endospore release:

The endospores present inside exerts pressure on the sporangium and this leads to rupture of the sporangium. Released endospores acts as trophocyte further.
Mode of transmission:
Water contaminated by diseased animals.

Clinical features:

Most common sites involved: Nose and nasopharynx.
Other sites like lips, palate etc can also get affected.
In nose it is present as - leafy, polypoidal mass, pink to purple in color.
Can extent upto soft palate.
Bleeds easily on touching. So, we can also see blood tinged discharge.

Diagnosis: Biopsy 


Complete excision with diathermy knife and cauterization of its base.

That's all
-Demotional bloke

Friday, June 8, 2018

MCQ Mnemonic Series: Apple jelly nodules


Apple jelly nodules on nasal septum are seen in :

A) Leprosy

B) Syphilis

C) Lupus vulgaris

D) Wegner’s granulomatosis


LLuPPus vulgaris
aPPLLe jelly nodules
{Luppal ~ Apple)

Dr. Shubham Patidar

Monday, February 5, 2018

Pearls on polyps

Hey everyone, this is my first blog! So I realised recently that Ear, Nose, Throat (or ENT for short) has a lot of theory so here's a short post on nasal polyps, for remembering this short, important but a little tedious topic. 

Antrochoanal and ethmoidal polyps are the commonly found types of polypoid growths found in the nasal cavity. They can be fleshy growth of tissue due to various causes, and usually leads to complaints of nasal obstruction and breathing difficulties. Here's a guide to remember the points of difference between the antrochoanal and ethmoidal polyps. For the following:

A - age 

A - aetiology

N - number

L - laterality

O - origin

G - growth

S - size and shape

R - recurrence

T - treatment 

The mnemonic is: "An Apple Never Lives On Green Shrubs (and) Red Trees" 

Interesting imagery, ain't it? 

So what are the differences between the two types of polyps based on these points? 

Age - antrochoanal polyps are found in children, whereas ethmoidal are found in adults. 

Aetiology - usually antrochoanal are having an infectious aetiology, whereas ethmoidal have allergic or other factors as cause for their origin. 

Number- only one antrochoanal polyp usually is present, whereas ethmoidal is usually multiple in number. 

Laterality - antrochoanal are unilateral, the other kind is bilateral mostly. 

Origin - Antrochoanal begins from the ostium of maxillary sinus but ethmoidal, as the name suggests, originates from the ethmoidal sinuses, uncinate process, middle turbinate and middle meatus. 

Growth - As the name suggests, this polyp grows behind towards the choana and hangs down behind the soft palate. The ethmoidal polyp, grows forward and may present at the nares. 

Size and shape - interestingly, antrochoanal polyps are trilobed with the three parts being antral, choanal and nasal. Ethmoidal are grape- like round masses. 

Recurrence - antrochoanal has lesser chance of recurrence as compared to ethmoidal polyps. 

Treatment - antrochoanal polyps are removed by polypectomy, endoscopic removal or Caldwell-Luc operation. Ethmoidal polyps are treated by ethmoidectomy, polypectomy or endoscopic surgery. 

I hope this has been helpful to you! Best of luck for your studies! 

Also, Fact Fatigue: Polyps growing in the ear, middle ear cavity ones, are never avulsed, because it's dangerous and could lead to damage to the branches of facial nerve passing through the walls of the middle ear.

This mnemonic was written by our Medical Student Guest Author, Devanshi Shah

Read more about MSGAI:

Friday, December 29, 2017

Nasotracheal intubation


This post is about the indications and contraindications of nasotracheal intubation.

1) Oral surgery
2) Fracture mandible
3) Inadequate mouth opening
4) Tube to be kept for longer time
5) Awake fibre-optic intubation

1) Fracture of base of skull (may directly enter inside skull)
2) CSF rhinorrhea (increases infection - meningitis)
3) Nasal mass (do not allow tube to pass)
4) Adenoids
5) Coagulopathy
6) Decreased movement of endotracheal tube
7) Nasal mucosal damage.

Thanks for reading.

Madhuri Reddy

Sunday, November 12, 2017

DD of white membrane over tonsil

DD of white membrane over tonsil -

M- Membranous tonsillitis
A - Aphthous ulcers
L -  Leukocytosis
A -  Agranulocytosis

V - Vincent Angina
I   - Infectious mononucleosis
T  - Traumatic ulcers

D- Diphtheria
C - Candidia infection

Thank you :)
~Pratheek Prabhu

Tuesday, October 3, 2017

Types of tympanic membrane perforation

Hello Awesomites ! :D

There are different types of perforation of tympanic membrane. We name it on the basis of :-
1. Size of perforation
2. Site of perforation

So, let us begin.

1. Pinhole :- 1-2 mm in size.
2. Small :- Area involving one quadrant or <10% of pars tensa.
3. Medium :- Area involving 2-3 quadrant or 10-40% of pars tensa.
4. Subtotal :- Area involving the pars tensa >75% and does not involve the annulus.
5. Total :- A total perforation is present in tympanic membrane. Tympanic membrane is essentially absent and involve annulus also. 

1. Anterior 


1.Central :- A simple perforation in pars tensa with intact annulus. 
                   Perforation is surrounded all around by pars tensa.
2. Marginal :- Perforation in the pars tensa surrounded partly by pars tensa and partly by bone.
3. Attic :- Perforation in pars flaccida.

I found this topic very confusing in my exams.
I hope it helped. :D

Have a great day ahead.
-Upasana Y. :) 

Friday, August 25, 2017

Treatment of streptococcal tonsillopharyngitis: Important points for USMLE


Here's a quick post of treatment of "strep throat" (my slang for "Tonsillopharyngitis due to Streptococcus pyogenes, also known as group A Streptococcus.")