■ Tympanogram : -

● ossicular disruption : type Ad ( hypermoile)

● secretory OM : type B

● adhesive OM : type C

● E T dysfunction : type C

● otosclerosis : type As ( restricted curve)

Affect last 4 cranial nerves : 9 , 10, 11 and / or 12

I say that again more & more
● hemotympanum is one of signs of transverese fracture
بمعنى لما يحصل الدم اللي جاي من ال inner ear بيتجمع ف middle ear وراء ear drum
Which mean the ear drum is intact
يعني مش هشوفها غير لما ادخل بالمنظار و هشوف ال blood وراءها
اعتقد كده وصلت و مش محتاجه يعني شرح .

■Notes on EOM :-
● The nearest EOM to macula is IO
● The nearest EOM to limbus is MR
● when you bring viusal axis to longitudunial axis to ms is called main action
● when the viusal axis is perpendicular to longitudinal axis of ms is called subsiadiary action
● MR is the largest & strongest ms in the eye
● So is the only depressor when the eye is adducted
● SR is the only elevator when the eye is abducted
● All EOM supplied by oculomotor nerve except ( SO by IV nerve , LR by VI nerve) 
● insertion of EOM :
*MR > 5.5 mm
* IR > 6.5 mm
*LR > 7mm
*SR > 7.7mm
From limbus
● Action of EOM :-
*SO & SR : intortion
* IO & IR : extortion
♧ Recti ms : Adduction except LR ( Abduction)
♧ oblique ms : Abduction
♧ SO & IR : depression
♧ IO & SR : elevation 

ده جدول مقارنة مهم لل types of squint

■ Notes on squint ( part 1 ) :

● the most important procedure in a child with unilateral squint is fundus examinaton
● Pseudo squint : two  visual axises are normal  , while true squint  the abnormal direction of visual axis of one or both eyes
■ Apparent squint :
♧ high mypia : angle alpha are -ve
♧ hypermetropia: angle alpha are + ve
♧ Angle alpha is b.t  visual axis & optical axis & it is normally + 5 degree & measured by ambyloscope
♧ corneal light reflex in the center of pupil
♧ TTT of cause such as epicanthus by skin re-distribution not Excision
■ Latent squint :-
● the most common cause is errors of refraction
● if not treated lead to manifest squint
● correct of errors of refraction is the most important step in ttt
● surgical TTT is done in case of large deviations
● examination :
♤ firstly the pt has no squint before & even after the examination but during the examination the pt has it
♤ Cover test is done to detect manifest squint in other eye
♧ un-cover test is done to detect latent squint in affected eye which mean the eye is cover
♧ Maddox Rod & maddox wing is done for dissociation of binocular vision for far object & near object respectively . 

■ NOTES on Squint : -

● Part 1 :
https://t.me/med_Notes2/108
● comparison between the types of squint :
https://t.me/med_Notes2/110

● Part 2 :
https://t.me/med_Notes2/112

● Part 3 :
https://t.me/med_Notes2/119
https://t.me/med_Notes2/126

● Cover & un cover test :
https://t.me/med_Notes2/117
https://t.me/med_Notes2/127

في حد عاوز يفهم جزء cover & un-cover test في درس latent squint
قبل ما اعمل test بشوف هل في ocular deviation و لا لأ ؟ عشان استبعد وجود manifest squint
طيب بغطي العين اللي فيها latent squint و بشوف هل العين الثانية فيها manifest squint و لا لأ يعني cover test detect manifest in other eye
طيب العين ال cover هشيله و بعد كده هيظهرلي أنه العين كان فيها latent squint لأنها عاوزه تعمل fixation to object ترجع لوضعها الطبيعي بمعنى
Un-cover test is detecting latent squint in affected eye which is cover

■ Notes :-
● Paralytic squint :
♧ it is the most serious type of squint
♧ Corneal light reflex is not at the centre of pupil
♧ Angle of deviation is variable in all directions of gaze
♧ All the manifestations are in the same direction of action of paralyzed ms EXCEPT squint itself
♧ False projection occur in the direction of action of paralyzed ms
♧ un-crossed squint diplopia occur with LR paralysis , while crossed with MR paralysis
♧ TTT of the cause in the 1st 6 months firstly
♧ paralytic squint with no diplopia :
* single eye , deep amblyopia , 3rd nerve palsy (unilateral marked ptosis) , young age

♧ 6th nerve palsy+ horner syndrome = cavernous sinus syndrome
♧ 3rd nerve palsy + dilated pupil + paralysis of accommodation = post.communicating aneurysm
♧ 3rd nerve palsy + spared accommodation + dilated pupil = DM & HTN
♧ AHP in case of EOM paralysis :
♤ MR & LR paralysis = face turn
♤ SR & IR prarlysis = chin elevation & depression
♤ SO& IO paralysis = head tilt

■ Note :-
● concomitant squint :-
♧ The most important cause  is errors of refraction ( excessive hypermetropia)
♧  Convergent squint ( esotropia ) is more common in children d.t strong MR
♧ the angle of deviation is constant in all directions of gaze
♧ Normal ocular motility
♧unilateral concomitant : ambylopia , while alternating there is no ambylopia
♧ there is no diplopia & face turn
●infantile esotropia :
♤ low hyperopia
♤  it Starts at age of 6 m
♤ it is not  caused by errors of refraction
♤Large angle of deviation
♤ Latent nystagmus
♤ Common ambylobia (30%)
♤ Cross fixation
♤ttt: Correct ambylobia + Early surgical ttt before age of 12 m (Bilateral MR recession)
● TTT of concomitant squint :- ( GOOS)
♧ Glasses : to improve VC
♧ occulsion : to correct amblyopia
♧ orthoptic exercise : to gain SBV
♧Surgery: to correct deviation 

■Cover & uncover test in concomitant squint :
If you cover the squint eye
مفيش حاجة هتحصل للعين السليمة اللي عاملها fixating
If you cover normal eye
العين اللي فيها squint تتحرك عشان تبقى fixating و العين السليمة تبقى squinting
* طيب لو شلت cover :
• العين ترجع لوضعها الطبيعي = unilateral squint
• أو العين تبقى زي ما هي fix هتبقى alternating squint

مساء الخير يا شباب كده أنا خلصت كل النوت على TBL و بكده آخر نوت هتكون في المديول ده و الفصل ده
دعواتكم لا تنسوني من صالح دعائكم
نلتقي مرة أخرى .

■ NOTE :-

● Glucoma :
https://t.me/med_Notes2/148
https://t.me/med_Notes2/149

● Eye lid :
https://t.me/med_Notes2/58

● Cornea :
https://t.me/med_Notes2/72

● Squint :
https://t.me/med_Notes2/114

● Key words for ear diseases :
https://t.me/med_Notes2/133?comment=122

● Middle ear diseases :
https://t.me/med_Notes2/95

● inner ear diseases :
https://t.me/med_Notes2/138

● Audiology :
https://t.me/med_Notes2/143
https://t.me/med_Notes2/139
https://t.me/med_Notes2/141

مساء الخير يا شباب في أكثر من حد بعت عاوز key words بتاعت شابتر ال ear
لأنه غالباً قسم ال ent بيحب يجيب الأسئلة ال mcq على شكل cases
بالنسبة لل mcq أحسن حاجة تحلوا من كتاب القسم و ممكن من كتاب دكتور مسعد

د. مسعد MCQs

By: @AUData_bot

مساء الخير يا شباب عارف الوقت ضيق على الكل و أنا اولكم بلاش خالص الصياح و العصبية رغم أنه ده مش هيفيد حد اعمل اللي عليك و بس و اترك النتيجة
بما أنه الوقت ضيق فاحسن حاجة تعملها ي أما تخصص يوم لل ear وبس أو تقسمها على الأيام ديي و ابدأ بال external ear بعدين inner ear بعده middle ear لأنه ذاكرناها قبل
لو الوقت أسعفني و قدرت ممكن انزل نوتس مهمة لل mcq بشكل general كنت نزلت قبل كده ع middle ear