■ 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

■ NOTES on inner ear :-
● Most cases of cochlear  sudden SNHL are idiopathic
● Secretory& intermittent OM & meniere's &Rupture of R.W membrane & wax cause fluctuant H.L  
● Presbycusis is the commonest cause of SNHL in adults
● Both gentamycin & streptomycin sulphate affect firstly vestibular labyrinth before cochlea 
● Meniere disease :
♧ it is common cause of peripheral labyrinthine vertigo
♧ SNHL is initailly reversible then become permenant
♧ In case of dead ear  : labyrinthectomy
♧ sterptomycin it represents a medical labyrinthectomy in toxic cases ( bilateral severe SNHL )
● both  Radiotherapy & electricity may cause CHL or SNHL
● in acoustic trauma the hearing loss max at 5500 hz , while chronic at 4000 hz 
● Acoustic neuroma :
♧ C/P : unilateral SNHL & tinnitus & Vertigo not marked
♧ The earliest neurological manifest is trigeminal
♧ MRI is the most accurate & most diagnostic

■ Tympanogram : -

● ossicular disruption : type Ad ( hypermoile)

● secretory OM : type B ( flat)

● adhesive OM : type C

● E T dysfunction : type C (-ve peak)

● otosclerosis : type As ( restricted curve

● oscillatory in glomus tumor

■ Notes on audiology :
● Poor speech discrimination in acoustic neuroma
●Acoustic ( stapedial) reflex is absent in case of facial paralysis & otosclerosis
● ABR measures electrical acitivity in cochlear nerve & brain stem &  used in detection  acoustic neuroma ( delayed wave V)
● OAEs is used for detection of cochlear pathology ( ototoxicitiy & noise exposure)
● hearing aids are using in case of :
♧ congeintal deafness as CAA
♧ Aquired deafness :
♤ CHL : when operation is CI or refused
♤ SNHL : cochlear otosclerosis , presbyacusis  
● PTA:
♧ it used for selection of hearing aids
♧ when you perform it , mask of non ear test to avoid cross transmission
♧ frequncy : 125 to 8000 Hz , while intensity from -10 to 120 dB
♧ CHL =  increases Ac threshold + normal BC = air bone gap
♧ SNHL = increase both AC & BC threshold ( no air bone gap) 
♧ Mixed = both AC & BC increased but more AC = air- bone gap   

■ NOTE :

● 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
في أكثر من حد بعت ايه أفضل مصدر لل MCQ يكون شامل كل حاجة سواء في الرمد أو ear
الرمد حل من كتاب د.وائل و لل ear حل من كتاب د.مسعد أو القسم

د. مسعد MCQs

By: @AUData_bot

■ NOTES on TTT of glucoma :-

● Both BBs & CAi & brimonidine act on decrease production of aqueous
● PG analogue & adrenaline act on increase outflow of aqueous
● Brimonidine is CI under the age of 2 years
● Acetazolamide is given in case of acute attack of glucoma with high IOP
● Never given BBs at bed time to avoid profound Hypotension
● Betaxolol is selective B blocker  & Increase ON blood flow
● PG consider as 1st line of TTT , while BB as a 2nd line , BB considers as 1st line if there is no CI
● Nerver give adrenaline locally for fear of closed angle glucoma 
● Mannitol is DOC in Acute closure glucoma , but CI in DM
● Trabeculectomy is DOC in case :
Congeintal glucoma , POAG , PACG 

■ Notes on 2ry glucoma :-
● Open angle :
♤Acute iridocyclitis , 2ry iridocyclitis (early non perforated corneal ulcer), Rubeosis iridies
♤ steriods , sublaxation of lens
♤ Hypopyon , hyphema
♤ DR , CRVO
♤ Phacolytic , phacoanaphylactic glucoma
♤ Pseudo- exfoliation, Pigmentry glucoma
● Closed angle :
♧ Ant. Staphyloma, Ant dislocation of lens , leucoma adherent
♧ Mydriate in narrow angle , maligant glucoma
♧ Occlusion , seclusion ( pupilae)
♧ Inversus , phacomorphic (glucoma), PAS
♧  End stage of NVG