صور مش موجودة في ملازم د زيد المراني ، عرضها وقت المحاضرات وبيجيب منها اسئلة ( وموجود منها اسئلة في اختبارات سابقة )

Functions of Eustachian tube
1. Equalize air pressure between middle ear and nasopharynx
2. Ventilation of middle ear
3. Drainage of secretion of middle ear
4. Protect the middle ear from nasopharyngeal secretion
5. Protect the middle ear from loud sounds

ال attic هذا اسم قديم وحاليا يسموه marginal وهو يعتمد على المكان الي حصل فيه perforation سواء ب pars tensa or pars flaccida

Most common causes of referred otalgia ?

- tonsilitis and tonsilectomy
- wisdom tooth
- TMJ dislocation

- why cone of light is present ?
=
a- make an angle with external auditory meatus 55 degree
b- facing antero-inferiory
c- concave toward the external auditory meatus and convex toward middle ear
this criteria of position make cone of light appears antero-inferiorly

- the change in position of cone of light indicate abnormal conditions like bulging which indicates pus accumulation behind TM or mass or retraction inward pulling of TM towards middle ear as in case of ET dysfunction.

in case of retracted TM the following changes occur in TM :
a- the handle of malleus retracted posteriorly so it is appears shorter
b- dilated blood vessels on periphey of TM and handle of malleus
c- prominent lateral process of malleus
d- absence cone of light or des-arrangement of light

🔰Basal Skull Fracture

▪︎Longitudinal ➡️ Conductive Hearing Loss

▪︎Transverse ➡️ Sensorineual Hearing loss

▪︎Facial Palsy ➡️ More In Transverse Fracture

🔴🔴 Tuning Fork Results 🔴🔴

🔹Sensorineual Deafness
•Rinne +Ve (AC>BC)
•Weber Lateralized to Healthy Ear (Contraleateral / Other Ear)


🔹Conductive Deafness
•Rinne -Ve (BC>AC)
•Weber Lateralized To Diseased Ear


🔹Normal
•Rinne +Ve (AC>BC)
•Weber in the Center


🔹Dead Ear
•Rinne -Ve (BC>AC)
•Weber Lateralized to Contralateral Ear (Healthy Ear)

- name the instrument ?
= otoscope or auroscope

- function of it ?
= detailed visualization of the tympanic membrane

- for which direction u pull the ear during the procedure in adult ?
= upwards and backwards

- for which direction u pull the ear during the procedure in children ?
= downwards and backwards

💛Nerves💛

Throat

👅Tongue:
🫧Sensory ->
🌸Ant 2/3
1. General sensation by lingual n. CN V3
2. Taste by corda tympani CN Vll
🌸Post 1/3
Both general & taste by CN lX glossopharyngeal
🌸Most posterior (near epiglottis)
Internal laryngeal n. CN X
🌸Circumvallate papilla
Taste by CN lX glossopharyngeal
🫧Motor ->
All by CN XII hypoglossal ex. Palatoglossus by CN X

👄Floor of mouth -> lingual n.
➖Hard palate -> Greater palatine + nasopalatine nerves.

🗣Pharynx:
🫧Motor ->
All m. from pharyngeal plexus CN X vagus except 2
- tensor palati by trigeminal n.
- stylopharyngeus by glossopharyngeal n.
🫧 Sensory ->
From pharyngeal plexus (glossopharyngeal) ex. hypopharynx from glossopharyngeal & vagus (mainly vagus)

🌟Note: pharyngeal plexus motor -> Vagus / sensory -> glossopharyngeal

🧶Tonsils:
Glossopharyngeal nerve (CN IX)

👤Larynx:
🫧Motor ->
- external br. of sup. laryngeal n. For cricothyroid m.
- recurrent laryngeal n. For other muscles
🫧Sensory ->
-Above vocal cords by internal br. of sup. Laryngeal n.
-Below vocal cords by recurrent laryngeal n.

Nose

👃🏻 Nose:
🫧Motor ->
1. Deep petrosal n. (sympathetics )
2. Greater superficial petrosal n. (parasympathetic)
Both form vidian nerve which gives
pterygopalatine ganglion that goes to nasal glands

🫧Sensory ->
1. General sensation -> Maxillary branch of trigeminal
2. Smell -> olfactory n.

Ear

👂🏻External ear ->
1. Greater Auricular n. (C2 & C3):
most of the med. surface of pinna & post. part of the lat. surface.
2. Lesser occipital n. ( C2):
upper part of med. surface.
3. Auriculotemporal n. (Trigeminal ):
tragus, crus of helix & the adjacent
part of the helix.
4. Facial n.:
small area of skin of post. wall of EAM
5. Auricular branch of vagus n. (Arnold’s N):
Post. part of the skin of EAM & drum

👂🏻Middle ear ->
6. Branch from Glossopharyngeal n.
(Jacobson n.):
Medial wall of the tympanic cavity through the tympanic plexus.

🦻Inner ear ->
Vestibulocochlear nerve (CN VIII)

❣Blood supply❣

Throat

Tongue:
❤️Arterial -> lingual a. Br of ECA supply tongue & floor of mouth
💙Venous -> lingual v.

Hard palate:
❤️Arterial -> Greater palatine artery
💙Venous -> Pterygoid plexus of veins

Pharynx:
❤️Arterial ->
1. Ascending pharyngeal from ECA
2. Ascending palatine + Tonsillar from Facial
3. Descending palatine from Maxillary
4. Dorsalis lingual from Lingual
💙Venous -> pharyngeal plexus to IJV

Tonsils:
❤️Arterial -> same as pharynx but The main blood supply to the tonsil comes from the tonsillar branch of the facial artery (حسب البنك)
💙 Venous -> Paratonsillar vein -> Pharyngeal plexus -> Jugular vein

Larynx
❤️Arterial ->
- supraglottic by Superior thyroid artery
- infraglottic by Inferior thyroid artery
💙Venous ->
- Superior laryngeal vein -> sup. Thyroid v. -> internal jugular
- Inferior laryngeal vein -> Brachiocephalic veins

Nose

Nose:
❤️Arterial ->
1- sphenopalatine artery (main artery)
2- greater palatine artery
3- superior labial artery
4- anterior ethmoidal artery
5- posterior ehmoidal artery

🌟1,2,3&4 -> Kiesselbachs plexus Little's area on area on ant. septum

💙Venous ->
- Ethmoidal v. -> ophthalmic v. -> cavernous sinus
- Sphenopalatine v. -> pterygoid plexus -> maxillary v.
• Woodruff's venous plexus : present on lat. wall near post. end of middle turbinate
• Retro columellar v. : behind columella

Ear

External Ear:
❤️Arterial ->
External carotid a. ➡️ Superficial temporal + Posterior auricular + Deep auricular + Occipital a.
💙Venous -> Superficial temporal, post. auricular, Occipital

Middle ear:
❤️Arterial ->
1. Anterior tympanic artery → from maxillary artery
2. Stylomastoid artery → from posterior auricular artery
3. Inferior tympanic artery → from ascending pharyngeal artery
4. Caroticotympanic arteries → from internal carotid artery
5. Petrosal branch of middle meningeal artery
💙Venous -> tympanic veins into Pterygoid plexus + Petrosal sinuses

Inner ear:
❤️Arterial -> Labyrinthine artery
💙Venous -> Labyrinthine veins into Petrosal/Sigmoid sinus

💚Lymphatic drainage💚

Throat

♻️Pharynx -> retro pharyngeal LN to deep cervical

♻️Tonsils -> Jugulodigastric LN

♻️Larynx ->
Above vocal cords to upper deep cervical LN
Below vocal cords to pre laryngeal & pre tracheal LN ➡️ lower deep cervical & mediastinal LN

🌟 Vocal cords have no lymphatic

💚Lymphatic drainage💚

Nose

♻️Nose:
- External nose & ant. nasal cavity -> submandibular LN
- remaining cavity -> upper deep cervical LN
- Nasal roof (dangerous area) -> subarachnoid space along olfactory n.
PNS -> retro pharyngeal JD node

Ear

♻️External ear ->
Preauricular + Posterior auricular + Upper deep cervical

♻️Middle ear ->
Retropharyngeal → Upper deep cervical

تلخيص ل
Nerves
Blood supply
Lymphatic
حق ال ENT كامل

⬆️⬆️⬆️

MC in larynx

📌most typical place of congenital Web is glottis at level of VF

📌mc cause of VF paralysis is peripherals vocal cord paralysis

📌acute Epiglottitis caused by hemophlus influenza b

📌singer nodule more in female

📌singer nodule usually at junction of anterior and middle third of VF

📌main line of ttt of singer nodule is speech therapy

📌VF poyp more in Male

📌main symptom of acute non specific laryngitis is horsness
And in child is stridor

📌the most critical procedure of chronic hypertrophic difuse laryngitis is elimination of pdf

📌the comon symptom of reinke Edema is horsness

📌scleroma caused by klebsiella rhinoscleroma

📌mc site of affection of scleroma is subglottis

📌main investigation of scleroma is histopathology

📌main ttt of scleroma is rifambcin or sterptomycin

📌main invx in TB laryngitis is
Bacteriological, xray chest

📌main invx in syphilis is serology

📌main ttt of Tb is anti tb drug

📌main ttt of syphilis is penicillin

📌syphilis affect mainly anterior and epiglotic

📌tb...affect posterior and interarytenoid

📌scleroma ....subglottic

📌syphilis caused by trepinema palladium

📌TB...mycobacteria tubercli

📌reinke Edema mostly in middle age men and women

📌acute Epiglottitis more common among infants and children

📌cancer more in old age 60..70 y

📌juvenile papillomatosis...children
5...15 y

📌juvenile papillomatosis   commonly affect vocal cord

📌mc site of malignant carcinoma is glottic

📌comenst histopathology of cancer is sq cell
.....

📌mc congenital disesof larynx is laryngromalacia
〰〰〰〰〰〰〰〰〰〰〰〰
يبقى
✅Glottis.....أشهر أماكن
1 Cancer
2.reinke edema
3.Congenital web

✅subglotis
Rhioscleroma.......
Subglottic stenosis
Subglotic hemangioma
#هام_ENT

♦مهم للمراجعة

⚡Schrimers Test:
In Facial nerve
-Test for lacrimation to investigate level of facial nerve paralysis

⚡Ramsay-Hunt syndrome:
( Herpes zoster oticus)
-viral infection of skin over auricle and EAC

⚡Sagging and positive reservoir sign :
Signs of acute mastoiditis

⚡Positive fistula sign :
Circumscribed labyrinthitis

⚡Gardenigo's Syndrome: 
(in pertrositis)
-Discharge
-Deep temporal and retro-orbital pain ( facial pain) (5th)
-Diplopia and Sequint(6th)

⚡Kernig's+Brudziniski sign:
Signs of meningitis
-Kernigs (patient in supine position with hip and knee flaxion= he can't do extension)
-Brudziniski ( flexion of the neck is accompanied with reflex flexion of hip and knee)

⚡Griesinger's Sign:
 (  in lateral sinus Thrombophlepitis)
-Tenderness and edema over mastoid

⚡Brown's Sign:
(In Glomus Tumor)
-The red color of Glomus tumor disappears on compression

⚡Paracusis Willissi:
In Otosclerosis
-better hearing in noisy environment

⚡Schwartz Sign:
In Otosclerosis
-Flamingo red tinge appear on TM
-increase vascularity over promontory
- Active stage Otosclerosis

⚡Carhart's notch:
In investigation of Otosclerosis
-Air bone gap with dip of bone conduction at 2000HZ

♦️triads in ENT

⓫Gradenigo’s Triad ➪Petrositis
- Discharging Ear
- Diplopia & Squint (6th n. affection)
- Facial Pain (5th n. affection) “also called Trigeminal Facial Pain”


⓫ Beck’s Triad ➸Para-Pharyngeal Abscess.

- Internal Swelling : swelling Lateral to the Tonsil & Pushing the Tonsil Medially
- External Swelling : Below & Behind the Angle of the Mandible deep to the Anterior Border of Sternomastoid
- Trismus.


⓫Trotter’s Triad ➸ Naso-Pharyngeal Carcinoma

- Uni-lateral Facial Pain (Trigeminal Nerve)
- Uni-lateral Palatal Immobility “due to Fixation of ms. & NOT to Nerve Paralysis”
- Uni-lateral Conductive Deafness


#ENT_clinical

ملزمة ear عملي للدكتورة سناء العريقي