Section 1 : Basic Sciences

1. Anatomy and Physiology of ear 1Temporal Bone 2

� Anatomy of External Ear 2 Auricle 2; External Auditory Canal 4; Tympanic Membrane 5; Middle Ear Anatomy 6; Parts of Middle Ear (Tympanum) 6; Boundaries of Middle Ear 7; Ossicles 8; Intratympanic Muscles 9; Intratympanic Nerves 9; Middle Ear Mucosa 9; Compartments and Folds of Middle Ear 9; Mastoid Antrum 11; Types of Mastoid 11; Korner’s Septum 11; Blood Supply 13; Lymphatic Drainage of Ear 13

� Anatomy of Internal Ear 13Bony Labyrinth 13; Membranous Labyrinth 15; Inner Ear Fluids 16; Organ of Corti 16; Vestibular Receptors 16; Blood Supply of Labyrinth 19; Internal Auditory Canal 19

� Development of Ear 19 � central connections (Neural pathways) 20

Auditory Neural Pathways 20; Central Vestibular Connections 21; Physiology of Hearing 22; Conduction of Sound 22; Transduction of Mechanical Energy to Electrical Impulses 23; Medial Geniculate Body and Temporal Lobe Auditory Cortex 25

� physiology of Vestibular System 25Semicircular Canals Functions 25; Utricle and Saccule Functions 26

� Maintenance of Body Equilibrium 26

2. Anatomy and Physiology of Nose and Paranasal Sinuses 29 � Anatomy of Nose 30

External Nose 30; Internal Nose 30; Anatomy of Paranasal Sinuses 37 � physiology of Nose 39

Respiration 39; Air-Conditioning of Inspired Air 40; Protection of Airway 40; Vocal Resonance 41; Nasal Reflexes 41; Olfaction 41

� physiology of paranasal Sinuses 41Functions 41; Ventilation of Sinuses 42

3. Anatomy and Physiology of Oral Cavity, Pharynx and esophagus 43 � oral cavity 44 � Salivary Glands 46 � pharynx 49

Waldeyer’s Ring 51 � Nasopharynx 51

Adenoids 52 � oropharynx 52

Palatine (Faucial) Tonsils 53 � Laryngopharynx 56 � Esophagus 56 � physiology of Swallowing 58 � Embryology 58

4. Anatomy and Physiology of Larynx and Tracheobronchial Tree 61 � Anatomy of Larynx 61

Cartilages 61; Joints 62; Membranes and Ligaments 62; Cavity of the Larynx 63; Mucous Membrane of the

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Larynx 64; Lymphatic Drainage 64; Spaces of the Larynx 64; Functional Divisions of Vocal Folds 65; Phase Difference 65; Muscles of Larynx 65; Nerve Supply of Larynx 66; Development 67

� functions of Larynx 68Protection of Lower Airways 68; Phonation and Speech 68; Respiration 68; Fixation of Chest 68

� Anatomy of Tracheobronchial Tree 68Trachea and Bronchi 68; Tracheal Cartilages 68; Mucosa 69; Bronchopulmonary Segments 69

5. Anatomy of Neck 72Surface Anatomy 72; Triangles of Neck 73; Cervical Fascia 74; Lymph Nodes of Head and Neck 75; Neck Dissection 78; Thyroid Gland 78; Parathyroid Glands 79; Development 79

6. Bacteria and Antibiotics 80 � Bacteria 81

Staphylococci 81; Streptococci 83; Corynebacterium Diphtheriae 83; Neisseria Species 84; Morexella Catarrhalis 84; Haemophilus Influenzae 84; Bordetella Pertussis 84; Pseudomonas Aeruginosa 84; Enterobacteriaceae 84; Anaerobes 84; Microaerophilic Bacteria 84; Mycobacteria 84; Mycoplasma Pneumoniae 85; Chlamydiae 85; Spirochaetes 85

� Antibiotics 85Inhibitors of Bacterial Cell Wall Synthesis (Beta-Lactam Antibiotics) 86; Inhibitors of Nucleic Acid Synthesis 88; Inhibitors of Bacterial Protein Synthesis (Ribosomal) 88; Antitubercular Drugs 89; Nonspecific Antiseptics 90

7. Fungi and Viruses 92 � fungi 93 � Antifungal Therapy 93 � Viruses 94 � Antivirals 95

Pandemic Influenza A H1N1 (Swine Flu) 96

8. Human immunodeficiency Virus infection 101 HIV/AIDS 101; Cervical Adenopathy 104; Neoplasms 104; Nose and Sinuses 105; Nasopharynx 105; Ear 105; Oral Cavity 105; Occupational Exposure 106

9. History and examination 107Otorhinolaryngology 107; History Taking 108; Physical Examination 108; General Set-Up 109; Swellings and Ulcers 109; Examination of Cranial Nerves 115; Headache 115; Facial Pain 120; Temporomandibular (Craniomandibular) Disorders 121

Section 2 : ear

10. Otologic Symptoms and examination 125 � Ear Symptoms 125 � Ear Examination 125 � otalgia (Earache) 128 � otorrhea 130

Assessment 131 � Ear polyp 132 � Tinnitus 132 � Hyperacusis 135

11. Hearing evaluation 137Audiology and Acoustics 138; Types of Hearing Loss 139; Need of Hearing Evaluation 139; Methods of Hearing Evaluation 139; Tuning Fork Tests 140; Pure Tone Audiometry 142; Speech Audiometry 143; Impedance Audiometry 144; Electrocochleography 145; Brainstem Evoked Response Audiometry 146; Otoacoustic Emissions 146; Auditory Steady State Response (ASSR) 147

12. Conductive Hearing Loss and Otosclerosis 149Classification of Hearing Loss 149; Conductive Hearing Loss 149; Otosclerosis 150; Stapedectomy 153

13. Sensorineural Hearing Loss 156Sensorineural Hearing Loss 157; Labyrinthitis 158; Syphilis 158; Cisplatin 160; Aminoglycoside Antibiotics 160; Noise Trauma 160; Sudden Sensorineural Hearing Loss 161; Presbycusis 162; Genetic Sensorineural Hearing Loss 163; Non-Organic Hearing Loss 163; Degree of Hearing Loss 164; The Only Hearing Ear 165

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14. Hearing impairment in infants and Young Children 166Etiology 167; Clinical Features 168; High-Risk Registry 168; Universal Newborn Hearing Screening (UNHS) 168; Evaluation of Universal Newborn Hearing Screening Refer Infants 169; Other Hearing Tests 170; Treatment 171; Rehabilitative Measures 171

15. Hearing Aids and Cochlear implants 173Training 173; Hearing Aids 174; Assistive Devices 177; Implantable Hearing Aids 177; Cochlear Implants 178; Auditory Brainstem Implant 182

16. Diseases of external ear and Tympanic Membrane 183 � Disorders of Auricle 183

Congenital Disorders 183; Traumatic Disorders 185; Erysipelas 186; Perichondritis and Chondritis 186; Chondrodermatitis Nodu-laris Chronica Helicis 186; Relapsing Polychondritis 186

� Disorders of External Auditory canal 187Congenital Disorders of External Auditory Canal 187; Trauma of External Auditory Canal 187; Foreign Bodies of Ear 187; Ear Maggots 187; Otitis Externa 187; Otomycosis 189; Furunculosis 189; Keratosis Obturans 189; Ear Wax 190; Ear Syringing 190; Herpes Zoster Oticus-Ramsay Hunt Syndrome (Varicellazoster Virus) 191; Bullous Otitis Externa and Myringitis 191

� Disorders of Tympanic Membrane 191Granular Myringitis 191; Malignant or Necrotizing Otitis Externa 191; Retracted Tympanic Membrane 191; Tympanosclerosis 192; Perforation of Tympanic Membrane 192; Traumatic Rupture of Tympanic Membrane 192

17. Disorders of eustachian Tube 194Anatomy 194; Physiology 196; Examination of Eustachian Tube 196; Tests for Eustachian Tube Function 197; Obstruction of Eustachian Tube 198; Patulous Eustachian Tube 199

18. Acute Otitis Media and Otitis Media with effusion 200 � Acute otitis Media 201

Etiopathology 201; Clinical Features 201; Diagnosis 202; Treatment 202; Recurrent Acute Otitis Media 203; Acute Necrotising Otitis Media 204

� otitis Media with Effusion 204Etiology 204; Clinical Features 204; Diagnosis 204; Treatment 205; Sequelae and Complications 205; Aero Otitis Media (Otitic Barotrauma) 205

19. Chronic Suppurative Otitis Media and Cholesteatoma 207Mastoid Pneumatization 207; Atelectasis and Adhesive Otitis Media 208; Chronic Suppurative Otitis Media 208; Atticoantral CSOM or Chronic OM with Cholesteatoma 210; Tubotympanic CSOM or Chronic OM without Cholesteatoma 214

20. Complications of Suppurative Otitis Media 216Factors Influencing Development of Complications 217; Pathways of Spread 217; Acute Mastoiditis 218; Masked (Latent) Mastoiditis 219; Extratemporal Complications (Abscesses) 219; Petrositis or Petrous Apicitis 220; Facial Nerve Paralysis 221; Labyrinthitis 221; Extradural (Epidural) Abscess 221; Subdural Abscess or Empyema 221; Meningitis 222; Otogenic Brain Abscess 223; Lateral Sinus Thrombophlebitis 224; Otitic Hydrocephalus 225

21. evaluation of Dizzy Patient 227Evaluation–General Outline 228; Description of Dizziness 228; Onset, Duration and Progression 230; Provoking Factors 230; Associated Symptoms 231; Personal, Family and Past History 231; Spontaneous Nystagmus 231; Dynamic Ocular Examination 232; Fistula Test 232; Valsalva Maneuver 233; Dix-Hallpike Maneuver 233; Optokinetic Test 234; Rotation Tests 234; Caloric Test 234; Tandem Walking 235; Romberg’s Test 235; Cerebellar Tests 235; Hyperventilation 235; Orthostatic Hypoten-sion 235; Special Vestibular Investigations 235; Differences between Central and Peripheral Vertigo 235

22. Peripheral Vestibular Disorders 237Benign Paroxysmal Positional Vertigo 237; Acute Vestibular Neuritis 239; Ménière’s Disease (Idiopathic Endolymphatic Hydrops) 241; Delayed Endolymphatic Hydrops 244; Recurrent Vestibulopathy 244; Middle Ear Effusion 244; Labyrinthine Fistula 244; Serous Labyrinthitis 245; Suppurative (Purulent) Labyrinthitis 245; Perilymphatic Fistula 245

23. Central Vestibular Disorders 248Migraine 248; Vertebrobasilar Insufficiency 250; Subclavian Steal Syndrome 250; Wallenberg’s Syndrome 250; Cerebellar Infarction 251; Cerebellar Hemorrhage 251; Multiple Sclerosis 251; Motion Sickness 252; Phobic Postural Vertigo 253; Hyperventilation 253; Agoraphobia 253; Cervical Vertigo or Whiplash Vertigo 253

24. Facial Nerve Disorders 255Pertinent Anatomy 255; Surgical Landmarks 257; Clinical Evaluation of Facial Palsy 258; Pathophysiology of Nerve Injury 258; Sunderland Classification 258; Differences between Upper and Lower Motor Neuron Palsy 259; Investigations 259; Causes of Facial Nerve Paralysis 261; Sequelae/Complication of Facial Nerve Palsy 261; Bell’s Palsy 262; Recurrent Facial

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Palsy 263; Melkersson’s Syndrome 263; Ramsay Hunt Syndrome or Herpes Zoster Oticus (Varicella-Zoster Virus) 263; Temporal Bone Fracture 263; Lyme Disease (Bannwarth’s Syndrome) 265; Sarcoidosis 265; Mobius Syndrome 265; Iatrogenic or Surgical Trauma 265; Hyperkinetic Disorders of Facial Nerve 266; Surgical Treatment of Facial Nerve Palsy 266

25. Tumors of the ear and Cerebellopontine Angle 268Benign Tumors of External Ear 268; Malignant Tumors of External Ear 269; Tumors of Middle Ear and Mastoid 270; Internal Auditory Canal and Cerebellopontine Angle 273

Section 3 : Nose and Paranasal Sinuses

26. Nasal Symptoms and examination 279 � History Taking 279 � Examination 280

External Nose 280; Vestibule 280; Anterior Rhinoscopy (Examination of Nasal Cavity) 281; Posterior Rhinoscopy 284; Patency of Nasal Cavities 284; Sense of Smell 284; Paranasal Sinuses 284

� Special Investigations of Nasal complaints 285Smell 285; Measurement of Mucociliary Flow 286; Nasal Obstruction 286; Nasal Valves Disorders 287; Radiological Imaging 288; Diagnostic Antrum Puncture 288; Allergic Tests 288

27. Diseases of external Nose and epistaxis 289 � Diseases of External Nose 289

Infections 289; Deformities of External Nose 290; Tumors of External Nose 291 � Epistaxis 293

Pertinent Anatomy 293; Causes 293; Evaluation 293; Sites of Epistaxis 294; Investigations 294; Treatment 294

28. infectious Rhinosinusitis 298Classification 298; Viral Rhinosinusitis (Common Cold) 299; Pandemic Influenza A H1N1 (Swine Flu) 299; Acute Bacterial Rhinosinusitis 299; Chronic Rhinosinusitis 302; Pediatric Rhinosinusitis 304; Complications of Rhinosinusitis 305; Mucocele/Pyocele 305; Orbital Complications 306; Osteomyelitis/Osteitis 306; Cavernous Sinus Thrombosis 307; Intracranial Complications 307; Hypertrophied Turbinates 307; Nasal Polyps 307; Fungal Sinusitis 309; Atrophic Rhinitis (Ozena) 309

29. Nasal Manifestation of Systemic Diseases 311Wegener’s Granulomatosis 312; Peripheral T-Cell Neoplasm (Nonhealing Midline Granuloma, Polymorphic Reticulosis) 313; Atrophic Rhinitis (Ozena) 313; Rhinitis Sicca 314; Rhinitis Caseosa 314; Sarcoidosis 314; Churg-Strauss Syndrome 315; Rhinoscleroma 315; Tuberculosis 315; Lupus Vulgaris 315; Nontuberculous Mycobacteria 316; Leprosy 316; Syphilis 316; Histoplasmosis 316; Rhinosporidiosis 316; Fungal Sinusitis 317

30. Allergic and Nonallergic Rhinitis 320 � Allergy and Immunology 321

Types of Immunologic (Hypersensitivity) Mechanism 322 � Allergic Rhinitis 323

Etiology 323; Classification 324; Investigations 326; Treatment 327 � Nonallergic Rhinitis (Vasomotor Rhinitis) 330

Pathophysiology 330; Classification 330; Clinical Features 331; Investigations 332; Treatment 332

31. Nasal Septum 333Fracture of Nasal Septum 333; Deviated Nasal Septum 334; Septal Hematoma 336; Septal Abscess 336; Perforation of Nasal Septum 336; Hypertrophied Turbinates 337; Nasal Synechia 337; Choanal Atresia 337

32. Maxillofacial Trauma 339Etiology 339; Classification 340; General Principles 340; Evaluation 341; Soft Tissue Injuries 342; Frontal Sinus 342; Supraorbital Ridge 342; Frontal Bone 342; Nasal Bones and Septum 342; Naso-Orbital Ethmoid (NOE) 344; Zygoma (Tripod Fracture) 344; Zygomatic Arch 345; Orbit (Blowout Fracture) 345; Naso-Maxillary Complex 345; Mandible 346; Oroantral Fistula 347; Cerebrospinal Fluid Rhinorrhea 348; Foreign Body Nose 349; Rhinolith 349; Nasal Myiasis (Maggots Nose) 350

33. Tumors of Nose, Paranasal Sinuses and Jaws 351 � Tumors of Nose and paranasal Sinuses 352

Neoplasms in Children 352; Diagnosis 352; Angiofibroma 353; Intranasal Meningoencephalocele 353; Gliomas 353; Nasal Dermoid 353; Monostotic Fibrous Dysplasia 353; Squamous Papilloma 353; Osteomas 353; Pleomorphic

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Adenoma 353; Chondroma 353; Schwannoma and Neurofibroma 353; Ossifying Fibroma and Cementoma 354; Odontogenic Tumors 354; Inverted Papilloma 354; Meningiomas 354; Hemangiomas 354; Hemangiopericytoma 354; Plasmacytoma 354; Malignant Neoplasms 354; Malignancy of Maxillary Sinus 358; Malignancy of Ethmoid Sinus 358; Malignancy of Frontal Sinus 359; Malignancy of Sphenoid Sinus 359; Adenocarcinoma 359; Adenoid Cystic Carcinoma 359; Malignant Melanoma 359; Olfactory Neuroblastoma 359; Sarcomas 359; Rhabdomyosarcoma 360

� Tumors and Related Jaw Lesions 360Management of Jaw Swellings 360; Fissural Cysts 361; Periapical Cysts 361; Follicular (Dentigerous) Cysts 361; Odontogenic Keratocyst 361; Basal Cell Nevus Syndrome 362; Retention Cyst 362; Ameloblastoma 362; Ossifying Fibroma 362; Fibrous Dysplasia 362; Cherubism 362; Adenomatoid Odontogenic Tumor 363

Section 4 : Oral Cavity and Salivary Glands

34. Oral Symptoms and examination 365Oral Cavity 365; Evaluation of Cancer Lesions 369; Salivary Glands 369; Diagnostic Imaging 370; Fine-Needle Aspiration Cytology 372

35. Oral Mucosal Lesions 373 � Red/White Lesions 374

Oral Submucous Fibrosis 374; Leukoedema 375; Oral Leukoplakia 376; Oral Hairy Leukoplakia 377; Oral Lichen Planus 378; Chronic Discoid Lupus Erythematosus 378; Candidiasis (Moniliasis) 378; Fordyce’s Spots 379; Nicotine Stomatitis 379

� Vesiculobullous/Ulcerative Lesions 379Pemphigus Vulgaris 379; Mucous Membrane Pemphigoid or Cicatricial Pemphigoid 379; Herpes Simplex Virus: Herpetic Gingivostomatitis or Orolabial Herpes 380; Hand, Foot and Mouth Disease 381; Herpangina 381; Acute Necrotizing Ulcerative Gingivitis 381; Recurrent Aphthous Stomatitis 381; Behçet’s Syndrome 383; Erythema Multiforme 383; (Eosinophilic) Granuloma 384; Traumatic Ulcers 384; Radiation Mucositis 384; Blood Disorders 384; Drug-Induced Oral Lesions 384

� pigmented Lesions 384Melanotic Macules 385; Melanoma 385; Amalgam Tattoo 385

� Lesions of Tongue 385Geographical Tongue or Migratory Glossitis 385; Hairy Tongue 385; Fissured Tongue 385; Tongue Tie (Ankyloglossia) 386

36. Disorders of Salivary Glands 387 � Inflammatory Disorders 387

Acute Suppurative Sialadenitis 388; Parotid Abscess 389; Neonatal Suppurative Parotitis 390; Recurrent Parotitis of Childhood 390; Chronic Sialadenitis 391; Tuberculous Mycobacterial Disease 391; Nontuberculous Mycobacterial Disease 391; Actinomycosis 392; Cat Scratch Disease 392; Toxoplasmosis 393; HIV 393

� obstructive Disorders 393Sialolithiasis 393

� Neoplasms of Salivary Glands 394Histogenesis of Neoplasms 394; Pleomorphic Adenoma 395; Warthin’s Tumor or Adenolymphoma (Papillary Cystadenoma Lymphomatosum) 396; Oncocytoma 396; Hemangiomas 396; Lymphangiomas 396; Mucoepidermoid Carcinoma 396; Adenoid Cystic Carcinoma (Cylindroma) 397; Acinic Cell Carcinoma 398; Squamous Cell Carcinoma 398; Malignant Mixed Tumor 398; Adenocarcinoma 398; Lymphoepithelial Carcinoma or Undifferentiated Carcinoma 398

� Xerostomia 398Sjögren’s Syndrome 398; Diffuse Infiltrative Lymphocytosis Syndrome 399; Frey’s Syndrome (Gustatory Sweating) 399

37. Neoplasms of Oral Cavity 401 � Benign Tumors of oral cavity 401

Papilloma 401; Pleomorphic Adenoma 402; Hemangioma 402; Lymphangioma 402; Granular Cell Tumor 402; Ameloblastoma 402; Torus 403; Pyogenic Granuloma 403; Irritation Fibroma 403; Mucocele 403; Ranula 403; Dermoid Cysts 403

� carcinoma of oral cavity 403Carcinoma Lips 406; Carcinoma Gingiva/Alveolar Ridge 407; Carcinoma Oral Tongue 407; Carcinoma Floor of Mouth 409; Carcinoma Buccal Mucosa 410; Carcinoma Hard Palate 411; Carcinoma Retromolar Trigone 411; Minor Salivary Gland Tumors 412; Melanoma 412; Kaposi’s Sarcoma 412

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Section 5 : Pharynx and esophagus

38. Pharyngeal Symptoms and examination 415 � Evaluation of pharynx 415

Nasopharynx 415; Oropharynx 416; Laryngopharynx 417 � Evaluation of Esophagus 417

Barium Esophagography 418; Esophageal Manometry 420; Ambulatory 24-Hours Esophageal pH Recording 420; Esophagoscopy 420

� Dysphagia 420Evaluation 421

39. Pharyngitis and Adenotonsillar Disease 423Pharyngitis 423; Infectious Mononucleosis 424; Streptococcal Tonsillitis-Pharyngitis 424; Faucial Diphtheria 425; Tonsillar Concretions/Tonsilloliths 426; Intratonsillar Abscess 427; Tonsillar Cyst 427; Keratosis Pharyngitis 427; Diseases of Lingual Tonsils 427; Chronic Adenotonsillar Hypertrophy 427; Adenoid Facies and Craniofacial Growth Abnormalities 428; Obstructive Sleep Apnea 428

40. Sleep Apnea and Sleep-Disordered Breathing 430Pathophysiology of Obstructive Sleep Apnea 431; Diagnosis and Evaluation of OSA 431; Severity of OSA 432; Complications of OSA 433; Nonsurgical Treatment 433; Surgical Treatment of OSA 434; Surgical Treatment of Snoring without OSA 435

41. Tumors of Nasopharynx 436Juvenile Nasopharyngeal Angiofibroma 437; Nasopharyngeal Carcinoma 438; Teratomas 441; Thornwaldt’s Disease (Pharyngeal Bursitis) 441; Proptosis (Exophthalmos) 441

42. Tumors of Oropharynx 443 � Malignant Tumors 443

Histopathology 443; Risk Factors 444; Evaluation 444; Staging 444; Treatment 444; Carcinoma Base of Tongue 445; Carcinoma Tonsil 446; Lymphoma 446; Carcinoma Soft Palate 446; Carcinoma Posterior Pharyngeal Wall 447

� Benign Swellings 447Parapharyngeal Tumors 448; Stylalgia (Eagle’s Syndrome) 448

43. Malignant Tumors of Hypopharynx 449Risk Factors 449; Pathology 450; Clinical Features 450; Diagnosis 450; Staging 450; Management 450; Carcinoma Pyriform Sinus 451; Carcinoma Postcricoid 452; Carcinoma Posterior Pharyngeal Wall 453

44. Disorders of esophagus 455Perforation of Esophagus 455; Corrosive Burns 456; Mallory Weiss Syndrome 457; Foreign Bodies 457; Pill-Induced Esophagitis 458; Gastroesophageal Reflux Disease 458; Barrett’s Esophagus 460; Benign Strictures 460; Hiatus Hernia 460; Schatzki's Ring 461; Plummer-Vinson (Patterson Brown-Kelly) Syndrome 461; Infectious Esophagitis 461; Cricopharyngeal Spasm 462; Diffuse Esophageal Spasm 462; Nutcracker Esophagus 462; Cardiac Achalasia 462; Scleroderma or Progressive Systemic Sclerosis 463; Zenker Diverticulum 463; Globus Hystericus Pharyngeus 463; Benign Neoplasms 463; Carcinoma Esophagus 464

Section 6 : Larynx, Trachea and Bronchus

45. Laryngeal Symptoms and examination 467Symptoms 467; Clinical Examination 467; Endoscopy 469; Laryngoscopic Parameters and Patient’s Task 471; Stroboscopy 472; Direct Laryngoscopy (Microlaryngoscopy) and Bronchoscopy 472

� Hoarseness of Voice 472 � Stridor 473

Assessment of Patient with Stridor 473; Treatment 475

46. infections of Larynx 477Acute Laryngotracheobronchitis Croup or Laryngotracheitis 478; Bacterial Tracheitis 479; Pediatric Epiglottitis 479; Adult Supraglottitis 480; Whooping Cough 480; Diphtheria 480; Chronic Nonspecific Laryngitis 481; Atrophic Laryngitis (Laryngitis Sicca) 481; Tuberculosis 481; Lupus 482; Syphilis 482; Leprosy (Hansen’s Disease) 482; Scleroma 482; Edema of Larynx 483

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47. Benign Tumors of Larynx 484Vocal Nodules (Singer’s or Screamer’s Nodules) 485; Vocal Polyp 485; Reinke’s Edema (Bilateral Diffuse Polyposis) 486; Contact Ulcer or Granuloma 486; Intubation Granuloma 486; Leukoplakia or Keratosis 487; Amyloid Tumors 487; Ductal Cysts 487; Saccular Cysts 487; Laryngocele 487; Recurrent Respiratory Papillomatosis 488; Chondroma 488; Hemangioma 488

48. Neurologic Disorders of Larynx 490Neurological Disorders of Larynx 490; Classification of Laryngeal Paralysis 491; Positions of Vocal Cords 491; Causes of Laryngeal Paralysis 491; Unilateral Recurrent Laryngeal Nerve (RLN) Paralysis 491; Bilateral Recurrent Laryngeal Nerve (Abductor) Paralysis 492; Unilateral Superior Laryngeal Nerve Paralysis 492; Bilateral Superior Laryngeal Nerve Paralysis 492; Unilateral Combined (Complete) Paralysis of Recurrent and Superior Laryngeal Nerve 492; Bilateral Combined (Complete) Paralysis of Recurrent and Superior Laryngeal Nerve 493; Congenital Vocal Cord Paralysis 493; Phonosurgery 493

49. Voice and Speech Disorders 495Voice and Speech 495; Classification of Voice and Speech Disorders 496; Dysphonia Plica Ventricularis (Ventricular Dysphonia) 497; Functional Aphonia (Hysterical Aphonia) 497; Puberphonia (Mutation Falsetto Voice) 497; Phonasthenia 497; Hyponasality (Rhinolalia Clausa) 497; Hypernasality (Rhinolalia Aperta) 497; Spasmodic Dysphonia 498; Vocal Tremor 498; Stuttering 498; Myoclonus 499; Tourette’s Syndrome 499; Botulinum Toxin Therapy 499

50. Malignant Tumors of Larynx 501Risk Factors 501; Evaluation 502; Staging 503; Management 504; Glottic Cancer 505; Supraglottic Cancer 506; Subglottic Cancer 507; Verrucous Carcinoma 507; Organ Preservation Therapy 507; Photodynamic Therapy 507; Post-Laryngectomy Vocal Rehabilitation 507

51. Management of impaired Airway 509 � Tracheostomy/Tracheotomy 510

Cricothyrotomy (Laryngotomy or Coniotomy) 513; Percutaneous Dilational Tracheostomy 513 � congenital Lesions of Larynx 514

Laryngomalacia 514; Congenital Vocal Cord Paralysis 514; Congenital Subglottic Stenosis 514; Laryngeal Web/Atresia 515; Subglottic Hemangiomas 515; Laryngoesophageal Cleft 515

� foreign Bodies of Air passages 515 � Laryngotracheal Trauma 517

Section 7 : Neck 52. Cervical Symptoms and examination 519

� Neck 519History 519; Physical Examination 519; Diagnostic Tests 522

� Thyroid Gland 523History 523; Examination 523; Investigations 525

53. Neck Nodes, Masses and Thyroid 527Neck Nodes and Masses 527; Thyroid Neoplasms 532

54. Deep Neck infections 538Pertinent Anatomy 538; Sources of Infections 540; Microbiology 540; Clinical Features 540; Investigations 540; Treatment 541; Peritonsillar Infections 541; Parapharyngeal Space Abscess or Pharyngomaxillary Abscess or Lateral Pharyngeal Space Abscess 542; Acute Retropharyngeal Abscess 543; Chronic Retropharyngeal Abscess or Prevertebral Space Abscess 543; Ludwig’s Angina 543; Abscess of Space of Body of Mandible 544; Masticator Space Abscess 544; Trismus 545

Section 8 : Operative Procedures and instruments 55. Middle ear and Mastoid Surgeries 547

Myringotomy and Tympanostomy Tubes (Grommet) 547; Mastoidectomy 549; Cortical Mastoidectomy 550; Radical Mastoidectomy 552; Modified Radical Mastoidectomy 553; Tympanoplasty 553

56. Operations of Nose and Paranasal Sinuses 557 � Sinus operations 557

Preoperative Assessment 557; Diagnostic Nasal Endoscopy (Sinuscopy) 558; Endoscopic Sinus Surgery 559; Antral Puncture or Proof Puncture 561; Inferior Meatal Antrostomy 562; Caldwell-Luc Operation 562

� Surgery of Nasal Septum 563Submucous Resection of Nasal Septum 564; Septoplasty 564; Postoperative Care 565; Complications 565

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57. Adenotonsillectomy 567Preoperative Assessment 567; Indications for Tonsillectomy 567; Indications for Adenoidectomy 568; Contraindications 568; Surgical Techniques 568; Preoperative Measures 568; Anesthesia 569; Position 569; Surgical Instruments 569; Operative Steps 569; Postoperative Care 570; Complications 571

58. endoscopies 573 � Direct Laryngoscopy/Microlaryngoscopy 573

Indications 574; Contraindications 574; Anesthesia 574; Position 574; Procedures 574; Postoperative Care 575; Complications 575; Flexible Nasopharyngolaryngoscopy 575

� Bronchoscopy 575Indications for Bronchoscopy 575; Rigid Bronchoscopy 575; Flexible Fiberoptic Bronchoscopy 576

� Esophagoscopy 577Indications 577; Contraindications of Esophagoscopy 577; Rigid Esophagoscopy 578; Flexible Esophagoscopy 579

59. instruments 581OPD Instruments 582; Mastoid and Ear Microsurgery 583; Antrum Puncture 585; Inferior Meatal Antrostomy 585; Nasal Fracture Reduction Forceps 585; Nasal Septal and Sinus Surgery 585; Mouth Gags and Retractors 588; Adenotonsillectomy 588; Incision and Drainage of Quinsy 590; Endoscopes 590; Tracheostomy 591; Airway Devices 593

Section 9 : Related Disciplines

60. Diagnostic imaging 595Conventional Radiology 595; Orthopantomogram 598; Ultrasound 598; Computerized Tomography 598; Magnetic Resonance Imaging 599; Radionuclide Imaging 600; Interventional Radiology 600; Applications of CT, MRI and US 601; CT Anatomy of Ear, Nose, Throat, Head and Neck 602

61. Radiotherapy and Chemotherapy 608 � Radiotherapy 609

Basic Physics 609; Radiobiology 610; Therapeutic Window 610; Modes of Radiotherapy 610; Combined Modality Treatment 611; Planning of Radiotherapy 611; Complications of Radiotherapy 612

� chemotherapy 613Palliative Chemotherapy 615; Combined Modality Therapy 615; Organ Preservation 616; Intra-Arterial Chemotherapy 616; Prevention of Cancer 616

62. Anesthesia 618General Anesthesia 618; Immediate Airway Management 621; Local Anesthesia 622

63. Laser Surgery and Cryosurgery 625 � Laser 625

Related Physics 625; Control of Laser 626; Tissue Effect 626; Laser In Otolaryngology 626; Photodynamic Therapy 628 � Radiofrequency Surgery 628 � cryosurgery 628 � Hyperbaric oxygen Therapy 629

Appendix 631Top 101 Clinical Secrets 631; Problem-Oriented Cases 634; Miscellaneous Key Points 636

Index 639