| Otorhinopharyngology |
●External ear 1.Erysipelas, Swimmer's otitis 2.Furuncle 3.VZV: Ramsay Hunt Syndrome, CN 7&8 palsy (Geniculate body) TX: Vit B 4.Bullous Myringitis鼓膜炎 5.Malignant Otitis Externa: DM, pseudomonas, sinus thrombosis 6.Otomycosis: Aspergilosis 7.Eczema 8.aural fistula: 1st branchial groove incomplete closure ●Middle ear ☉not changing after birth 1.AOM: →Scott-Brown: tympanic membrane rupture →meningismus, pulsating pain 2.Influenzed otitis: Hemophilus 3.Measles otitis: 4.Scariatinal otitis: 5.Mastoiditis: →most common complication, petrositis, dissolution →Triad: aural discharge, mastoid tenderness, protruding →Bezold's mastoiditis: torticollis →mastoidectomy 6.COM: →Schueller's view: 氣化減低 7.Cholesteatoma: →otorrhea, not tumor →Tympanoplasty ●Middle ear: Complication 1.Labyrinthitis 2.Epidural Empyema 3.Otogenic menigitis 4.Petrositis →paralabyrinthine →Gradenigo triad: otorrhea, Trigeminal irritation, CN VI palsy ●Middle ear: Tumor 1.Non-chromoffin paraganglioma →most common →Jugular foramen syndrome: CN 9,10,12 2.Bone cyst 3.Middle ear ca. ●Inner ear →supplied by AICA 1.Acoustic neuroma: →Schwannoma, most common CP angle tumor →Hitselberger's sign: 外聽道後壁感覺降低(CN 7) →ABR: auditory brainstem response 2.Facial nerve neuroma 3.Von Recklinghausen's neurofibromatosis 4.Histiocytosis 5.Aminoglycoside 6.Ototoxic occupational toxins 7.Acute vestibular paralysis 8.Sudden deafness 9.BPPV: benign paraxymal positional vertigo: cupulolithiasis 10.Hearing loss: →high pitch(>1000Hz) loss in old →conversational speech: 50-60dB, shout: >80dB →Rinne test: normal: AC>BC, conductional: AC< BC →Schwaback test: BC: compare doctor/patient →Weber test: BC: compare bilateral （總而言之，氣導差，骨導就強） 11.Vertigo (1)Central: directional preponderance, vertical, no nausea (2)Peripheral: severer on closing eyes, horizontal, nausea, inhibited by visual fixation →Caloric test: ice water in right→ slow phase toward right ☉Otosclerosis →slowly progressive hearing loss without prior trauma or infection. Tinnitus is present in 75% of cases, a positive family history in 60%, and imbalance in 25% of cases. Women may notice onset or exacerbation during pregnancy. →Physical Exam: only 10% having a pinkish hue behind the tympanic membrane (Schwartze's sign). Although uncommon, Schwartze's sign is almost pathognomonic for otosclerosis. The tuning fork exam may indicate a conductive hearing loss, with bone conduction greater than air conduction first at 256 Hz, then 512Hz, and finally 1024 Hz. →★Carhart's notch is a 10-30dB drop in the bone line at 2000Hz, induced by stapes fixation. When present, Carhart's notch is virtually diagnostic of otosclerosis ●Nose →Ethmoid sinus(fully born)→Sphenoid(developed from 6 y/o)→Frontal(10-12 y/o)→Maxillary(15 y/o) →★Dangerous triangle: thrombophlebitis, cavernous sinus thrombosis 1.Allergic rhinits 2.Nasal polyp: frog face 3.Atrophic rhinitis & Ozena臭鼻: olfactory loss 4.Wegener's granulomatosis: renal failure, TX: steroid 5.Epistaxis: Kiesselbach's plexus, Littel's area (anterior portion of the septum has a rich vascular supply) 6.Osteoma of frontal sinus: most common benign tumor 7.Mucocele: in frontal sinus 8.Sinusitis →Kartagener's triad: bronchiectasis, situs inversus, dextrocardia →FESS: functional endoscopic sinus surgery ●Nasopharynx 1.NPC: →1. jugulodigastric LAP(earliest) 2.Nasal bleeding 3. E tube obstruction 4.hearing loss.... →EBV IgA/VCA →5 year survival: 34% 2.Nasopharyngeal angiofibroma 3.Choanal atresia: ●Oropharynx 1.Adenoid hyperplasia 2.Waldeyer's Ring: lingual, pharyngeal, palatine tonsil,scattered lymphoid nodule (1)acute tonsilitis: beta-hemolytic strept., penicillin (2)herpangina: Coxsackie A (3)scarlet fever: strawberry tongue, A hemolytic Strept. (4)Vincent's angina (5)Peritonsillar abscess 3.Tumer (1)Oral ca. (2)Tongue ca. 50% 舌側, ant 1/3 ●Larynx →Abduction: PCA, Adduction: LCA & TA, Tension: cricothyroid, vocalis m. →all innervated by recurrent laryngeal n. except cricothyroid by sup.laryngeal n. 1.laryngeal ca.: →male: 10 folds, hoarseness: cardinal, →glottic(vocal cord) ca.: 56%, least LN meta 2.laryngeal papilloma: most common in children 3.vocal polyps: singer's nodule ●Salivary glands →Parotid gland: Stensen's duct to 上排第二大臼齒, 30%, serous →Submandibular gland: Wharton's duct to sublingual caruncle, →Sublingaul gland: Ranula蝦蟆腫: little frog, retension cyst 1.Sialadenitis 2.Parotid ca.: Mucoepidermoid carcinoma most commmon →biopsy inhibited →rule of 75%: all, benign, mixed →CN VII palsy 3.Sialolithiasis: salivary colic, electrolyte sialadenitis, submandibular gland: 85% ●Head & Neck 1.Bell's palsy: 2.Hemifacial spasm: vascular loop, AICA, PICA 3.Mandibular bone fracture: Le Fort I-III. 4.Thyroglossal duct cyst: midline ●Branchial cleft cysts, sinuses, and fistulas First: in close proximity or in communication with the ★external auditory canal Second: the majority, the external opening or cyst found along the anterior border of the ★sternocleidomastoid muscle, into the ★oropharynx in the area of the tonsillar fossa Third: the anterior border of the sternocleidomastoid muscle and are lateral and superior to the common carotid. opens into the ★piriform sinus Fourth: ★→Branchial Arches: 1st: mandibular:CN V 2nd: hyoid bone:CN VII 3rd: CN IX 4th: CN X 5th: CN XI
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