Notes on NEET PG

Facial nerve : Facial nerve enters the ear through the internal auditory meatus .                        In ear it passes through a bony canal known as Fallopian canal . It has 3 segments : 1) Labyrinthine 2) Horizontal 3) Vertical  Labyrinthine segment = narrowest segment= bottleneck of facial nerve  Facial nerve has two bends : 1st genu has geniculate ganglion                                                 2nd genu  Facial nerve has 3 branches in the ear : 1) branch from 1st genu : greater superficial petrosal nerve supllies the lacrimal glands  2) branch from second genu : nerve to stapedius  3) from vertical segment : chorda tympani nerve , supplies taste sensation to anterior two third of tongue . BELL'S PALSY : Idiopathic sudden...

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Complications of unsafe CSOM  1) Intratemporal  2)  Intracranial  1) Intracranial :   a) Abscess formation : 4 types of abscess can be formed .                                      i) Mastoid abscess : Post auricular MC type .                                                       ii ) Bezold's abscess : Along Sternoclavicular Mastoid  muscle . Mastoid tip is involved in Bezold's abscess .                                     iii) Citelli's abscess : Along digastric muscle                                     iv) Luc's ...

MRM is of 2 types : 1) E and E Or Canal Wall Up : a) Cortical mastoidectomy b) Posterior tympanotomy c) Combined approached Tympanoplasty  2) E, E , E or canal wall down :   Modified Radical Mastoidectomy b) Radical Mastoidectomy c) Atticotomy  mcq : First step of mastoidectomy ? Answer : Finding the mastoid antrum . The surface landmark of mastoid antrum : Mc. Evan's Triangle or Suprameatal triangle  Q. What is Corner's septum ? Answer :It is petrosquamous suture , seen in some people , leads to difficulty in finding the antrum

Unsafe CSOM :  Characterized by presence of cholesteatoma ( skin in middle ear cleft ) : Pearly white in colour .  ORIGIN OF CHOLESTEATOMA ::  1) Congenital : Levenson's criteria : i) Pearly white mass behind intact TM  ii) There shouldn't be past history of ear surgery iii) There may be past history of ear infection , ear discharge or perforation of tympanic membrane but at present TM is intact.   2) Primary acquired : Due to retraction pocket , lined by skin and filled by keratin     When retraction pocket gets perforated , it forms cholesteatoma . This is the most common origin of cholesteatoma .  Why cholesteatoma is unsafe ? Because of its bone eroding property .  Skin is dangerous when it grows in a closed space which is happening in cholesteatoma .  Bone erosion +  Ossicle erosion +  Granulation formation +  Middle ear polyp formation + Red polyps seen  ...

Eustachian Tube :   # 26 mm in length  # Outer 12 mm bony , inner 14mm cartilaginous   # At birth it is a horizontal tube .  # In adult it makes an angle of 45 degree with the horizontal  #  It opens 1.25 cm behind the posterior end of inferior turbinate . Closure of the tube is apassive process .  # It opens during swallowing with the help of tensor tympani muscle  Eustachian  Tube Test : 1) Tympanometry (Best)  2) ET catheterization  3) Politzerization  4) Valsalva  SAFE CSOM :  # Tubotympanic CSOM  # Characterised by presence of  permanent central perforation , some margin of Tympanic membrane left all around the perforation  #  Marginal perforation is seen in unsafe CSOM  C/F : 1) Ear discharge : Mucopurulent , not foul smelling , not blood stained , no bone erosion , no granulation   2) Hearing loss : Conductive  ...

Also known as : Secretory Otitis Media   # Collection of thick sterile glue like fluid in the middle ear . #Adenoid hypertrophy in school going children causing B/L glue ear is the most common etiology .  #Nasopharyngeal Carcinoma in an adult causing unilateral Glue ear is a rare etiologfy . C/F : Heaviness in the ear . Not a painful condition . Conductive hearing loss 10-40 dB .  Adenoid face . Poor school performance .  Investigation : 1. PTA  2. Tympanometry -B curve 3. Treatment of choice : Myringotomy with Grommet insertion + Adenoidectomy  Myringotomy for glue ear is done at anteroinferior quadrant . Grommet is a ventilation tube .  Aero Otitis Media : Or Barotrauma of the ear .     # It happens during descent of a flight  # It fails to open up it leads to sudden retraction of tympanic membrane which causes severe earache . Treatment : Valsalva        ...

Principles : This test records the compliance of middle ear system ( Tympanic membrane and ossicles ) Type A = normal  Type As= otosclerosis Type Ad = Ossicular dislocation Type C = Retracted tympanic membrane   Stapedial reflex :   On hearing loud sound stapedius contracts . This is for thye protection of inner ear .  Afferent : 8th nerve Efferent : 7th nerve   This reflex is absent in 1 ) Deafness                                           2) Facial Palsy                                           3) Otosclerosis   Noise induced  hearing loss : It is an occupational disorder . Permissible level of noise 90dB 8 hours a day 5 days a week .   Typical finding on PTA : Dip at 4000 Hz in AC and...

 Hearing loss : 2 types : i) conductive hearing loss (pinna to footplate)                                          ii) sensory hearing loss    Conductive hearing loss causes :                                                      Wax                                                      CSOM                                                      Glue Ear                              ...

  Anatomy  :  2 parts :             i ) Membranous                                                 ii) Bony      Membranous labyrinth is the actual inner ear . Bony labyrinth is the bony cover of membranous labyrinth .     Fluids of inner ear : Inner ear filled with endolymph and surrounded by perilymph .  Stria vascularis of Cochlea secretes Endolymph which is present in endolymphatic space .Perilymph = CSF   NOTE :Perilymph is connected to CSF through aqueduct of cochlea . That is why in a case of   meningitis deafness can occur . So BERA   should be done before discharge . Endolymph has high Potassium low sodium .   Perilymph has high Sodium and low potassium. (Tips : How to re...