- Otitis Externa table.

Otitis Externa table.

This is a table for comparison between different types of Otitis Externa.

First what is Otitis Externa?

Simply it is It is Inflammation of the skin of the external auditory canal.

To download the table from MediaFire Click here size 20KB

In the table there is a comparison between

• Furunclosis( Localized otitis externa )
• Diffuse otitis externa
• Necrotizing otitis externa (Malignant otitis externa)
• Otomycosis
• Herpes zoster oticus (Ramsey- Hunt syndrome)

As regard:-

• Definition
• Aetilogy
• Predisposing Factors
• Clinical picture
• Treatment

You can print the table on large papers (A3 papers)

Good luck,

Dr Ibrahim

- Medical syndromes.

Medical syndrome is defined as :-
A group of symptoms and signs that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.
There are a lot of medical syndromes and we try to list some of them:-
1-Down syndrome (click here).
2-Plummer-Vinson syndrome (click here).
3-Ramsay Hunt syndrome (click here).
4-Wolf-Hirschhorn Syndrome (click here).
5-Cri-du-chat syndrome (click here).
6-YY syndrome (click here).
7-Klinefelter's syndrome (click here).
8-Turner's syndrome (click here).
9- Fanconi syndrome (click here).
10-Abderhalden-Kaufmann-Lignac syndrome (click here) .
11-Light Wood-Albright syndrome(Lightwood syndrome)(click here).
12-Oculo-cerebro-renal Syndrome (click here).
13-Metabolic syndrome (click here).
14-Pickwickian syndrome (click here).
15- Kallmann syndrome (click here).
16-Sertoli-cell-only syndrome (click here).
17-Lambert-Eaton syndrome (click here).
18-Guillain Barré syndrome (click here).
19-Horner's syndrome (click here).
20-Brown-Séquard syndrome. (click here).
21-Carpal tunnel syndrome. (click here).
22-Sjögren's syndrome (click here).
23-Felty's syndrome (click here).
24-Caplan's syndrome (click here).
25-Congenital Rubella Syndrome  (click here).
26-Caroli's syndrome.  (click here).
27-Malabsorption syndrome.  (click here).
28-Duhin-Johnson syndrome.  (click here).
29-Exploding head syndrome. (click here). 

If you have other syndromes plz tell us...
Dr Ibrahim,,

- Trotter's triad.

-Trotter's triad is diagnostic for nasopharyngeal carcinoma.

- It consists of:-

1. unilateral conductive hearing loss (secretory otitis media).
2. Ipsilateral earache and facial pain (trigeminal nerve).
3. Ipsilateral paralysis of the soft palate.

Return to other triads here.

- Gradenigo's triad.

Gradenigo's triad of Petrositis:-

1- persistant otorrhea.

2- Ipsilateral retro-orbital pain due to irritation of the nearby trigeminal ganglion.

3- Ipsilateral squint and diplopia due to paralysis of the 6th nerve.

Return to other triads here.

- Beck's triad.

Beck's triad of  Parapharyngeal Abscess:-

1. External cervical swelling: at the submandibular region which is tender.
2. Trismus due to spasm of the medial pterygoid.
3. Internal swelling: of the lateral pharyngeal wall,pushing the tonsil medially.

 

Beck's triad of cardiac temponade:-

1-Decrease of systolic blood pressure.
2-Distended jugular vein.
3-Diminished heart sounds(quite heart).

Return to other triads here.

- Anatomy of the External nose.

- The external nose extends the nasal cavities onto the front of the face and positions the nares so that they point downwards.

- The anterior parts of the nasal cavities are held open by a  skeletal framework (i.e external nose ).

- The external nose is pyramidal in shape , has anterior border called "dorsum" and two lateral sides.
- It´s root lies at the naso-facial suture.
- It´s apex called the tip of the nose.
- The septum below the tip of the nose called "columella".
- The opening of the nose to air is called "nostrils" or "anterior nares" which are openings through which air enters nasal cavities...

- The external nose is composed of two parts:

1- Upper bony part:-
which is composed of :

• Nsal bones which is articulate together in the middle line .
• Nasal process of frontal bone.
• Nasal process of maxillry bone.

2- lower cartilagenous part:-
which is composed of :

• upper lateral cartilage.
• Major alar cartilage(lower lateral cartilage).
• Minor alar cartilage at ala nasi.

N.B: Major alar cartilage is composed of two crura lateral and medial.
The two medial crura form "columella".

*References:-
-Netter anatomy atlas.
-Richard l.darke,wayne vogl& Adam mitchell:Gray´s anatomy for students.
-Mohammed Fareed:Illustrated Otolaryngology.
-Hassan Allam:Manual of Otorhinolaryngology.
-Mansoura E.N.T department:Essentials of Otorhinolaryngology.

-Three in human ear.

There are...

- 3 parts of the human ear:-

1. External ear.
2. Middle ear.
3. Inner ear.

- 3 parts of the External ear:-

1. auricle (pinna).
2. external auditory meatus.
3. Tympanic membrane.

- 3 layers in tympanic membrane:-

1. Outter skin layer.
2. middle fibrous layer.
3. inner mucosal layer.

- 3 cranial nerves innervate the tympanic membrane:-

1. C.N. V (trigeminal).
2. C.N. IX(glossopharyngeal).
3. C.N. X (Vagus).

 -3 Parts of middle ear:-

1. Tympanic cavity.
2. Eustachian tube.
3. Mastoid air cells.

- 3 parts of the tympanic cavity:-

1. epi-tympanum.
2. meso-tympanum.
3. hypo-tympanum.

- 3 middle ear bones (auditory ossicles):-

1. malleus.
2. incus.
3. stapes.

- 3 parts of the malleus:-

1. Head.
2. lateral process.
3. handle.

- 3 parts of labyrinth:-

1. Bony cochlea.
2. 3 semicircular canals.
3. Vestibule.

- 3 semicircular canals :

1. Posterior.
2. lateral.
3. superior.

- 3 compartments of cavity of bony cochlea :-

1. scala vestibuli: Upper compartment.
2. scala media (cochlear duct):middle compartment.
3. scala tympani: lower compartment.

- 3 membranes in cochlear duct:-

1. vestibular.
2. Tectorial.
3. Basilar .

- 3 labyrnthine sensory end organs:-

1. Of cochlea..called organ of corti.
2. of s c c....called crista.
3. of utricle and saccule..called macula.

Enjoy it,,,,,
Dr Ibrahim...

-Dangerous area of the face.

Dangerous area of the face

- It is the area () the root of  the nose and 2 angles of the mouth.
- The veins in this region are connected to cavernous sinus so any infection in this area may lead to cavernous sinus thrombosis.

- Venous draingae of Dangerous area:-

• Antearior and  post etmoidal veins drain to opthalmic vein.
• sphenopalatine & greater palatine veins drain to pterygoid veins.
• Angular vein,lateral nasal and superior labial veins drain to facial vein...

- All of the above veins drain finally to cavernous sinus.

So, Donnot put your finger in your nose..:)

See you,
Dr Ibrahim...

- Stapedectomy.

**Stapedectomy**

-Def :-

is a surgical procedure of the middle ear

performed to improve hearing.

-Indications:-

• Conductive deafness due to fixation of stapes (Otosclerosis)
  
• Air bone gap of at least 40 dB.
  

-Contraindications:-

• Poor general condition of the patient.
• Only hearing ear.
• Poor cochlear reserve as shown by poor speech discrimination scores.
• Patient with tinnitus and vertigo.
• Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
• Conductive deafness due to Ehlers-Danlos Syndrome (EDS).
  

- Complications of stapedectomy:-

• Facial palsy.
• Vertigo.
• Vomiting.
• Floating foot plate.
• Tympanic membrane tear
• Dead labyrinth
• Labyrinthitis.
  

-surgery:-

*Preoperative:-

The patient will have a hearing test just prior

to or during admission to the hospital.

*The day of surgery:(technique):

Surgery can be done under local ansesthesia or

general anesthesia.

We prefer to use general anesthesia, i.e. the patient

is asleep during the operative procedure.

During the operative procedure the eardrum is gently lifted,

the diseased and fixed stapes is removed.

Next, a prosthesis is put in place.

The eardrum is gently put back into place and held

there by absorbable packing ointment.

*Postoperative:-

After awakening from anesthesia, the patient is

returned to his room and is usually discharged

the next morning. During this immediate post-operative

period, it is important NOT to blow the nose and

not to get the ear wet until the ear has completely healed.

This video is an Stapedectomy by Dr. Bliouras Konstantinos.

enjoy, see you...

-Plummer-Vinson Syndrome.

Plummer-Vinson Syndrome

- Synonyms:-

Chronic Pharyngo-oesophagitis or Patterson-Brown-Kelly's disease.

-Definition:-

Chronic inflammation of the mucous membrane of the hypopharynx and upper oesophagus.

-Aetiology:-

Unknown, may be iron deficiency anaemia, vitamin deficiency or autoimmune.

- Incidence:-

Commonly in females above 40 years.

-Pathology:-

Atrophic mucosa and submucosal fibrosis leading to formation of webs.

-Clinical picture:-

Symptoms: gradual progressive dysphagia.

Signs:-

• Angular stomatitis with fissured angles of the mouth
• glossitis: (smooth glazed dry tongue)
• glazed atrophic mucosa of the hypopharynx and upper oesophagus with mucosal webs
• splenomegaly
• spooning of the nails (Koilonychia).

-Investigations:-

• Blood picture shows hypochromic microcytic anaemia.
• Gastric secretions: achlorohydria due to atrophic gastritis may be caused by vit. B12 deficiency.
• Hypopharyngoscopy: web formation and stenosis.

- Complications:-

• Submucosal fibrosis leading to web formation and stenosis.
• Pre-cancerous leads to Post-cricoid carcinoma.

-Treatment:-

• Iron and vitamin B complex by injection.
• Repeated endoscopic dilatation.
• Regular follow up to detect early post-cricoid carcinoma.

Return to list of medical syndromes here.

- Herpes zoster oticus (Ramsey- Hunt syndrome).

Herpes zoster oticus

(Ramsey-Hunt syndrome)

-Aetiology:-

• herpes zoster viral infection of the geniculate ganglion of the facial nerve.
• It is caused by reactivation of herpes zoster virus that has previously caused chickenpox in the patient.

-Clinical picture:-

• Pain in and around the ear
• vesicles on the auricle and in the external auditory canal
• Lower motor neuron facial nerve paralysis due to affection of the geniculate ganglion of the facial nerve.
• May be associated with sensory-neural hearing loss and vertigo due to affection of the cochleo-vestibular nerve (Ramsey-Hunt syndrome).

-Treatment:-
1.Anti-viral therapy as acyclovir (oral and local).
2.Corticosteroids (oral and local) in severe cases with affection of the facial and or cochleo-vestibular nerves.

Return to list of medical syndromes here