Tag: HYT Module

Otosclerosis / Otospongiosis

Otosclerosis / Otospongiosis

Q. 1 Otosclerosis typically begins at:
 A Scutum
 B Round window
 C Tympanic membrane
 D Fossa antefenestrum
Q. 1 Otosclerosis typically begins at:
 A Scutum
 B Round window
 C Tympanic membrane
 D Fossa antefenestrum
Ans. D

Explanation:

Fossa antefenestrum


Q. 2

The part most commonly involved in Otosclerosis is:

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Q. 2

The part most commonly involved in Otosclerosis is:

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Ans. A

Explanation:

Oval window


Q. 3

In Otosclerosis, the Tympanogram is:

 A

Normal

 B

Type AS

 C

Type B

 D

Type A

Q. 3

In Otosclerosis, the Tympanogram is:

 A

Normal

 B

Type AS

 C

Type B

 D

Type A

Ans. B

Explanation:

Type AS


Q. 4

All of the following statements about the medical management in otosclerosis using sodium flouride are true, EXCEPT:

 A

Acts by inhibiting proteolytic enzymes in cochlea

 B

Acts by inhibiting osteoblastic activity

 C

Is contraindicated in chronic nephritis

 D

Is indicated in patients with a positive Schwartze sign

Q. 4

All of the following statements about the medical management in otosclerosis using sodium flouride are true, EXCEPT:

 A

Acts by inhibiting proteolytic enzymes in cochlea

 B

Acts by inhibiting osteoblastic activity

 C

Is contraindicated in chronic nephritis

 D

Is indicated in patients with a positive Schwartze sign

Ans. B

Explanation:

Sodium fluoride in osteosclerosis increases osteoblastic bone formation and does not inhibit. All the other options are true.
 
There are numerous marrow and vascular spaces with plenty of osteoblasts and osteoclasts in immature active lesions.
Taking oral sodium fluoride can stabilize the hearing loss associated with otosclerosis in about 80% of patients.
This reduces bone absorption and enhances the calcification of new bone, essentially stopping further progression of otosclerotic damage.

Sodium fluoride can also reduce tinnitus and any symptoms of imbalance.

Q. 5

High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?

 A

Otosclerosis

 B

Ototoxicity

 C

Otospongiosis

 D

Meniere’s disease

Q. 5

High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?

 A

Otosclerosis

 B

Ototoxicity

 C

Otospongiosis

 D

Meniere’s disease

Ans. B

Explanation:

High-frequency audiometry is specifically for ototoxicity monitoring, comprises air conduction thresholds from 10,000 to 20,000 Hz.

 Most ototoxic hearing losses will first occur in that frequency region, which is higher than the speech range. 


Q. 6

Otosclerosis shows which type of tympanogram?

 A

Type A

 B

Type B

 C

Type C

 D

Type D

Q. 6

Otosclerosis shows which type of tympanogram?

 A

Type A

 B

Type B

 C

Type C

 D

Type D

Ans. A

Explanation:

Type A tympanograms have normal peak height and pressure.

Two variations of the Type A tympanogram also are normal in pressure, but may be shallow (AS), reflecting otosclerosis or middle ear effusion, or peaked very high (AD), reflecting ossicular discontinuity or a monomeric eardrum


Q. 7

Which of the following part of the ear is most commonly involved in otosclerosis?

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Q. 7

Which of the following part of the ear is most commonly involved in otosclerosis?

 A

Oval window

 B

Round window

 C

Tympanic membrane

 D

Malleus

Ans. A

Explanation:

While otosclerosis may potentially involve any part of the bony labyrinth, it carries a distinct predilection for the region near the anterior border of the oval window (fissula ante fenestram). 

Q. 8

Otosclerosis mostly affects:

 A

Malleus

 B

Stapes

 C

Incus

 D

Tympanic membrane

Q. 8

Otosclerosis mostly affects:

 A

Malleus

 B

Stapes

 C

Incus

 D

Tympanic membrane

Ans. B

Explanation:

  • Otosclerosis is caused by immobility of the stapes.
  • Its most distinctive feature is conductive hearing loss, but sensorineural hearing loss and vertigo are also common; 
  • tinnitus is infrequent.
  • Otosclerosis is suggested by a positive family history, 
  • a tendency toward onset at an earlier age, 
  • the presence of conductive hearing loss, or
  •  bilateral symmetric auditory impairment
  • Treatment with a combination of sodium fluoride, calcium gluconate, and vitamin D may be effective. If not, surgical stapedectomy should be considered.
 

Q. 9

Conductive hearing loss is seen in all of the following except:

 A

Otosclerosis

 B

Otitis media with effusion

 C

Endolymphatic hydrops 

 D

Suppurative otitis media

Q. 9

Conductive hearing loss is seen in all of the following except:

 A

Otosclerosis

 B

Otitis media with effusion

 C

Endolymphatic hydrops 

 D

Suppurative otitis media

Ans. C

Explanation:

 

Endolymphatic hydrops i.e menieres disease leads to SNHL and not conductive hearing loss.



Q. 10

True about otosclerosis:

 A

50% have family history

 B

Males are affected twice than female

 C

More common in Negro’s and African’s

 D

All

Q. 10

True about otosclerosis:

 A

50% have family history

 B

Males are affected twice than female

 C

More common in Negro’s and African’s

 D

All

Ans. A

Explanation:

Q. 11

Common age for otosclerosis is:

 A

5-10 years

 B

10-20 years

 C

20-30 years

 D

30-45 years

Q. 11

Common age for otosclerosis is:

 A

5-10 years

 B

10-20 years

 C

20-30 years

 D

30-45 years

Ans. C

Explanation:

 

  • 50% of patients of otosclerosis have positive family history.
  • Females are more commonly affected than males. 
  • Whites are affected more than negroes.
  • Age = most common between 20-30 years and is rare before 10 and after 40 years.
  • Deafness is increased by pregnancy, menopause, trauma and major operations.
  • Viruses like measles virus have also been associated with it.



Q. 12

The part most commonly involved in Otosclerosis is: 

 A

Oval window

 B

Round window

 C

Tympanic membranes

 D

Malleus

Q. 12

The part most commonly involved in Otosclerosis is: 

 A

Oval window

 B

Round window

 C

Tympanic membranes

 D

Malleus

Ans. A

Explanation:

Ans. is a i.e. Oval window


Q. 13

Most common site for the initiation of otosclerosis is: 

 A

Footplate of stapes     

 B

Margins of stapes

 C

Fissula ante fenestram 

 D

Fissula post fenestram

Q. 13

Most common site for the initiation of otosclerosis is: 

 A

Footplate of stapes     

 B

Margins of stapes

 C

Fissula ante fenestram 

 D

Fissula post fenestram

Ans. C

Explanation:

Q. 14

Otosclerosis tinnitus is due to:

 A

Cochlear otosclerosis

 B

Increased vascularity in lesion

 C

Conductive deafness

 D

All of the above

Q. 14

Otosclerosis tinnitus is due to:

 A

Cochlear otosclerosis

 B

Increased vascularity in lesion

 C

Conductive deafness

 D

All of the above

Ans. A

Explanation:

Q. 15

In majority of the cases with otosclerosis the tympanic membrane is:

 A

Normal

 B

Flamingo-pink

 C

Blue

 D

Yellow

Q. 15

In majority of the cases with otosclerosis the tympanic membrane is:

 A

Normal

 B

Flamingo-pink

 C

Blue

 D

Yellow

Ans. A

Explanation:

Ans. is a i.e. Normal


Q. 16

Gene’s test is for:

 A

Otosclerosis

 B

NIHL

 C

Sensorineural deafness 

 D

None

Q. 16

Gene’s test is for:

 A

Otosclerosis

 B

NIHL

 C

Sensorineural deafness 

 D

None

Ans. A

Explanation:

 

Gene’s Test

This test was earlier done to confirm the presence of otospongiosis.

In this test, BC (bone conduction) is tested and at the same time Siegle’s speculum compresses the air in the meatus.

In normal individuals hearing is reduced after this; i.e. Gelles test is positive; but in stapes fixation, sound is not affected. i.e Gelles test is negative.


Q. 17

Feature in otosclerosis includes:

 A

Sounds not heard in noisy environment

 B

Normal tympanum

 C

More common in males

 D

Malleus is most commonly effected

Q. 17

Feature in otosclerosis includes:

 A

Sounds not heard in noisy environment

 B

Normal tympanum

 C

More common in males

 D

Malleus is most commonly effected

Ans. B

Explanation:

Q. 18

Carhart’s notch in audiometery is seen in:

 A

Ocular discontinuity

 B

Haemotympanum

 C

Otomycosis

 D

Otosclerosis

Q. 18

Carhart’s notch in audiometery is seen in:

 A

Ocular discontinuity

 B

Haemotympanum

 C

Otomycosis

 D

Otosclerosis

Ans. D

Explanation:

 

Carharts notch

  • Bone conduction is normal in otosclerosis.
  • In some cases there is a dip in bone conduction curve which is maximum at 2000 Hz / 2 KHZ called as Carharts notch.
  • Carharts notch is seen only in bone conduction curve.
  • It disappears after successful stapedectomy/stapedotomy.

 

  • The reason why it disappears after successful surgery is that when the skull is vibrated by bone—conduction sound, the sound is detected by the cochlea via 3 routes:

–  Route (a)—is by direct vibration within the skull.

–  Route (b)—is by vibration of the ossicular chain which is suspended within the skull.

–  Route (c)—is by vibrations emanating into the external auditory canal as sound and being heard by the normal air-conduction route.

  • In a conduction type of hearing loss (as in otosclerosis) the latter two routes are deficient but regained by successful reconstruction surgery. Hence bone conduction thresholds improve following surgery.

Q. 19

All are true about otosclerosis except:

 A

Increased incidence in female

 B

Sensorineural deafness

 C

Irreversible loss of hearing

 D

b and c

Q. 19

All are true about otosclerosis except:

 A

Increased incidence in female

 B

Sensorineural deafness

 C

Irreversible loss of hearing

 D

b and c

Ans. D

Explanation:

 

  • In otosclerosis-50% cases have positive family history.
  • Females are affected more than males.
  • Bilateral conductive deafness seen in otosclerosis is not irreversible as it can be successfully treated by stapedectomy / Stapedotomy.
  • Sensorineural hearing loss occurs when later in the course of time 
  • osteosclerotic focus reaches the cochlear endosteum but actually most common hearing loss seen is conductive type.Q
  • Carharts notch is seen in bone conduction curve at 2000 Hz.



Q. 20

Characteristic feature of Otosclerosis are all except: 

 A

Conductive deafness

 B

Positive Rinne’s test

 C

Paracusis willisii

 D

Mobile ear drum

Q. 20

Characteristic feature of Otosclerosis are all except: 

 A

Conductive deafness

 B

Positive Rinne’s test

 C

Paracusis willisii

 D

Mobile ear drum

Ans. B

Explanation:

 

Tuning Fork Tests in Otosclerosis

  • Rinnes test-negative
  • Webers test-lateralised to ear with greater conductive loss
  • Absolute bone conduction-normal (It is decreased in cochlear otosclerosis)
  • Pure tone audiometry-shows loss of air conduction more for lower frequency.

 • Tympanic membrane is normal and mobile in 90% cases. 

  • Schwartz sign—Flammingo cases pink colour of tympanic membrane is seen in 10% cases. It indicates active focus with increased vascularity.
  • Stapes footplate—Shows a rice grain / biscuit type appearance
  • Blue mantles are seen histopathologically.



Q. 21

A 30- year old woman with family history of hearing loss from her mother’s side developed hearing problem dur­ing pregnancy. Hearing loss is bilateral, slowly progres­sive, Pure tone audiometry bone conduction hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Q. 21

A 30- year old woman with family history of hearing loss from her mother’s side developed hearing problem dur­ing pregnancy. Hearing loss is bilateral, slowly progres­sive, Pure tone audiometry bone conduction hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Ans. A

Explanation:

Q. 22

Medication which may prevent rapid progress of cochlear otosclerosis is:

 A

Steroids

 B

Antibiotics

 C

Fluorides

 D

Vitamins

Q. 22

Medication which may prevent rapid progress of cochlear otosclerosis is:

 A

Steroids

 B

Antibiotics

 C

Fluorides

 D

Vitamins

Ans. C

Explanation:

Q. 23

All are true statements regarding use of sodium fluoride in the treatment of otosclerosis except:

 A

It inhibits osteoblastic activity

 B

Used in active phase of otosclerosis when Schwartz sign is positive

 C

Has proteolytic activity (bone enzymes)

 D

Contraindicated in chronic nephritis

Q. 23

All are true statements regarding use of sodium fluoride in the treatment of otosclerosis except:

 A

It inhibits osteoblastic activity

 B

Used in active phase of otosclerosis when Schwartz sign is positive

 C

Has proteolytic activity (bone enzymes)

 D

Contraindicated in chronic nephritis

Ans. A

Explanation:

Ans. is a i.e. It inhibits osteoblastic activity

The most useful medication which prevents rapid progression of cochlear otoscierosis is sodium fluoride

Mechanism of Action

  • It reduces osteoclastic bone resorption and increases osteoblastic bone formation, which promote recalcification and reduce bone remodelling in actively expanding osteolytic lesion.
  • It also inhibits proteolytic enzymes that are cytotoxic to cochlea and lead to SNHL (Hence specially useful in cochlear otosclerosis). 
    • Current Otolaryngology 2nd/ed pg 678 

Q. 24

Following operations are done in case of otosclerosis:

 A

Stapedectomy

 B

Fenestration

 C

Stapedotomy

 D

All

Q. 24

Following operations are done in case of otosclerosis:

 A

Stapedectomy

 B

Fenestration

 C

Stapedotomy

 D

All

Ans. D

Explanation:

Q. 25

In otosclerosis during stapes surgery prosthesis used is:

 A

Round window

 B

Grommet

 C

Total ossiculear replacement

 D

All of the above

Q. 25

In otosclerosis during stapes surgery prosthesis used is:

 A

Round window

 B

Grommet

 C

Total ossiculear replacement

 D

All of the above

Ans. A

Explanation:

Ans. is a i.e. Teflon piston

The currently used prosthesis in otosclerosis surgery are:

  • Teflon (M/C used)
  • Stainless steel
  • Platinum                       — All are MRI compatible
  • Gold
  • Titanium

The prosthesis is placed between the long process of incus and foot plate of stapes



Q. 26

A pure tone audiogram with a dip at 2000 Hz is char­acteristic of:

 A

Presbyacusis

 B

Ototoxicity

 C

Otosclerosis

 D

Nose induced hearing loss

Q. 26

A pure tone audiogram with a dip at 2000 Hz is char­acteristic of:

 A

Presbyacusis

 B

Ototoxicity

 C

Otosclerosis

 D

Nose induced hearing loss

Ans. C

Explanation:

Q. 27

Recruitment test is positive in:             

 A

Retrocochlear lesions

 B

Otosclerosis

 C

Meniere’s disease

 D

None of the above

Q. 27

Recruitment test is positive in:             

 A

Retrocochlear lesions

 B

Otosclerosis

 C

Meniere’s disease

 D

None of the above

Ans. C

Explanation:

Q. 28

Gelle’s test is done/ negative in:           

 A

Senile deafness

 B

Traumatic deafness

 C

Otosclerosis

 D

Serous otitis media

Q. 28

Gelle’s test is done/ negative in:           

 A

Senile deafness

 B

Traumatic deafness

 C

Otosclerosis

 D

Serous otitis media

Ans. C

Explanation:

Q. 29

Blue ear drum is seen in:   

 A

Tympanosclerosis

 B

Secretory otitis media

 C

Otosclerosis

 D

Myringitis bullosa

Q. 29

Blue ear drum is seen in:   

 A

Tympanosclerosis

 B

Secretory otitis media

 C

Otosclerosis

 D

Myringitis bullosa

Ans. B

Explanation:

Q. 30

Paracusis willisii is seen in:      

 

 A

CSOM

 B

ASOM

 C

Otosclerosis

 D

Meniere’s disease

Q. 30

Paracusis willisii is seen in:      

 

 A

CSOM

 B

ASOM

 C

Otosclerosis

 D

Meniere’s disease

Ans. C

Explanation:

 

Diagnosis of otosclerosis

  • Otosclerosis is traditionally diagnosed by characteristic clinical findings, which include progressive conductive hearing loss, a normal tympanic membrane, and no evidence of middle ear inflammation.
  • The cochlear promontory may have a faint pink tinge reflecting the vascularity of the lesion, referred to as the Schwartz sign.
  • Conductive hearing loss is usually secondary to impingement of abnormal bone on the stapes footplate.
  • This involvement of the oval window forms the basis of the name fenestral otosclerosis.
  • The most common location of involvement of otosclerosis is the bone just anterior to the oval window at a small cleft known as the fissula ante fenestram.
  • The fissula is a thin fold of connective tissue extending through the endochondral layer, approximately between the
    oval window and the cochleariform process, where the tensor tympani tendon turns laterally toward the malleus.

Q. 31

Hyperacusis is seen in all of the following except:

 A

Exposure to loud sounds

 B

Otosclerosis

 C

Meniere’s disease

 D

Severe head injury

Q. 31

Hyperacusis is seen in all of the following except:

 A

Exposure to loud sounds

 B

Otosclerosis

 C

Meniere’s disease

 D

Severe head injury

Ans. B

Explanation:

 

Hyperacusis is characterized by an over-sensitivity to certain frequency ranges of sound (a collapsed tolerance to normal environmental sound).

Hyperacusis can be acquired as a result of:

  • The most common cause of hyperacusis is overexposure to excessively high decibel levels (or sound pressure levels).
  • Migraine
  • Severe head trauma
  • Facial nerve dysfunction (to Stapedius)
  • Tension Myositis Syndrome
  • Adverse drug reaction
  • Autism
  • Bell’s palsy
  • Meniere’s disease
  • Asperger syndrome

In cochlear hyperacusis (the most common form of hyperacusis), the symptoms are ear pain, annoyance, and general intolerance to any sounds that most people don’t notice or consider unpleasant.

In vestibular hyperacusis, the sufferer may experience feelings of dizziness, nausea, or a loss of balance when certain pitched sounds are present.

Otosclerosis presents with hearing loss (bilateral and conductive type) and paracusis willisii (patient hears better in noisy environment).


Q. 32

Schwartz sign is seen in

 A

Otosclerosis

 B

Serous otitis media

 C

CSOM

 D

ASOM

Q. 32

Schwartz sign is seen in

 A

Otosclerosis

 B

Serous otitis media

 C

CSOM

 D

ASOM

Ans. A

Explanation:

 

FINDINGS IN OTOSCLEROSIS

Symptoms of otosclerosis

  • Hearing loss :- Bilateral conductive deafness which is painless and progressive with insidious onset. In cochlear otosclerosis sensorineural hearing loss also occurs along with conductive deafness.
  • Paracusis willissii :- An otosclerotic patient hears better in noisy than quiet surroundings.
  • Tinnitus :- More common in cochlear otosclerosis.
  • Speech :- Monotonous, well modulated soft speech.
  • Vertigo :- is uncommon.

Signs in otosclerosis

  • Tympanic membrane is quite normal and mobile.
  • In 10% of cases flamingo – pink blush is seen through the tympanic membrane called as Schwartz sign. Various tests show conductive hearing loss.

Tuning fork tests in otosclerosis

  • As otosclerotic patients have conductive deafness, the tuning fork tests results will be as follows :‑
  1. Rinnes :- Negative
  2. Webers :- Lateralized to the ear with greater conductive loss.
  3. Absolute bone conduction (ABC) :- Normal (can be decreased in cochlear otosclerosis).
  4. Gelles test :- No change in the hearing through bone conduction when air pressure of ear canal is increased by Siegle’s speculum.

Audiometry in otosclerosis

Audiometry is one of the important tools in evaluation of a patient of otosclerosis.Various audiometric tests are :‑

1) Pure tone audiometry

  • Shows loss of air conduction, more for lower frequencies with characteristic rising pattern. Bone conduction is normal. However in some cases, there is a dip in bone conduction curve which is maximum at 2000 Hz (2 KHz) and is called the Carhart’s notch.

2) Impedance audiometry

  • Impedance audiometry shows :-

i) Tympanometry

  • Patient with early disease may show type A tympanogram (because middle ear areation is not affected) Progressive stapes fixation results in classical As type tympanogram.

ii) Acoustic (stapedial reflex)

It is one of the earliest sign of otosclerosis and precedes the development of airbone gap. In early stage, diphasic on-off pattern is seen in which there is a brief increase in compliance at the onset and at the termination, stimulus occurs. This is pathognomonic of otosclerosis. In later stage the reflex is absent.


Q. 33

Fluctuating deafness is seen in

 A

Meniers disease

 B

Otosclerosis

 C

CSOM

 D

ASOM

Q. 33

Fluctuating deafness is seen in

 A

Meniers disease

 B

Otosclerosis

 C

CSOM

 D

ASOM

Ans. A

Explanation:

 

Meniere’s disease is a disorder of the inner ear which is characterized by :-

i) Episodes of vertigo

ii) Tinnitus (ringing in the ears)

iii) Fluctuating sensorineural hearing loss

iv) Feeling of fullness or pressure in ear (aural fullness)



Pinna / Auricle

Pinna / Auricle


AURICLE OR PINNA 

  • The entire pinna (except its lobule and outer part of external acoustic canal) is made up of a framework of a single piece of yellow elastic cartilage
  • It is covered with integument, and connected to the surrounding parts by ligaments and muscles; and to the commencement of the external acoustic meatus by fibrous tissue. 
  • Elastic cartilage, if damaged, repairs itself with fibrous tissue.
  • Pinna develops from the cleft of  1st and 2nd pharyngeal arch
  • Ear pinna develops from Ectoderm
  • Skin over the pinna is closely adherent to the perichondrium on the lateral surface while it is loosely attached on the medial surface.
  • There is no cartilage between the tragus and crus of the helix – incisura terminalis
  •  An incision made in this area will not cut through the cartilage – used for endaural approach in surgery of external auditory canal and mastoid

 Nerve Supply

Skin of pinna is supplied majorly by

  • Greater auricular nerve(C2C3)- Major Part supplied by it
  • Lesser occipital nerve(C2)
  • Auriculotemporal nerve (mandibular branch of 5th nerve) and

With little contribution from

  • Auricular branch of Vagus (Arnold’s N)
  • Facial nerve

Sensory nerve supply of pinna is Mandibular nerve

 Cauliflower ear (boxer’s ear, wrestler’s ear)

is an acquired deformity of the outer ear.

In this injury, the ear can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear.

Wrestlers, boxers and martial artists in particular are susceptible to this type of injury.

When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the connection of the skin to the cartilage is disrupted.

Exam Question

  • The entire pinna (except its lobule and outer part of external acoustic canal) is made up of a framework of a single piece of yellow elastic cartilage
  • Pinna develops from the cleft of  1st and 2nd pharyngeal arch
  • Ear pinna develops from Ectoderm
  • Skin over the pinna is closely adherent to the perichondrium on the lateral surface while it is loosely attached on the medial surface.
  • Greater auricular nerve(C2C3)-Supplies Major Part of Pinna
  • Sensory nerve supply of pinna is Mandibular nerve
  • Cauliflower ear (boxer’s ear, wrestler’s ear)is an acquired deformity of the outer ear.
  • In this injury, the ear can shrivel up and fold in on itself and appear pale, giving it a cauliflower-like appearance, hence the term cauliflower ear.
  • Wrestlers, boxers and martial artists in particular are susceptible to this type of injury.
  • When the ear is struck and a blood clot develops under the skin, or the skin is sheared from the cartilage, the connection of the skin to the cartilage is disrupted.
Don’t Forget to Solve all the previous Year Question asked on Pinna / Auricle

Malignant Otitis Externa

Malignant Otitis Externa


MALIGNANT OTITIS EXTERNA

  •  Necrotizing otitis externa or skull base osteomyelitis
  • Caused by Pseudomonas aeruginosa infection
  • Diabetes is the major predisposing factor
  • Can occur in Immuno-compromised Patients
  •  Severe pain worsening at night
  • Presence of granulations at bony cartilaginous junction (Also in Floor of External Auditory Canal)
  •  Biopsy and radical surgery to be avoided
  •  Multiple cranial nerve palsies can occur – Most Common – Facial Nerve Palsy
  • Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies.
  • Anteriorly, infection spreads to temporomandibular fossa,
  • Posteriorly to the mastoid and medially into the middle ear and petrous bone.
  • Most common nerve palsy – facial nerve
  • Gallium-67 scan is useful in diagnosis and follow-up
  • Treatment: diabetes control, antibiotics, surgery (drainage of subperiosteal abscess, removal of necrotic tissue and sequestrated bone)
Exam Question
  • Caused by Pseudomonas aeruginosa infection
  • Diabetes is the major predisposing factor
  • Can occur in Immuno-compromised Patients
  •  Severe pain worsening at night
  • Presence of granulations at bony cartilaginous junction (Also in Floor of External Auditory Canal)
  •  Biopsy and radical surgery to be avoided
  •  Multiple cranial nerve palsies can occur – Most Common – Facial Nerve Palsy
Don’t Forget to Solve all the previous Year Question asked on Malignant Otitis Externa

CSF Rhinorrhoea

CSF Rhinorrhoea


CSF RHINORRHEA

  • Discharge is clear, watery, appears suddenly in a gush of drops when bending forward (tea pot sign) or straining
  •  Uncontrollable and cannot be sniffed back
  • No associated sneezing, nasal congestion or lacrimation
  • When collected in a test tube and allowed to stand, it remains clear (nasal discharge leaves a sediment)
  • Glucose content > 30mg/dI (nasal discharge – < 10 mg/dl)
  • β2 transferrin is specific for CSF (absent in nasal discharge)
  • In traumatic CSF leak, CSF and blood are mixed – double ring sign or target sign
  • CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II  and type III. (as cribriform plate is injured here) and also in nasal fracture class Ill

 Localization of CSF leak

Intrathecal injection of a dye or a radioisotope and placing pledges of cotton in the olfactory slit, middle meatus, Sphenoethmoidal recess and near the Eustachian tube and examine the pledges for radioactivity

  • Olfactory slit – cribriform plate (most common site)
  • Middle meatus – frontal or ethmoidal sinus
  • Sphenoethmoidal recess – sphenoid sinus
  • Eustachian tube – temporal bone

Management

  • Immediate Management – Antibiotics and Observation
  •  Persistent Case Treated surgically by nasal endoscopy or intracranial route

Exam Question

  • Discharge is clear, watery, appears suddenly in a gush of drops when bending forward (tea pot sign) or straining
  • Uncontrollable and cannot be sniffed back
  • Glucose content > 30mg/dI (nasal discharge – < 10 mg/dl)
  • β2 transferrin is specific for CSF (absent in nasal discharge)
  • Olfactory slit – cribriform plate of Ethmoid Bone (most common site)In traumatic CSF leak, CSF and blood are mixed – double ring sign or target sign
  • Immediate Management – Antibiotics and Observation
  •  Persistent Case Treated surgically by nasal endoscopy or intracranial route
  • CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II  and type III. (as cribriform plate is injured here) and also in nasal fracture class Ill
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Hypospadias

Hypospadias


Hypospadias

  • Hypospadias is most common congenital malformation of urethra.
  • Hypospadias is a condition in which the urethral meatus opens on the underside of penis or the perineum (i.e. ventral surface of penis) proximal to the tip of the glans penis.
  • It is as an association of 3 anatomic and developmental anomalies of penis.
  • An abnormal ventral opening of the urethral meatus
  • An abnormal Ventral curvature of the penis (chordee)
  • A abnormal distribution of foreskin with a ‘hood’ present dorsally and deficient foreskin ventrally (hooded prepuce)
  • Remember that Cryptorchidism is not a feature of hypospadias. But it may be seen associated with hypospadias in 8-9% of cases

Types of hypospadias

  • Glandular (50-70%)
  • Penile
  • Subcoronal
  • Penoscrotal
  • Scrotal
  • Perineal

Also remember

  • Ventral chordee is seen in hypospadias while Dorsal chordee is a feature of epispadias
  • Meatal stenosis may be associated with hypospadias and needs meatotomy for correction.
  • Bifid scrotum may be seen in penoscrotal, scrotal & perinea! hypospadias.
  • Epispadias is less common in relation to hypospadias

Management

  • “The best time for surgery for hypospadias is between 6-12 months of age”

Exam Question

  • Hypospadias is most common congenital malformation of urethra.
  • M/c Type – Glandular
  • Cryptorchidism is not a feature of hypospadias. But it may be seen associated with hypospadias in 8-9% of cases
  • Ventral chordee is seen in hypospadias while Dorsal chordee is a feature of epispadias
  • Meatal stenosis may be associated with hypospadias and needs meatotomy for correction
  • The best time for surgery for hypospadias is between 6-12 months of age”
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Scapula

SCAPULA


SCAPULA

  • Flat triangular bone overlapping second to seventh rib of the upper part of posterolateral chest wall.
  • Important features are:
  1. Inferior angle overlaps seventh rib or seventh intercostal space & lies opposite to tip of T7 spinous process.
  2. Superior angle lies opposite to tip of T2 spinous process.
  3. Lateral angle corresponds to glenoid fossa.
  4. Junction of medial (vertebral) border corresponds to tip of T3 spine.
  • The medial border, inferior angle and part of the lateral border of scapula can be palpated on a patient as can the spine and acromian.
  • The superior border and angle of the scapula are deep to soft tissue and are not readly palpable.
  • Triangle of Auscultation bounded by trapezius, lattismus dorsi and medial border of scapula, lies just medial to lower half of medial border.
  • Congenital high scapula is known as sprengel’s deformity. It is due to failure of normal descent of scapula during development.
 
MUSCLES ATTACHED TO SCAPULA:
 
  1. Coracoid process:  Tip of the coracoid process gives origin to coracobrachialis (medially) and short head of the biceps laterally.  The upper surface receives insertion of pectoralis minor.
  2. Spine of scapula and acromian process: There is origin of Deltoid and insertion of trapezius.
  3. Glenoid tubercle:  Supraglenoid tubercle gives origin to the long head of biceps and infra glenoid tubercle gives origin to long head of triceps.
  4. Lateral border:  Origins of teres minor & teres major.
  5. Medial border: Insertion of serratus anterior (anteriorly); & rhomboideus major, rhomboideus minor & levator scapulae (posteriorly).
  6. Costal (anterior) surface (origin): Subscapularis.
  7. Dorsal surface (origins): Supraspinatus, infraspinatus and at inferior angle latissimus dorsi.
 
 
MOVEMENTS OF SCAPULA:
 

MOVEMENTS OF SCAPULA

MUSCLES CAUSING MOVEMENTS

Elevation

  • Trapezius (upper part)
  • Levator scapulae

Depression

  • Pectoralis minor
  • Serratus anterior

Protraction

  • Serratus anterior
  • Pectoralis minor

Retraction

  • Rhomboideus major
  • Rhomboideus minor
  • Trapezius

Forward rotation of inferior    angle (for overhead abduction)

  • Trapezius (upper fibers)
  • Serratus anterior (lower fibers)

Backward rotation

  • Levator scapulae
  • Rhomboideus major & minor

 

Exam Question

  • Congenital elevation of scapula is called Sprengel shoulder.
  • Winging of scapula is seen in paralysis of Serratus anterior muscle.
  • Superior angle of scapula lies at T2 level.
  • Inferior angle of scapula lies at T7.
  • Superior border of scapula is non palpable.
  • Protractor of scapula is Serratus anterior.
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