ENT OSCE for medical students of kuhs.pptx

Charts and x-rays

1. ENT OSCE JL

2. The audiogram in NIHL shows a typical notch, at 4 kHz, both for air and bone conduction .It is usually symmetrical on both sides. At this stage, patient complains of high-pitched tinnitus and difficulty in hearing in noisy surroundings but no difficulty in day-to-day hearing. As the duration of noise exposure increases, the notch deepens and also widens to involve lower and higher frequencies. Hearing impairment becomes clinically apparent to the patient when the frequencies of 500, 1000 and 2000 Hz (the speech frequencies) are also affected. JL

3. BERA (brainstem evoked response audiometry) is to elicit brainstem responses to auditory stimulation by clicks or tone bursts. In a normal person, seven waves are produced in the first 10 ms Wave I Distal part of CN VIII Wave II Proximal part of CN VIII near the brainstem Wave III Cochlear nucleus Wave IV Superior olivary complex Wave V Lateral lemniscus Waves VI and VII Inferior colliculus ABR is used: ( i ) As a screening procedure for infants. (ii) To determine the threshold of hearing in infants; also in children and adults who do not cooperate and in malingerers. (iii) To diagnose retrocochlear pathology particularly acoustic neuroma. (iv) To diagnose brainstem pathology, e.g. multiple sclerosis or pontine tumours . (vi) To monitor CN VIII intraoperatively in surgery of acoustic Brainstem auditory evoked potentials. Interpeak latency between I–III, 2.0 ms ; III–V, 2.0 ms ; I–V, 4.0 ms . acoustic neuroma –increase in IPLbtw waves I and III, increase inter aural latency, difference of wave V JL

4. Type C Maximum compliance occurs with negative pressure in excess of 100 mm H2O. Seen in retracted tympanic membrane and may show some fluid in middle ear. 2. Otoscopic findings. Tympanic membrane is often dull and opaque with loss of light reflex. It may appear yellow, grey or bluish in colour . Thin leash of blood vessels may be seen along the handle of malleus or at the periphery of tympanic membrane and differs from marked congestion of acute suppurative otitis media. Tympanic membrane retraction. Sometimes, it may appear full or slightly bulging in its posterior part due to effusion. Fluid level and air bubbles may be seen when fluid is thin and tympanic membrane transparent Mobility of the tympanic membrane is restricted. 2. SURGICAL When fluid is thick and medical treatment alone does not help, fluid must be surgically removed. Myringotomy and aspiration of fluid. Grommet insertion (c) Tympanotomy or cortical mastoidectomy . JL

5. 6. OTOACOUSTIC EMISSIONS (OAEs) They are low-intensity sounds produced by outer hair cells of a normal cochlea and can be elicited by a very sensitive microphone placed in the external ear canal and analyzed by a computer. OAEs are present when outer hair cells are healthy and are absent when they are damaged and thus help to test the function of cochlea. Types of OAEs. (a) Spontaneous OAEs. They are present in healthy normal hearing persons where hearing loss does not exceed 30 dB. They may be absent in 50% of normal persons. (b) Evoked OAEs. They are further divided into ( i ) Transient evoked OAEs (TEOAEs). Evoked by clicks. A series of click stimuli are presented at 80–85 dB SPL (sound pressure level) and response recorded. (ii) Distortion product OAEs (DPOAEs). Two tones are simultaneously presented to the cochlea to produce distortion products. They have been used to test hearing in the range of 1000–8000 Hz. Uses (a) screening test of hearing in neonates and to test hearing in uncooperative or mentally challenged individuals after sedation (b) They help to distinguish cochlear from retrocochlear hearing loss (c) OAEs are also useful to diagnose retrocochlear pathology, JL

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7. Causes of facial paralysis • Poliomyelitis • Acoustic neuroma • Meningitis – Bell palsy • Infections – Acute suppurative otitis media – Chronic suppurative otitis media – Malignant otitis externa • Trauma – Facial nerve neuroma – Metastasis to temporal bone (from cancer of breast, bronchus, prostate) • Extracranial part • Malignancy of parotid • Surgery of parotid • Accidental injury in parotid region • Neonatal facial injury (obstetrical forceps) • Systemic diseases • Diabetes mellitus • Hypothyroism JL

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