ENT surgery pics Flashcards
Nose, Otology, Vestibular system and Paediatric A and E [tonsils, adenoids],
What does this image show?
Broken nose
Sections of ear?
Outer ear- up until eardrum
Middle ear- eardrum to stapes
Inner ear- semi-circular canals, cochlea
Bones of middle ear
Malleus
Incus
Stapes
What is a cholesteatoma? What are the complications?
Tympanic membrane retraction pocket - has grown bigger and dead squamous cells have accumulated in it
Grows and starts secreting osteolytic enzymes + activating osteoclasts
Grows back into mastoid + affects:
- Semicircular canal
- Sigmoid sinus- main venous drainage of brain
- Dura of middle cranial fossa
- Eventually fatal- meningitis, brain abscess
Methods of approach for operation of cholesteatoma/inner ear surgery?
- Through ear canal
- pro: cosmetic, doesn’t leave much scarring
- cons: difficult/fiddly to surgery
- Cut behind pinna, through bone and mastoid
- Pro: better access
- Cons: Risk of cutting through important structures such as sigmoid sinus
- Through both ear canal and mastoid bone
- Pro- best access
- Con
- have to decide either keep posterior bone wall [and can then reconstruct, but makes operation harder]
- or leave a mastoid cavity [remove all of posterior bone and leave it off]
What happens if mastoid cavity pts go swimming?
- Get really dizzy
- Water is in direct contact with lateral semicircular canal
What is glue ear?
How is it treated?
What can precipitate it?
How does the precipitating factor change the presentation?
Who is it most common in and why?
Otitis media with effusion
Treatment: Insertion of grommets- drain effusion and remove low pressure environment that caused effusion
Precipitated by: Upper respiratory tract system
If due to URTI- usually bilateral
If unilateral- something compressing Eustacian tube- maybe cancer
Most common in children: Eustacian tube less well developed
What is a BAHA?
Used when no middle ear bones [ossicular chain]
Causes vibration of bones in skull near cochlea
What is an auditory brainstem implant?
Electrodes directly to brainstem
Experimental
Used if eighth nerve not working
What does this image show?
Lateral semi-circular canal- bright white spots MRI
What are the adenoids?
Post nasal nasopharynx
What is an active middle ear implant?
Directly stimulates stapes
If other conductive hearing loss
What is this?
Nasal polyp
What is this?
Otitis media
What is highlighted?
Malleus
What is highlighted?
Incus
What is this?
Mastoid fistula [Caused by otitis media that goes backwards]
Occur in areas where people don’t have access to safe surgery commonly
What is this?
Mastoiditis
Caused by otitis media that goes backwards
What is this?
Otitis externa
What is this?
Bilateral septal haematoma
What is a tympanic membrane retraction pocket?
When the pressure in the inner ear falls, the pars flaccida [red circled below] can fold in on itself, creating a pocket of tympanic membrane
Picture of the vestibular system
What is grading of tonsil size?
0- in fossae
1 -<25%
2- 25-50%
3- 50-75%
4- >75%
