Dr.Rao's ENT Care Centre

EAR

Discharge: it could be

	Serous- Otitis Externa , Chronic Otitis Media
	Mucoid- Chronic Otitis Media (safe)
	Mucopurulent & foul smelling- Chronic Otitis Media (dangerous)
	Watery- CSF otorrh treatment – medical followed by surgical eradication of disease in middle ear and reconstruction of ear drum. CSF Otorrhoea- reconstructing the defect in skull base responsible for CSF leak

Hearing loss: 2 types;

	Conductive: this is due to loss of integrity of sound conducting apparatus (or) fixation of ossicles.Treatment is reconstructing the ossicular chain (or) mobilizing the fixed ossicle.
	Nerve deafness: this is due to degeneration of auditory nerve. Cause can be old age, trauma, ototoxic drugs, metabolic disorderscan be treated by giving steroids, hearing aids.

Ear pain: can arise from ear itself (or) from its surrounding structures. Local- Infections of external ear- Furuncle, Otitis externa, Otomycosis Infections of middle ear, Eustachian tube dysfunction, Mastoiditis, Malignancies.Referred otalgia- 5 Ts

	Tongue
	Tooth
	Throat
	TM joint
	Tube Eustachian

Ringing sensation/ Tinnitus-

a. Subjective- wax

	Fluid in middle ear
	Middle ear ventilation
	Abnormally patent Eustachian tube
	Meniere’s disease
	Otosclerosis
	Tumours of auditory nerve
	Anaemia
	Hypertension
	Migraine
	CNS disorders

b. Objective- vascular tumours like

	Palatal myoclonus
	Psychogenic

Giddiness/ Vertigo-

Bleeding from ear-

	Trauma- laceration of EAC with FB fracture base of skull in RTA
	ASOM
	Glomus tumours
	Haemangiomas

Itching sensation-

	General disorders- Dermatitis, Allergies, Diabetes
	Local- Otomycosis

Swellings around the ear;

	Preauricular tags, sinuses, cysts
	Perichondritis
	Mastoiditis
	Tumours

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NOSE

Nasal obstruction- it can be Unilateral / Bilateral

	Continuous / Intermittent aggravated with cold.
	MC causes- Deviated Nasal Septum
	Inferior Turbinate Hypertrophy
	Foreign bodies- (unilateral)
	Polyps
	Growths like Angiofibroma, Inverted Papilloma.
	Rx- corrected by Septoplasty / FESS depending upon the cause

Nasal discharge- it can be mucoid- infection(cold)

	Watery- allergy, polyps it can be unilateral /bilateral can be whitish / yellowish
	MC causes- foreign body, upper respiratory tract infections (rhinitis, sinusitis) tumours causing stasis of secretions by blocking their openings

Head ache: due to inflammation in rhinitis the osti of the sinuses get bocked causing stasis of secretions.this causes unilateral / bilateral moderate to severe headache.

	Site- frontal & maxillary sinuses- forehead
	Ethmoid – bridge of nose
	Sphenoid- occiput, vertex, mastoid region
	Rx. Medical Surgical- FESS (functional endoscopic sinus surgery)

Recurrent attacks of cold – in dicates the severity of the problem. The predisposing condition should be identified and treated accordingly with medicines (or) surgery,

Bleeding from nose (EPISTAXIS)- very alarming & frightening situation to the patient. Causes could be –

a. Local- foreign body

	Trauma/ injury
	Upper respiratory tract infection
	Sharp spur
	Tumours like hemangioma, angiofibroma

b. General- hypertension

Sneezings : more commonly it is caused due to allergy association with nasal polyps , bronchial asthma should be considered

Loss of smell: due to trauma upper respiratory tract infections diabetes

External deformity of nose: now a days cosmetic sense is receiving great importance. Various deformities like-

	Saddle nose
	Hump nose
	Crooked nose can be corrected by Rhinoplasty (or) Septorhinoplasty These deformities can be congenital
	Developmental
	Post-traumatic
	Post-operative

Swellings of nose- can be due to post-traumatic oedema

	Vestibulitis
	Septal abscess

10.

Fracture nasal bones- occur following injury. This usually is associated with bleeding from nose. undisplaced fractures can be dealt conservativelyif bones are displaced and causing obstruction- they are to be reduced within 5 days or after 2 weeks of injury.

11.

Change of voice / rhinolalia / nasal twang. It can be of 2 types- Rhinolalia clausa- due to mass occupying the nasal cavities, nasopharynx.Rhinolalia aperta- due to cleft palate.

12.

Snoring- it is generated by collapse of airways during sleep due to loss of muscle tone. This obstruction can be at various levels-

	Nose- common cold, enlarged turbinates, tumours
	Nasopharynx- tumours, decreased palatal tone.
	Base of tongue-falling back of tongue
	Pharynx Obstruction can be relieved by identifying the level of obstruction and correcting it with surgery.

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THROAT

Throat pain- pricking type- infection burning type- acid peptic disease. Rx- can be treated medically.

Difficulty in swallowing – pts feel that something is obstructing the passage. If this is more for solids than liquids-

	Mass lesions- intrinsic / extrinsic
	Globus Hystericus
	Oesophageal webs in PV syndrome. These are evaluated and mass lesions excised by surgery. If liquids > solids and associated with nasal regurgitation and cough- can be due to neurological cause.This is treated medically and the cause of nerve palsy is addressed.

Hoarseness of voice- can be due

	Vocal abuse- vocal nodules appear on vocal cords.
	Acute and chronic laryngitis- due to viral, bacterial, fungal infections
	Cysts, deposits
	Tumours.

Breathy voice- due to vocal cord paralysis, paresis.

Cough- a protective phenomenon to expel foreign body from respiratory tract causing irritation.

	Infections of respiratory tract
	Foreign body inhalation.

Fever- infections of upper and lower respiratory tract, oral cavity.

Trismus-inability to open the mouth.

	Tetanus
	Ludwig’s angina
	TM joint fixation
	Sub mucosal fibrosis due to smoking
	Oral malignancies

Disturbance of taste- can be due to ;

	Chorda tympani nerve injury – either by surgery / infections of the nerve or facial nerve
	Vitamin deficiencies
	Old age
	Diabetes

Disturbance of salivation;

	Increased – local infection / ulcer in oral cavity, throatincreased secretion of salivary gland
	Decreased – salivary gland infection (sialadenitis)gland duct obstruction.

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DR.RAU'S ENT SUPER SPECIALITY HOSPITAL

Behind Durga Malleswara Swamy Temple,

1/2 RT, Housing Board Colony,

Opp.Mosque, Panjagutta,

Hyderabad- 500 082

Clinic No : 2373 6677

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