
- •In an adult by pulling the auricle upwards, outwards and backwards. Inconstant
- •Incudis in the aditus, and the annular ligament attaches the footplate of the
- •Inferior tympanic branches of the sympathetic plexus of the internal carotid
- •Via the cochlear aqueduct.
- •Internal Ear
- •Intensity of the stimulating source. These are known as cochlear microphonics
- •Inferior turbinate is a separate bone attached to the maxilla. Each turbinate
- •In the normal nose these parts can rarely be seen from the front. Between these
- •Venous drainage from the nasal cavity is through the sphenopalatine foramen to
- •Vasoconstriction and diminished secretion, arise from the superior cervical
- •Infection to the meninges.
- •In the adult. The lateral wall is contiguous with the internal carotid artery,
- •Immunoglobulin a (IgA), immunoglobulin m (IgM), and immunoglobulin g (IgG).
- •Vertebra.
- •Internal and external ligaments and membranes unite the cartilages and stabilise
- •Vein and for the internal branch of the superior laryngeal nerve which supplies
- •Internal laryngeal musculature. In addition, it provides sensation to the
- •Vital and Communicative Functions of the Larynx
- •Is therefore of interest to the otolaryngologist. Furthermore, endoscopic
- •Is held open by 16 to 20 horseshoe-shaped cartilaginous rings. The posterior
- •Vascular supply. The trachea is mainly supplied by the inferior thyroid artery
- •In combination with other non-pathogenic organisms. Less often Staphylococcus
- •Infection may be seen as a small, red, circumscribed and very tender swelling on
- •Injected along the upper wall of the meatus. Excessive force should not be
- •Infection entering the middle ear through the perforation from the external
- •It is in the upper respiratory tract that the source of infection will be found.
- •In all cases the aim of the treatment is to produce a safe, dry ear and, if
- •In addition the tympanic membrane and ossicles were removed, and the Eustachian
- •It is diseased, a homograft incus, to reconstitute the ossicular chain. Where
- •Incus are removed and, if this mobilizes the malleolar handle, the drum
- •Intramuscular injection starting with 1 million units (benzylpenicillin)
- •Incision is made, the mastoid bone is exposed and Shipo's triangle identified.
- •I.E. Cholesteatomatous erosion of the bony capsule of the labyrinth, usually the
- •Initial stages. Sedation with labyrinthine sedatives is required, dimenhydrinate
- •Intracranial complications. It is more common in the posterior than in the
- •Is associated with deep-seated boring pain, tenderness on tapping over the
- •Infections although more frequently in the latter. The local inflammation in the
- •Intervals between the rigors the patient is free from symptoms, although in
- •Is recommended. When active surgical intervention is required this consists of
- •Intracranial pressure. The patient's initial conscious level may be normal but
- •5Ml may be introduced is turbid. Surgery of the underlying ear disease should be
- •Venous system of the neck via the facial vein, but also drain via the angular
- •Initial catarrh occurs in influenza and infection with other types of viruses
- •Includes decongestant nose drops or oral decongestants. Antibiotics should only
- •Inflammation with gradual irreversible to the mucosa; infection in the sinuses,
- •Vascular-type face-aches arise.
- •Is a common problem, and rather than blindly instigating medical or surgical
- •Is affected, it can be removed locally. Only a very limited portion of the
- •Infection, particularly of the sinuses, should be sought and treated. Twenty
- •In more severe cases there is a vascular-type face-ache which throbs and becomes
- •Increasing around midday and decreasing in the afternoon. Sphenoidal sinusitis,
- •Inhalation of dust or fumes, is a further predisposing factor.
- •Infection, but is unlikely to be found unless the X-ray is carried out during an
- •1. Lavage of the sinus.
- •In the floor of the maxillary sinus if the cyst is small. When the cyst fills
- •Vary greatly in their tolerance of nasal obstruction, some complaining bitterly
- •In the young, but when it is successful a smooth, greyish-white, spherical mass
- •Inflammations of the pharynx
- •In localized forms, the disease is restricted to the tonsil, the nose, the
- •Injuring the major vessels of the neck. The incision is made parallel to the
- •If these measures fail and there is increasing dyspnea, the child must be
- •In addition to redness, this type displays a hypertrophy in the supraglottis and
- •Investigation is indicated, whose objective is shown in Table 1.
- •In appearance. The skin is coarse and pitted, and has an oily appearance due to
- •Intense headaches. In later disease pain is a prominent feature. Spread to lymph
- •Very least of maxillectomy with the fitting of an obturator, and before
- •If the soft tissues of the cheek are infiltrated by tumour, this area will have
- •Vessels. In later stages there is swelling of the lateral part and the face of
- •Immediately to further surgery if massive bleeding occurs.
- •Investigations. Radiography is not usually helpful except to see if there has
- •Vocal cord either on a pedicle or sessile. It is seroedematous and occasionally
- •Immunologic and antiviral treatment are used. Today there is no alternative to
- •Ventricles
- •Inherited Syphilis
- •Infiltration, dark red in colour, involving one or both sides of the septum.
- •Is found on the nasal septum syphilis should be suspected. The diagnosis is made
- •Venerologist. Local hygiene is necessary and the highly contagious nature of the
- •Is a rare complication of the pulmonary lesion. It is characterized by minute
- •It is, however, sound surgical practice to remove the tonsils from children who
- •If a hematoma is not treated, connective tissue organization, secondary
- •Into the bony labyrinth and the internal auditory meatus. In both cases the dura
- •View, tomograms, and possibly ct in patients with facial paralysis or csf
- •Vestibular provocation nystagmus in the presence of vertigo, and more rarely
- •Inflammatory diseases of the eustachian tube should be dealt with. These
- •In gunshot trauma there is a short stabbing pain in the ear, a marked continuous
- •Inevitably cause considerable soft-tissue swelling. This becomes marked very
- •Incisions are again made on both sides of the septum, the pus is removed and a
- •Vomiting, sialorrhea, and at times glottic edema and dyspnea. White corrosive
- •Introduced. Contraindications include shock and suspected perforation. Immediate
- •In any long-standing cases of nasal discharge
- •Impacted foreign bodies cause necrosis of the esophageal wall leading, depending
- •View should be obtained; the nose is less likely to be actively bleeding, and a
- •Is told to swallow it. At the moment at which he does so, just as the larynx is
- •Interesting point about it is that although it was first described over a
- •Is almost no evidence to support this theory. Allergy has been blamed,
- •Infections.
- •In nearly 50% of cases a history of deafness in the family can be obtained. The
- •Is likely to progress rapidly. Paracusis Willisii is frequently present,, I.E.
- •Include allergy, focal infection, biochemical disturbance, vitamin deficiency,
- •Is due to the inability to hear higher frequencies which means that consonant
In more severe cases there is a vascular-type face-ache which throbs and becomes
more severe when the head is dependent or when venous pressure is raised by
straining. The pain may be excruciating, and associated with lacrimation and
epiphora, and the muscles on that side of the face may go into spasm, indicating
the degree of discomfort.
The site of the pain can indicate which sinus is involved. Maxillary sinusitis
causes pain in the infraorbital region, or in the teeth and gums. Ethmoidal
sinusitis gives pain over the bridge of the nose and between the eyes, and
frontal sinusitis gives pain in the supra-orbital area. This pain of frontal
sinusitis often has a characteristic periodicity, starting in the forenoon,
Increasing around midday and decreasing in the afternoon. Sphenoidal sinusitis,
which is rare, can cause occipital, vertical or retro-orbital pain.
The nose is obstructed on one or both sides, and the watery rhinorrhoea
associated with the prodromal coryza or influenza changes to a thicker
mucopurulent secretion, which in severe cases can be almost entirely purulent in
character. The sense of smell is reduced, or there may be an unpleasant smell,
cacosmia. In children there can be excoriation of the vestibule of the nose and
the upper lip. Much of the purulent secretion runs into the nasopharynx and
pharynx, due partly to the action of the cilia, but also because the ostium of
the maxillary sinus, which is most commonly affected, lies posteriorly in the
middle meatus of the nose. There is an associated systemic upset, with malaise,
headache and fever, and the circulating white-cell count is raised.
CLINICAL FEATURES. Anterior rhinoscopy shows signs of an acute inflammatory
response. The inferior and middle turbinates are red and swollen, and the colour
of the mucosa overlying the septum is similar. The degree of swelling of the
turbinates may preclude an adequate view of the middle meatus, but this swelling
can be reduced by the local application of 0,1% adrenaline solution on a pledget
of cotton wool. If the ostia are patent, pus will be seen in the middle meatus,
high up and anteriorly in frontal sinusitis, and lower and more posteriorly if
the anterior ethmoidal cells or the maxillary sinus is affected. If mucopus is
seen running medial to the middle turbinate, this indicates infection in the
posterior ethmoidal or sphenoid sinuses.
Posterior rhinoscopy will show mucopus on the superior surface of the soft
palate, or dried yellow crusts on the roof of the nasopharynx. There is often an
associated granular pharyngitis. There may be flushing and some swelling of the
affected cheek in maxillary sinusitis, while oedema of the eyelids or forehead
suggests infection of the frontal or ethmoidal sinuses. Tenderness over the
inflamed sinus is elicited on pressure.
Radiography of the sinuses is indicated in acute sinusitis. Should there be a
diagnostic problem the standard occipitomental and occipitofrontal views are
usually sufficient, although oblique views of the ethmoids or submentovertical
views for the sphenoid sinus may be required. The acutely inflamed sinus will
appear homogeneously opaque or a fluid level may be present. Bacteriological
analysis of the discharge should be done. CT-scan of the sinuses is indicated.
Chronic sinusitis
Chronic sinusitis usually follows an episode of acute sinusitis. The latter may,
however, be far in the past and forgotten by the patient. The essential
abnormality is intermittent or constant blockage of a sinus ostium resulting in
poor aeration and stasis of secretions leading to infection. One or more of the
paranasal sinuses may be involved. The condition may be unilateral or bilateral.
The maxillary sinuses are the most commonly affected.
PREDISPOSING CAUSES. These can be divided into nasal and dental. Any
pathological process resulting in a decreased airway over a long period of time
will predispose to chronic sinusitis. In children the commonest cause is adenoid
enlargement. In adults a unilateral pansinusitis may be associated with a
deviate nasal septum. This is not necessarily on the convex side of the
deviation, but may be on the contralateral side as compensatory hypertrophy of
the middle turbinate causes poor aeration of the middle meatus, into which most
sinuses drain through their ostia.
Allergic rhinitis, particularly of the perennial type, causes oedema with
narrowing of the ostia. When allergy and chronic sinusitis, particularly of the
ethmoidal labyrinth, coexist, nasal polypi are found. Chronic rhinitis, which
often has a social or occupational aetiology such as excessive smoking or the