- •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
If a hematoma is not treated, connective tissue organization, secondary
calcification, and deformity of the auricle occur leading to a cauliflower ear.
Frostbite
Grade 1 - cyanosis of the skin due to vascular spasm
Grade 2 - ischemia with formation of vesicles
Grade 3 - deep necrosis of tissue
Treatment. Sterile dressings, antibiotics, intravenous vasodilators. The part
must be kept dry.
Burns require the same treatment as burns of the skin; particular attention must
be paid to the close relationship between the skin and the cartilage.
Late complications include necrosis of the auricle and atresia or stenosis of
the external auditory meatus.
Temporal bone fracture
Pathogenesis. Direct fractures are caused by the effect of external violence
concentrated on a small surface, e.g., by gunshot wounds. The result is a
penetrating perforating fracture with brain damage. Indirect fractures are due
to diffused external violence. The course of the fracture may run either: (1)
along the pyramidal axis (i.e., a longitudinal fracture) extending into the
middle ear; (2) across the pyramid axis (i.e., transverse fracture) extending
Into the bony labyrinth and the internal auditory meatus. In both cases the dura
may be torn, producing an open connection between the pneumatic system of the
temporal bone and the subarachnoid space of the cranial fossae. The patient is
then in danger of a latent infection ascending via the eustachian tube to the
meninges.
Symptoms of the longitudinal pyramidal fractures (mainly affecting the middle
ear):
- Hemotympanum.
- Tearing of the tympanic membrane.
- Bleeding from the external auditory meatus.
- A break in the contour of the anulus tympanicus.
- Step formation in the external auditory meatus, which should be differentiated
from posterior displaced fracture of the mandibular condyle.
- Middle ear deafness.
- Facial paralysis in about 20% of patients.
- Occasionally CSF otorrhea.
Diagnosis. This rests on otoscopic findings, radiographs including Schueller’s
View, tomograms, and possibly ct in patients with facial paralysis or csf
otorrhea.
Symptoms of the transverse pyramidal fractures (mainly affecting the inner ear):
- Intact external auditory meatus.
- Intact tympanic membrane, possibly with a hemotympanum.
- Hearing loss.
- Vertigo.
- Spontaneous nystagmus beating to the healthy ear.
- Facial paralysis in about 50% of patients.
- Cerebrospinal fluid leak via the eustachian tube to the nasopharynx.
Diagnosis. This is based on otoscopic and functional findings, radiographs in
Stenver’s view and tomograms.
Treatment of longitudinal and transverse pyramidal fractures. The treatment is
dictated by the ever-present danger of otogenic meningitis. Therefore,
prophylactic antibiotics are given consisting of high-dose, long-term parenteral
broad-spectrum agents.
The temporal bone must be explored for early or late complications.
Indications for early otologic intervention:
- Early meningitis, treated by mastoidectomy.
- Bleeding from the sinus, treated by opening of the mastoid and packing or
ligature of the sinus.
- Persistent CSF otorrhea, treated by repair of the dura.
- Facial paralysis, treated by decompression.
- Depressed fracture of the external auditory meatus, treated by reconstruction
of the meatus because of the danger of secondary atresia.
- Gunshot wounds of the temporal bone, treated by debridement of the fragmented
area.
Indications for late otologic intervention:
- Antibiotic-resistant traumatic otitis media.
- Chronic mastoiditis, treated by mastoidectomy.
- Late facial nerve paralysis with symptoms of denervation, treated by facial
nerve decompression.
- Posttraumatic deafness, treated by tympanoplasty.
- Posttraumatic cholesteatoma, treated by radical mastoidectomy and
tympanoplasty.
Emergency surgery must certainly be carried out, as soon as the general
condition of the patient permits, for the indications detailed above.
Course and prognosis. The following complications are possible, especially as a
result of unsatisfactory treatment or missed diagnosis:
Early complications:
- Acute otitis media with mastoiditis.
- Extension of the above infection to the subarachnoid space causing early
meningitis or an infected labyrinthitis extending to the meninges.
Late complications:
- Chronic otitis media with mastoiditis.
- Late otogenic meningitis.
- Subdural abscess.
- Otogenic brain abscess.
- Posttraumatic cholesteatoma.
Labyrinthine concussion
Posttraumatic disorders of the inner ear function (deafness and dizziness) in
the presence of normal otoscopic and radiographic findings are included under
the term labyrinthine concussion.
Symptoms. These include tinnitus, unilateral or bilateral sensorineural deafness
with positive recruitment and high-tone loss or a notch at 4000 Hz, dizziness
especially on change of position or rapid movements of the head, and disorders
of balance.
Pathogenesis. This disease is usually due to organic mechanical damage to the
membranous labyrinth similar to acute acoustic trauma. Microfractures of the
labyrinthine capsule accompanied by bleeding into the peri- and endolymphatic
space and mechanical disturbances of the microcirculation causing degeneration
of the cochleovestibular sensory cells may also occur.
Diagnosis
Normal otoscopic findings
Normal radiographs in Schueller's and Stenver's views
A pure-tone audiogram showing a sensorineural deafness with a notch at 4000 Hz
or high-tone loss with recruitment