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- •Foreword
- •Preface
- •Acknowledgement
- •Contents
- •1.1 General History Taking and Examination
- •1.2.2 Systemic Examination
- •3.2 Examination of Ear
- •6.2.2 Oral Cavity Examination
- •7.1.2 Odynophagia (Painful Swallowing)
- •7.1.5 Cough
- •7.1.1 Throat Pain
- •7.1.6 Expectoration
- •7.1.7 Halitosis
- •7.1.9 Swelling/Bulging/Growth
- •7.1.10 Snoring
- •7.2.3 Other Examination Includes
- •10.3.1 Swelling or Growth or Ulcer
- •10.4.3 Nasopharynx
- •10.4.4 Oropharynx
- •10.4.5 Laryngeal Tumours
- •10.4.6 Laryngopharyngeal Tumours
- •10.4.7 Oesophageal Tumour
- •10.4.8 Salivary Gland Tumours
- •10.4.15 Lymphoma
- •10.5.1 Neck Sweeling/Lump/Mass
- •10.5.2 Sinus
- •10.5.3 Head Movement
- •10.5.4 Neck Pain
- •13.1 Maxillofacial/Facial Trauma
- •13.1.1 Overview of Maxillofacial Fracture
- •15.1 Facial Aesthetic, Structural and Functional Deformities
- •16.1 Craniofacial Anomalies
- •17.1 Skull Base
- •18.1.3 Stridor
- •18.1.4 Wheeze
- •18.1.5 Stertor
- •18.2.1 Acute Dysphagia
- •18.3.4 Oral Bleeding


Clinical Methods of Otorhinolaryngology,
Skull Base & Head Neck Surgery

SushilKumarKashyap • SharmisthaSagar
Clinical Methods of
Otorhinolaryngology,
Skull Base & Head Neck
Surgery

SushilKumarKashyap
Department of ENT & Head Neck
Surgery
MLB Medical College
Jhansi, Uttar Pradesh, India
SharmisthaSagar
Department of Anatomy
Autonomous State Medical College
Lalitpur, Uttar Pradesh, India
ISBN 978-981-96-1764-7 ISBN 978-981-96-1765-4 (eBook)
https://doi.org/10.1007/978-981-96-1765-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
If disposing of this product, please recycle the paper.

Dedicated to my Godfather and parents

Foreword
This book titled Clinical Methods of Otorhinolaryngology, Skull Base and
Head Neck Surgery is the rst edition and author has included clinical history,
examination and interpretation of these ndings in making diagnosis of
disorders of general otorhinolaryngology, and allied subspecialties like head
neck oncology, thyroid gland, salivary gland, maxillofacial trauma, skull
base, facial plastic surgery, and skin diseases of head and neck. This book has
also included approach to patient in emergency and trauma. This book is
sheer hard work of author to include comprehensive knowledge of clinical
methods like history taking and examination. Wherever needed author has
explained the situation with the help of diagrams and tables. There are two
chapters in this book to explain the emergency and trauma of this eld.
The various clinical images have been included to undersatnd disease.
Dr. Kashyap has worked with me as assistant professor in LHMC, New
Delhi. At present, he is working as Professor and Head of the Department of
Otorhinolaryngology and Head Neck Surgery in MLB Medical College,
Jhansi. His knowledge about otorhinolaryngology and head neck is very
extensive. The depth of his knowledge helps him in formatting this book.
He has limited the contents of this book to the clinical aspect of ear, nose,
throat, head, neck, and skull base.
Otorhinolaryngologist and head neck surgeon deal not only with patients
of general otorhinolaryngology but also with patients of head neck oncology,
nasal and facial structural deformities, maxillofacial trauma, and diseases of
lateral, anterior, and middle skull base. The endoscopic skull base surgery is
emerging eld for both ENT and neurosurgeon. Most of clinical books of this
eld do not include these subspecialties. This book has included all these
specialties to help readers in making correct diagnosis. I recommend this
book to all postgraduate students, ENT surgeon, and head neck surgeon.
This book will help young ENT and head neck surgeon in making diagnosis
in routine and emergency situation.
Thank you
Lady Hardinge Medical College SunilKumar
New Delhi, India
vii

Preface
In clinical practice, history taking and examination are the rst steps in
making diagnosis. ORL and head neck surgery is a rapidly expanding broad
specialty which includes subspecialties like head neck oncology, skull base
(ventral and lateral) surgery, facial and nasal plastic surgery, and maxillofacial surgery. Diagnosis making is a very important task which requires history, examination, and investigation ndings. A book is required on clinical
methods which includes all subspecialties.
Otorhinolaryngology and head neck surgery has changed a lot in last few
decades. After the newer diagnostic methods, surgical procedure and surgical
equipment. The skull base tumours, CSF rhinorrhoea, etc. have also been
treated trans nasally with the help of endoscope with less mortality and morbidity. The advanced use of endoscope in treating the skull base tumours and
brain tumours with the help of neurosurgeon opened new horizon for ENT
surgeons. The lateral skull base tumours are treated using trans labyrinthine
approach. The disorders and tumours of thyroid gland have been treated via
trans vestibular approach without incision on neck. The maxillofacial trauma
has been treated by ENT surgeon. The head neck carcinoma has been surgically treated by ENT or head neck surgeon. The otorhinolaryngology is rapidly changing and growing surgical speciality, require a clinical book to make
clinical diagnosis easy of all subspecialities of ORL & HNS. There was a
need of a book on clinical methods which include all subspecialties of otorhinolaryngology, head neck disease, skull base disease, facial and nasal plastic
surgery, and maxillofacial trauma.
This book includes clinical aspects of all subspecialties of ENT and HNS
to help students and ENT surgeon, head neck surgeon, endoscopic skull
base surgeon in interpretation of history and examination ndings to make
diagnosis and also explains how to take proper history and perform the
examination.
This rst edition has 18 chapters which include history taking, general
examination, systemic examination, and differential diagnosis. This book
starts with general history taking and general examination and also includes
how to perform examination with a list of probable diagnosis. It is anticipated
that this clinical methods of otolaryngology head and neck surgery will provide immediate access to necessary detail information on diagnosis making
in otolaryngology and head neck surgery. This book has included all aspects
to decrease the amount of time spent on searching for needed information.
With that goal in mind, this book is well organized, follows an established
ix

x
format, is thoroughly indexed, and in all areas is focused on providing detail
information that is likely to be clinically most useful. It is hoped that this
book will serve students (UG and PG) and otorhinolaryngologist, head neck
surgeon well to the benet of the patient.
This standard organization was chosen to allow the user to review a subject in the typical pragmatic manner in which one approaches a clinical problem. Furthermore, the fact that each chapter follows this same outline should
enable the reader to become comfortable nding necessary subjects rapidly.
When applicable, tables and images are also used to present and organize key
information. The extensive index has been thoughtfully planned as a quick
and easy reference. We are condent that this book will serve clinicians well.
This book has been created for otorhinolaryngologist, head neck surgeon,
skull base surgeon, postgraduate students, and undergraduate students.
We will be pleased to receive comments and suggestion for improved second
edition at sushiled20@gmail.com.
Jhansi, Uttar Pradesh, India SushilKumarKashyap
Preface

Acknowledgement
Writing a book is harder than I thought and more rewarding than I could
have ever imagined. In completion of this assignment, I had to take the help
and guidance of some respected persons, who deserve my deepest
gratitude.
The completion of this assignment gave me much pleasure. First and foremost, I would like to praise and thank my Godfather (Dr. B.R.Ambedkar, the
Father of the Constitution of India) and my parents for their efforts made in
past and their showers of blessings from heaven throughout.
I would like to show my special gratitudeto my elder brother Mr. Rakesh
Kashyap for his untiring encouragement throughout my life and during this
project. His dynamism, vision, sincerity, and motivation have deeply
inspired me. I would like to thank my wife Dr. Sharmistha Kashyap for giving me a good support throughout the assignment. She stood by me during
every struggle and all my success. She helped me a lot in gathering information, collecting data despite her busy schedules. She gave me different
ideas in making this project unique by suggesting to include all elds like
skull base, head and neck oncology, facial plastic surgery, craniofacial
surgery, and maxillofacial trauma. I am very much thankful to my children
for their love, understanding, prayers, and continued support to complete
this work.
I would like to express my thanks to all my teachers and special regard to
Dr. Sunil Saxena, Professor and Head, Department of ENT and Head Neck
Surgery, JIPMER, Pondicherry, India and Dr. Sunil Kumar, Director
Professor, Department of ENT, LHMC, New Delhi. It was a great privilege
and honour to work and study under their guidance.
Dr. Sharmistha Kashyap and Dr. Shirin Jahan have edited the anatomical
part of this book. I would like to thank both of them for their efforts and hard
work. Dr. Neeraj Srivastava, Professor, Skin and VD, MLB Medical College,
Jhansi has contributed Chap. 14 (History and Examination of Skin, and
Hair Disorders of Head and Neck) of this book. Dr. Kuldip Chandel and
Dr. Madhurmay helped in preparing the topic on general and systemic
examination of this book.
None of this would have been possible without my past students who
inspired me to write this book on clinical methods in otorhinolaryngology
and head neck surgery. I would also like to expand my gratitude to all
those who have directly and indirectly helped me in writing this book.
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xii
Many people, especially my friends, have made valuable comment and
suggestions on this book which gave me an inspiration to improve the
quality and contents. I would like to say thanks to my friends and contributors, for their constant encouragement and support.
Dr. S.K.Kashyap
Acknowledgement
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