- •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
Infection, but is unlikely to be found unless the X-ray is carried out during an
acute exacerbation of the chronic infection. Mucosal thickening, is the
commonest abnormality, on radiography of a patient suspected of having chronic
sinus infection, and it is unfortunately also the least diagnostic. Any
condition causing swelling of the nasal mucosa can also cause swelling of the
sinus mucosa, and it is therefore important to correlate the radiographic
appearances with the clinical appearances of the nose. If the mucosal thickening
on the X-ray is more marked than examination of the nose would lead one to
suspect, or if there is a difference in degree in one side compared with the
other, it is more likely that chronic infection is present.
A swab should be taken to determine the organisms and their sensitivity to
antibiotics. CT-scan of the sinuses is indicated.
TREATMENT OF SINUSITIS
Maxillary sinus
Acute maxillitis
1. Lavage of the sinus.
Two different methods are in routine use: access via the inferior meatus (sharp
puncture) and access via the middle meatus (blunt puncture).
Principle of lavage through the inferior meatus
Local anesthesia of the inferior meatus is induced. A needle of Culycovsky is
placed against the lateral nasal wall beneath the origin of the inferior
turbinate. After pushing the needle through this usually thin part of the
lateral nasal wall, aspiration, lavage, or the introduction of drugs may be
carried out through the needle. A thin polyethelen tube can be inserted into the
sinus and sinus is washed 1, 2, 3 times a day by the antiseptic until clear.
Principle of lavage via middle meatus
Local anesthesia of the middle meatus is induced. The ostium of the maxillary
antrum is sought, and a blunt curved cannula is introduced through it.
Aspiration, lavage, and introduction of drugs can be carried out through the
cannula. This manipulation carried out daily.
2. Introduction of antibiotics, corticosteroids and ferments into the sinus
daily. Antibiotics are used according to the result of bacteriological analysis.
3. Systemic antibiotics.
4. Decongestant nasal drops.
5. Antihistamine drugs in tablets.
6. Calcii gluconas.
7. Physiotherapy.
If the complications take places and their conservative treatment has not
effects radical antrostomy should be carry out.
Chronic maxillitis
1. Lavage of the sinus.
2. Introduction of the antibiotics, corticosteroids and ferments into the sinus.
3. Decongestant nasal drops.
4. Antibiotics are given systemically.
5. Antihistamine drugs in tablets.
6. Calcii gluconas.
7. Physiotherapy.
Surgical treatment:
1. Endoscopic enlargement of the sinus ostium.
2. Endoscopic antrotomy and removal of the pathological mucosa, polyps, cysts.
3. Radical antrostomy.
4. Intranasal antrostomy.
Frontal sinus
Acute frontitis
1. Lavage of the sinus.
Puncture can be carried out using a fine drill or special trocar under local
anesthesia. Puncture is carried out through the anterior wall. A thin
polyethelene tube is inserted and daily lavage is carried out.
2. Introduction of the antibiotics, corticosteroids, ferments into the sinus.
3. Systemic antibiotics.
4. Decongestant nasal drops.
5. Antihistamine drugs.
6. Calcii gluconas.
7. Physiotherapy.
Chronic frontitis
Conservative treatment is the same as in the case of acute frontitis.
Surgical treatment:
1. Endoscopic enlargement of the sinus ostium.
2. Radical operation on the frontal sinus.
Ethmoidal sinus
1. Intramuscular introduction of antibiotics.
2. Decongestant nasal drops.
3. Antihistamine drugs.
4. Calcii gluconas.
5. Endoscopic intranasal ethmoidotomy.
6. Radical ethmoidotomy.
Sphenoid sinus
1. Antibiotics.
2. Nasal drops.
3. Antihistamine drugs.
4. Calcii gluconas.
5. Endoscopic intranasal sphenoidotomy.
6. Radical sphenoidotomy.
Operations for maxillary sinusitis
Intranasal antrostomy. The principal indication for this operation is in the
treatment of recurrent, acute sinusitis, but it is also recommended for chronic
sinusitis of recent origin and is particularly effective in children. It creates
a large dependent opening in the medial wall of the antrum so that stasis of
mucoid secretions does not occur within the sinus. A flap is raised under the
anterior end of the inferior turbinate and the antronasal wall is breached and
cleanly punched out as far inferiorly as the floor of the nose. The flap of
mucosa is then turned into the sinus to lessen the chance of subsequent closure.
Radical antrostomy. This is sometimes referred to as the Caldwell-Luc operation
and is the procedure of choice when conservative measures have failed, and when
it is considered that the pathological changes within the sinus have reached an
irreversible state. A sublabial incision is made over the canine fossa, and an
area of bone removed to gain sufficient access to the antrum. All diseased
mucosa is removed, and a large intranasal antrostomy is fashioned. The sublabial
incision is closed with absorbable sutures, and the sinus is washed out through
the intranasal antrostomy postoperatively and prior to discharge from hospital.
Cysts of the maxillary sinus
Cysts of the maxillary sinus are usually of dental origin and are called dental
cysts. If the cyst contains a tooth it is termed a dentigerous cyst. The cause
of a dental cyst lies in the periodontium or periosteum of a diseased upper
premolar or molar tooth. The cyst enters the antrum through its floor and
gradually enlarges until it may distend the sinus cavity by pressure on its
walls. Dental cysts may occur at any age.
The cyst may be entirely painless, giving rise to no symptoms and being
discovered accidentally. Infection within the cyst causes toothache, headache
and pain in the infra-orbital region. Similarly, distension of the sinus
produces local pain.
CLINICAL FEATURES. Clinical examination may be negative if the cyst is small.
When the antrum becomes enlarged there may be a fullness of the inferior meatus
or even of the hard palate, and palpation of the gingivolabial fold gives a
sensation of crackling elasticity. Radiography will show a spherical dense area