1. Named Signs, Syndromes, Tests Procedures and Structures in ENT Dr. Akshita Goyal Dr. Apurva Palatkar

2. Tragal Sign Furuncle of the EAC- Tragal tenderness Rior tragal crease( anterior tragal crease)-- created by the superficial displacement of the parotid gland and the downward angle of the tragus Importance of tragal pointer: identifying the extratemporal branch of the facial nerve during a parotidectomy procedure ( lies medial and inferior to this pointer.

3. Cauliflower Ear Hematoma of the Pinna followed by blunt trauma Aka Boxer’s ear Collection of fluid or blood between the skin and cartilage disrupting blood flow 20XXpresentation title3

4. Swimmer’s ear Aka telephonist ear Diffuse otitis externa Infection of eac and external ear Organism- Pssuedomonas Aeruginosa 20XXpresentation title4

5. Skull base osteomyelitis Seen in malignant otitis externa Most common organism – P. aeruginosa Davis staging depending on the extension 20XXpresentation title5

6. Prussak’s space Prussak's space is a small recess in the middle ear. It is bordered by different parts of the eardrum, the neck of the malleus bone, and the scutum, a bony spur. It can only be ventilated posteriorly and is part of the lateral epitympanic space. Importance: Most common site of primary cholesteatoma 20XXpresentation title6

7. Donaldson’s Line Surgical landmark for endolymphatic sac Passes through horizontal semicircular canal bisecting the posterior SCC. Endolymphatic sac is situated inferior to the line 20XXpresentation title7

8. Trautman’s Triangle Is a landmark on medial wall of mastoid antrum to approach the posterior cranial fossa Boundaries Superiorly: superior petrosal sinus Posteriorly: Sigmoid Sinus Anteriorly: semi circular canals 20XXpresentation title8

9. Macewan’s triangle AKA suprameatal triangle Landmark for mastoid antrum Boundaries Superiorly: Temporal line Anteriorly: Posterior superior margin of Bony EAC Posteriorly: Tangent drawn to posterior wall of EAC Content: Spine of henle. Mastoid antrum lies 1.5cm deep to triangle 20XXpresentation title9

10. Canal of Huguier Opening on the anterior wall of middle ear for exit of the chorda tympani. Aka civinini canal 20XXpresentation title10

11. Bill’s bar Vertical crest in the internal auditory meatus Aka crista verticalis. Divides the superior compartment of IAM into and anterior and posterior compartments. IAM Diameter-12mm Most common site of origin of acoustic neuroma or vetibular schawannoma or benign schwann cell tumor is Inferior vestibular nerve 20XXpresentation title11

12. Korner’s Septum Persistent petrosquamosal suture formed at the junction of mastoid and temporal squama Can be taken up as a false medial wall of antrum during surgery Osseous lamina within the temporal bone 20XXpresentation title12

13. Arnold’s Nerve Auricular branch of the vagus nerve aka Alderman’s nerve Evokes cough reflex Named after Friedrich Arnold as he described the cough reflex Supplies sensory nerve supply to the skin of ear canal tragus and auricle Arnold’s canal: passage of petrous portion of temporal bone for the auricular branch of vagus Arnold’s ganglion: otic ganglion 20XXpresentation title13

14. Jacobson’s nerve Tympanic branch of glossopharyngeal nerve. Arising from its inferior ganglion Enters the middle ear though inferior tympanic canaliculus. Main sensory innervation to mucosa of mesotympanum and et. Named after Ludwig Jacobson. 20XXpresentation title14

15. Nerve of Wrisberg Aka nervus intermedius or intermediate nerve of Wrisberg or glossopalatine nerve Sensory and parasympathetic bundle of facial nerve Known as intermedius as the intermediate position of nerve between the superior part of vestibular nerve and facial nerve 20XXpresentation title15

16. Fissures of Santorini Named after Giovanni Santorini They are natural openings in the lateral cartilaginous ear canal which are a potential route of spread for malignancy or infection to the parotid area. These are defects in the cartilaginous (lateral 1/3) part of the external auditory canal Foramen of Huschke aka foramen tympanicum, which is an embryologic remnant in the medial bony ear canal which is another potential route of spread 20XXpresentation title16

17. Hennebert Sign False positive fistula sign in absence of labyrinthine fistula. Meniere’s disease Hypermobile stapes footplate: congenital syphilis Idiopathic False negative fistula sign in presence of labyrinthine fistula : cholesteatoma, dead labyrinth, impacted wax 20XXpresentation title17

18. Light house sign Pulsatile discharge from middle ear with each arterial dilation in asom patients. Seen during stage of suppuration. Stages: Stage of hyperemia—cartwheel sign Stage of exudation---nipple sign- impending perforation Stage of suppuration—light house sign Stage of coalescent mastoiditis— mastoid reservoir sign—pus fills up on mopping Stage of resolution Stage of complications— Gradenigo syndrome 20XXpresentation title18

19. Pulsatile tinnitus Pulsatile tinnitus: synchronous with pulse decreases on carotid occlusion Rising sun sign: red reflex on otoscopy Browne’s pulsation sign on siegalization: Positive pressure  tumor engorges  tumor blanches  pressure released  tumor engorges High resolution C.T. scan with contrast: erosion of carotico-jugular spine (Phelp’s sign) 20XXpresentation title19

20. Bezold’s abscess Types of subperiosteal abscess Bezold---over scm Citelli---posterior belly of digastric Zygomatic Luc—swelling in eac Retromastoid---swelling over occipital? Parapharyngeal and Retropharyngeal---via et tube 20XXpresentation title20

21. Citelli’s angle Aka sinodural angle Angle between sigmoid sinus and middle fossa dural plate. Angle is acute in primary sclerosis but obtuse in secondary sclerosis of csom cases. Formed by tegmen surperiorly and transverse sinus inferiorly. 20XXpresentation title21

22. Gradenigo’s triad Persistent otorrhoea: despite adequate cortical mastoidectomy  Retro-orbital pain: Trigeminal nv involvement  Diplopia: convergent squint due to lateral rectus palsy by injury to abducent nv in Dorello’s canal under Gruber’s petro-sphenoid ligament, at petrous apex Aka APEX PETROSITIS Giuseppe Gradenigo 20XXpresentation title22 Dorello’s canal : bow-shaped bony enclosure surrounding the abducens nerve and the inferior petrosal sinus as the two structures merge with the cavernous sinus. It is sometimes found at the tip of the temporal bone.

23. Griesinger’s sign Edema over the mastoid region due to thrombosis of the mastoid emissary vein Queckenstedt or Tobey-Ayer test: compression of I.J.V.  rapid rise of C.S.F. pressure (50 – 100 mm water  rapid fall on release of compression. In L.S.T. no rise / rise by only 10 – 20 mm water. Delta/ Empty triangle sign—seen in contrast ct mri contrast scans in LST Lillie – Crowe - Beck test: pressure on I.J.V. on normal side  engorgement of retinal veins + papilloedema seen in fundoscopy due to L.S.T. on opposite side. 20XXpresentation title23

24. Schwartz Sign Aka Flamingo pink sign Seen in active otosclerosis Indicates active focus with increased vascularity. Vanderhoeve syndrome—otosclerosis + osteogenesis imperfecta + blue sclera Surgery contraindicated if sign present. Sodium fluoride used instead Carhart’s notch—dip in BC at 2000hz *Schwartz surgery: Cortical mastoidectomy* 20XXpresentation title24

25. Acoustic dip Also known as boiler’s notch Dip at 4000hz both AC and BC 20XXpresentation title25

26. Seen in Meniere’s disease. Dizziness induced by loud low frequency sound. Sound induced disequilibrium or oscilliopsia. Distortion of sound frequency, called diplacusis binauralis dysharmonica PTA: rising curve in early disease Lermoyez’s reverse Meniere syndrome: Deafness  vertigo  improvement in hearing Tumarkin’s sudden drop attack: Pt falls without vertigo / loss of consciousness Meyerhoff’s oculo-vestibular response: Vertigo due to opto-kinetic stimulus 20XXpresentation title26 Tulio’s Phenomenon

27. Pt has better hearing in noisy surroundings (people increase their voice intensity & pt’s speech discrimination becomes better). 20XXpresentation title27 Paracusis Willisii

28. Aka Nylen – Barany maneuver Diagnostic test for BPPV Epley’s canalith repositioning maneuver— treatment for BPPV Semont’s liberatory maneuver—if epley’s fails. 20XXpresentation title28 Dix Hallpike Maneuver

29. Tests for vestibular function. Pt supine + 30° head elevation. Each ear irrigated in turn for 40 sec with warm water at 44°C & then cold water at 30°C. Duration of nystagmus is from start of irrigation to end point of nystagmus. Normal = 90–140 sec Direction of fast component: Cold → Opposite ear; Warm → Same ear Modified Kobrak’s test E.A.C. irrigated for 60 sec with ice cold water in increasing quantity (5, 10, 20 & 40 ml) till nystagmus is noticed. Nystagmus noticed with: 5 ml = Normal vestibular labyrinth. 10 / 20 / 40 ml = Hypoactive labyrinth. No nystagmus (40 ml) = Dead labyrinth 20XXpresentation title29 Fitzgerald Hallpike caloric Test

30. Air in coiled copper tube is cooled by pouring ethyl chloride in it Effluent cool air is blown into E.A.C. to produce vertigo + nystagmus Done in cases with TM perforation as water syringing is contraindicated. 20XXpresentation title30 Dundas Grant cold air caloric test

31. KErnigs: resistance to extension of leg while hip is flexed. Sign of meningitis. BrudziNsKi’s : Flexion of hips and knees in response to neck flexion. Seen in meningitis. 20XXpresentation title31 Kernigs and Brudzinski’s Sign

32. Seen in acoustic neuroma/ Vestibular schwanoma Hypoaesthesia of posterior external auditory canal wall As a result of facial nerve weakness. Trigeminal nerve first to be involved in acoustic neuroma cases. AKA NEURILEMMOMA 20XXpresentation title32 Hitzelberger’s Sign

33. Seen in meningocoele and meningoencephalocoele. Apply pressure on ipsilateral jugular vein to elicit swelling or pulsation of the lesion 20XXpresentation title33 Furstenberg Test

34. ONODI CELLS: posterior ethmoidal cells lateral to sphenoid sinus HALLER CELLS: intraorbital anterior ethmoidal cells AGGER NASII CELL: anterior most ethmoidal air cell Cottle’s test: Patency of nasal valve 20XXpresentation title34 Ethmoidal air cells

35. Mulberry turbinate: aka inferior turbinate hypertrophy. Mulberry mass in nose: Rhinosporidiosis Mulberry like vocal cord: Also in rhinosporidiosis 20XXpresentation title35 Mulberry Signs in ENT

36. Potato nose: Rhinophyma Hard/Woody/Hebra/Tapir nose: Rhinoscleroma Frisch Bacillus in Rhinoscleroma( Klebsiella rhinoscleromatis) aka von Frisch bacillus Mickulikz cells and Russell bodies– Rhinoscleroma. (warthin starry stain) Gothic sign: obliteration of nasopharynx due to adhesions. 20XXpresentation title36

37. Rhinosporidium Seeberi (aquatic parasite? Or unicellular prokaryotic cyanobacterium Strawberry mass/ Mulberry mass in the nose. Bleeds. Gomory Methanamine silver staining done. 20XXpresentation title37 Rhinosporidiosis

38. Lupus vulgaris: apple jelly appearance on diascopy. Syphilis : Hutchinson’s incisors, Moon’s mulberry molars, interstitial keratitis, corneal opacities, SNHL, Palate perforation Leprosy: Saddle Nose deformity Sarcoidosis: Lupus pernio. Reddish discoloration of nasal tip 20XXpresentation title38

39. Waldenström’s uveo-parotid fever—aka Special form of sarcoidosis with: 1. Transient B/L Facial palsy 2. Parotid enlargement 3. Uveitis 4. Fever 20XXpresentation title39 Heerfordt’s syndrome

40. coloboma, heart defects, atresia choanae (also known as choanal atresia), growth retardation, genital abnormalities, and ear abnormalities. caused by a mutation in the CHD7 gene 20XXpresentation title40 CHARGE Syndrome

41. Samter’s triad: Nasal polyp, Bronchial asthama and aspirin intolerance Young’s syndrome: Recurrent sinusitis, bronchiectasis and azoospermia Kartagener’s syndrome: Recurrent sinusitis, bronchiectasis and situs inversus Churg – Strauss syndrome: Asthma + eosinophilia + vasculitis + granuloma + nasal polypi Darrier’s Crease/Hilton’s Line Frequent twitching of face (bunny nose) Dennie-Morgan creases (in lower eyelid skin) 20XXpresentation title41

42. Seen in CSF rhinorrhea CSF mixed with blood produces peripheral CSF halo around central blood on filter paper / pillow cover Reservoir Sign / Tea Pot Sign: Bending forward produces watery nasal discharge Handkerchief sign: Nasal discharge causes stiffening of hanky (due to presence of mucin), but not CSF 20XXpresentation title42 Double ring/Halo sign/ Target sign

43. Seen in allergic fungal sinusitis Presence of allergic mucin produces the characteristic intrasinus hyperdensity in a background of hypodense polypoidal mucosal disease. 20XXpresentation title43 Double density sign

44. Refers to appearance of herniated intraorbital fat +/- inferior rectus muscle. Which has protruded through fracture of inferior orbital wall. Blunt trauma to orbit. Le fort 1/2/3 Transverse/Pyramidal Craniofacial dysjunction 20XXpresentation title44 Tear Drop Sign

45. Locally invasive carcinoma of basal layer of skin and mucocutaneous junction 20XXpresentation title45 Rodent Ulcer

46. Seen in inverted Papilloma— contrast Ct pns AKA ringertz tumour Dodd’s/ Crescent sign: xray finding- crescent of air between mass and posterior pharyngeal wall– seen in AC POLYP 20XXpresentation title46 African continent sign

47. An imaginary plane extending between medial canthus of eye & angle of mandible—ohngren’s line 2 horizontal lines of Sebileau pass through floors of orbits & maxillary sinus—producing supra meso and infrastructure Weber Fergusson Incision taken for total maxillectomy. Weber Fergusson Diffenbach incision for orbital fat involvement 20XXpresentation title47 Carcinoma Maxilla

48. Proptosis + nasal bridge broadening in nasal angiofibroma patients Holman miller sign: anterior bowing of posterior wall of maxillary sinus on ct. 20XXpresentation title48 Frog facies

49. Seen in nasopharyngeal carcinoma Conductive deafness due to et dysfunction Ipsilateral temporoparietal neuralgia—d/t 5 th nerve palsy Palatal paralysis—d/t 10 th nerve palsy Trotter’s or Hippocratic manuever- nasal pinching in epistaxis Woodruff’s Plexus: Venous plexus Posterior to inf turbinate Kisselbach’s Plexus: arterial plexus at little’s area 20XXpresentation title49 Trotter’s triad

50. Pressure on anterior pillar will cause release of puss or cheesy material in chronic follicular tonsillitis Seen in Post cricoid Carcinoma Absence of Laryngeal crepitus when larynx moved side to side. 20XXpresentation title50 Irwin Moore Sign Moure’s Sign

51. Aka PATTERSON KELLY BROWN SYNDROME Hypopharyngeal webs Iron deficiency anemia Post crcicoid dysphagia 20XXpresentation title51 Plummer Vinson Syndrome

52. In DLSCOPY Bronchoscopy and esophagoscopy surgeries Extension of head in relation to cervical spine and flexion of neck in relation to chest Aka sniffer’s position For best visualization of larynx In tonsillectomy tracheostomy and surgery Extension of both head and neck Boyce’s sign: seen in zenker’s diverticulum: gurgling sound due to noise of splashing fluid accumulated in a large Zenker's diverticulum, can be heard on palpation. 20XXpresentation title52 Boyce’s position Rose’s position

53. a hissing or gurgling sound produced by manual pressure on an external laryngocele- edematous and enlarged epiglottis which is seen on lateral soft-tissue radiograph of the neck Seen in acute epiglottitis 20XXpresentation title53 Bryce’s Sign Thumb Sign

54. tapering of the upper trachea on a frontal chest radiograph reminiscent of a church steeple. The appearance is suggestive of croup, which should be obvious clinically. Glottic ans subglottic narrowing of airway Aka laryngotracheobroncheitis 20XXpresentation title54 Church steeple sign/ Pencil tip sign

55. Seen in laryngomalacia supraglottic collapse during the inspiratory phase of respiration, resulting in intermittent upper airway obstruction and stridor. LM is the most common source of stridor in infants and the most common congenital laryngeal anomaly. Self resolving 20XXpresentation title55 Elongated omega epiglottis

56. Pre epiglottic space Anterior and lateral to epiglottis Inferiorly in continuation with paraglottic space Contains fat 20XXpresentation title56 Space of Boyer

57. 20XXpresentation title57 Space of Tucker `

58. potential space between the vocal ligament and the overlying mucosa. It is not an empty space, but contains cells, special fibers and extracellular matrix. Swelling is called reinke’s edema Role in vibration of vocal cords 20XXpresentation title58 Reinke’s space

59. Mouse nibbled appearance Mammilated arytenoids. All seen in TB LARYNX 20XXpresentation title59 Turban epiglottis

60. Retropharyngeal compartment divided into two lateral compartments space of Gillette by a fibrous raphe. Extends from base of skull to tracheal bifurcation. B Between two parapharyngeal spaces. 20XXpresentation title60 Space of Gillette

61. Lateral retropharyngeal lymph nodes lie between carotid artery and prevertebral muscles. The upper most positioned nodes anterior to the atlas are called as NOR 20XXpresentation title61 Nodes of Rouviere

62. The diverticulum is exposed with a bivalved (two-blade) endoscope with one blade in the pouch and the other blade in the cervical esophagus. Under direct visualization, the common wall between the pouch and the esophagus is ablated (usually with the carbon dioxide, CO2, laser). Endoscopic staple diverticulotomy. Killian’s dehiscence- site of diverticulum( triangular area of wall of pharynx between cricopharyngeus and thyropharyngeus 20XXpresentation title62 Dohlman’s Procedure—for zenker’s diverticulum

63. Mitral stenosis Left recurrent laryngeal nerve palsy Galen anastomosis: connects superior and recurrent laryngeal nerve 20XXpresentation title63 Ortner’s/ Cardiovocal syndrome

64. Frey’s syndrome aka Baillarger's syndrome, Dupuy's syndrome– gustatory sweating due to damage to auriculotemporal nerve Crocodile tears/ Bogorad syndrome ( gustatory lacrimation) shedding of tears while drinking or eating. Faulty regeneration of superior salivatory nucleus to lacrimal gland via superior petrosal nerve leads to improper stimulation. Sludder’s neuralgia- sphenopalatine neuralgia. Unilateral headache with pain in upper jaw and soft palate. Caused due to irritation of sphenopalatine ganglion First bite syndrome: severe pain in preauricular region initiated on first bite of meal. Imbalanced sympathetic and parasympathetic innervation of partoid gland. 20XXpresentation title64