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ENT REVISION
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OTOLOGY
1. HEARING: Conductive and Sensorineural deafness : Etiology andmanagement.
2. Hearing assessment using a tuning fork.
3. Minimal understanding of audiograms, tympanometry andhearing aids.
4. Infectious and non-infectious diseases of the external andmiddle ear: OME,ASOM,CSOM
5. Cholesteatoma
6. Otosclerosis
7. Menieres Disease
8. Audiology9. Facial Nerve Palsy
10. The Deaf Child
11. Vertigo and Vestibular disorders and assessment
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RHINOLOGY
1. Nasal Septum and its diseases.
2. Epistaxis
3. Allergic rhinitis
4. Acute & chronic sinusitis
5. Nasopharyngeal carcinoma and other nasal
tumours.
6. Nasal Polyps
7. Facial trauma
8. FB,CSF rhinorrhoea, Rhinolith
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LARYNGOLOGY AND HEAD & NECK
SURGERY
Diseases of PharynxAcute and Chronic Pharyngitis
Acute and Chronic tonsillitis
Laryngitis or Laryngotracheitis
Epiglottitis
Head and neck space infections-peritonsillar abscess, Hoarseness of voice
Foreign bodies
Dysphagia
Stridor
Tracheostomy/Tonsillectomy Salivary gland disorders
Swellings of neck
Thyroid
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SYMPTAMOTOLOGY
EAR
NOSE
THROAT
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ENT EXAMINATION
EAR
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INTERPRETATION
TEST NORMAL CONDUCTIVE
HEARING LOSS
SENSORINEURAL
DEAFNESS
RINNE AC>BC BC>AC AC>BC
WEBER EQUAL/NOT
LATERALIZED
LATERALIZED TO
THE POOR EAR
LATERALIZED TO
THE BETTER EAR
FALSE RINNES NEGATIVE : BC>AC BUT WEBER LATERALIZED TO BETTER EAR
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`EXAMINATION:
NOSE
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Examination:
Neck & Larynx
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Introduction to Audiology
How to Read an Audiogram
Degrees of Hearing Loss
Types, Causes and Prevalence ofHearing Loss
Types of Tests
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How to Read an Audiogram
Terminology Used
Hertz (Hz) is used to describe frequency or
pitch, cycles per second
Decibel (dB) is the unit that describes theintensity, or loudness, of the sound
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Audiometric Symbols
Universally Used Pure Tone Air Conduction
Pure Tone Bone Conduction
May be Masked or Unmasked Tests in Soundfield (Narrow Band
Noises, Warble Tones, or Speech)
May obtain responses to Speech via
Air and/or Bone Conductionpathways
N l H i
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Normal Hearing
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Determine Hearing Level Establish Hearing Threshold Level
(HTL or simply HL)
What is threshold?
With earphones or via bone, softest sound
detected 50% of time In the soundfield, tests reveal response of
better ear
Speech Reception Threshold (SRT) is softest level
possible to hear closed set of bi-syllabic words
Thresholds are measured in decibels (dB) at various
frequencies, reported in Hertz
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Determine Amount of Loss (3)
Hearing impairment is documentedunilateral or bilateral sensorineural,mixed, or conductive hearing levels
greater than 20dB HL
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Determine Amount of Loss
Minimal, or mild, hearing loss
is from
25dB - 40dB HL(4,5)
Moderate loss is from 40dB -
70dB HL
Severe loss is from
70dB - 90dB HL
Profound loss is greater than
90dB HL
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Determine Amount of Loss
From bass to treble, or low to high pitch
From
faint
to
intense,
or
softto
loud
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Types of Hearing Loss
Conductive
Bone Conduction better
than Air Conduction
Sensorineural
Bone Conduction equal to
Air Conduction
Mixed
Some amount of Air and
Bone Conduction loss
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Prevalence of Hearing Loss
Prevalence data vary by study and by
age range, but hearing loss is more
prevalent than anyother condition(5)
6:1000 infants(6)
25-40% > 65 years(7)
70-80% > 80 years(7)
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Causes of Hearing Loss
Presbyacusis (aging) is #1 cause of hearing loss(7)
Hazardous noise exposure is #2
Just a few other causes include genetics, teratogens, otitis
media, idiopathic hearing loss, fistula, congenital
anomaly, prenatal or perinatal exposures (syphilis, CMV,rubella), syndromes, head injury, among hundreds of
others!
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Tests Frequently Used
Speech Reception Threshold
Tests in Soundfield
Air Conduction
Bone Conduction
Immittance or Tympanometry
Various Screening Tests OAE, AABR, Hand-held audiometer
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Tests Via Air Conduction
May be as simple as a tuning fork
Most precise is with earphones
Audiologists can obtain results with earphones in children as
young as 6 months
With children, thresholds obtained at a high frequency in eachear, a low frequency in each ear, then additional frequencies as
attention permits
Goal is to obtain as much information as quickly as possible, short
attention of child limiting factor
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Tympanometry
Tympanometry providesobjective results todetermine status of middleear
When sound energy strikesthe TM some can beabsorbed, some can bereflected.
Probe has three parts:oscillator- tone of 220 Hz,air pump, microphone
A(d)
A
A(s)
B
C
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Five classifications of results, referred to as
Modified Jerger Classification System
Type A(d), A, A(s), B and C
A(d)
A
A(s)
B
C
0
-
200 +200-400
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Otoacoustic Emissions(14) Evoked OAE (EOAE) are sounds that come out
of the cochlea upon stimulation
Spontaneous emissions (SOAE) are found in60% of ears, 2:1 females to males OAEs should not be confused with TINNITUS
EOAE indicate movement of Outer Hair Cells
Corresponds to thresholds
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Audiology Screening Tests(3, 15)
Several screening applications exist that aretotally microprocessor driven and are
applicable for use in a newborn nursery or
physicians office
OAE - Otoacoustic Emissions (Transient Evoked or
Distortion Product Evoked)
AABR - Automatic Auditory Brainstem Response
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Normal Hearing
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Low Frequency Loss
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Conductive Hearing Loss
h
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High Frequency
Sensorineural Hearing Loss
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Mixed Hearing Loss