Clinical examination techniques in otology Edition II

Clinical examination techniques in otology Edition II by Dr. T. Balasubramanian

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Acoustic neuroma

CT scan petrous apex shows widened internal acoustic meatus a feature of acoustic neuroma.

Radiological features of acoustic neuroma:

1. Widening of internal acoustic meatus "Trumpet sign"

2. Extracanalicular extension into cerebellopontine angle (path of least resistance) can lead to "ice cream cone" appearance

Thyroid cancer staging (AJCC)

TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor 2 cm / less in its greatest dimension, limited to thyroid
T1a	Tumor 1 cm or less limited to thyroid
T1b	Tumor more than 1cm but less than 2 cms and limited to thyroid
T2	Tumor size more than 2cms but not more than 4 cms and is limited to thyoid
T3	Tumor more than 4 cms limited to thyoid / tumor of any dimension with minimal extrathyroid extension (sternomastoid muscle, perithyroid soft tissues)
T4a	Moderately advanced disease. Tumor of any size extending beyond the confines of thyroid capsule to invade soft tissues, larynx, trachea, oesophagus or recurrent laryngeal nerve
T4b	Very advanced disease. Tumor invades prevertebral fascia / encases carotid sheath, mediastinal involvement
	All anaplastic carcinomas of thyroid are T4 tumors. T4a includes anaplastic carcinoma within thyroid tissue and T4b includes anaplastic carcinoma thyroid with extra thyroid involvement.

Surgery is indicated up to stage T4a.  Any stage above this level should be treated with palliative radioactive ablation.

Acoustic Manometry

Acoustic manometry determines the cross sectional area of the nasal cavity as a function of distance into the nasal cavity. This provides a two dimensional picture of nasal cavity. These measurements help in objective assessment of nasal patency. Nasal patency is actually a complex issue which can involve mucosal, structural and psychological factors. It should always be borne in mind that the sensation of nasal obstruction is purely subjective and does not correlate `100%
always with clinical examination findings 3. This test has been intended as an objective quantification of nasal patency.

Rhinomanometry 8 is a measurement of pressure encountered by air passing through the nasal cavity 1. This procedure was first introduced by Hilberg 7 as an objective method in assessing the
nasal cavity. It uses the reflected sound signal to measure the cross sectional area of nasal cavity.

This is painless, non invasive, fairly rapid and easily tolerated even by children 6. The sound frequency used should be above 250 Hz. The equipment used for this purpose is odisoft rhino. It
has also been borne out in various studies that there are many objective test values where some patients will complain of nasal obstruction while others may not.

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Rhinology selections

This e book contains selected rhinology works of Prof. Balasubramanian Thiagarajan

Rhinology Selections by Dr. T. Balasubramanian