Otolaryngology clinical notes

Otolaryngology clinical notes Simplified ENT education / Diseases /Radiological image/Investigations/ Surgical Steps / Case Discussions.
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26/03/2026

Anatomy of Larynx part 1

25/03/2026

Q.Why does the Carhart notch appear at 2000Hz in otosclerotic patients and at no other frequency?

Laryngoscopy view of vocal vord and other structures.Labels are🔹 PPW-Posterior Pharyngeal Wall🔹 PCS-Post Cricoid Space🔹 ...
25/03/2026

Laryngoscopy view of vocal vord and other structures.
Labels are
🔹 PPW-Posterior Pharyngeal Wall
🔹 PCS-Post Cricoid Space
🔹 PS-Pyriform Sinus
🔹 AEF-Aryepiglottic Fold
🔹 CT-Corniculate Tubercle
🔹 TVC-True Vocal Cord
🔹 FVC-False Vocal
🔹 Epiglottis

Oral Antidiabetic Drugs (Oral Hypoglycemic Agents)1. BiguanideDrug: MetforminDose:500 mg once or twice daily (OD/BD)Usua...
25/03/2026

Oral Antidiabetic Drugs (Oral Hypoglycemic Agents)
1. Biguanide
Drug: Metformin
Dose:
500 mg once or twice daily (OD/BD)
Usual: 1500–2000 mg/day
Max: 2550 mg/day
When to prescribe:
First-line in T2DM

2. Sulfonylureas
Drugs: Glimepiride, Glipizide, Glyburide
Doses:
Glimepiride: 1–8 mg OD
Glipizide: 2.5–20 mg/day
Glyburide: 2.5–20 mg/day
When to prescribe:
Add-on when metformin is insufficient

3. DPP-4 Inhibitors
Drugs: Sitagliptin, Vildagliptin, Linagliptin, Saxagliptin
Doses:
Sitagliptin: 100 mg OD
Vildagliptin: 50 mg BD
Linagliptin: 5 mg OD
Saxagliptin: 2.5–5 mg OD
When to prescribe:
Add-on therapy when metformin inadequate
Low risk of hypoglycemia

4. SGLT2 Inhibitors
Drugs: Empagliflozin, Dapagliflozin, Canagliflozin
Doses:
Empagliflozin: 10–25 mg OD
Dapagliflozin: 5–10 mg OD
Canagliflozin: 100–300 mg OD
When to prescribe:
T2DM with CVD/CKD
Helpful for weight loss

5. Thiazolidinediones
Drug: Pioglitazone
Dose:
15–45 mg OD
When to prescribe:
Insulin resistance
Avoid in heart failure

6. Alpha-glucosidase Inhibitors
Drugs: Acarbose, Voglibose
Doses:
Acarbose: 25–100 mg TID
Voglibose: 0.2–0.3 mg TID
When to prescribe:
Postprandial hyperglycemia
Early diabetes

7. Meglitinides
Drugs: Repaglinide, Nateglinide
Doses:
Repaglinide: 0.5–4 mg
Nateglinide: 60–120 mg
Note: Taken before meals
When to prescribe:
Irregular meals
Postprandial glucose control

Cause of Inflammatory neck node in children
23/03/2026

Cause of Inflammatory neck node in children

Kawasaki Syndrome (Kawasaki Disease)Definition:An acute, self-limited vasculitis of medium-sized arteries, mainly affect...
23/03/2026

Kawasaki Syndrome (Kawasaki Disease)

Definition:
An acute, self-limited vasculitis of medium-sized arteries, mainly affecting children under 5 years. It is a leading cause of acquired heart disease in children.

Cause:
Unknown (likely immune response to infection in genetically predisposed children).

Key Clinical Features
(≥5 days fever + signs):
Prolonged high fever (≥5 days)
Conjunctivitis (non-purulent)
Strawberry tongue, red cracked lips
Rash (polymorphous)
Swelling/redness of hands and feet → later peeling
Cervical lymphadenopathy

Complications:
Coronary artery aneurysms (most serious)
Myocarditis, thrombosis

Diagnosis:
Clinical (based on symptoms and fever duration)

Treatment:
IVIG (Intravenous immunoglobulin)
Aspirin (anti-inflammatory + antiplatelet)

Prognosis:
Good with early treatment; risk of heart complications if untreated.

21/03/2026

Cochlea

Middle ear ossicles in CT scan
19/03/2026

Middle ear ossicles in CT scan

19/03/2026

Trigeminal nerve

Classification & Features of Thyroiditis🔵 1. Hashimoto’s Thyroiditis (Chronic Autoimmune)-Age: All (peak 30–50)-S*x rati...
18/03/2026

Classification & Features of Thyroiditis

🔵 1. Hashimoto’s Thyroiditis (Chronic Autoimmune)
-Age: All (peak 30–50)
-S*x ratio: 8–9 : 1
-Cause: Autoimmune
-Function: Hypothyroidism
-TPO antibodies: ↑ High
-ESR: Normal
Pathology:
-Diffuse symmetrical enlargement
-Firm, pale, multilobulated gland

🟢 2. Painless Postpartum Thyroiditis
-Age: Childbearing women
-Cause: Autoimmune
-Function: Hyper → Hypo → Recovery
-TPO: High
-ESR: Normal
Pathology:
-Firm, tan-white gland
-Nodules of varying size

🟢 3. Painless Sporadic Thyroiditis
-Age: All (peak 30–40)
-S*x ratio: 2 : 1
-Cause: Autoimmune
-Function: Hyper ↔ Hypo
TPO: High
ESR: Normal
Pathology: Similar to postpartum type

🔴 4. Painful Subacute Thyroiditis (De Quervain)
-Age: 20–60
-S*x ratio: 5 : 1
-Cause: Likely viral / unknown
-Function: Hyper → Hypo (transient)
-TPO: Low
-ESR: ↑ High (key feature)
Pathology:
-Firm, tender gland
-Granulomatous inflammation

🟠 5. Suppurative Thyroiditis (Bacterial)
-Age: 20–40
-S*x ratio: 1 : 1
-Cause: Infection
-Function: Usually euthyroid
-TPO: Absent
-ESR: ↑ High
Pathology:
-Abscess formation
-Focal/diffuse enlargement

⚫ 6. Riedel’s Thyroiditis (Fibrosing)
-Age: 30–60
-S*x ratio: 3–4 : 1
-Cause: Unknown
-Function: Usually euthyroid
-TPO: Present
-ESR: Normal
Pathology:
-Dense fibrosis replacing thyroid
-Hard “woody”


-Painful thyroid → think De Quervain or infection
-High ESR → De Quervain / Suppurative
-Autoimmune → Hashimoto + painless types (↑ TPO)
-Woody hard thyroid → Riedel’s
-Postpartum + transient hyper/hypo → painless postpartum

17/03/2026

How to use surgical blade

FNAC Findings of Pleomorphic Adenoma (Parotid Gland)FNAC (Fine Needle Aspiration Cytology) is a test where a thin needle...
15/03/2026

FNAC Findings of Pleomorphic Adenoma (Parotid Gland)

FNAC (Fine Needle Aspiration Cytology) is a test where a thin needle is used to take cells from a lump in the parotid salivary gland to examine under a microscope.
In Pleomorphic Adenoma (the most common benign salivary gland tumor), the FNAC report usually shows three main components.

1. Cells
These are gland cells.
Appearance in FNAC:
Cells arranged in clusters, sheets, or ducts
Uniform (similar looking) cells
Round or oval nucleus
No major abnormal features
This indicates the tumor is benign.

2. Cells
These are special support cells found in salivary glands.
Appearance:
Can look spindle-shaped, plasmacytoid, or round
Found scattered or in clusters

3. (Mucoid) Stroma
This is the characteristic background material of pleomorphic adenoma.
Appearance:
Gel-like or myxoid material
Looks bluish or fibrillary on staining
Sometimes resembles cartilage-like matrix
This mixed appearance is why it is called “pleomorphic” (many forms).

Classic FNAC Description
A typical report may say:
> “Smears show clusters of epithelial and myoepithelial cells in a chondromyxoid background, suggestive of Pleomorphic Adenoma.”

Diagnostic Triad
Pleomorphic adenoma FNAC shows:
1. Epithelial cells
2. Myoepithelial cells
3. Chondromyxoid stroma

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