Dr Muhammad Hammad consultant ENT specialist Head and neck surgeon

18/02/2026

05/02/2026

Blood supply of inner surface of
tympanic membrane

31/01/2026

Epistaxis in children:Local and systemic aetiologies

16/01/2026

Clinical Points: Psoriasis & Otitis Externa

•Psoriasis of the external auditory canal is not an infection, but a chronic inflammatory skin disease.
•It commonly presents with persistent itching, dryness, and thick silvery scales, while pain is usually mild or absent.
•Psoriatic ear disease may mimic otitis externa, leading to misdiagnosis and unnecessary antibiotics.
•Disruption of the skin barrier in psoriasis predisposes to secondary bacterial or fungal otitis externa.
•Always ask about scalp psoriasis; ear canal involvement is frequently an extension of scalp disease.
•History of scalp scaling, dandruff-like lesions, or lesions at the hairline and postauricular area strongly supports the diagnosis.
•Treating the ear without addressing scalp psoriasis leads to frequent relapse, as both represent the same disease process.
•Recurrent or bilateral otitis externa with prominent itching should raise suspicion of underlying psoriasis or eczema.
•Otoscopy may show dry adherent scales rather than edematous, wet, or purulent canal skin.
•Excessive ear cleaning and frequent topical drops worsen psoriasis by increasing irritation and maceration.
•Pure psoriasis responds poorly to antibiotics but improves with topical corticosteroids and emollients.
•When secondary infection is suspected, use combined antibiotic–steroid ear drops, after gentle canal toilet.
•Long-standing canal psoriasis may cause canal stenosis and conductive hearing loss if untreated.

Clinical Pearl;
Management of psoriatic otitis externa is incomplete without treating associated scalp psoriasis; the ear and scalp should always be managed as one disease unit.

14/01/2026

COMING SOON PODCAST WITH IMRAN SANAULLAH DR MUHAMMAD HAMMAD CONSULTANT ENT SPECIALIST HEAD AND NECK SURGEON ENDOSCOPIC SURGEON RHINOPLASTY SURGEON FOR APPOINTMENT PHONE 0334 6060909

13/01/2026

10 MUST-KNOW POINTS IN ACUTE VERTIGO / ACUTE VESTIBULAR SYNDROME

Mnemonic: “VERTIGO SAFE”

– Vascular until proven otherwise
Acute Vestibular Syndrome (AVS) = posterior circulation stroke until excluded.

– Eye signs first
Examine the eyes before the ear.
Nystagmus often gives more information than imaging early on.

– Red flags rule
The presence of any red flag should immediately raise concern for a central cause.

– Time course matters
Continuous vertigo lasting ≥ 24 hours defines AVS.
Not episodic → not BPPV, not Ménière’s.

– Imaging when central signs appear
If central signs are present, do not hesitate to request imaging.
MRI brain with DWI
± MRA / CTA when indicated
Do not wait for treatment failure.
Do not be reassured by young age.

– Gait tells the truth
Inability to stand or walk without assistance
= central cause until proven otherwise.

– Otologic symptoms guide you
Vertigo + hearing loss → think AICA stroke or labyrinthitis
Vertigo without hearing loss → vestibular neuritis or PICA stroke

– Spontaneous nystagmus pattern
Unidirectional horizontal-torsional → usually peripheral
Vertical, pure torsional, or direction-changing → central

– Associated neurological signs
Even subtle signs (dysarthria, diplopia, facial numbness)
= central until proven otherwise → imaging is mandatory.

– False-negative MRI early
MRI within the first 24–48 hours may be falsely negative.
Clinical examination remains the cornerstone.

– Early rehabilitation, not prolonged suppression
After stabilization:
Start vestibular rehabilitation early
Avoid prolonged use of vestibular suppressants

Clinical insights

“If you see central signs, don’t hesitate — image.”
or
“In acute vertigo, the eyes and gait often speak louder than the MRI.”