About the Book

• This book is primarily intended for undergraduate and postgraduate medical students.

• New edition includes latest advances in the specialty, such as Skull Base Surgery, Thyroplasty, Functional Endoscopic Sinus Surgery, Cochlear Implantation, and Hearing Implants, etc

. • Includes a separate new section on “Pediatric Otolaryngology”.

• Several new Chapters under “Related Topics” are added.

• The section on Diseases of the Throat has been further subdivided into “Oral Cavity and Head and Neck”, and “Pharynx and Larynx”

. • Key Points in colored boxes are added after every chapter for quick revision before the examination.

• Special emphasis has been given to the pathophysiology of diseases.

• Emphasizes particularly on the clinical methods in ENT which are important for undergraduate medical students in preparing for further examination in ENT.

• Diseases prevalent in this part of the world and other third world countries have been given due importance.

• Aim to feature those conditions which are prevalent in Southeast Asia.

• Enriched with full colour diagrams, photographs, tables, flow charts and information boxes for the better understanding of concepts.

• Every disease condition is well explained by highlighting its Clinical Features, Diagnosis, Procedure, and Treatment accompanied with information tables and illustrations

. • X-ray images are given in a separate chapter on Common X-rays in ENT and Head and Neck.

• A separate chapter on Common Instruments used in ENT and Head and Neck Surgery.

• Extensive index is provided at the end of the book for indicating important terminologies, figures and tables.

• This book will also serve as a reference book to general practitioners (GPs), pediatricians and medical officers who are working in district hospitals

About The Author:

Rakesh Prasad Shrivastav, MS FRCS, Dean Tribhuvan University Institute of Medicine, Professor and Former Head,Department of ENT, Tribhuvan University Teaching Hospital, Kathmandu,Nepal

Table of Contents:
SECTION 1: ENT EXAMINATION Section Editor: Rakesh Prasad Shrivastav 1. Examination of the ear, Nose and Throat 2. Rabindra B Pradhananga SECTION 2: THE EAR Section Editor: Hari Bhattarai 2. Anatomy of the Ear and Facial Nerve Rabindra B Pradhananga • External Ear • Middle Ear Cleft • Inner Ear • Facial Nerve 3. Physiology of Hearing and equilibrium Yogesh Neupane • Physiology of Hearing • Physiology of Equilibrium 4. Symptoms of ear Diseases Pabina Rayamajhi • Earache (Otalgia) • Hearing Loss • Discharge • Vertigo • Tinnitus • Facial Nerve Paralysis • Itching/Irritation • Others • Symptoms Suggestive of Possible Complications Due to Otitis Media 5. Clinical examination of the ear Pabina Rayamajhi • Auricle, External Auditory Canal (EAC) and Surrounding Area • Tympanic Membrane (TM) • Hearing Tests • Fistula Test • Eustachian Tube (ET) Function • Facial Nerve • Nystagmus • Tests for Vertigo 6. Investigations for ear Diseases Inku Shrestha Basnet • Audiological Investigations • Vestibular Investigations • Radiological Investigations 7. Diseases of the external Ear Rabindra B Pradhananga • Diseases of the Auricle • Diseases of the External Auditory Canal (EAC) 8. Infections of the Tympanic Membrane and Middle Ear Cleft Rakesh Prasad Shrivastav • Infections of the Tympanic Membrane (TM) • Infections of the Middle Ear Cleft 9. Complications of otitis Media Rakesh Prasad Shrivastav • Routes of Spread • Extracranial Complications • Intracranial Complications 10. The Mastoidectomy operation Rakesh Prasad Shrivastav • Canal Down Mastoidectomy • Canal Up Mastoidectomy 11. Trauma to the Ear Anupama Shah Rijal • Physical Trauma • Barotrauma 12. otosclerosis Rakesh Prasad Shrivastav • Definition • Types • Pathology • Characteristic Features of Otosclerosis • Clinical Features • Investigations • Treatment 13. Neoplasms of the Middle ear Bikash Shrestha • Malignant Tumors • Glomus Tumor • Langerhans Cell Histiocytosis • Osteoma 14. Diseases of the Inner Ear Hari Bhattarai • Inflammatory Diseases • Trauma • Neoplasms • Autoimmune Diseases • Others 15. ototoxicity Hari Bhattarai • Clinical Features • Common Ototoxic Drugs • Treatment of Ototoxicity 16. Vertigo Rakesh Prasad Shrivastav • Definition • History • Causes of Vertigo • Examination • Investigations • Diagnosis of Common Causes of Vertigo • Treatment 17. Hearing Aid, Cochlear Implant and Tinnitus Masker Hari Bhattarai • Hearing Aids • Ear Mould • Cochlear Implants • Tinnitus Maskers 18. Facial Nerve Paralysis Hari Bhattarai • Bell’s Palsy (Idiopathic Facial Nerve Paralysis) SECTION 3: THe NOSE AND PARANASAL SINUSES Section Editor: Bibhu Pradhan 19. Anatomy of the Nose and Paranasal Sinuses Meera Bista • The Nose • The Paranasal Sinuses 20. Physiology of the Nose and Paranasal Sinuses Bibhu Pradhan • The Nose • The Paranasal Sinuses 21. Symptoms of the Nose and Paranasal Sinus Diseases Meera Bista • Pain • Nasal Obstruction • Nasal Discharge (Rhinorrhea) • Nasal Bleeding (Epistaxis) • Sneezing • Disorders of Smell • Nasal Deformity • Nasal Intonation of Voice (Rhinolalia) 22. Clinical examination of the Nose and Paranasal Sinuses Sangeeta Shrestha • Inspection and Palpation of the External Nose, Orbit and the Face • Palpation of the Paranasal Sinuses • Assessment of Nasal Patency • Inspection of the Nasal Vestibule • Anterior Rhinoscopy • Posterior Rhinoscopy • Endoscopic Examination of the Nasal Cavity and Nasopharynx 23. Investigations for the Nose and Paranasal Sinus Diseases Sangeeta Shrestha • Radiology • Bacteriology • Tests for Allergy • Proof Puncture • Rhinomanometry • Test for Smell • Biopsy 24. Diseases of the external Nose Narmaya Thapa • Infections of the External Nose and Nasal Vestibule • Neoplasms of the External Nose • Injuries to the External Nose • Congenital Anomalies of the External Nose • Others 25. Noninfective Rhinitis: Allergic Rhinitis and Nonallergic Rhinitis Yogesh Neupane • Allergic Rhinitis 113 • Nonallergic Rhinitis 115 26. Rhinosinusitis Bibhu Pradhan • Acute Rhinitis or Common Cold or Coryza • Acute Sinusitis • Chronic Sinusitis • Drainage Procedures for Different Sinuses • Obliteration Procedures for Different Sinuses • Management of Associated Nasal Conditions • Fungal Rhinosinusitis • Other Types of Rhinosinusitis 27. Complications of Rhinosinusitis Yogesh Neupane • Local Spread • Nasal Complications • Orbital Complications • Intracranial Complications • Pharyngeal, Laryngeal and Pulmonary Complications • Distant Complications 28. Diseases of Nasal Septum Yogesh Neupane • Septal Trauma • Septal Hematoma/Abscess • Deviated Nasal Septum (DNS) • Septal Perforation • Septal Neoplasms 29. Nasal Polyps Bibhu Pradhan • Etiology • Types of Nasal Polyps • Differences between Antrochoanal and Ethmoidal Polyps • Differential Diagnosis • Investigations • Treatment 30. Chronic Infections, Granulomas and other Diseases of the Nasal Cavity Bibhu Pradhan • Chronic Infections • Granulomas • Other Diseases 31. Neoplasms of the Nasal Cavity and Paranasal Sinuses Narmaya Thapa • Benign Neoplasms • Malignant Neoplasms 32. Facial Trauma Narmaya Thapa • Fracture of the Nasal Bone • Fracture of the Orbit • Zygomaticomaxillary Complex Fracture (Tripod Fracture) • Fracture of the Middle 1/3rd of Face (Maxilla) • Fracture of the Mandible 33. Epistaxis and its Management Bibhu Pradhan • Etiology • Site of Bleeding • Management 34. Diagnosis and Management of Facial Pain, Headache and Neuralgia of the Face Sangeeta Shrestha • Local Causes of Pain • Pain of Vascular Origin • Neuralgias • Other Causes 35. Functional endoscopic Sinus Surgery and other endoscopic Procedures Bibhu Pradhan • Goals of Functional Endoscopic Sinus Surgery (FESS) SeCTIoN 4: THe ORAL CAVITY AND HEAD AND NECK Section Editor: Bimal Kumar Sinha 36. Embryology and Applied Anatomy of the oral Cavity Bimal Kumar Sinha • Embryology • Applied Anatomy 37. Physiology of the oral Cavity: Perception of Taste Sensation, Formation and Functions of Saliva and Swallowing Mechanism Bimal Kumar Sinha • Perception of Taste Sensation • Swallowing 38. Symptoms of oral Cavity and Head and Neck Diseases Bimal Kumar Sinha • Oral Cavity • Head and Neck 39. Clinical examination of oral Cavity and Head and Neck Krishna Koirala • Oral Cavity • Head and Neck 40. Investigations for oral Cavity and Head and Neck Diseases Bimal Kumar Sinha • Imaging • Thyroid Hormone Assay • Endoscopy (Sialendoscopy) • Tests to Assess Taste Sensation • Pathological Tests 41. Inflammatory Diseases of the oral Cavity, Diseases of the Tongue and Immune Disorders of the oral Cavity Bimal Kumar Sinha • Inflammatory Diseases of the Oral Cavity • Diseases of the Tongue • Immune Disorders of the Oral Cavity 42. Neoplasms, Tumor-like Lesions and Premalignant Conditions of the oral Cavity Bimal Kumar Sinha • Benign • Tumour-like Lesions • Premalignant Conditions • Malignant Neoplasms • Other Malignant Neoplasm 43. Oral Manifestations of Systemic Diseases Bimal Kumar Sinha • Hematological Disorders • Endocrine Disorders • Acquired Immune Defici ency Syndrome (AIDS) • Others 44. Infections of the Salivary Glands and Sialolithiasis Toran KC • Infections of the Salivary Glands • Sialolithiasis 45. Neoplasms of the Salivary Glands Toran KC • Benign Neoplasms • Neoplasms of Variable Malignancy • Malignant Neoplasms 46. Neoplasms of the Thyroid Gland Bimal Kumar Sinha • Thyroid Gland • Benign Neoplasms • Malignant Neoplasms 47. other Diseases of the Thyroid Gland including endocrine Disorders Bimal Kumar Sinha • Infections/Inflammation of the Thyroid Gland • Acute Infections/Inflammation • Chronic Infections/Inflammations • Nontoxic Goiter • Endocrine Disorders 48. Applied Anatomy and Diseases of Deep Neck Spaces of the Neck Urmila Gurung • Layers of Deep Cervical Fascia • Classification of Deep Neck Spaces • Retropharyngeal Space • The Carotid Space • Parapharyngeal Space • Peritonsillar Space • Submandibular Space • Parotid Space • Masticator Space 49. Swellings of the Neck Heempali Dutta • Lateral Neck Swellings • Mid-line Neck Swellings SECTION 5: THe PHARYNX AND LARYNX Section Editor: Dharma Kanta Baskota 50. Anatomy of the Pharynx Rabindra B Pradhananga • Anatomy of the Pharynx 51. Anatomy of the Larynx Rabindra B Pradhananga 52. Physiology of the Pharynx and Larynx Toran KC • Physiology of the Pharynx 53. Symptoms of Pharyngeal and Laryngeal Diseases Inku Shrestha Basnet • Pharynx • Larynx 54. Clinical examination of the Pharynx and Larynx Bikash Shrestha • Pharynx • Larynx 55. Investigations for Pharyngeal and Laryngeal Diseases including endoscopy Bimal Kumar Sinha • Imaging • Histopathological Investigations • Flexible and Rigid Endoscopy • Tests for Esophageal Diseases 56. Diseases of the Tonsils Kunjan Acharya • Acute Tonsillitis • Ulcers of the Tonsil • Tonsillar Cysts and Tonsollith • Unilateral Tonsillar Enlargement 57. Neoplasms of the Nasopharynx and Skull Base including Basic Principles of Skull Base Surgery Dharma Kanta Baskota • Squamous Cell Carcinoma (SCC) • Angiofibroma • Basics of Skull Base Surgery 58. Infections and Non-neoplastic Diseases of the Pharynx including Snoring and Sleep Apnea in Adults 227 Dharma Kanta Baskota • Infections of the Pharynx • Non-infective Diseases of the Pharynx • Pharyngeal Manifestations of Systemic Diseases • Snoring and Sleep Apnea 59. Neoplasms of the Pharynx Urmila Gurung • Neoplasms of the Nasopharynx • Neoplasms of the Oropharynx • Neoplasms of the Hypopharynx 60. Infections and Non-neoplastic Diseases of the Larynx Dharma Kanta Baskota • Infections of the Larynx • Non-neoplastic Lesions of the Larynx 61. Neoplasms of the Larynx Urmila Gurung • Benign Neoplasms of the Larynx • Malignant Neoplasms of the Larynx 62. Neurological Lesions of the Pharynx and Larynx 243 Heempali Dutta • Etiology • Investigations • Intracranial Causes • Extracranial Causes 63. Laryngotracheal Injuries Heempali Dutta • Acute Laryngeal Trauma • Chronic Laryngeal Stenosis 64. Voice Disorders including Phonosurgery Toran KC • Voice Disorders • Phonosurgery 65. Stridor and Management of obstructed Airway Dharma Kanta Baskota • Stridor • Management of Obstructed Airway SECTION 6: AERODIGESTIVE TRACT Section Editor: Chop Lal Bhusal 66. Anatomy and Physiology of esophagus and Tracheobronchial Tree Chop Lal Bhusal • The Esophagus • The Tracheobronchial Tree 67. Foreign Bodies in the Aerodigestive Tract including Bronchoscopy and Esophagoscopy Procedures Chop Lal Bhusal • Foreign Bodies in the Airway • Foreign Bodies in the Digestive Tract 68. Dysphagia Dharma Kanta Baskota • Acute Dysphagia • Chronic Dysphagia SECTION 7: PEDIATRIC ENT Section Editor: Rajendra PS Guragain 69. Congenital Diseases of the Ear, Nose and Throat Anupama Shah Rijal • Congenital Diseases of the Ear • Congenital Anomalies of the External Auditory Canal (EAC) • Congenital Anomalies of the Inner Ear • Congenital Diseases of the Nose • Congenital Diseases of Oral Cavity and Head and Neck • Congenital Diseases of the Pharynx • Congenital Diseases of the Hypopharynx • Congenital Diseases of the Larynx • Congenital Diseases of the Trachea and Esophagus 70. Acute otitis Media Rajendra PS Guragain 71. otitis Media with effusion Rajendra PS Guragain 72. Diseases of the Adenoids including Snoring and obstructive Sleep Apnea Anupama Shah Rijal • Diseases of the Adenoids • Adenoidectomy • Snoring and Obstuctive Sleep Apnea in Children 73. Infections of the Tonsils Rishi Bhatta • Surgical Anatomy of the Palatine Tonsil • Infections of the Tonsils • Complications of Acute Tonsillitis 74. Pediatric Upper Airway Problems Rajendra PS Guragain • Upper Airway Problems 75. Pediatric Neck Swellings Rishi Bhatta • Inflammatory Conditions • Congenital Conditions • Neoplasia • Others 76. The Deaf Child Rajendra PS Guragain SeCTIoN 8: RELATED ToPICS Section Editor: Narmaya Thapa 77. ENT and Head and Neck Anil Kumar Jha • Ear • Nose and Paranasal Sinuses • Oral Cavity, Pharynx, Larynx and Head and Neck 78. Imaging in ENT and Head and Neck Diseases Dharma Kanta Baskota • Ultrasonogram (USG) • Computed Tomography (CT) • Magnetic Resonance Imaging (MRI) • Radioisotopes and Radiotracers (Nuclear Medicine) 79. Radiotherapy in ENT and Head and Neck Cancers Pabina Rayamajhi • Curative Radiotherapy • Adjuvant Radiotherapy • Types of Radiotherapy • Units of Radiation Measurement • Sources of Radiation • Conventional Fract ionation of Radiotherapy • Side Effects of Radiotherapy 80. Chemotherapy in ENT and Head and Neck Cancers Pabina Rayamajhi • Types of Chemotherapy 81. Laser in ENT and Head and Neck Surgery Bimal Kumar Sinha • Principle of Laser Action • Types of Lasers • Advantage of Lasers over Conventional Surgery 82. Common Instruments Used in ENT and Head and Neck Surgery Krishna Koirala • Ear Instruments • Nasal Instruments • Throat Instruments