HISTORY AND NECK HISTORY

 Adult – pull the ear upward, backward and outward.

 Children – pull the ear down and backward.
 Weber’s test determines if hearing impairment is conductive or neural origin.
 Conductive hearing loss, the fork is heard on the ipsilateral side or the same side of hearing loss.
 Sensorineural hearing loss, the fork is heard on the opposite side or the unaffected side.
 Rinne test is used to compare the duration of bone production with air conduction.
 The fork is heard twice as long and louder by air conduction compared to bone conduction.
 Schwabach test is a bone conduction test.
 Diminish schwabach implies sensorineural hearing loss.
 Prolonged schwabach implies conductive hearing loss.
 Fossae of rosenmuller is the most common site for nasopharyngeal carcinoma.

LARYNX
 Larynx is a hollow musculoligamentous structure with a cartilaginous framework that caps the
respiratory tract. It is located at the fourth to sixth vertebrae.
 Thyroid cartilage is the largest.
 Cricoid cartilage is the strongest.
 Epiglottis is a leaf like structure.
 Petiole is the small, narrow portion of the epiglottis.
 Vestibule is an opening in the lateral wall of the larynx, between the vestibular fold above and
the vocal folds below.
 False vocal cords are responsible for constricting function.
 True vocal cords are responsible for voice.
 Superior laryngeal vein drains into superior thyroid vein into internal jugular vein.
 Inferior laryngeal vein drains into inferior thyroid vein into left brachiocephalic vein.
 Injury to the recurrent laryngeal nerve has the potential to cause unilateral vocal cord paralysis.
Patients with this typically complain of new-onset hoarseness, changes in vocal pitch, or noisy
breathing.

LARYNX INFLAMMATORY DISEASES

 Croup is a rapidly developing infection of the larynx with airway obstruction and stridor.
 Streptococcus is the most common cause of laryngitis.
 Most common site for singer nodules is anterior and middle thirds and is usually bilateral.
 Acid laryngitis is the most common manifestation of GERD.
 Dysphonia is the most common symptom of laryngeal GERD.
 Subglottic stenosis signs and symptom include dyspnea, wheezing, stridor and nonproductive
cough.
 Laryngomalacia is the most common laryngeal abnormality of the newborn.
  Cri-du-chat syndrome signs and symptom include mental retardation, hypertelorism,
microcephaly, strabismus.
 The most common postoperative problem is the subglottic laryngeal edema.
 Unilateral paralysis of the larynx is the most common.

CANCER OF THE LARYNX

 Hoarseness is the primary symptom when glottis is affected.
 Dysphagia is the primary symptom when supraglottic is affected.
 Dyspnea is the primary symptom when subglottic is affected.
 Tumor in the supraglottic that is confined to site of origin is considered T1, if it involves adjacent
structures T2, if extends T3, if extends beyond T4.
 Tumor in the glottic that is confined to site of origin is considered T1, if limited to one vocal cord
T1a, if anterior commissure is involved T1b, if it extends to supraglottic and subglottic T2, if
confined to larynx with cord fixation T3, if there is destruction or extends beyond T4.
 N1 is when there is unilateral node.
 N2 is when there is bilateral node.
 N3 is when there is fixed node.
 Stage 1 is T1, N0, M0.
 Stage 2 is T2, N0, M0.
 Stage 3 is T3, N0, M0 or T1-3, N1, M0.
 Stage 4 is T4, N0, M0 or T4, N1, M0, or T1-3, N2-3, M0 or any N0, M1.
 Glottic cancer has the best prognosis of the three cancers.
 Transglottic carcinoma has the worst prognosis among laryngeal carcinoma.

HEAD AND NECK

 The tubular form of adenoid cystic carcinoma has the best prognosis while the solid form has
the worst prognosis.
 Parotid gland is the largest salivary gland that derives from the first laryngeal pouch.
 Parotid gland drains to the retromandibular vein.
 Submandibular gland is the second largest salivary gland that lies within submandibular triangle
below the mylohyoid muscle.
 Sublingual gland is the smallest salivary glands.
 Saliva is produced at 1 – 1.5 L in 24-hour period.
 Sialography is a low viscosity contrast study of a salivary gland that may trigger sialodenitis.
 Acute sialoadenitis is secondary to salivary obstruction or stasis. Mumps virus is the most
common cause of acute parotid enlargement while S. aureus is the most common bacterial
cause.
 Sialolithiasis is more common in submandibular gland, its calculi are radiopaque while parotid
calculi are radiolucent.
  Heerfordt’s disease is a chronic inflammatory disease of the uveal tract of the eye with
enlargement of the parotid glands, often running a febrile course, and frequently complicated
by paralysis of the facial nerve.
 Sjogren’s syndrome is a disorder of your immune system identified by its two most common
symptoms dry eyes and a dry mouth. The condition often accompanies other immune system
disorders, such as rheumatoid arthritis and lupus.
 Pleomorphic adenoma is the most common benign salivary gland tumor in children.
 Warthin’s tumor is the second most common benign salivary gland, has high mitochondrial
content with biphasic composition.
 Oncocytoma is a slow growing, well circumscribed, but not encapsulated tumor.
 Monomorphic adenoma is common in minor salivary glands.
 Mucoepidermoid carcinoma is the most common malignant tumor of the salivary glands in adult
and children.
 Adenoid cystic carcinoma is the second most common malignancy of submandibular gland and
minor salivary glands.
 Adenocarcinoma is a high grade and aggressive that is common in minor salivary gland.
 Frey's syndrome is a rare, neurological disorder that causes a person to sweat excessively while
eating. It most often occurs as a complication of surgery involving the parotid gland.
 Parotitis presents with typically unilateral painful swelling and pus from the stensen’s duct.

CARCINOMA OF THE ORAL CAVITY, PHARYNX

AND ESOPHAGUS
 Leukoplakia is a white, mucosal based keratotic plaque that cannot be wiped free.
 Erythroplakia is a red mucosal plaque that does not arise from any obvious mechanical cause.
 Necrotizing sialometaplasia is a butterfly shaped area of ulceration at the junction of hard and
soft palate.
 Squamous cell carcinoma is the most common malignancy of the palate.

CANCER OF THE NASAL CAVITY

 Squamous cell carcinoma is the most common malignancy of the nasal cavity.
 Lateral wall is the most common site of the malignant tumor.
 Cancer of maxillary sinus symptoms include deviation of eye, diplopia, visual problems, bulging
of cheek, numbness and paresthesia.
 Onhgren’s line is an imaginary line drawn from the inner canthus to the angle of the mandible.
 Mucormycosis precedes the onset of ischemic darkened necrosis of nasal cavity. The most
common and virulent species is Rhizopus oryzae. It is the most acutely fatal fungal infection.
 Nephrotoxicity is the major-dose limiting toxicity.
EAR
 Cerumen is the product of sebaceous and ceruminous gland.
 Furunculosis or acute circumscribed otitis externa is the infection of pilosebaceous follicle due to
trauma.
 Diffuse otitis externa or swimmer’s ear is secondary to acute or chronic otitis media.
 Otitis externa pain and tenderness is severe while otitis media is mild and no tenderness.
 Malignant otitis externa is very destructive and is common in diabetic and immunocompromised
patient. Common agent is P. aeruginosa.
 Otomycosis is presence of mycelia or sporangia.
 Perichondritis is the formation of pus between cartilage and perichondrium.
 Otitis media is infection or inflammation of the middle ear because of the mucosa connecting
the middle ear and the mastoid. Acute otitis media is less than 12 weeks while chronic is more
than 12 weeks.
 Aerotitis media is due to rapid descent or loss of altitude in air travel.
 Otitis media with effusion is due to dysfunction of eustachian tube.
 Acute suppurative otitis media is secondary to URTI.
 Acute necrotizing otitis media occurs in infant and young children.
 Embryonic cell theory is due to congenital cholesteatoma and entrapment of epithelial rest.
 Metaplasia theory is due to chronic infection and irritation.
 Retraction of pas flaccida causes ingrowth of squamous epithelium.
 Migratory theory is secondary acquired type of cholesteatoma.
 Congenital cholesteatoma is due to embryonic rest.