surgical procedures for acute otitis media (AOM)Indications
Not routinely indicated in acute AOM
Consider for patients with treatment failure or recurrent infection.
Procedures
・Myringotomy
Surgical incision into the tympanic membrane to drain fluid to relieve pressure/pain
Consider as an adjunct to antibiotic therapy for severe otalgia and a ☆bulging tympanic membrane
・Myringotomy with tympanostomy tube insertion
for chronic otitis media infectious diseaseENT国試過去3年 Jan 28, 2021, 8:25 AM HirotoShishido
management of otitis media with effusionPatients without speech impairement at the time of diagnosis: ★monitor for 3 months
Patients with speech impairement or persistent OME at follow-up
Age < 4 years: placement of tympanostomy tubes
Age ≥ 4 years: placement of tympanostomy tubes and/or adenoidectomy ENTpediatricsUWorld step2CK Dec 16, 2020, 1:21 AM HirotoShishido
真菌性副鼻腔炎 CTCTにおける軟部組織陰影内の高吸収域と，MRIでT1，T2強調像ともにやや低信号であることが画像の特徴で，この2つがそろうとほぼ真菌症と断定して間違いない ENTinfectious disease Oct 20, 2020, 12:56 PM HirotoShishido
先天性難聴 検査新生児聴覚スクリーニングで両側の難聴が疑われたらもう一度聴力評価を行う必要がある．また内耳・中耳奇形の有無を確認するために画像検査(側頭骨CTなど)が必要である． ENT国試 Oct 20, 2020, 12:48 PM HirotoShishido
audiogram and treatment of otosclerosischaracteristic dip at 2000Hz (Carhart’s notch)
典型例ではstiffness curve（低音部でA-B gapが大きい）が認められる．
☆stapedectomy or stapedotomy (with laser or drill) with prosthesis is definitive treatment ENT国試 Oct 20, 2020, 8:31 AM HirotoShishido
indication of tympanoplasty鼓室形成術
適応は（1）健全な耳管機能，（2）可動性のある卵円窓・正円窓，（3）内耳機能の健在な例．
具体的には慢性中耳炎，☆真珠腫性中耳炎，外・中耳奇形，外傷性耳小骨障害など，伝音難聴と中耳の慢性炎症が対象となる ENT国試 Oct 20, 2020, 6:00 AM HirotoShishido
Treatment of chronic sinusitis非好酸球性では，保存療法として，鼻汁の除去，抗菌薬の注入（ネブライザー法），副鼻腔洗浄（自然孔洗浄），14員環マクロライド系抗菌薬の少量長期投与を行う．
好酸球性では，保存療法として，経口ステロイド投与などの薬物治療を行う．
手術療法としては，☆内視鏡下鼻内手術が第一選択である．Caldwell-Luc法（口腔経由で上顎洞から下鼻道へ排泄孔をつくる）やKillian法（眉に沿って鼻根部を切開し前頭洞に達する）は，慢性副鼻腔炎の手術としては現在ほとんど行われていない． ENT国試直前 Oct 20, 2020, 5:42 AM HirotoShishido
structure of lacrimal apparatusPCSN
Lacrimal punctum
Lacrimal canal
Lacrimal sac
Nasolacrimal duct
Inferior meatus ophthalmologyENT国試 Oct 20, 2020, 3:06 AM HirotoShishido
causative organism for chronic otitis media小児期から反復する耳漏，鼓膜の穿孔から本例は慢性中耳炎を有している．急性中耳炎の起炎菌は，肺炎球菌，インフルエンザ菌，Moraxella catarrhalisが三大起炎菌であるが，慢性中耳炎では，☆黄色ブドウ球菌（ときにメチシリン耐性黄色ブドウ球菌：MRSA），緑膿菌や嫌気性菌などが起炎菌となることが多 ENT国試過去3回 Oct 12, 2020, 1:58 AM HirotoShishido
cutaneous innervation of the external auditory canalCNⅤ-3, Ⅶ,Ⅸ, Ⅹ
Ⅴ-3→ anterior wall, external portion of the tympanic membrane
Ⅸ→ internal portion of the tympanic membrane
Ⅹ→ ☆posterior wall
(stimulation of the posterior wall can trigger vasovagal syncope) neurologyENTUWorld May 20, 2020, 3:52 AM HirotoShishido
complications of blow out fracture(fracture of orbital floor)
damage to ☆infraorbital nerve can result in eumbness and paresthesia of the upper cheek, ☆uppep lip, and upper gingiva
enophthalmos and entrapment of the inferior rectus muscle can impair vertical gaze ENTanatomyUWorld May 17, 2020, 4:56 AM HirotoShishido
reffered otalgiahypopharyngeal carcinoma→ irritation of the vagus nerve (CN X)
defect in the afferent pathyway of cough reflexSuperior laryngeal nerve (4th pharyngeal arch)
Motor innervation (☆external branch): cricothyroid muscle
Sensory innervation (Internal laryngeal nerve): ¥above the vocal cords
Recurrent laryngeal nerve
Motor innervation: all intrinsic muscles except for cricothyroid muscle
Sensory innervation: below the vocal cords
damage at ¥piriform recess→ damage to internl laryngeal nerve→ defect in the afferent pathyway of cough reflex anatomyENTAmboss level4 May 8, 2020, 9:00 AM HirotoShishido
dampendˈæmp(ə)n
Make less strong or intense.
'tensor tympani (innervated by CNⅤ-3) dampens loud sounds by tensing the tympanic membrane'
motor innervation of the tongueCN Ⅹ→ ☆palatoglossus(elevates posterior tongue while swallowing)
CN Ⅻ→ genioglossus(protrudes tongue), hyoglossus (retracts and depresses tongue), and styloglossus (draws sides of tongue upward to create a trough for swallowing). neurologyENT Dec 4, 2019, 3:14 AM HirotoShishido
sympathomimetics used as a nasal decongestantnonselective α receptor agonist(α1>α2)
→phenylephrine pharmacologyENT Sep 28, 2019, 9:13 PM HirotoShishido
