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Presbycusis Presbycusis is characterised by a gradual loss of hearing in both ears, with or without tinnitus. The hearing loss usually a ff ects the higher frequencies and a classical audiogram is shown in Figure 51.28 . The consonants of speech lie within the...

RHINOSINUSITIS Rhinosinusitis is inflammation of the sinonasal mucosa and is defined as the presence of nasal congestion or nasal discharge and at least one of facial pain or hyposmia with endoscopic and/or CT changes to confirm the diagnosis. It can be divide...

Radiological investigation Computed tomography (CT) scanning of the temporal bones is commonly performed before mastoid surgery to show detailed individual anatomy , as well as alerting the surgeon to anatomical variants. Pus, bone and air are shown well on h...

Septal deformity Deviation of the nasal septum may occur naturally or arise as a result of nasal trauma and is readily apparent on anterior rhinoscopy ( Figure 51.40 ). Surgical correction can be achieved by a submucous resection (SMR) of the septum where t...

Septal injury A blunt injury of moderate force may lead to lateral displace - ment or deformity of the septal cartilage, restricting the nasal airway . Unlike the nasal bones the nasal septum cannot be manipulated back into position and requires a formal sep...

Septal perforation A hole in the nasal septum causes turbulent airflow through the nose and a resulting sensation of nasal blockage, extensive nasal crusting, bleeding and whistling. The causes of septal perforation are listed in Summary box 51.10 . Septal pe...

Sudden sensorineural hearing loss Defined as >30 /uni00A0 dB sensorineural hearing loss at three frequen - - cies within 3 days. History and examination should focus on a cause, which may be infective, neoplastic, traumatic, ototoxic, neurological or autoimmune...

THE EAR The mammalian ear is an evolutionary masterpiece. Its highly complex ‘three-dimensional anatomy’ is best learnt by dissect ing cadaver temporal bones. THE EAR The mammalian ear is an evolutionary masterpiece. Its highly complex ‘three-dimensional anato...

THE NOSE AND SINUSES BASIC ANATOMY OF THE NOSE AND PARANASAL SINUSES The supporting structures of the nose are shown in Figure 51.32 . The septum consists of the anterior quadri - lateral cartilage, the perpendicular plate of the ethmoid and the vomer ( Fig...

THE NOSE AND SINUSES BASIC ANATOMY OF THE NOSE AND PARANASAL SINUSES The supporting structures of the nose are shown in Figure 51.32 . The septum consists of the anterior quadri - lateral cartilage, the perpendicular plate of the ethmoid and the vomer ( Fig...

TRAUMA TO THE NOSE AND PARANASAL SINUSES Fracture of the nasal bones Blunt injury to the nose may fracture the nasal bones ( Figure 51.39 ). The fracture line can extend into the lacrimal bone and tear the anterior ethmoidal artery , producing cata strophic ha...

TRAUMA TO THE NOSE AND PARANASAL SINUSES Fracture of the nasal bones Blunt injury to the nose may fracture the nasal bones ( Figure 51.39 ). The fracture line can extend into the lacrimal bone and tear the anterior ethmoidal artery , producing cata strophic ha...

TUMOURS OF THE NOSE AND SINUSES Tumours arising in the nose or paranasal sinuses may present with unilateral nasal obstruction, persistent unilateral anterior rhinorrhoea, postnasal drip, epistaxis, unilateral bloodstained rhinorrhoea, facial swelling or propt...

The external ear The external and middle ear develop from the first two branchial arches. The external ear canal is 3 /uni00A0 cm in length; the outer two-thirds is cartilage and the inner third is bony . The skin on the lateral surface of the tympanic membran...

The inner ear The inner ear comprises the cochlea and vestibular labyrinth (saccule, utricle and semicircular canals). These structures are - embedded in dense bone called the otic capsule. The cochlea is a coiled shell of two and three-quarter turns. Within ...

The sensory nerve supply The external ear is supplied by the auriculotemporal branch of the trigeminal nerve (cranial nerve [CN] V) and the greater auricular nerve (C2/3), together with branches of the lesser occipital nerve (C2). CNs VII, IX and X also suppl...

The tympanic membrane and middle ear The anatomy of the tympanic membrane and ossicles is shown in Figure 51.1 . The relations of the middle ear are important - ( Figure 51.2 ). The tympanic membrane and ossicles act as a transformer of vibrations in the ai...

Tinnitus Tinnitus is the perception of sound when no external sound source is present. It may have an extrinsic cause; for example, the pulsatile tinnitus of a glomus tumour. Usually , however, the tinnitus is generated within the internal auditory pathway ....