DO-HNS (RCSI) cheat sheet

Rinne test: air conduction greater than bone conduction is normal (positive); bone greater than air indicates conductive loss on that side.

Weber test lateralises to the ear with conductive loss and away from the ear with sensorineural loss.

Pure-tone average (0.5, 1, 2, 4 kHz) thresholds of 26-40 dB = mild, 41-55 moderate, 56-70 moderately severe, 71-90 severe, >90 profound.

Acoustic neuroma: unilateral sensorineural loss with disproportionately poor speech discrimination; MRI with gadolinium is the confirmatory test.

Benign paroxysmal positional vertigo is diagnosed by Dix-Hallpike; posterior canal variant is treated with the Epley repositioning manoeuvre.

Meniere disease: episodic vertigo lasting 20 minutes to hours with fluctuating low-frequency sensorineural loss, tinnitus and aural fullness.

Cholesteatoma: attic retraction with keratin debris and scanty foul discharge; conductive loss occurs early, sensorineural loss suggests labyrinthine erosion.

Otosclerosis: normal tympanic membrane, absent stapes reflexes, Carhart notch at 2 kHz on audiometry; bilateral in about 70 percent.

Epistaxis: most bleeds arise from Kiesselbach plexus (Little area) on the anterior septum; posterior bleeds arise from sphenopalatine branches.

Allergic rhinitis: nasal obstruction, clear rhinorrhoea, sneezing, pale oedematous mucosa; skin-prick testing or specific IgE confirms sensitisation.

Nasal polyps in a child should prompt testing for cystic fibrosis (sweat chloride or CFTR genotyping).

Unilateral polypoid mass with bleeding in an adult requires biopsy to exclude inverted papilloma or malignancy.

Fractured nasal bones: reduce within 2 weeks (ideally 7-10 days) before fibrous union; septal haematoma must be drained urgently to prevent saddle deformity.

Facial nerve: temporal branch crosses the zygomatic arch within the superficial temporal fascia; the marginal mandibular branch lies near the mandibular border.

Basal cell carcinoma: pearly rolled edge with telangiectasia; rarely metastasises but causes local tissue destruction.

Cerebrospinal fluid rhinorrhoea: clear unilateral discharge, positive beta-2 transferrin; confirm defect site with high-resolution CT or MRI cisternography.

Hoarseness lasting more than 3 weeks in a smoker warrants urgent laryngoscopy to exclude laryngeal carcinoma.

Glottic carcinoma presents early with hoarseness and has better prognosis than supraglottic disease because of sparse glottic lymphatics.

Neck lump in an adult: 80 percent rule - assume neoplastic until proven otherwise; fine-needle aspiration is first-line.

Branchial cyst: lateral neck swelling anterior to sternocleidomastoid, typically in young adults; excise after confirming no malignancy.

Thyroglossal duct cyst: midline, moves on tongue protrusion; treat with Sistrunk procedure (excision of cyst, tract and central hyoid).

Recurrent laryngeal nerve on the right loops around the subclavian artery; on the left it loops around the aortic arch, making it longer and more injury-prone.

Oral squamous cell carcinoma: commonest oral malignancy; risk factors include tobacco, alcohol, betel quid and HPV (oropharyngeal subset).

Parotid tumours: pleomorphic adenoma is most common; superficial parotidectomy with facial nerve preservation is standard; avoid enucleation due to recurrence.

Acute otitis media: bulging erythematous tympanic membrane with middle-ear effusion; Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are common.

Otitis media with effusion: persistent fluid >3 months with hearing loss; grommet insertion if bilateral and speech/language delay present.

Tonsillectomy indications (Paradise criteria): 7 or more episodes in 1 year, or 5 per year for 2 years, or 3 per year for 3 years.

Croup (laryngotracheobronchitis): barking cough, inspiratory stridor, steeple sign on X-ray; treat with dexamethasone and nebulised adrenaline if severe.

Epiglottitis: drooling, tripod posture, muffled voice; avoid throat examination and secure airway in theatre.

Choanal atresia: bilateral causes cyclical cyanosis relieved by crying; confirm with CT; unilateral presents later with unilateral discharge.

Paediatric stridor: inspiratory stridor suggests laryngeal level; expiratory suggests tracheobronchial; biphasic suggests subglottic narrowing.

Keratosis obturans and chronic suppurative otitis media are more common in children with cleft palate or Down syndrome.

Cochlea: outer hair cells amplify (electromotility), inner hair cells transduce; sound frequency mapping runs from high frequencies at the base to low at the apex.

Organ of Corti sits on the basilar membrane; the tectorial membrane overlies hair cell stereocilia.

Olfaction: bipolar receptor neurons in olfactory epithelium project through the cribriform plate to the olfactory bulb; only cranial nerve with direct cortical projection.

Vocal fold vibration follows the myoelastic-aerodynamic theory: subglottal pressure drives mucosal wave; Bernoulli effect assists closure.

Larynx innervation: recurrent laryngeal nerve supplies all intrinsic muscles except cricothyroid (external laryngeal nerve); superior laryngeal nerve also provides sensation above the vocal folds.

Facial nerve branches: temporal, zygomatic, buccal, marginal mandibular, cervical; motor nucleus lies in the pons.

Middle ear transformer: ossicular lever and tympanic membrane-to-stapes footplate area ratio (~17:1) amplify sound about 25-30 dB.

Thyroid: parathyroid glands lie near inferior thyroid artery; risk of hypocalcaemia after total thyroidectomy; recurrent laryngeal nerve runs in tracheo-oesophageal groove.

Sudden sensorineural hearing loss: >30 dB across 3 contiguous frequencies within 72 hours; treat with high-dose corticosteroids urgently.

Vestibular schwannoma: MRI internal auditory meatus with gadolinium is gold standard; conservative surveillance for small tumours in older patients.

Vertigo red flags: new focal neurology, headache, vertical or direction-changing nystagmus, or inability to walk suggests central cause.

Head impulse test, nystagmus and test of skew (HINTS) distinguish central from peripheral vertigo in acute vestibular syndrome.

Tympanometry: type A normal, type B flat (effusion or perforation), type C negative pressure (Eustachian tube dysfunction).

Fistula test: positive (nystagmus on pressure) suggests perilymph fistula or cholesteatoma erosion of labyrinth.

Autoimmune inner ear disease: rapidly progressive bilateral sensorineural loss responding to steroids; screen for systemic autoimmune disease.

Cerebellopontine angle tumours: acoustic neuroma most common; meningioma and epidermoid second; MRI differentiates.

Septoplasty indications: nasal obstruction from septal deviation unresponsive to medical therapy; must assess for septal perforation and haematoma.

Functional endoscopic sinus surgery: indicated after failed maximal medical therapy for chronic rhinosinusitis with polyps or recurrent acute sinusitis.

Orbital complications of sinusitis: periorbital cellulitis, subperiosteal abscess, orbital abscess; CT with contrast guides drainage decisions.

Facial laceration repair: primary closure within 6-8 hours for clean wounds; delayed for contaminated; fine monofilament sutures on face.

Skin graft vs flap: graft needs vascularised bed; flap brings its own blood supply for exposed bone, cartilage or tendon.

Rhinoplasty: dorsal hump reduction, tip support, osteotomies; septal cartilage is preferred graft for structural support.

Facial nerve palsy: House-Brackmann grading I-VI; incomplete palsy of recent onset may respond to corticosteroids within 72 hours.

Anosmia after head injury: shearing of olfactory filaments at cribriform plate; commonest cause of permanent anosmia.

Laryngeal cancer staging: T1 confined to subsite, T2 extends beyond subsite with normal cord mobility, T3 cord fixation or cartilage invasion, T4 invades adjacent structures.

Oral cavity cancer: T1 <=2 cm, T2 >2-4 cm, T3 >4 cm, T4 invades adjacent structures; depth of invasion affects nodal risk.

Neck node levels: level I submental/submandibular, II upper jugular, III middle jugular, IV lower jugular, V posterior triangle, VI anterior compartment.

Nasopharyngeal carcinoma: associated with Epstein-Barr virus; presents with neck mass, nasal obstruction, epistaxis; treated primarily with radiotherapy.

Salivary gland malignancy: mucoepidermoid, adenoid cystic, acinic cell; adenoid cystic has perineural spread and late recurrence.

Tracheostomy: indication for upper airway obstruction, prolonged ventilation, or airway protection; complications include bleeding, stenosis, tracheo-oesophageal fistula.

Head and neck cancer follow-up: assess for recurrence, second primary, and hypothyroidism after neck irradiation.

Chemoradiotherapy for head and neck cancer: cisplatin-based; HPV-positive oropharyngeal cancer has better prognosis and may allow de-escalation.

Audiological assessment in children: otoacoustic emissions and auditory brainstem response for newborns; play audiometry from about 3 years.

Newborn hearing screening: automated OAE or ABR; positive screen requires diagnostic ABR by 3 months and intervention by 6 months.

Tonsillectomy complications: primary haemorrhage within 24 hours (surgical), secondary 5-10 days (infection); avoid NSAIDs perioperatively.

Adenoidectomy: indication for nasal obstruction, sleep-disordered breathing, recurrent otitis media; risk of velopharyngeal insufficiency if submucous cleft.

Subglottic stenosis: congenital or acquired (intubation); Cotton-Myer grading I-IV by percentage obstruction.

Laryngomalacia: commonest cause of stridor in infants; inspiratory stridor worse on lying and feeding; usually resolves by 12-18 months.

Foreign body airway: right main bronchus commoner; rigid bronchoscopy for removal; avoid blind instrumentation.

Juvenile nasopharyngeal angiofibroma: adolescent males, recurrent epistaxis, nasal obstruction; do not biopsy; treat with embolisation and resection.

Temporal bone: contains middle ear, inner ear, mastoid air cells; facial nerve runs through fallopian canal; sigmoid sinus lies posteriorly.

Paranasal sinuses: maxillary drains into middle meatus via hiatus semilunaris; frontal via frontonasal duct; sphenoid drains into sphenoethmoidal recess.

Lymphatic drainage of tongue: tip drains to submental nodes, lateral tongue to submandibular and deep cervical nodes.

Blood supply of the nose: sphenopalatine artery (from maxillary) is main posterior supply; anterior ethmoidal from ophthalmic; Kiesselbach plexus anteriorly.

Vocal fold histology: epithelium, superficial lamina propria (Reinke space), vocal ligament (intermediate and deep lamina propria), vocalis muscle.

Cochlear fluids: endolymph high potassium (scala media), perilymph high sodium (scala tympani and vestibuli); stria vascularis maintains endocochlear potential.

Ossicular chain: malleus, incus, stapes; stapes footplate sits in oval window; round window allows cochlear fluid displacement.

Salivary glands: parotid secretes serous (facial nerve traverses), submandibular mixed (Wharton duct), sublingual mucous (Bartholin duct).

Mastoidectomy: cortical (simple) for chronic otitis media, modified radical preserves ossicles, radical removes posterior canal wall.

Tympanoplasty: repair of tympanic membrane perforation; underlay technique with temporalis fascia is common.

Cochlear implant: severe-to-profound bilateral sensorineural loss with limited benefit from hearing aids; best outcomes with early implantation in children.

Vestibular rehabilitation: effective for unilateral vestibular hypofunction and chronic imbalance; not for acute vertigo.

Intratympanic gentamicin: ablative treatment for intractable Meniere disease; monitor for hearing loss.

Bone-anchored hearing aid: conductive or mixed loss with normal cochlea; also for single-sided deafness.

Otitis externa: Pseudomonas aeruginosa commonest; topical antibiotic with steroid; avoid in perforated tympanic membrane.

Cholesteatoma surgery: combined approach tympanoplasty or canal wall down; second-look surgery to detect residual disease.

Le Fort fractures: I low transverse maxilla, II pyramidal, III craniofacial disjunction; assess for midface mobility and malocclusion.

Zygomatic complex fracture: malar depression, diplopia, infraorbital numbness; open reduction and fixation if displaced.

Mandibular fracture: commonest at angle; assess occlusion and inferior alveolar nerve sensation; treat with closed or open reduction.

Orbital blowout fracture: restricted upward gaze, enophthalmos, infraorbital numbness; CT confirms; repair if entrapment or significant defect.

Frontal sinus fracture: assess posterior table involvement; risk of cerebrospinal fluid leak and mucocele; may need cranialisation.

Nasal reconstruction: local flaps for small defects, forehead flap for larger; cartilage grafts for structural support.

Facial reanimation: options include nerve grafting, nerve transfer, static slings, and free functional muscle transfer.

Scar management: silicone gel sheeting, intralesional steroids for hypertrophic scars; avoid early re-excision.

Deep neck space infection: airway compromise risk; CT with contrast; urgent drainage and antibiotics; Ludwig angina involves submandibular and sublingual spaces.

Airway emergency: cannot intubate, cannot ventilate - surgical cricothyroidotomy; in children under 12 use needle cricothyroidotomy.

Thyroidectomy complications: recurrent laryngeal nerve injury (hoarseness), external laryngeal nerve injury (voice fatigue), hypocalcaemia, haematoma.

Parathyroid surgery: primary hyperparathyroidism from adenoma in 80 percent; sestamibi scan and ultrasound localise; intraoperative PTH confirms cure.

Salivary stones: submandibular commonest; sialendoscopy or duct incision; remove if recurrent.

Zenker diverticulum: dysphagia, regurgitation, halitosis; barium swallow shows pouch; treat with endoscopic stapling or open excision.

Tracheo-oesophageal puncture: voice rehabilitation after laryngectomy; assess with trial speaking valve.

Neck dissection: radical removes levels I-V with sternocleidomastoid, internal jugular vein, accessory nerve; modified spares structures.

Congenital laryngeal webs: cause of hoarse cry and stridor; treat with endoscopic division or tracheostomy for severe cases.

Tracheomalacia: expiratory stridor, worse on crying; usually self-limiting; severe cases need CPAP or aortopexy.

Vascular rings: biphasic stridor, feeding difficulty; barium swallow and CT angiography; surgical division of ring.

Subglottic haemangioma: inspiratory stridor worsening over first months; treat with propranolol; avoid tracheostomy if possible.

Choanal atresia: bilateral presents with cyanosis relieved by crying; unilateral with unilateral nasal discharge; CT confirms; treat with puncture and stenting.

Laryngeal cleft: aspiration and recurrent pneumonia; diagnose with endoscopy; small clefts may be managed conservatively.

Paediatric sleep apnoea: adenotonsillar hypertrophy commonest cause; polysomnography; adenotonsillectomy is first-line.

Congenital neck masses: thyroglossal duct cyst, branchial cyst, cystic hygroma, haemangioma; imaging before excision.

Aminoglycosides: ototoxic (cochlear and vestibular), nephrotoxic; risk increased with loop diuretics and renal impairment.

Ototoxic drugs: aminoglycosides, cisplatin, loop diuretics, salicylates; monitor audiometry with prolonged use.

Antibiotic prophylaxis for head and neck surgery: cefazolin or co-amoxiclav; single dose at induction.

Corticosteroids in sudden sensorineural hearing loss: high-dose oral prednisolone; intratympanic dexamethasone as salvage.

Antifungal treatment for otomycosis: topical clotrimazole; avoid in perforated tympanic membrane.

HPV and oropharyngeal cancer: HPV-16 accounts for most; p16 immunohistochemistry is a surrogate marker.

Methicillin-resistant Staphylococcus aureus: common in nosocomial wound infection; vancomycin or teicoplanin.

Local anaesthetics in ENT: lidocaine with adrenaline for haemostasis; avoid in digits and areas with end-arterial supply.

Tympanometry: type A normal, type B flat (effusion), type C negative pressure; type As stiff, type Ad hypermobile.

Acoustic reflex: stapedius contraction; absent in conductive loss, severe sensorineural loss, and retrocochlear lesions.

Otoacoustic emissions: present with normal outer hair cell function; absent in sensorineural loss >30 dB.

Auditory brainstem response: used for newborn screening and retrocochlear assessment; wave V latency prolonged in acoustic neuroma.

Speech audiometry: speech reception threshold and discrimination score; disproportionately poor discrimination suggests retrocochlear pathology.

Electronystagmography and videonystagmography: assess nystagmus; caloric testing identifies canal paresis.

Vestibular evoked myogenic potentials: assess saccule and inferior vestibular nerve; useful in superior canal dehiscence.

Pure-tone audiometry: air and bone conduction; air-bone gap indicates conductive component.

Nasal endoscopy: first-line for unilateral symptoms, epistaxis, and suspected neoplasia; allows biopsy.

CT paranasal sinuses: gold standard for chronic rhinosinusitis and preoperative planning; Lund-Mackay score quantifies opacification.

MRI sinuses: distinguishes soft tissue, tumour, and fungal disease; useful for skull base involvement.

Allergy testing: skin-prick testing or specific IgE; interpret in context of history.

Nasal nitric oxide: low in primary ciliary dyskinesia; useful screening test.

Sweat chloride test: screen for cystic fibrosis in children with nasal polyps or chronic sinusitis.

Biopsy of nasal mass: required for unilateral polypoid mass; avoid biopsy of angiofibroma.

Cerebrospinal fluid leak: beta-2 transferrin; CT cisternography or MRI for localisation.

TNM staging: T primary tumour size/invasion, N regional nodes, M distant metastasis; stage groups guide treatment.

Head and neck cancer treatment: surgery or radiotherapy for early disease; combined modality for advanced.

Radiotherapy side effects: mucositis, xerostomia, dysphagia, hypothyroidism, osteoradionecrosis.

Chemotherapy: cisplatin radiosensitiser; cetuximab for patients unfit for cisplatin.

Reconstruction: free flaps (radial forearm, fibula, anterolateral thigh) for large defects; pedicled flaps (pectoralis major) for salvage.

Sentinel node biopsy: emerging for early oral cavity cancer to avoid elective neck dissection.

HPV-positive oropharyngeal cancer: better prognosis; de-escalation trials ongoing.

Second primary tumours: risk after head and neck cancer; surveillance includes chest imaging and clinical examination.

Newborn hearing screening: automated OAE or ABR; diagnostic ABR by 3 months; intervention by 6 months for optimal language.

Causes of paediatric sensorineural loss: genetic (connexin 26), congenital cytomegalovirus, meningitis, ototoxic drugs, prematurity.

Connexin 26 mutation: commonest genetic cause of non-syndromic sensorineural hearing loss.

Congenital cytomegalovirus: leading non-genetic cause of sensorineural loss; test saliva or urine within 3 weeks of birth.

Auditory neuropathy: present OAE with abnormal ABR; may benefit from cochlear implant.

Otitis media with effusion: commonest cause of childhood hearing loss; resolves spontaneously in most within 3 months.

Speech and language delay: assess hearing first; multidisciplinary assessment with audiology, speech therapy, and paediatrics.

Cochlear implant in children: best outcomes with implantation before 2 years; requires auditory verbal therapy.

Branchial apparatus: arches give rise to structures; first arch (mandibular) forms malleus, incus, mandible; second arch (hyoid) forms stapes, styloid.

Pharyngeal pouches: first pouch forms middle ear and Eustachian tube; third pouch forms thymus and inferior parathyroid; fourth pouch forms superior parathyroid.

Thyroid development: descends from foramen caecum along thyroglossal duct; remnants cause thyroglossal cyst.

Cleft lip and palate: failure of fusion of facial processes; cleft lip at 6-8 weeks, palate at 8-12 weeks.

Treacher Collins syndrome: mandibulofacial dysostosis; first and second arch derivatives affected; conductive hearing loss.

Branchio-oto-renal syndrome: EYA1 mutation; branchial cysts, hearing loss, renal anomalies.

Neurofibromatosis type 2: bilateral vestibular schwannomas; also meningiomas and ependymomas.

Goldenhar syndrome: hemifacial microsomia, ear anomalies, vertebral defects; first and second arch involvement.

Facial nerve segments: intracranial, meatal, labyrinthine, tympanic, mastoid; tympanic segment is commonest site of injury in temporal bone fracture.

Bell palsy: acute unilateral lower motor neuron palsy; treat with corticosteroids within 72 hours; eye protection.

Ramsay Hunt syndrome: herpes zoster oticus; vesicles in ear canal, facial palsy, vertigo; treat with aciclovir and steroids.

Facial nerve decompression: for traumatic palsy with immediate complete paralysis and degeneration on electroneuronography.

Glomus tumours: glomus tympanicum in middle ear, glomus jugulare in jugular foramen; pulsatile tinnitus and conductive loss.

Skull base approaches: translabyrinthine, retrosigmoid, middle fossa; choice depends on hearing status and tumour size.

Cerebellopontine angle: acoustic neuroma, meningioma, epidermoid; MRI with gadolinium is investigation of choice.

Facial nerve monitoring: intraoperative electromyography reduces injury during parotid and temporal bone surgery.

Rhinoplasty assessment: dorsal profile, tip projection and rotation, nasal valve, septal deviation; photographs and consent.

Nasal valve collapse: causes obstruction; spreader grafts or alar batten grafts improve.

Septorhinoplasty: combine septal surgery with rhinoplasty; septal cartilage is preferred graft.

Complications of rhinoplasty: bleeding, infection, saddle deformity, nasal obstruction, unsatisfactory cosmesis.

Blepharoplasty: remove excess skin and fat; assess for dry eye and thyroid eye disease preoperatively.

Otoplasty: prominent ear correction; sutures to recreate antihelical fold; risk of haematoma and infection.

Face lift: superficial musculoaponeurotic system plication; risk of facial nerve injury, haematoma, skin necrosis.

Scar revision: timing after maturation (6-12 months); options include excision, dermabrasion, laser.

Thyroid nodule: ultrasound features (microcalcification, irregular margins, hypoechoic) predict malignancy; fine-needle aspiration for cytology.

Bethesda system: categories I-VI; VI malignant, V suspicious, IV follicular neoplasm.

Papillary thyroid carcinoma: commonest; lymphatic spread; excellent prognosis; treat with total thyroidectomy and radioiodine.

Follicular thyroid carcinoma: haematogenous spread; diagnosis requires capsular or vascular invasion.

Medullary thyroid carcinoma: from parafollicular C cells; calcitonin marker; associated with MEN2; genetic testing for RET.

Anaplastic carcinoma: elderly, rapidly enlarging neck mass; poor prognosis; palliative treatment.

Primary hyperparathyroidism: elevated calcium with inappropriately normal or high PTH; adenoma in 80 percent.

Post-thyroidectomy hypocalcaemia: monitor calcium; treat with calcium and vitamin D; risk higher after total thyroidectomy and central neck dissection.

Acute epiglottitis: Haemophilus influenzae type b; drooling, tripod, muffled voice; do not examine throat; secure airway.

Retropharyngeal abscess: fever, neck stiffness, dysphagia; CT with contrast; drainage and antibiotics.

Peritonsillar abscess: unilateral tonsillar swelling with uvula deviation; needle aspiration or incision and drainage.

Lemierre syndrome: Fusobacterium necrophorum; jugular vein thrombosis after oropharyngeal infection; treat with antibiotics.

Acute mastoiditis: postauricular swelling, erythema, tenderness; CT; intravenous antibiotics and mastoidectomy if no response.

Bacterial tracheitis: toxic child with stridor and copious secretions; Staphylococcus aureus; antibiotics and airway.

Kawasaki disease: fever, rash, conjunctivitis, mucositis, cervical lymphadenopathy; risk of coronary aneurysm; treat with IV immunoglobulin.

Measles and mumps: parotitis and hearing loss; vaccination prevents.

Sound conduction: air conduction via tympanic membrane and ossicles; bone conduction bypasses middle ear.

Impedance matching: middle ear amplifies sound by area ratio and ossicular lever; loss causes conductive hearing loss.

Cochlear travelling wave: high frequencies at base, low at apex; von Bekesy described.

Endocochlear potential: +80 mV from stria vascularis; drives hair cell transduction.

Vestibular system: semicircular canals detect angular acceleration; otolith organs (utricle, saccule) detect linear acceleration and gravity.

Vestibulo-ocular reflex: stabilises gaze during head movement; tested by head impulse test.

Central vestibular pathways: vestibular nuclei in brainstem, cerebellum, thalamus, cortex.

Nystagmus: slow phase towards lesion in peripheral; direction-changing in central.

Chronic suppurative otitis media: persistent discharge through perforation; Pseudomonas and Staphylococcus aureus; treat with topical antibiotics and aural toilet.

Cholesteatoma: keratinising squamous epithelium in middle ear; bone erosion; treat with surgery.

Mastoiditis: complication of acute otitis media; postauricular swelling; CT; IV antibiotics and surgery.

Facial nerve palsy in chronic ear disease: suggests cholesteatoma erosion; urgent imaging and surgery.

Labyrinthitis: vertigo and hearing loss after infection; treat with steroids and vestibular sedatives.

Petrositis: deep ear pain, sixth nerve palsy, discharge; Gradenigo syndrome; MRI.

Otogenic intracranial complications: meningitis, brain abscess, sigmoid sinus thrombosis; urgent imaging and neurosurgical input.

Tympanoplasty: repair perforation; underlay fascia graft; success rate 80-90 percent.

Inverted papilloma: unilateral nasal mass, bleeding; associated with HPV; risk of malignant transformation; treat with endoscopic resection.

Juvenile nasopharyngeal angiofibroma: adolescent males; epistaxis; do not biopsy; embolisation and resection.

Nasopharyngeal carcinoma: EBV-associated; radiotherapy; presents with neck mass and epistaxis.

Sinonasal adenocarcinoma: wood dust exposure; ethmoid region; surgical resection.

Olfactory neuroblastoma: superior nasal cavity; staged with Kadish; surgery and radiotherapy.

Melanoma of nasal cavity: poor prognosis; wide local excision.

Lymphoma: can present as nasal mass; biopsy for diagnosis.

Metastatic disease: renal cell carcinoma can metastasise to sinonasal tract; vascular tumour.

Oral cavity subsites: lips, buccal mucosa, floor of mouth, tongue, hard palate, alveolus.

Oropharynx subsites: tonsil, base of tongue, soft palate, posterior pharyngeal wall.

Oral cavity cancer: surgery is primary treatment; neck dissection for depth >4 mm or node-positive.

Oropharyngeal cancer: HPV-positive tumours treated with radiotherapy or surgery; better prognosis.

Tongue cancer: partial glossectomy with reconstruction; assess swallowing and speech.

Floor of mouth cancer: risk of mandibular invasion; marginal or segmental mandibulectomy.

Buccal mucosa cancer: betel quid association; wide excision.

Hard palate cancer: rare; salivary gland tumours commoner than squamous cell carcinoma.

Tonsillectomy indications: recurrent tonsillitis (Paradise criteria), obstructive sleep apnoea, quinsy, suspected malignancy.

Adenoidectomy: nasal obstruction, otitis media with effusion, sleep-disordered breathing.

Post-tonsillectomy bleeding: primary within 24 hours, secondary 5-10 days; return to theatre for cautery or ligation.

Tonsillar hypertrophy: can cause obstructive sleep apnoea; assess with sleep study.

Adenoid hypertrophy: mouth breathing, snoring, nasal voice; lateral neck X-ray or endoscopy.

Velopharyngeal insufficiency: risk after adenoidectomy in submucous cleft palate; assess preoperatively.

Tonsilloliths: chronic cryptic infection; treat with tonsillectomy if symptomatic.

Recurrent tonsillitis: viral vs bacterial; throat swab and clinical criteria.

Squamous cell carcinoma: commonest head and neck malignancy; risk factors tobacco, alcohol, HPV.

Basal cell carcinoma: locally destructive, rarely metastasises.

Melanoma: poor prognosis; Breslow thickness determines staging.

Lymphoma: Hodgkin and non-Hodgkin; can present as neck mass.

Wegener granulomatosis: nasal crusting, epistaxis, saddle deformity; c-ANCA positive.

Sarcoidosis: nasal mucosa involvement; non-caseating granulomas.

Amyloidosis: can affect larynx and tongue; Congo red stain.

Immunodeficiency: recurrent infections; assess immunoglobulin levels.

Congenital hearing loss: 1 in 1000 births; genetic in 50 percent; screen with OAE or ABR.

Connexin 26: commonest genetic cause; autosomal recessive.

Congenital cytomegalovirus: test within 3 weeks of birth; leading non-genetic cause.

Otitis media with effusion: commonest cause of childhood hearing loss; resolves within 3 months in most.

Grommet insertion: for persistent effusion with hearing loss and speech delay.

Cholesteatoma in children: more aggressive; surgery.

Microtia and atresia: assess hearing; bone-anchored hearing aid or reconstruction.

Auditory neuropathy: present OAE with abnormal ABR; cochlear implant may help.

Epistaxis: most from Little area; posterior from sphenopalatine artery; treat with pressure, cautery, packing.

Posterior epistaxis: risk of airway compromise; admit; balloon tamponade or sphenopalatine artery ligation.

Nasal fracture: reduce within 2 weeks; septal haematoma drainage.

Nasal septal haematoma: urgent drainage to prevent saddle deformity and abscess.

Le Fort fractures: I, II, III; assess midface mobility and malocclusion.

Zygomatic fracture: malar depression, diplopia, infraorbital numbness; open reduction.

Orbital blowout: restricted upward gaze, enophthalmos; CT; repair if entrapment.

Frontal sinus fracture: assess posterior table; risk of CSF leak and mucocele.