EBEORL-HNS cheat sheet

Rinne test: air conduction greater than bone conduction = positive (normal or sensorineural loss); bone greater than air = negative (conductive loss). Weber lateralizes to the conductive ear or the better cochlear ear in sensorineural loss.

Pure-tone average (PTA) = (500 Hz + 1000 Hz + 2000 Hz thresholds)/3; hearing loss severity: 26-40 dB mild, 41-55 moderate, 56-70 moderately severe, 71-90 severe, >90 dB profound.

Acoustic neuroma/vestibular schwannoma arises from vestibular Schwann cells at the internal acoustic meatus; MRI with gadolinium is the diagnostic standard, and the tumor causes unilateral sensorineural hearing loss with disproportionately poor speech discrimination.

Recurrent laryngeal nerve on the right loops around the subclavian artery; on the left it loops around the aortic arch at the ligamentum arteriosum - explaining the longer left-sided course and greater vulnerability to thoracic disease.

Parotid tumors: pleomorphic adenoma is the most common benign lesion; the facial nerve courses between the superficial and deep lobes, so superficial parotidectomy preserves it. Warthin tumor is bilateral in about 10%.

Epistaxis: Kiesselbach plexus (Little area) on the anterior nasal septum accounts for most anterior bleeds; posterior bleeds arise from the sphenopalatine artery and present with blood running down the pharynx.

Thyroid: recurrent laryngeal nerve runs in the tracheoesophageal groove; the external branch of the superior laryngeal nerve runs close to the superior thyroid artery and is at risk during ligation of the superior pole.

Cochlear tonotopy: high frequencies at the basal turn, low frequencies at the apex; outer hair cells provide the cochlear amplifier, and their loss produces recruitment and reduced frequency selectivity.

Vestibular system: semicircular canals detect angular acceleration, utricle and saccule detect linear acceleration and gravity; caloric testing with cold water produces nystagmus with the fast phase away from the irrigated ear (COWS).

Sudden sensorineural hearing loss is an emergency: start high-dose corticosteroids within 72 hours; add intratympanic steroids for salvage or in diabetics, and obtain MRI to exclude retrocochlear pathology.

Epistaxis algorithm: apply pressure and topical vasoconstrictor, then cautery for visible anterior vessels; if bleeding persists, anterior packing, then posterior packing or endoscopic sphenopalatine artery ligation - never bilateral posterior packs without airway monitoring.

Deep neck abscess with airway compromise or fascial space spread requires prompt incision and drainage plus intravenous antibiotics covering aerobes and anaerobes; do not rely on needle aspiration alone.

Peritonsillar abscess: confirm with needle aspiration or imaging, then incise and drain; perform interval tonsillectomy only for recurrent episodes, not routinely after a single abscess.

Malignant otitis externa in a diabetic or immunocompromised patient: suspect Pseudomonas aeruginosa, obtain CT/MRI, start antipseudomonal intravenous therapy, and assess cranial nerve VII and lower cranial nerves.

Acute mastoiditis with postauricular swelling and abscess requires intravenous antibiotics and myringotomy or mastoidectomy; facial nerve palsy or intracranial signs mandate urgent imaging.

Airway: a patient with stridor and impending obstruction needs a controlled approach - awake fiberoptic intubation or tracheostomy in the operating room; avoid blind instrumentation and muscle relaxation before securing the airway.

Head and neck cancer workup: triple endoscopy (nasopharyngolaryngoscopy, esophagoscopy, bronchoscopy) plus CT/MRI and PET-CT for staging; biopsy the primary, and do not excise a neck node as a diagnostic procedure without prior fine-needle aspiration.

Vertigo: distinguish peripheral (horizontal-rotatory nystagmus suppressed by fixation, no focal signs) from central (vertical or direction-changing nystagmus, focal neurological deficits) - central signs require urgent neuroimaging.

Tracheostomy indications: prolonged ventilation, upper airway obstruction, and airway protection; the stoma should be placed below the first tracheal ring, avoiding the cricothyroid membrane except in emergency cricothyrotomy.