Ear, nose and throat block — Lectures 15 to 17, everything that has to be recallable cold
| Term | What you need to know |
|---|---|
| WEBER | Tuning fork on the MIDLINE. Compares BONE conduction between the two ears. Asks WHICH SIDE IS LOUDER. |
| RINNE | Tuning fork at the EAR then the MASTOID. Compares AIR against BONE in ONE ear. |
| CONDUCTIVE | Weber lateralizes TO the BAD ear. Rinne: BC ≥ AC. Voice stays SOFT. Hearing BETTER in noise. |
| SENSORINEURAL | Weber lateralizes AWAY, to the GOOD ear. Rinne: AC > BC — SAME AS NORMAL. Voice LOUD. Hearing WORSE in noise. |
| WHY WEBER DECIDES | A sensorineural Rinne looks exactly like a normal ear. Only WEBER separates them. |
| THE QUESTION SHE PROMISED | Fullness + reduced hearing AFTER A COLD, AMBER effusion behind an INTACT drum with REDUCED MOBILITY → conductive → Weber TO that ear, BC ≥ AC. She also asks it BACKWARDS: given the fork findings, name the diagnosis — the distractors die on LOSS TYPE. |
| AUDIOMETRY — ALL BY 20s | Normal 0–20 · MILD 20–40 · MODERATE 40–60 · SEVERE 60–80 · PROFOUND >80 dB. The prevalence percentages are explicitly NOT to be memorized. |
| TYMPANOGRAM | A normal · B FLAT = fluid or perforation · C peak NEGATIVE = eustachian tube dysfunction · As SHALLOW/stiff = ossicular FIXATION, tympanosclerosis · Ad DEEP = ossicular DISCONTINUITY, monomeric drum. |
| VESTIBULAR | ELECTRONYSTAGMOGRAPHY = gold standard, one ear at a time. MRI WITH GADOLINIUM = gold standard for RETROCOCHLEAR. DIX-HALLPIKE diagnoses positional vertigo; EPLEY treats it. |
| Term | What you need to know |
|---|---|
| SECONDS (10–60) | BENIGN PAROXYSMAL POSITIONAL VERTIGO. On rolling over. Hearing NOT affected, NO tinnitus. Beyond a MINUTE → think again. Dix-Hallpike diagnoses, EPLEY treats. |
| MINUTES TO HOURS | MÉNIÈRE’S. Tetrad: vertigo + FLUCTUATING LOW-FREQUENCY sensorineural loss + LOW-TONE tinnitus + FULLNESS. Hearing IS affected. RULE OUT SYPHILIS — indistinguishable. |
| DAYS TO WEEKS, hearing AFFECTED | LABYRINTHITIS. Inflammation of the membranous labyrinth. Viral. Meclizine or diazepam, steroids, antibiotics ONLY if bacterial features. |
| DAYS TO WEEKS, hearing NORMAL | VESTIBULAR NEURONITIS. Inflammation of the VESTIBULAR portion of CN VIII. BENIGN and SELF-LIMITING. No hearing change, NO focal neurology. |
| THE ONE WORD | Labyrinthitis vs vestibular neuronitis = does it affect HEARING. That is the whole difference. |
| CENTRAL — STOP | Vertigo + FACIAL PARALYSIS, CROSSED sensory loss, GAZE palsy or HORNER = VERTEBROBASILAR. Vertigo + ATAXIA, HEADACHE or facial numbness = CEREBELLAR INFARCT. Both EMERGENT. |
| Term | What you need to know |
|---|---|
| CONDUCTIVE | EUSTACHIAN TUBE DYSFUNCTION · ACUTE OTITIS MEDIA · OTITIS MEDIA WITH EFFUSION · CHRONIC OTITIS MEDIA · MASTOIDITIS · CERUMEN IMPACTION · CHOLESTEATOMA · TYMPANIC MEMBRANE PERFORATION · FOREIGN BODY OF THE CANAL · OTITIS EXTERNA · MALIGNANT OTITIS EXTERNA · OTOMYCOSIS · OTOSCLEROSIS · CARCINOMA OF THE EAR CANAL · CONDUCTIVE HEARING LOSS · EXOSTOSIS · GLOMUS TUMOR |
| SENSORINEURAL | SENSORINEURAL HEARING LOSS · PRESBYCUSIS · OTOTOXICITY · NOISE-INDUCED HEARING LOSS · PERILYMPHATIC FISTULA · AUTOIMMUNE SENSORINEURAL LOSS · SYPHILITIC SENSORINEURAL LOSS · AIDS-RELATED SENSORINEURAL LOSS · HEREDITARY SENSORINEURAL LOSS · SUDDEN SENSORINEURAL HEARING LOSS · MÉNIÈRE'S DISEASE · LABYRINTHITIS · ACOUSTIC NEUROMA |
| HEARING NOT AFFECTED | HEMATOMA OF THE EXTERNAL EAR · LACERATIONS AND AVULSION · FOREIGN BODY OF THE AURICLE · KELOID OF THE EAR · BENIGN PAROXYSMAL POSITIONAL VERTIGO · VESTIBULAR NEURONITIS · ISOLATED CEREBELLAR INFARCTION |
| EMERGENT | MALIGNANT OTITIS EXTERNA · CARCINOMA OF THE EAR CANAL · SUDDEN SENSORINEURAL HEARING LOSS · VERTEBROBASILAR INSUFFICIENCY OR OCCLUSION · ISOLATED CEREBELLAR INFARCTION · SINUSITIS WITH URGENT FEATURES · EPISTAXIS — POSTERIOR · NASOPHARYNGEAL CARCINOMA · NECK NEOPLASM — GENERAL · PRIMARY NECK TUMORS — THE LIST · ANAPLASTIC THYROID CARCINOMA · EPIGLOTTITIS (SUPRAGLOTTITIS) · DIPHTHERIA · PERITONSILLAR ABSCESS (QUINSY) · RETROPHARYNGEAL ABSCESS · LUDWIG ANGINA · ERYTHROPLAKIA · ORAL CAVITY AND OROPHARYNGEAL CANCER |
| Term | What you need to know |
|---|---|
| ACUTE OTITIS MEDIA | BULGING ERYTHEMATOUS drum, reduced mobility. Otalgia + FEVER + hearing loss. Peak age ~2 YEARS; adults only 3–15%. |
| ITS CAUSE — the slide is incomplete | FAR AND AWAY MOST ARE VIRAL. Bacterial three: S. PNEUMONIAE, H. INFLUENZAE, M. CATARRHALIS. M. catarrhalis has OVERTAKEN H. influenzae because of VACCINATION — ask IMMUNIZATION STATUS. |
| ITS TREATMENT | MOST RESOLVE SPONTANEOUSLY. Bacterial → AMOXICILLIN. RECURRENT = 3 in 6 months or >4 in 12 → TYMPANOSTOMY TUBES. |
| OTITIS MEDIA WITH EFFUSION | DULL drum, AIR–FLUID LEVEL, reduced mobility. OFTEN ASYMPTOMATIC, found incidentally. Treat on DURATION + degree of hearing loss + effect on SPEECH AND LANGUAGE. |
| CHRONIC OTITIS MEDIA | NON-HEALING PERFORATION. Benign = dry. With effusion = serous drainage. SUPPURATIVE = pus. Refer to ENT. |
| MASTOIDITIS | Spread into the MASTOID AIR CELLS. Complication of acute otitis media — alongside PERFORATION, LABYRINTHITIS, rarely MENINGITIS. |
| Term | What you need to know |
|---|---|
| OTITIS EXTERNA | PAIN ON MOVING THE TRAGUS. Swimmer. P. AERUGINOSA 38%. Remove debris FIRST, then drops ± steroid. WICK if the canal is closed. |
| MALIGNANT (NECROTIZING) | ELDERLY DIABETIC + PAIN OUT OF PROPORTION + FACIAL NERVE WEAKNESS. >95% P. aeruginosa. IMAGING shows BONY involvement. ANTIPSEUDOMONAL — ciprofloxacin. EMERGENT. |
| OTOMYCOSIS | ITCH > pain. ASPERGILLUS = “WET NEWSPAPER”. CANDIDA = WHITE CURD. Debris removal + topical antifungal. |
| CERUMEN IMPACTION | MOST OFTEN SELF-INDUCED BY CLEANING. Irrigate ONLY if the drum is INTACT, body-temperature water. TUBES or PERFORATION → ENT. |
| FOREIGN BODY | DO NOT PUSH DEEPER. Firm → loop/hook. Soft → alligator forceps. ORGANIC SWELLS WHEN WET — no irrigation. INSECT → LIDOCAINE first. |
| CARCINOMA OF THE CANAL | OTITIS EXTERNA THAT WILL NOT RESPOND + BLOODY otorrhea + FRIABLE canal. Often MISDIAGNOSED. BIOPSY. EMERGENT. |
| Term | What you need to know |
|---|---|
| EUSTACHIAN TUBE DYSFUNCTION | RETRACTED drum, reduced mobility. Fullness + CRACKLING/POPPING after a cold. Decongestant + intranasal steroid. NO FLYING until it resolves. |
| BAROTRAUMA | Flying or DIVING. HEMOTYMPANUM. Window rupture adds VERTIGO + TINNITUS + SENSORINEURAL loss. MYRINGOTOMY gives instant relief. |
| TM PERFORATION | THE PAIN STOPS when it ruptures. CENTRAL vs MARGINAL. Most heal; after acute otitis media as fast as 48–72 HOURS. |
| CHOLESTEATOMA | KERATIN in a RETRACTION POCKET + RECURRENT OTORRHEA WITH NO OTITIS EXTERNA. Not a neoplasm, no cholesterol. CT for extent. SURGERY — it erodes bone. |
| OTOSCLEROSIS | STAPES fixation. Gradual CONDUCTIVE loss with a NORMAL DRUM. HEARS BETTER IN NOISE. Weber TO the affected ear. CT first-line imaging. Stapes prosthesis. |
| AURICULAR HEMATOMA | Sub-perichondrial. Landmarks LOST. DRAIN WITHIN 7 DAYS — then splint. Re-check at 12–24h because it can appear LATE. Otherwise CAULIFLOWER EAR. |
| Term | What you need to know |
|---|---|
| PRESBYCUSIS | Commonest sensorineural loss. BILATERAL, SYMMETRICAL, GRADUAL, HIGH FREQUENCY FIRST. “Hears but cannot make out words.” Screen from 65. |
| OTOTOXICITY | AMINOGLYCOSIDES most ototoxic and most common — monitor peaks. Also FUROSEMIDE, ASPIRIN, PLATINUM. Ototoxic drugs are frequently NEPHROTOXIC too. |
| NOISE-INDUCED | TEMPORARY threshold shift recovers in 24–48h; repeated exposure makes it PERMANENT. Damage from ~80 dB; PAIN at 120. |
| SUDDEN SNHL | UNILATERAL. A SYNDROME, NOT A DISEASE. Viral or vascular. SAME-DAY ENT REFERRAL — steroids work only in the first weeks. |
| ACOUSTIC NEUROMA | UNILATERAL loss with SPEECH DISCRIMINATION WORSE THAN THE TONES PREDICT. May involve CN V and VII. MRI WITH GADOLINIUM. |
| PERILYMPHATIC FISTULA | AUDIBLE POP then sudden loss + vertigo after STRAINING, DIVING or a BLOW. Round or oval window. |
| SYPHILIS | INDISTINGUISHABLE FROM MÉNIÈRE’S and TREATABLE. Order FTA-ABS and MHA-TP; VDRL IS NOT HELPFUL. Antibiotic + systemic steroid. |
| GLOMUS TUMOR | PULSATILE TINNITUS + vascular middle ear mass. Can paralyze CN IX, X, XI. |
| TINNITUS RED FLAG | UNILATERAL or PULSATILE is investigated. No drug beats placebo; masking and biofeedback may help. |
| Term | What you need to know |
|---|---|
| ACUTE SINUSITIS | UNDER 4 WEEKS. 90–98% VIRAL; only 0.5–2% superinfect. Pain WORSE BENDING FORWARD, localizes to the sinus. 1 in 8 adults; 5th leading reason antibiotics are prescribed. |
| BACTERIAL — the 5 features | DOUBLE WORSENING after 5–6 days · ≥10 DAYS persistent · persistent PURULENT discharge · UNILATERAL tooth/facial pain or maxillary tenderness · FEVER. |
| PAIN IS THE DISCRIMINATOR | Pain occurs ONLY in bacterial and fungal sinusitis and is REPRODUCIBLE ON PALPATION. A common cold is not. |
| DISCHARGE COLOR | Yellow/green = LEAST helpful. Clear = viral or allergic. Yellow AND putrid = bacterial. BLACK = FUNGUS. Rust = possible S. pneumoniae. |
| SINUSITIS DIAGNOSTICS | NO test separates viral from bacterial. Routine radiography DISCOURAGED — 3+ clinical findings match imaging accuracy. CT for recurrence, treatment failure, or suspected EXTRASINUS involvement. |
| SINUSITIS TREATMENT | Most improve WITHOUT antibiotics. Symptomatic: decongestants, NSAIDs, lavage, intranasal steroids. Bacterial → AMOXICILLIN/CLAVULANATE. Penicillin allergy → DOXYCYCLINE or moxifloxacin. Influenza → oseltamivir 5 days if >13. |
| URGENT IN SINUSITIS | DIPLOPIA or visual disturbance · PERIORBITAL swelling/erythema · ALTERED MENTAL STATUS. Get the CT. |
| CHRONIC SINUSITIS | OVER 12 WEEKS. Impaired MUCOCILIARY CLEARANCE → REPEATED infections, not one persistent one. Oral steroids + 2 weeks amoxicillin/clavulanate; courses often 3–4 weeks. ENT for surgery, allergy for skin testing. |
| CHRONIC FUNGAL | ASPERGILLUS, noninvasive, immunocompetent. Mild disease cured by ENDOSCOPIC SURGERY WITHOUT ANTIFUNGALS. Fungus ball → surgery, antifungals ONLY if bony erosion. Allergic form: polyps + asthma + PEANUT-BUTTER mucus. |
| DEVIATED SEPTUM | One passage smaller. Congestion → ANOSMIA; severe = OSA, snoring, facial pain, RECURRENT NOSEBLEEDS. Treatment SEPTOPLASTY. |
| PERFORATED SEPTUM | INTRANASAL STEROIDS or COCAINE — chronic ischemia. Rarely GRANULOMATOSIS WITH POLYANGIITIS or secondary SYPHILIS. Treat the cause; else septoplasty. |
| SEPTAL HEMATOMA | Between septum and PERICHONDRIUM. Usually TRAUMA; associated with nasal fracture. DRAIN via intranasal incision under general anesthesia. |
| EPISTAXIS — ANTERIOR | 90%, from KIESSELBACH’S PLEXUS. Commonest cause = the patient’s finger. Peaks <10 and 45–65; WINTER. |
| EPISTAXIS — POSTERIOR | SPHENOPALATINE ARTERY. Significant hemorrhage. HIGHER RISK because of ASPIRATION and subsequent infection. |
| STOPPING THE BLEED | Blow out clots → spray OXYMETAZOLINE → PINCH THE ALAE 10 MINUTES CONTINUOUSLY. Sit up, lean FORWARD. Cold compress. Then tampons, packing, balloon catheters, thrombogenic foams. DO NOT BLOW THE NOSE. |
| EPISTAXIS WORKUP | PT/INR is NOT routine — only if anticoagulated. Hematocrit + type and crossmatch if massive, with 2 large-bore IV lines. |
| NASAL FOREIGN BODY | UNILATERAL PURULENT FOUL-SMELLING discharge in a young child. Floor of the passage under the INFERIOR turbinate, or in front of the MIDDLE turbinate. Visualization is the diagnosis. |
| NASAL FRACTURE — no x-ray if | ALL FOUR: tenderness/swelling ISOLATED to the bony bridge · breathes through EACH naris · nose STRAIGHT, no septal deviation · NO SEPTAL HEMATOMA. Otherwise film it. Initial care: ICE + head of bed up. |
| NASAL POLYPS | GRAY, GLISTENING masses → congestion, thick discharge, ANOSMIA. Asthma 20–50%, allergic fungal sinusitis 85%, aspirin intolerance 8–20%, alcohol intolerance 50%, Churg-Strauss 50%, CF 5–44%. EVALUATE EVERY CHILD WITH MULTIPLE POLYPS FOR CF AND ASTHMA — chloride sweat test. Surgery gives only TEMPORARY relief. |
| ALLERGIC RHINITIS | CLEAR discharge from BOTH nostrils, BLUISH hue, edematous mucosa, ± polyps. 80% end up on 2+ medicines. Antihistamine + leukotriene inhibitor at night + intranasal steroid; ipratropium; immunotherapy. Allergy creates the environment for infection but is not itself an -itis. |
| NASOPHARYNGEAL CARCINOMA | NECK MASS + DIPLOPIA + facial numbness + headache. EBV, HPV, smoking; endemic SOUTHERN CHINA; 2–3× more in males. ENT + endoscopic guided biopsy. |
| Term | What you need to know |
|---|---|
| THINK MALIGNANCY WHEN | No infectious origin · >2 WEEKS · >1.5 CM · FIRM, non-cystic, NON-TENDER, immobile · AGE >40 · tobacco + alcohol · ULCERATION. Under 40 most are inflammatory — except HODGKIN LYMPHOMA. |
| FOUR RULES OF THUMB | Present for YEARS = benign (lipoma, cyst) · RAPIDLY growing = infectious if other symptoms, LYMPHOMA if not · FLUCTUANT = cystic · PULSATILE or BRUIT = VASCULAR. |
| MIDLINE vs LATERAL | MIDLINE → THYROGLOSSAL DUCT CYST (moves with tongue protrusion), DERMOID CYST, THYROID. LATERAL → BRANCHIAL CLEFT CYST (anterior border of SCM), lymphadenopathy, cystic hygroma. |
| THE TWO CONGENITAL SIGNS | THYROGLOSSAL DUCT CYST moves VERTICALLY with SWALLOWING or TONGUE PROTRUSION — pathognomonic, and why the SISTRUNK operation takes the CENTER OF THE HYOID. LYMPHANGIOMA TRANSILLUMINATES. |
| BRANCHIAL CLEFT CYST | Infected after a URI. AVOID I&D — it makes definitive excision harder; needle aspiration if you must. Rule out HPV-associated SCC in an adult — it can present as a cystic neck mass. |
| HEMANGIOMA | Grows through year 1, involutes at 18–24 months, 90% self-resolve. Enlarges with CRYING. First line if you must treat: PROPRANOLOL. |
| THE EXPOSURE HISTORIES | CATS scratch → Bartonella henselae · CAT FECES / undercooked meat → toxoplasmosis · RABBITS, TICKS → tularemia (STREPTOMYCIN) · UNPASTEURIZED MILK → brucellosis (total-body nodes). |
| MYCOBACTERIA, THE TWO | ATYPICAL: children, UNILATERAL, BRAWNY reddish-brown skin, surgical excision. TB (SCROFULA): adults > children, DIFFUSE and BILATERAL, RIPE. |
| THE WORKUP | FNA BIOPSY = STANDARD OF CARE, minimum 4 PASSES; separates neoplasm from inflammation and carcinoma from lymphoma. FNA not EXCISIONAL — excision spills tumor. AVOID IODINE CONTRAST if thyroid cancer is suspected. |
| THYROID MASS | Immobile MIDLINE mass that ELEVATES WITH SWALLOWING. Low TSH + nodule → RADIONUCLIDE SCAN FIRST: HOT = no biopsy (low malignant risk); COLD or WARM = FNA. |
| THYROID CANCER, THE FOUR | PAPILLARY 75%, best prognosis, young women · FOLLICULAR 16%, spreads by BLOOD to BONE and LUNG, Hürthle variant worse · MEDULLARY 5%, C cells, CALCITONIN, screen family for MEN · ANAPLASTIC 1%, elderly, death 6–36 months, resistant to everything. |
| THYROID LYMPHOMA | Non-Hodgkin B cell, on a background of HASHIMOTO. FNA alone cannot separate it from Hashimoto — needs biopsy. Chemo + radiation, NOT surgery. |
| Term | What you need to know |
|---|---|
| THE SCRAPE TEST | WIPES OFF → CANDIDIASIS. Will NOT scrape off + WHITE → LEUKOPLAKIA (premalignant, 5–20% → SCC). Lacy white lines → LICHEN PLANUS (Wickham striae, 1–4% → SCC). Disappears on STRETCHING → LEUKOEDEMA, a normal variant. |
| ERYTHROPLAKIA | Like leukoplakia but RED. 90% are already dysplastic or carcinoma. Red beats white for danger, every time. |
| HAIRY LEUKOPLAKIA | LATERAL TONGUE, painless, waxes and wanes. EBV. Strongly associated with HIV — a common EARLY finding. |
| APHTHOUS vs HERPES | APHTHOUS → NON-KERATINIZED, freely moving mucosa (buccal, labial, non-attached gingiva); yellow-gray center, RED HALO. HERPES → keratinized surfaces, with a 24-hour BURNING PRODROME. Recurrent aphthous = SUTTON DISEASE. |
| SIALOLITHIASIS | Pain and swelling WITH EATING (salivary colic). 80–90% SUBMANDIBULAR — longer duct, alkaline mucin-rich saliva. RADIOPAQUE. CT most sensitive; digital subtraction sialography most accurate. |
| SUPPURATIVE SIALADENITIS | PAROTID, dehydrated post-op or elderly patient. S. aureus. PUS FROM THE DUCT. Rehydrate + antistaphylococcal antibiotics. No improvement in 48 h = presume ABSCESS. |
| VOCAL CORDS | NODULES: BILATERAL, symmetric, junction of anterior 1/3 and posterior 2/3, vocal abuse, SPEECH THERAPY first line. POLYPS: UNILATERAL, smokers, excise — may hide an occult SCC. PAPILLOMATOSIS: HPV 6 and 11, warty, AVOID TRACHEOSTOMY. |
| HOARSENESS CLOCK | ACUTE LARYNGITIS = commonest cause, persists ~1 week after the cold clears, NO antibiotics. >2 WEEKS = CHRONIC = not a diagnosis → SCOPE IT for cancer and polyps. |
| EPIGLOTTITIS | ENT EMERGENCY. Children 4 Ds: DROOLING, DYSPHAGIA, DYSPHONIA, DISTRESS + TRIPOD position. HIB. DO NOT examine the mouth or draw blood — it can complete the obstruction. THUMBPRINT SIGN not needed; laryngoscopy is the gold standard. STRIDOR IS LATE. |
| CENTOR | +1 each: NO COUGH, tonsillar EXUDATE, FEVER, tender anterior cervical NODES. Age 3–14 +1, 15–44 0, ≥45 −1. Negative rapid test → ALWAYS culture. Definitive = ASO. Treat: PENICILLIN VK 10 DAYS. |
| MONONUCLEOSIS | Fever + tonsillar pharyngitis + cervical adenopathy, ages 15–24, EBV 90%. MONOSPOT falsely negative in WEEK 1 (heterophile antibodies take a week to appear) — slide 84 prints “falsely positive”, which is wrong; Prof. Shah confirmed so in class on 9 September. NO CONTACT SPORTS ~1 MONTH — splenic rupture. GIVING PENICILLIN CAUSES A RASH — that rash is often how the diagnosis gets made. |
| RHEUMATIC FEVER | 2–3 WEEKS after untreated GABHS, peak ages 5–15. Cross-reactive antibodies attack heart muscle. This is why a sore throat gets an antibiotic at all. |
| PERITONSILLAR ABSCESS | TRIAD: TRISMUS (most reliable) + UVULAR DEVIATION + DYSPHONIA. “HOT POTATO” voice. Commonest deep head and neck infection. Airway first, then needle aspiration / I&D + amoxicillin-clavulanate or clindamycin. |
| RETROPHARYNGEAL ABSCESS | SURGICAL EMERGENCY. Child <5. WIDENED RETROPHARYNGEAL SPACE on lateral neck XR; CT is gold standard. MEDIASTINITIS carries 50% MORTALITY. |
| LUDWIG ANGINA | EMERGENCY. Floor of mouth + submental + sublingual + submandibular. TONGUE PUSHED UP AND BACK. Usually ODONTOGENIC — dental consult is part of the treatment. PCN + metronidazole; bilateral submental drainage if the airway is threatened. |
| DIPHTHERIA | TENACIOUS GRAY MEMBRANE over tonsils and pharynx, unimmunized child. ANTITOXIN from the CDC + PCN or erythromycin 14 days. MYOCARDITIS and cranial neuropathy are the killers. |
| TMJ DISORDERS | SECOND commonest musculoskeletal cause of pain and disability. Women of childbearing age. Three categories: MYOFASCIAL PAIN, INTERNAL DERANGEMENT, ARTHRITIS. The ear symptoms are the trap — tinnitus, fullness, dizziness with a normal ear exam. |
| ORAL CANCER | NON-HEALING ULCER. Tobacco + alcohol; 60–80% of OROPHARYNGEAL is HPV. SCC commonest. REFERRED OTALGIA and ill-fitting dentures in advanced disease. Oral cavity → SURGERY ALONE; oropharynx → SURGERY + RADIOTHERAPY. |
| SALIVARY NEOPLASM | The SMALLER the gland, the likelier MALIGNANT. Parotid 75–80% benign; minor glands only 35% benign. Commonest benign = PLEOMORPHIC ADENOMA; commonest malignant = MUCOEPIDERMOID CARCINOMA. PAIN or FACIAL NERVE involvement = bad prognosis. |