1. E N T IN DAILY PRACTICE. Dr. Pranav Bhagwat, M.D.(ayu.) Reader, dept. Of Shalakya, G.A.M.R.C.; Shiroda, Goa.

2. NOSE

3. Nasasrava. Nasanaha. Kshavathu. Karnasrava, Tinnitus. Badhirya. Dysphagia. contents

4. Nasasrava. • duration - acute -pratishyaya, vaatakaphaj jwara, Jeerna- dushta pratishyaya, nasasthigata pra.; kshawathu;

5. Type • Watery-allergic- paroxysmal sneezes, periodic nature, perennial or seasonal, Irritation in nose (jantunaam iva sarpanam), bluish nasal mucosa. eosin. in discharge. Eosino in blood.

6. watery • Pratishyaya- goes thru stages, no paroxysms, no h/o exposure to allergens. Csf rhinorrhoea-

7. treatment • Allergic- 1) nidan parivarjanam 2) avoid fan/ breeze. 3) cleaning of bed materials. 4) haridra khanda.

8. treatment • Rasasindura, vacha, pimpali, vyoshadi vati, sanjivani vati, bhallataka, • Nasya- shodhana-kshavathuhara, shamana-shadbindu, Snehavirechanam.

9. treatment • Pratishyaya- vaataja- • Pachana-shodhana- chitraka haritaki. • Amla rasa, ardraka-guda, • Vyadhi pratyaneeka- panchalavana, vidari, shatavari, tri.ki., • Dashamula taila, • Basti,

10. Vaso motor rhinitis = vataj pratishyaya.

11. Watery discharge • Polyps- nasarsha. • Two types – ant.(allergic) post.(sec to max. sinusitis) • kruchhrat shwasanam, peenasa, pratat kshawa, sanunasika-vaditwam.

12. polyps • Pale, painless ,pearly white, polypoidal, • chitrakadi taila, • Treatment of cause. • Udavartahara yogas.

13. watery • Nasasrava- more at night, pichchila, continuous , • Kaphapradhana • Teekshna shirovirechana.

14. Ghana srava • Pratishyaya- pakwavastha shirovirechanam, dhumapana, vyoshadi vati, tri ki. (If pitanubandha or pittaprakriti, sut instead of tri ki.)

15. pratishyaya • Vaatapradhana tridosha. • Rasadhatu, mamsa, shukra. • Malasanchaya. • Jalagnidushti.

16. Ghana srava • Nasasthigata pratishyaya Frontal , ethmoidal or maxillary tenderness. No facial swelling. May be fever, headache, malaise. Paranasal x ray.

17. treatment • Nasya • Dhumapana. • Correct blowing of nose.

19. Foul smelling discharge • Old people- malignancy (blood stained) • Children – old neglected F B (blood stained) • Nasashosha . • Sinusitis 2” to dental infection.

20. Blood stained discharge • Malignancy. • Children. • Diphtheria. • Rhinosporidiosis.

22. Nasal obstruction • Unilateral/ bil. • Tempo/permanent. • Intermittent or persistent.

23. Physiological • Cyclic. • Postural • Reflex to cold.

24. pathological • Choanal atresia- persistent unilateral nasal discharge with blockage in an infant. • If bilateral- cyclic asphyxia. • Suckling difficult.

25. pathological • Nasanaha- • Kaphavrit udaan vayu. • r/o udavarta. • Snehapanam. • Tikshna nasya f.u. by balataila nasya.

26. DNS • Most cases are asymptomatic. • After puberty. • Opposite hypertrophic turbinates, • Rec. cold,rec. sinusitis,rec. middle ear inf.

27. adenoids • Enlarged nasopharyngeal tonsil. • Rec. cold, rec obstruction, immunity lowered. • Lateral x ray of nasopharynx.

28. adenoids • Treatment – same lines of pratishyaya. • Nasya, dhumapana, • Balavardhana- suvarna. • pippali, kantakari, si.chu. Talisadi, rasasindura. Gandamala kandana rasa. Yashada.

29. Hypertrophic turbinates • Can be decongested. ( d d polyps) • More at night. • Probing reveals soft nature and deep bones.( d d DNS).

30. Atrophic rhinitis • Progressive atrophy of mucous membrane. White mucosa, sup. Turbinate. • Ozaena, merciful anosmia,

31. treatment • Yashti ghrita nasya • Balataila pana.

32. Lateral wall of nose

33. Ear.

36. Ear diseases • Karnasrava, • Badhirya. • Tinnitus.

37. karnasrava • HETU : if the pt had- • Shiro abhighata i.e. trauma causes raktasrava • Jalanimajjana i.e. swimming causes Jalavat srava or puyasrava. • Prapaka of vidradhi i.e. rupture of furuncle causes puyasrava

38. AGE • If the pt is a child-A.S.O.M. IS COMMON As The Eustachian tube is shorter, wider more horizontal and opens at a lower level • 15-20yrs-Keratosis obturans • Middle age-Glomus jugulare

39. Past history • H/O water entering into ear for e.g. swimming, head bath, damp climate or rainy season then- ---- Acute otitis ext; otomycosis, A.S.O.M. • Trauma to ear e.g. traumatic perforation of eardrum, traumatic ulcer-Aural polyp, scratching, slapping, cleaning, head injury, foreign body or valsalva procedure done forcefully can cause --- A.O.E. otomycosis or A.S.O.M. • H/O Recurrent URTI---- A.S.O.M.

40. H/O Influenza---- Viral O.E. • H/O Recurrent sinusitis & bronchiectasis----- Keratosis obturans • H/O Diabetes----- A.O.E. • Recurrent furuncles----- A.O.E., unhealed furuncle or Aural polyp

41. H/O recurrent diseases of Mid. Ear----- C.S.O.M. A.S.O.M. or Acute mastoiditis • Prolonged use of antibiotics----- Otomycosis • Presence of skin infections----- Otomycosis • Sudden or insidious onset with unilat. Deafness & pulsatile tinnitus----- Glomus jugulare • Operative history- e.g. H/O Adenoidectomy or post nasal packing then---- A.S.O.M.

42. character • The ear discharge may be profuse or scanty, continuous or intermittent. • Serous: may be due to eczematous otitis externa • Mucoid or mucopurulent: containing mucin is produced by the mucous of the middle ear in patients with perforated ear drum

43. Purulent: may come from the lesions of ext. ear, middle ear or an abcess of the parotid gland or temporomandibular jnt • Foul smelling: often due to cholesteatoma • Sanguineous: due to polyp, granulations, trauma or tumor • Watery: C.S.F. otorrhoea • Brownish/Blackish: Otomycosis • Asso. with severe pain & deafness: Keratosis obturans • Blood stained: Viral otitis ext., Glomus jugulare • Bleeding from ear: Traumatic perforation of ear drum, Aural polyp

44. Bleeding on touch: Cancerous growths • Intermittent or pulsatile: C.S.O.M.(Benign) • Continuous: C.S.O.M.(Dangerous) • Copious: C.S.O.M.(Benign) • Scanty: C.S.O.M.(Dangerous)

45. Associated symptoms • PAIN- A.O.E., trauma & Wax- pain is the presenting symptom • Severe pain- Keratosis obturans, Viral O.E., A.S.O.M. • Boring type of pain in mastoid area-A. Mastoiditis.

46. DEAFNESS • Conductive deafness- Viral O.E. • Unilateral deafness- Glomus jugulare • Also in A.O.E., Keratosis obturans, C.S.O.M. & Aural polyp ITCHING • A.O.E., Wax & Aural polyp • Prominent in Otomycosis

47. TINNITUS • A.O.E., Wax, C.S.O.M. • Pulsatile tinnitus- Glomus jugulare GIDDINESS • C.S.O.M., Wax FEVER & MALAISE • A.S.O.M. & are aggravated in acute mastoiditis BLEEDING • C.S.O.M.

48. SIGNS • SWELLING- Gen. in A.O.E.-local. In A.O.E., C.S.O.M., Keratosis Obturans • TENDERNESS-C.S.O.M., K. Obturans & on mastoid antrum in acute mastoiditis • COTTON LIKE/WET NEWSPAPER LIKE MASS-Otomycosis

49. HAEMORRHAGIC VESICLES- Viral O.E. • RISING SUN SIGN- Glomus jugulare • BROWNISH/BLACKISH MASS IN EAR- Wax • PERFORATED EARDRUM- A.S.O.M., C.S.O.M.(attic/ marginal) & irregular in traumatic type

50. PEDUNCULATED MASS IN EXT. AUDI. CANAL- polyp. • PROBING- Profuse bleeding on probing IN Glomus jugulare & malignancy.