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mebooksfree.com Diseases of Ear, Nose and Throat & Head and Neck Surgery Title mebooksfree.com Page left intentionally blank mebooksfree.com , , ,-- -F' I ' ' 1- ,..- ! I ~- I I : I -! SEVENTH EDITION Diseases of Ear, Nose and Throat & Head and Neck Surgery PL DHINGRA, MS, DLO, MNAMS, FIMSA Emeritus Consultant, lndraprastha Apollo Hospital, New Delhi Formerly Director, Professor & Head, Department of Otolaryngology and Head & Neck Surgery, Maulana Azad Medical College and Associated LNJP & GB Pant Hospitals, New Delhi SHRUTI DHINGRA, MS (MAMC), DNB, MNAMS Member, International Medical Sciences Academy; Fellow, Laryngology and Voice Disorders; Head of Department of Otolaryngology and Head & Neck Surgery, ESIC Medical College, Faridabad, Haryana Assisted by DEEKSHA DHINGRA, MD, PGDHA, MPH (UNIVERSITY SYDNEY) OF ELSEVIER Copyright ELSEVIER RELX India Pvt. Ltd. Registered Office: 818, 8th floor, Indraprakash Building, 21, Barakhamba Road, New Delhi-110001 Corporate Office: 14th Floor, Building No. 10B, DLF Cyber City, Phase II, Gurgaon-122002, Haryana, India Diseases of Ear, Nose and Throat & Head and Neck Surgery, 7th Edition, PL Dhingra, Shruti Dhingra and Deeksha Dhingra Copyright © 2018 by RELX India Pvt. Ltd. (formerly known as Reed Elsevier India Pvt. Ltd) Previous editions 2014, 2010, 2007, 2004, 1998, 1992. Reprinted 2016 (Twice), 2015, 2014, 2013, 2012, 2011 (Twice). All rights reserved. ISBN: 978-81-312-4884-3 e-Book ISBN: 978-81-312-4939-0 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. 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Manager—Content Strategist: Renu Rawat Content Strategist: Sheenam Aggarwal Manager—Education Solutions (Digital): Smruti Snigdha Content Project Manager: Shivani Pal Sr Production Executive: Ravinder Sharma Typeset by Thomson Digital Printed by mebooksfree.com Dedicated to all my students: past, present and future who are the inspiring force behind this work. I reproduce below the invocation from our great ancient scripture—the Kathopanishad which shows the relationship between the teacher and the taught. “O God, the almighty, bless us both (the teacher and the student) together, develop us both together, give us strength together. Let the knowledge acquired by us be bright and illuminant, and second to none. Let both of us live together with love, affection and harmony. O God, let there be physical, mental and spiritual peace.” mebooksfree.com Page left intentionally blank mebooksfree.com Preface It is a matter of pride and pleasure to bring out the silver imaging techniques, operative surgery, recent and newer jubilee edition of our book “Diseases of Ear, Nose and Throat modalities of treatment in a concise, lucid and student- & Head and Neck Surgery.” The book was first published friendly manner. The chapter on “Nuggets for Rapid in 1992 and has been well accepted and appreciated by Review” covers most of the questions that are often set the students and teachers all over the country as well as in post-graduate entrance and Diplomat of National Board in adjoining South Asian countries. During this period of (DNB) examinations. 25 years, six editions and several reprints were brought The present edition is revised, updated and expanded. out. This was the result of growth of the speciality, in- Several new clinical photographs, diagrams, tables and novations in technology and surgical techniques but be- flowcharts have been added to make the subject clear. A hind it was students’ burning desire to know the subject unique feature of this edition is white board lectures and and quest for knowledge. They freely interacted through videos ( ), depicting through animations, the surgical emails, letters and other types of social media to clarify, procedures. and send suggestions, omissions, commissions, and their It is hoped that the present edition would continue to interest in the subject to further add the topics of their serve the needs of MBBS students, residents and practi- need. We complied practically with all of them as far as tioners. The postgraduate students of the DLO, MS and possible. DNB will find it useful as a foundation book before taking Our basic aim in writing this book has been to build recourse to comprehensive volumes on the subject. concepts in disorders of ENT, superstructured with the The students of allied subjects, Audiology and Speech students’ earlier knowledge of anatomy and physiology Therapy, Physiotherapy and those studying alternative learnt in previous professionals. Since Otolaryngology, medicine (Ayurveda, Sidha, Unani and Homeopathy) will commonly called ENT, is a full-fledged subject in MBBS also find it useful to learn basics and concepts of ENT. examination and is so recognized in various universities The authors will gratefully accept any suggestions in India and Medical Council of India, we did not lose and comments from the learned teachers and students sight of the fact that students have to clear the exams too. at [email protected] or [email protected] or The book covers disorders of ENT, surgical instruments, [email protected]. PL Dhingra Shruti Dhingra vii mebooksfree.com Page left intentionally blank mebooksfree.com Acknowledgements We profusely thank all the Heads of Departments of ENT We also thank Dr Tarun Sahni, Head of Hyperbaric and the teaching faculty members of medical institutions Oxygen Therapy Unit, Indraprastha Apollo Hospital for who appreciated our efforts and sent words of encour- his contribution to Hyperbaric Oxygen Therapy chapter. agement. In particular we mention Prof (Dr) SA Jagdish We thank the entire team of RELX India Pvt. Ltd. (for- Kumar, Ex-DVC (aca), IMT University of Tanzania, who merly known as Reed Elsevier India Pvt. Ltd) for their sup- spent several hours in going through the book and true port and excellence in publication. We especially appreci- to his abiding interest in the speciality, sent valuable sug- ate cheerful and professional approach and hard work put gestions which we have tried to incorporate. in by Ms Shabina Nasim, Senior Manager; Ms Shivani Pal, We thank Dr GK Jadhav and Dr Sapna Manocha Verma, Content Project Manager; and Ms Sheenam Aggarwal, Senior Consultants, Department of Radiation Oncology, Content Strategist. Indraprastha Apollo Hospitals, Delhi, in contributing the chapter on Radiotherapy in Head and Neck Cancers. PL Dhingra Shruti Dhingra ix mebooksfree.com