Fourth Edition ENT for Entrance Exams (EEE) Manisha Sinha Budhiraja MBBS (LHMC, Delhi) MS (ENT), Safdarjung Hospital Delhi University DNB (ENT) ([email protected]) Editor Sachin Budhiraja MBBS (UCMS, Delhi) MD (Medicine), Safdarjung Hospital Delhi University ([email protected]) CBS Publishers & Distributors Pvt Ltd New Delhi•Bengaluru• Chennai •Kochi •Kolkata • Mumbai Bhopal • Bhubaneswar • Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand • Dhaka (Bangladesh) Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The authors have tried their best in giving information available to them while preparing the material for this  book. 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My son Medhavi who gives meaning to my life. My husband Sachin for being the light and strength of my life. My parents Dr ARP Sinha and Mrs Kumud Sinha because of whom I am all that I am today. My parents in law Shri KL Budhiraja and Mrs Geeta Rani whose support has been there always. My Naani, Naana Ji, Maa and Lala Ji whose blessings will always be there and who will always remain in my sweet memories. and most importantly to all my dear students STAND UP, BE BOLD, BE STRONG Take the whole responsibility on your own shoulders, and know that you are the creator of your own destiny. All power is within you; you can do anything and everything. Believe in that. “I will drink the ocean” says the persevering soul, “at my will, mountains will crumble up”. Have that sort of energy, that sort of will, work hard and you will reach the goal. —Swami Vivekananda For queries, valuable feedback and suggestions please write to [email protected] [email protected] Also join us at www.facebook.com/groups/manishasachin/ www.facebook.com/groups/sachinmanisha/ Preface to the Fourth Edition We would like to thank all our students for the overwhelming response they have given to this book. It gives us the enthusiasm to improve this book further. The key additions in this 4th edition are: 1. It has been thoroughly updated from the most recent edition of all the standard ENT books especially Scott- Brown, 8th edition and Cummings, 6th edition. 2. References to the answers of all questions have been put from the most recent editions of standard ENT books. With the inflow of so many question banks available nowadays, all giving different answers, the students were in a dilemma of which one to follow giving the need for proper reference. 3. Annexures for quick revision have been added. 4. Points to ponder have been added at the end of each chapter to stimulate your mind which will also be of lots of help to quickly revise the chapter before the exams. 5. A large number of pictures has been added keeping in mind the trend of exams these days. 6. All the recent MCQs from various exams have been added. 7. The text has been made further easy and new flowcharts and tables have been added. Whether it be the prefinal year students or the students preparing for the entrance, the key to success is to understand every topic rather than cramming up the facts and answers to the questions. Understanding makes you remember the topics as well as solve the new MCQs asked from the same topics. It also gives you an edge over the others as even the questions that are repeated are not asked in the same manner again. The text contains everything possible you need to know in every topic in a very simple and easy to grasp language. With the surge of so many question banks, available students are in a fix what all to do! Our sincere advise is that the questions given after every chapter in this book are a must to do and are sufficient for all the exams. We have tried our best to make this book a one stop book for ENT which will save your precious time from referring many other ENT books. We hope that you will utilise all our efforts and love reading this book as much as we love writing it. Your suggestions for the further improvement of EEE are always welcome. All the best and God bless! Manisha Sinha Budhiraja Sachin Budhiraja This Page is Intentionally Left Blank Preface to the First Edition ENT (Otorhinolaryngology) is an extremely scoring subject in the MBBS curriculum. Being a teaching faculty of ENT for the past 10 years in the various institutes, I have been closely associated with the students preparing for postgraduate entrance exams. Almost invariably, after every lecture, students would approach me to know which book to read for ENT for the preparation of PG entrance exams, considering the short time available with many subjects to prepare. It was then, that I realised the need for a one stop book of ENT containing everything relevant to meet the requirement of students so that consulting many books for text as well as MCQs for ENT can be avoided. It was a difficult decision considering the time that would be required to accomplish it, which would be very difficult to take out from my busy schedule. But with tremendous perseverance and tremendous will and unstinting support of my husband Dr Sachin Budhiraja, this book has grown out of, my years’ long experience in teaching. Each chapter contains an enriched, concise text written in very simple, easy to understand language. I have tried to illustrate the book extensively with simple explanatory line diagrams along side. Several easy to grasp mnemonics have been given throughout the text to make learning easy. All the topics have been thoroughly scrutinized so as to ensure that no stone is left unturned. Once the text is read and the concepts are clear, the students will be able to answer not only the previously asked MCQs but also the questions likely to come in future exams. The text is followed by previously asked MCQs in various PG entrance exams across India along with their answers and explanations. In spite of keeping an eagle’s eye, some imperfections are bound to remain. Suggestions for improvement are most welcome. I hope this book proves to be useful to you and that you enjoy reading it as much as I enjoyed writing it. Manisha Sinha Budhiraja MS (ENT), DNB (ENT) [email protected] Editor’s Note The author, my wife, Dr Manisha Sinha Budhiraja has done a tremendous effort and has finally come up with a very good book on ENT. The book reflects the vast teaching experience and absolute command of the author over the ENT subject. She has herself made all the diagrams in Section I and many a diagrams of other sections as well, in the book. Besides a very good human being and a perfect mother, she is also the best teaching faculty and a great clinician and surgeon. Sometimes I wonder how many qualities a person can have simultaneously! I am sure that this book ENT for Entrance Exams (EEE) will be of great help to the students. I have thoroughly and repeatedly read this book as a student to point-out the areas which require more simplification and further elaboration for better understanding from a student’s perspective. I have thoroughly edited this book with the help of the author and placed tables and added mnemonics wherever required. I being a consultant in medicine, my expertise in this subject has helped to make the concepts clearer in areas where there is a cross link of ENT with Medicine, for example, vestibular system and stridor, etc. This is the first of its kind book in the ENT. All the chapters contain an up-to-date, concise text followed by all the possible MCQs available, of various PG entrance exams. Besides this book being easy to understand and easy to memorise, the other USP of this work is that all the other choices given in the MCQs have been commented upon which will help the students to solve further new questions. This book will definitely be of help to: 1. All the students preparing for various PG entrance exams. 2. All the undergraduate students, while giving viva voce and MBBS professional exams. 3. Postgraduate students for a quick revision and understanding of ENT in the beginning of their course. Purity, patience and perseverance are the three essentials to success, and above all, love! All the Best and God Bless! Sachin Budhiraja MD (Medicine) [email protected] Acknowledgements I owe this effort to many people without whose help this book would have remained just a dream. Words cannot describe the contribution of my husband Sachin, who besides editor is also the typist of this book and my son Medhavi, my parents, my sisters Rashmi and Swati & Anand for their constant support throughout and not letting me give up at any moment. I convey my sincere thanks to Dr Gobind Rai Garg (MD, Pharmacology) for giving his valuable advice whenever needed. I would also like to acknowledge the guidance of Prof. Dr V P Venkatachalam, Dr Gul Motwani, Dr NN Mathur, Dr S Mandal, Dr Neena Chaudhary, Dr Himani Lade, Dr S Majhi, Dr Deepak Gupta, Dr Tilak Raj, Dr Naresh Bharadwaj, Dr Niranjan, Dr Vikas all faculty in the department of ENT at Safdarjung Hospital, Delhi and Dr B Gupta (Head, Department of Medicine, Safdarjung Hospital) and Dr Kalpana Uppal (Head of the Department, ABGH, Moti Nagar, Delhi) and all my teachers at Lady Hardinge Medical College, Delhi. Although it is impossible to acknowledge the contribution of every one individually, I extend my heartfelt thanks to: • Akarsh, Arjun, Medhavi, Madhav, Raghav, Shivani, Anchit, Dr Kisley Dayal and other family members. • Dr ARP Sinha (Ex Principal, JNRM Govt. College, Port Blair) for the beautiful diagrams of nose and pharynx sections. • Ms Rashmi Sethi, a wonderful person, teacher and artist, for the beautiful diagrams of larynx section. • Mr Sunil, Lakhya Arts for the beautiful diagrams of pharynx. • My seniors Dr Friji MT, Dr Sanjay Aggarwal, Dr Alok, Dr Kadambari, Dr Sanjeev, Dr Nitin, Dr Dravid. • My colleagues Dr Bulbul Gupta, Dr Sameer Sethi, Dr Pooja Gambhir, Dr Siddharth, Dr Rajeev, Dr Lalming, Dr Natesh. • My juniors Dr Priya, Dr Payal, Dr Deepti, Dr Sameer, Dr Dipti, Dr Ashutosh, Dr Sarav Jeet Singh, Dr Arti, Dr Saurabh, Dr Radha, Dr Shveta, Dr Himanshu, Dr Amrita. • Dr Mukesh Kumar Joon (DM, Cardiologist), Dr Rashmi Joon (MD, Obs & Gynae), Dr Nitin Arora (MD, Paeds), Dr Harpreet Kaur Jassi (MD, Obs & Gynae), Dr Deb Datta Mazumdar (DM, Cardio), Dr Anish Singhal (MD, Medicine), Dr Ratnesh Kanwar (MD, Medicine), Dr Rajeev Singhal (MD, Medicine), Dr Pankaj Tikku (MD, Paeds), Dr Raman Allawadi (MD, Paeds), Dr S P Singh (MD, Skin), Dr Deepali and Anuj Gupta (MD, Paeds), Dr Dinesh Chauhan (MD, Biochemistery), Dr Neelam (MD, Pathology), Dr Swati (MD, Anaesthesia), Dr Ashish Goel (MS, Ortho), Dr Dinesh (MS, Anatomy), Dr Vipin Daga (MD, Radiology), Dr Vipin Nagpal (MS, Surgery), Dr Vineet (MS, Surgery), Dr Rajeev Dhawan (MS, ENT), Dr Deepak Arora (MS, ENT), Dr Vandana (MD, Paeds), Dr Parul and Mrs Shabana Yunus. • All my students specially Dr Prakriti, Dr Vasu, Dr Sabiya, Dr Afzal who have made the effort to point out the areas which needed further simplification and improvement. I also owe my sincere thanks to Mr Ganesh, Mrs Janki, Dr Suyog Sahu, Mr Neeraj Salunke, for their cooperation, help and support. I convey my sincere thanks to Mr SK Jain, CMD, CBS Publishers & Distributors Pvt. Ltd., Delhi, for his unstinted cooperation to bring out this 4th edition. Thanks to Mr YN Arjuna Senior Vice President Publishing, Editorial and Publicity, Mr SK Verma Vice President, Ms Ritu Chawla General Manager—Production, Mr Vikrant Sharma, Mr Ram Murti, Mr Kshirod Sahoo and Mr Neeraj Prasad for their fresh ideas, unparallel skills and enthusiasm to this venture. I am grateful to all of them for their help and support. With the blessings of Bhagwan Mahavir, Who are there on every book from CBS Publishers, I hope to reach my goal, i.e. to further the education and provide a foundation for the generations to follow. Manisha Sinha Budhiraja