ENT Articles
34 in-depth guides on ENT anatomy, physiology, and diagnostic technique — including a growing cluster on facial nerve anatomy, branches, and grading — written for residents, PG trainees, and surgeons.
Anatomy of the Ear — Outer, Middle, and Inner
The ear has three anatomical compartments — outer, middle, and inner — each with a distinct structure and role in the pathway from sound to signal. This article covers their components, boundaries, and clinical relevance.
Anatomy of the Nose
The anatomy of the external nose, nasal cavity, septum, turbinates, blood supply (Little's area / Kiesselbach's plexus), and nerve supply — the structural foundation for understanding epistaxis, rhinitis, obstruction, and nasal surgery.
Approach to Vertigo — A Clinical Framework
A systematic approach to the vertiginous patient — how to distinguish peripheral from central causes, use the history to narrow the differential, apply the HINTS examination, and know when vertigo is a neurological emergency.
Bell's Palsy — Presentation, Diagnosis, and Management
Bell's palsy — the idiopathic, lower motor neuron facial palsy that is the commonest cause of acute unilateral facial weakness. Its pathophysiology, the red flags that mean it is NOT Bell's palsy, the evidence-based role of early steroids, and what the recovery figures actually show.
Beyond Rinne and Weber — Other Tuning Fork Tests
Once Rinne and Weber are second nature, the tuning fork has more to offer: how to read the two tests together as one combined picture, the absolute bone conduction (Schwabach) test, and the Stenger test for suspected non-organic hearing loss.
BPPV — Diagnosis and the Epley Manoeuvre
Benign paroxysmal positional vertigo is the most common cause of vertigo worldwide. This guide covers the canalith mechanism, Dix-Hallpike test, nystagmus interpretation, and the Epley manoeuvre step by step.
Branches of the Facial Nerve
The facial nerve gives off branches at fixed, predictable points along its intratemporal and extratemporal course. Each intratemporal branch is a localisation marker — knowing which functions are intact above a palsy identifies exactly where the lesion sits. This article covers every branch, its clinical function, and its surgical significance.
Cholesteatoma — What It Is and Why It Matters
Cholesteatoma is not a tumour but is treated like one — it is expanding keratinizing squamous epithelium in the middle ear that destroys bone. This article covers its types, mechanism of destruction, presentation, and why early surgery is essential.
Chronic Rhinosinusitis
Chronic rhinosinusitis by the guideline definition: the ≥12-week symptom criteria, why objective evidence is mandatory, the polyp vs non-polyp split, the role of CT and the Lund–Mackay score, and the medical-then-surgical treatment ladder.
Complications of CSOM — Intracranial and Extracranial
A structured guide to the extracranial and intracranial complications of chronic suppurative otitis media — causes, clinical features, named syndromes, and the key exam findings.
Deviated Nasal Septum and Septoplasty
A deviated nasal septum is a displacement of the septal cartilage and bone away from the midline, obstructing nasal airflow. This article covers the septum's framework, why it deviates, how obstruction is assessed, and the principles of septoplasty — including the one rule that prevents a saddle-nose deformity.
Epistaxis — Anatomy, Assessment, and the Management Ladder
Epistaxis is bleeding from the nasal mucosa, ranging from a trivial anterior ooze to a haemodynamically significant posterior haemorrhage. This article covers the arterial anatomy of Little's area, anterior vs posterior bleeds, the causes worth not missing, and the stepwise management ladder from first aid through packing to arterial ligation and embolisation.
Examination of the Nose
A systematic approach to examining the nose — external inspection, assessing the nasal airway, anterior rhinoscopy with a Thudichum speculum, and the three-pass diagnostic nasal endoscopy — with the structures to inspect and the findings that matter at each step.
Facial Nerve — Anatomy and Course
The complete course of the facial nerve from its pontine nucleus to the facial musculature — segments, branches, surgical landmarks, and the clinical consequences of lesions at each level.
House-Brackmann Grading — Facial Nerve Function Scale
The House-Brackmann scale is the standard six-grade system for documenting facial nerve function. Published in 1985 and adopted by the AAO-HNS as the universal reporting standard, it grades from Grade I (normal) to Grade VI (complete paralysis). Understanding the exact distinguishing features of each grade — and which thresholds have direct management implications — is essential for anyone assessing facial palsy.
How to Examine the Ear — A Systematic Approach
A step-by-step guide to ear examination — auricle inspection, otoscopy technique, tympanic membrane interpretation by quadrant, and tuning fork tests — everything a student needs to examine a patient's ear competently.
How to Read a Pure Tone Audiogram
A complete guide to interpreting pure tone audiograms — the axes, symbols, normal range, air-bone gap, hearing loss patterns, and degree classification every clinician needs to know.
How to Read a Tympanogram
Tympanometry measures the compliance of the middle ear system as a function of ear canal pressure. This guide explains the axes, the Jerger types (A, As, Ad, B, C), acoustic reflexes, and how to correlate the findings with common diagnoses.
How We Hear — Impedance Matching and Cochlear Mechanics
The physiology of hearing explained from first principles — the impedance mismatch problem, how the middle ear solves it, the travelling wave, and how the cochlea converts mechanical energy into neural signals.
Landmarks of the Mesotympanum — A Surgical Orientation Guide
A structured walkthrough of the key anatomical landmarks inside the mesotympanum, their surgical significance, and the orientation frameworks that help surgeons navigate when disease has distorted normal anatomy.
Localising a Facial Nerve Palsy — Topognostic Testing
How the branches given off along the facial nerve's intratemporal course let you localise a lesion by which functions are lost — lacrimation (Schirmer), the stapedial reflex, and taste — with the level-by-level pattern that pinpoints where the nerve is injured.
Nasal Polyps — the Unilateral Red Flag
Nasal polyps are usually bilateral, inflammatory, and benign — but a unilateral polyp is a red flag until proven otherwise. Their pathology, the associations worth knowing (Samter's triad, allergic fungal disease, cystic fibrosis), and the steroids-then-surgery management.
Noise-Induced Hearing Loss — Mechanism, Pattern, and Prevention
Noise-induced hearing loss is the most preventable cause of sensorineural hearing loss. This article covers the hair cell damage mechanism, the characteristic 4 kHz audiometric notch, the difference between temporary and permanent threshold shift, and hearing conservation principles.
Otosclerosis — Presentation and Diagnosis
Otosclerosis is the most common cause of progressive conductive hearing loss in adults without ear disease. This article covers the pathology, clinical presentation, audiometric pattern including Carhart's notch, and the diagnostic workup.
Paranasal Sinuses — Anatomy, Drainage, and the Ostiomeatal Complex
The four pairs of paranasal sinuses are not independent cavities — they drain through a shared bottleneck on the lateral nasal wall called the ostiomeatal complex. Understanding this shared drainage anatomy explains why a single blocked structure can trigger rhinosinusitis across multiple sinuses simultaneously, and it is the anatomical foundation for endoscopic sinus surgery.
Presbycusis — Age-Related Hearing Loss
Presbycusis is the most common cause of hearing loss in adults globally. This article covers Schuknecht's four histological types, the audiometric pattern, the relationship between pure tone thresholds and speech discrimination, and the functional impact.
Ramsay Hunt Syndrome (Herpes Zoster Oticus)
Ramsay Hunt syndrome — facial palsy with a vesicular rash, caused by varicella-zoster reactivation in the geniculate ganglion. Why it is more severe than Bell's palsy, why the eighth nerve is dragged in, the zoster sine herpete trap, and why treatment timing decides the outcome.
Rinne and Weber Test — How to Perform and Interpret Results
A complete guide to tuning fork tests — technique, interpretation, the clinical patterns table, false negative Rinne, and the exam traps that trip students up every year.
The Facial Nerve and the Parotid Gland
How the facial nerve runs through the parotid and defines its surgical planes, the landmarks used to find the main trunk (with the measured distances), and why every parotidectomy is a facial-nerve operation — plus First Bite Syndrome.
The Facial Nerve in the Temporal Bone
The facial nerve travels 30–35 mm through a bony canal inside the temporal bone before emerging at the stylomastoid foramen. During mastoid surgery, the nerve cannot be seen until its canal is deliberately thinned — so surgeons navigate by landmark relationships rather than by direct visualisation. Understanding those landmarks, and knowing where the nerve is most vulnerable, is essential for anyone learning middle-ear or mastoid surgery.
Types of Hearing Loss — Conductive, Sensorineural, and Mixed
A clear breakdown of the three types of hearing loss — conductive, sensorineural, and mixed — covering their causes, audiogram patterns, clinical findings, and the key thresholds every student needs to know.
Upper vs Lower Motor Neuron Facial Palsy
The first fork in any facial palsy: central (upper motor neuron) or peripheral (lower motor neuron)? Why forehead movement answers it, the cortical-innervation reason the forehead is spared in a stroke, and the causes on each side of the line.
Vestibular Physiology — How the Balance System Works
The physiology of the vestibular system — how the semicircular canals detect rotation, how the otolith organs sense gravity and linear movement, and how the vestibulo-ocular and vestibulospinal reflexes maintain gaze and posture.
Wullstein Classification of Tympanoplasty — Types I to V
The Wullstein classification describes five types of tympanoplasty based on what ossicular structures remain intact. Understanding the types requires knowing the middle ear anatomy each reconstruction is designed to restore.