EN2.1-12 | Core ENT Clinical Skills — Glossary

International standard for universal newborn hearing screening: hearing loss identified by 1 month (OAE screening), diagnosed by 3 months (diagnostic ABR), and intervention (hearing aid fitting) commenced by 6 months of age.

A characteristic dip in hearing threshold at 4000 Hz on the PTA, with better thresholds at adjacent frequencies; the audiological signature of noise-induced hearing loss (NIHL).

The standard tuning fork frequency for clinical ENT testing (Rinne, Weber, ABC); chosen because 256 Hz produces confounding tactile sensation and 1024 Hz decays too quickly in air.

The occupational noise standard for maximum safe exposure: 85 decibels A-weighted for 8 hours per day (time-weighted average); above this level, hearing protection is mandatory and audiological surveillance required.

Compares patient's bone conduction duration to that of a normal-hearing examiner; reduced in SNHL (cochlear/nerve damage); normal in conductive hearing loss.

An objective electrophysiological test measuring brainstem auditory responses to sound; does not require behavioural response; used for diagnostic hearing assessment in neonates and uncooperative children after OAE referral.

A benign tumour of the Schwann cells of the vestibular portion of the eighth cranial nerve; arises in the internal auditory meatus; presents with unilateral SNHL, tinnitus, and later balance disturbance; diagnosed by MRI IAM with gadolinium.

The pathway of sound through the external auditory canal, tympanic membrane, and ossicular chain (malleus, incus, stapes) to the cochlea; the normal, amplified route for hearing.

The difference in dB between AC and BC thresholds at a given frequency; ABG >15 dB indicates a conductive component at that frequency.

Insertion of a haemostatic pack (Merocel foam or BIPP ribbon gauze) along the nasal floor to tamponade anterior epistaxis from Little's area; direction must be horizontal along the floor, not upward.

Examination of the anterior nasal cavity using a nasal speculum and light source; visualises the inferior turbinate, nasal septum, nasal floor, and (with head tilt) the middle meatus.

A nasal polyp arising from the maxillary antrum and extending through the choana into the nasopharynx; characteristically unilateral and single; more common in children and young adults — distinct from bilateral ethmoidal polyps of allergic origin.

Bruising over the mastoid process (behind the ear), indicating a basilar skull fracture involving the posterior cranial fossa; a clinical sign sometimes encountered in ENT examination of trauma patients.

Ring-shaped curette with a sharp cutting edge; used in adenoidectomy to scrape adenoid tissue from the posterior nasopharyngeal wall under Boyle-Davis gag retraction.

The most common cause of episodic vertigo in adults; caused by displaced otoconia in the posterior semicircular canal; characterised by brief (<1 minute) positional vertigo with positive Dix-Hallpike test and no hearing loss.

Through-cutting cup forceps used in FESS to remove ethmoidal air cells and polyps under endoscopic vision.

The pathway of sound via direct vibration of the skull bones to the cochlea, bypassing the outer and middle ear; tests cochlear function directly.

Spring-loaded mouth gag with a tongue depressor blade containing a central endotracheal tube channel; used in adenotonsillectomy; suspended from a Draffin bipod stand to maintain the operative field.

A lithium disc battery; if impacted in the nose or ear, causes rapid liquefactive necrosis (electrical and chemical) within 1–2 hours; requires immediate removal as an emergency.

A preparation used to soften and loosen ear wax for easier removal; common agents include olive oil, sodium bicarbonate drops, and 5% urea hydrogen peroxide; safe for use with TM perforation.

An abnormal accumulation of keratinising squamous epithelium in the middle ear or mastoid; associated with CSOM atticoantral (unsafe) type; causes bone erosion and intracranial complications.

A branch of the facial nerve that passes through the middle ear; may be stretched or cut during tympanoplasty or mastoidectomy; injury causes ipsilateral taste disturbance (metallic taste on the anterior two-thirds of the tongue).

A technique of directing both the examiner's line of sight and the light beam along the same axis, achieved with a head mirror or LED headlamp; essential for examining body cavities (ear, nose, throat) without shadows.

Hearing loss due to dysfunction in the external or middle ear (canal, tympanic membrane, or ossicular chain), preventing sound waves from being efficiently transmitted to the inner ear.

Flat elevator used in septoplasty to incise and elevate the mucoperichondrial flap from the septal cartilage.

Emergency surgical airway through the cricothyroid membrane (between thyroid and cricoid cartilages); indicated in 'cannot intubate, cannot oxygenate' situations; a temporary procedure requiring conversion to formal tracheostomy within 24–48 hours.

Using the right hand for the left nostril and the left hand for the right nostril when using a nasal spray; this angles the nozzle laterally toward the inferior turbinate rather than medially toward the septum.

Chronic suppurative otitis media with an attic or marginal perforation; associated with cholesteatoma; bone-erosive; risk of intracranial complications (mastoiditis, meningitis, brain abscess); requires mastoidectomy.

Chronic suppurative otitis media characterised by a central perforation in the pars tensa; involves the mucosal layer; no cholesteatoma; rarely causes intracranial complications.

Difficulty swallowing; may be oropharyngeal (difficulty initiating a swallow) or oesophageal (food sticking after initiation); progressive painless dysphagia in an older adult is a red flag for hypopharyngeal or oesophageal malignancy.

A herpesvirus associated with nasopharyngeal carcinoma (particularly undifferentiated type) and infectious mononucleosis; EBV serology (VCA IgA) is a screening marker for NPC in endemic areas.

Nosebleed; anterior epistaxis from Little's area (Kiesselbach's plexus) on the anterior nasal septum is commonest; posterior epistaxis from the sphenopalatine area is more severe and common in elderly/hypertensive patients.

A red velvety patch on the oral mucosa; approximately 50% contain invasive SCC on biopsy; higher malignant potential than leukoplakia; requires urgent biopsy.

Multiple bilateral nasal polyps arising from the ethmoidal mucosa; associated with allergy, aspirin sensitivity, and chronic rhinosinusitis; contrasted with the single unilateral antrochoanal polyp.

The most feared specific complication of mastoidectomy; the facial nerve runs in a bony canal through the mastoid and middle ear adjacent to the surgical field; permanent injury rate <1% in experienced hands; must be explicitly named in consent.

A Rinne NEGATIVE result in a dead (profoundly SNHL) ear, caused by BC vibration crossing the skull to stimulate the intact contralateral cochlea; the patient hears via the opposite ear, mimicking conductive loss on the tested side.

Aspiration of cells from a mass using a fine needle (23–25 gauge); the first-line tissue diagnosis investigation for neck and parotid masses; avoids tumour seeding and surgical risks of open biopsy.

Endoscopic nasal surgery to restore ventilation and drainage of the paranasal sinuses; requires pre-operative coronal CT PNS for planning and identification of surgical landmarks.

SCC of the true vocal cord; presents early with hoarseness; good prognosis due to sparse glottic lymphatics (late nodal spread); most common laryngeal cancer.

Failure of the repaired tympanic membrane to heal; rate approximately 5–20% for a first-operation tympanoplasty; higher in revision surgery and in patients who continue to smoke.

A concave reflective mirror worn on the forehead with a central hole; reflects an external light source to provide focused coaxial illumination for ENT examination; the traditional instrument before LED headlamps.

The hearing threshold expressed in decibels relative to the average threshold of normal-hearing young adults (0 dB HL = normal at each frequency); better hearing = lower dB HL value (plotted HIGHER on the audiogram).

Abdominal thrusts used to dislodge a foreign body causing airway obstruction in adults and children over 1 year; generate a sudden increase in intra-abdominal/intrathoracic pressure to expel the obstruction.

CT of the temporal bone using thin slices (0.5–1 mm) with bone window settings; the gold standard investigation for chronic ear disease, cholesteatoma, and pre-mastoidectomy surgical planning.

A rough, raspy, or breathy voice quality due to incomplete or irregular vocal cord vibration; duration >3 weeks in an adult is a red flag requiring laryngoscopy to exclude laryngeal malignancy.

Rigid rod-lens nasal endoscope available in 0°, 30°, 45°, and 70° viewing angles; used for nasal endoscopy, FESS, and foreign body removal from the airway.

SCC of the oropharynx (tonsil, tongue base) caused by HPV types 16/18; affects younger patients without conventional tobacco/alcohol risk factors; better prognosis than HPV-negative SCC.

Examination of the larynx using a warmed laryngeal mirror (No. 4 or No. 5) placed at the uvula, with coaxial headlamp illumination; allows visualisation of the epiglottis, arytenoids, false and true vocal cords, and subglottis.

A process (not merely a signature) by which a patient is provided with sufficient information about a proposed procedure — including its indication, benefits, risks, and alternatives — to make a voluntary and competent decision.

A thin, malleable ENT probe used to pass behind a nasal or aural foreign body and draw it forward (anteriorly); the correct direction is always anterior, never posterior.

A benign but locally aggressive, highly vascular tumour arising from the nasopharynx; affects adolescent males; presents with unilateral nasal obstruction and recurrent severe epistaxis; biopsy is absolutely contraindicated due to risk of catastrophic haemorrhage.

Long-bladed nasal speculum used in septoplasty to retract the nasal alae; distinct from the shorter Thudichum speculum used for bedside anterior rhinoscopy.

The paper-thin medial orbital wall forming the lateral boundary of the ethmoid sinus; at risk of breach during FESS, leading to orbital injury (orbital haematoma, diplopia, visual loss).

The crunching sensation felt when the larynx is displaced laterally against the anterior surface of the cervical vertebrae; normally present; absence indicates obliteration of the post-laryngeal space by a mass (postcricoid/hypopharyngeal carcinoma) — Muller's (Chevalier Jackson's) sign.

A white patch on the oral mucosa that cannot be rubbed off; histologically may represent hyperkeratosis, dysplasia (mild/moderate/severe), or carcinoma in situ; overall malignant transformation rate ~5%; requires biopsy.

The bright triangular reflection of the otoscope light on the normal TM, normally located in the antero-inferior quadrant; its absence or displacement suggests TM retraction, bulging, or abnormality.

The anterior part of the nasal septum where five vessels anastomose (anterior and posterior ethmoidal, greater palatine, superior labial, and sphenopalatine arteries); the most common site of epistaxis.

The application of a noise signal to the non-test ear during PTA to prevent the better ear from detecting tones presented to the worse ear (contralateral crossover); required when testing the worse ear if the ABG is large.

A disorder of the inner ear due to endolymphatic hydrops, presenting with the classic triad: episodic vertigo (minutes to hours), fluctuating low-frequency sensorineural hearing loss, and tinnitus; aural fullness is a fourth symptom.

The space lateral to the middle turbinate; receives drainage from the frontal, maxillary, and anterior ethmoid sinuses via the ostiomeatal complex; mucopus here indicates rhinosinusitis.

Patient position for instilling nasal drops to the middle meatus: kneel over the edge of a bed with the head lowered so the nose points toward the floor; gravity carries drops to the middle meatus and ostiomeatal complex.

MRI with gadolinium contrast of the internal auditory canal; the investigation of choice for unilateral SNHL without an obvious cause, to exclude acoustic neuroma or other retrocochlear pathology.

Absence of laryngeal crepitus on lateral displacement of the larynx; classically indicates postcricoid or hypopharyngeal carcinoma filling the space between the larynx and the vertebral column.

Small, curved blade for making the myringotomy incision in the antero-inferior quadrant of the TM; the antero-inferior quadrant is the safe site, away from the ossicles and jugular bulb.

SCC/undifferentiated carcinoma of the nasopharynx; associated with EBV; endemic in South/Southeast Asia; classic triad: bilateral cervical lymphadenopathy + nasal obstruction/epistaxis + serous otitis media (Eustachian tube obstruction).

Irreversible bilateral sensorineural hearing loss caused by chronic exposure to high-intensity noise; characterised by a notch at 4000 Hz on PTA; primary prevention by noise control and hearing protection.

National Programme for Prevention and Control of Deafness; launched in 2006 by the Ministry of Health and Family Welfare, India; addresses prevention, early detection, and rehabilitation of hearing loss across all age groups.

National Tobacco Control Programme; launched 2007, MoHFW India; aims to reduce tobacco use through awareness, cessation support, and legislation; relevant to ENT through prevention of oral cavity, laryngeal, and hypopharyngeal cancers.

Low-level sounds produced by outer hair cells of the cochlea in response to acoustic stimulation; measured non-invasively to screen cochlear function; absent if outer hair cells are damaged; primary tool for universal newborn hearing screening (UNHS).

The enhancement of low-frequency bone conduction perceived in a blocked ear, explaining why Weber lateralises to the affected ear in conductive hearing loss — the blocked ear has less environmental noise competing with the BC signal.

Painful swallowing; suggests active mucosal inflammation, ulceration, or infection in the oropharynx or oesophagus.

A premalignant condition caused by betel nut (areca nut) chewing; characterised by progressive submucosal fibrosis, pale blanched oral mucosa, and trismus; malignant transformation rate ~7–12%.

The common drainage pathway for the frontal, maxillary, and anterior ethmoid sinuses into the middle meatus; obstruction at this point causes rhinosinusitis; best assessed on coronal CT PNS.

Ear pain; classified as primary (arising from ear pathology) or referred (from distant structures sharing sensory innervation with the ear — teeth, TMJ, tonsils, larynx, cervical spine).

Discharge from the ear canal; characterised by consistency (serous, mucoid, mucopurulent), smell (foul smell suggests cholesteatoma), and duration.

Damage to the cochlea or vestibular system caused by topical ear drop medications; aminoglycoside drops (neomycin, gentamicin) are ototoxic when they contact the round window membrane through a TM perforation.

Combined examination of the oral cavity, oropharynx, hypopharynx, and larynx under general anaesthesia with biopsies of any suspicious sites; performed when a neck node is positive for SCC to identify the primary tumour.

Guidelines for tonsillectomy in recurrent tonsillitis: ≥7 episodes in 1 year, ≥5 per year for 2 years, or ≥3 per year for 3 years, each documented with temperature, adenopathy, exudate, or positive throat culture (as cited in Scott-Brown's).

The small, loose upper portion of the tympanic membrane above the anterior and posterior malleolar folds; the site of attic perforations in atticoantral CSOM (unsafe type) — involvement here raises the suspicion of cholesteatoma.

The taut, lower three-quarters of the tympanic membrane, supported peripherally by a fibrous ring (annulus); the site of central perforations in tubotympanic CSOM (safe type).

Abscess in the peritonsillar space between the tonsil capsule and superior pharyngeal constrictor; presents with unilateral tonsillar displacement, bulging soft palate, and uvular deviation to the contralateral side; requires drainage and antibiotics.

Otoscopy using an airtight speculum with a rubber bulb; allows positive and negative pressure to be applied to the EAC, assessing TM mobility; reduced mobility = middle ear effusion; unrestricted mobility = TM perforation.

A technique for nasal FB removal: the parent blows into the child's open mouth while occluding the unaffected nostril, generating positive nasopharyngeal pressure to expel the FB anteriorly; effective for cooperative children.

The sensation of mucus trickling from the posterior nasal cavity down the throat; causes chronic throat-clearing, cough, and intermittent hoarseness; associated with chronic sinusitis and allergic rhinitis.

Nosebleed originating from the sphenopalatine or Woodruff's plexus in the posterior nasal cavity; more severe, common in hypertensives/elderly; requires posterior packing (Foley balloon) when anterior packing fails.

Age-related bilateral symmetrical sensorineural hearing loss with a high-frequency sloping PTA pattern; caused by gradual loss of basal cochlear hair cells.

Bleeding occurring within 24 hours of adenotonsillectomy; usually due to inadequate intraoperative haemostasis; requires return to theatre.

A graphical representation of hearing thresholds at standard frequencies (250–8000 Hz), plotted as hearing level (dB HL) vs frequency; the gold standard for quantifying and classifying hearing loss.

The average of AC thresholds at 500, 1000, and 2000 Hz; used to classify hearing loss severity and for hearing aid fitting.

Branch of the vagus nerve that supplies intrinsic laryngeal muscles; the left RLN has a longer intrathoracic course looping around the aortic arch, making it more vulnerable to mediastinal, thoracic, and aortic pathology.

Ear pain originating from structures other than the ear, transmitted via shared cranial nerve branches (CN V, VII, IX, X) or cervical nerves (C2/C3); always suspect when otoscopy is normal.

Rebound nasal congestion caused by prolonged use (>3–5 days) of topical decongestant nasal sprays (oxymetazoline, xylometazoline); the nasal mucosa becomes dependent on the vasoconstrictor effect and rebounds when the drug is withdrawn.

Visualisation and instrument access to the larynx, trachea, and main bronchi using a rigid metal tube and Hopkins rod; the procedure of choice for retrieving inhaled foreign bodies below the vocal cords.

BC is heard after AC stops (or BC louder); indicates bone conduction exceeds air conduction — result in conductive hearing loss.

AC is heard after BC stops (or AC louder); indicates air conduction exceeds bone conduction — result in normal hearing AND in sensorineural hearing loss.

A tuning fork test comparing AC to BC in the same ear; POSITIVE (AC > BC) = normal or SNHL; NEGATIVE (BC > AC) = conductive loss.

Right-angled sharp elevator used in tympanoplasty to elevate the tympanomeatal flap (TM and EAC skin) to enter the middle ear.

A membrane separating the middle ear from the scala tympani of the cochlea; aminoglycosides that enter the middle ear through a TM perforation contact this membrane and cause cochleotoxicity.

A lateral oblique X-ray projection of the mastoid process; historically used for mastoid disease but now largely superseded by CT temporal bone due to poor sensitivity for cholesteatoma.

Bleeding occurring on days 5–10 post-operatively, when the slough over the tonsillar fossa separates; the most common and clinically significant form of post-tonsillectomy bleeding; can be life-threatening.

Hearing loss due to pathology in the cochlea (sensory hair cells) or the eighth cranial nerve, leading to impaired neural signal generation or transmission.

Defined as a loss of ≥30 dB across three consecutive frequencies occurring over 72 hours or less; a medical emergency requiring same-day ENT referral and systemic corticosteroids.

SCC of the epiglottis, aryepiglottic folds, or false cords; presents late (hoarseness only when vocal cords involved); early cervical nodal metastases due to rich supraglottic lymphatics; poorer prognosis than glottic.

A short-bladed, spring-loaded nasal speculum used for bedside anterior rhinoscopy; inserted approximately 1 cm horizontally into the nares, allowing the spring to gently dilate the vestibule and visualise the inferior turbinate and septum.

A perception of sound (ringing, buzzing, hissing) in the absence of an external acoustic stimulus; pulsatile tinnitus (synchronous with heartbeat) suggests a vascular aetiology.

Classification of tonsil size: Grade I = within tonsillar pillars; Grade II = reaching the pillars; Grade III = touching the uvula; Grade IV = meeting in the midline (kissing tonsils). Used to quantify degree of tonsillar hypertrophy.

Softening and weakening of the tracheal wall, occurring at the site of tracheostomy tube cuff pressure; a long-term complication of tracheostomy; may cause airway collapse after decannulation.

Curved flanged tube inserted into the trachea through a surgical opening between the 2nd and 3rd tracheal rings; consists of outer cannula, inner cannula (for cleaning), and cuff (for airway sealing).

Repeated compression of the tragus inward and outward after ear drop instillation; helps propel drops along the EAC and through a TM perforation into the middle ear.

Reduced mouth opening (normal >3.5 cm); caused by OSMF (fibrosis of pterygomandibular raphe), peritonsillar abscess (pterygoid muscle spasm), or malignant infiltration of the pterygoid muscles.

Hinged instrument with two blunt expanding arms; used during tracheostomy to dilate the tracheal incision between the 2nd and 3rd tracheal rings before inserting the tracheostomy tube.

A graph of TM compliance (mL or mmho) versus ear canal pressure (daPa), produced by impedance audiometry; reflects middle ear pressure and compliance.

Normal tympanogram: peaked curve near 0 daPa with compliance 0.3–1.6 mL; indicates normal middle ear pressure and normal TM compliance.

A-deep: normal peak position but very high peak height (compliance >1.6 mL); indicates a hypermobile middle ear — classically ossicular chain discontinuity.

A-shallow: normal peak position but reduced peak height (compliance <0.3 mL); indicates a stiff middle ear — classically otosclerosis.

Flat tympanogram with no identifiable peak; indicates middle ear effusion (normal canal volume) or TM perforation (large canal volume).

Tympanogram with peak at significantly negative pressure (< −150 daPa); indicates Eustachian tube dysfunction and negative middle ear pressure.

Objective assessment of TM compliance and middle ear pressure by measuring TM movement under varying air canal pressures; classified by Jerger type (A, B, C, As, Ad).

Calcification and hyalinisation within the layers of the tympanic membrane, appearing as chalky white patches; a sequela of repeated otitis media; may cause mild conductive hearing loss.

The central, most concave point of the tympanic membrane, at the tip of the handle of malleus; the reference landmark for the centre of the TM diagram.

An illusion of rotational movement of oneself or the environment, indicating pathology in the peripheral (labyrinthine) or central (brainstem/cerebellar) vestibular system.

Longer-bladed nasal speculum used for formal anterior rhinoscopy and epistaxis management; not self-retaining, requires an assistant; contrasted with the shorter Thudichum speculum for bedside examination.

Nasal bone reduction forceps with one blade inside the nose and one external; used for closed reduction of fractured nasal bones.

A plain X-ray projection of the paranasal sinuses that best shows the maxillary and frontal sinuses; used for screening in acute sinusitis at primary care level.

A tuning fork test placing the fork on the midline skull; tests lateralisation of bone conduction; lateralises to the AFFECTED ear in conductive loss; lateralises to the BETTER ear in SNHL.

An annual WHO awareness event observed on 3 March; aims to raise awareness about preventable hearing loss and promote ear care; medical students are expected to participate in community screening and education activities.