EN3.1-3 | ENT Diagnostic Procedures — Glossary

A unilateral, single smooth polyp arising from the maxillary antrum, passing through the accessory ostium into the middle meatus, and extending posteriorly through the choana into the nasopharynx; most common in children and young adults; requires surgical excision of both nasal and antral components.

The 'unsafe' type of chronic suppurative otitis media; characterised by an attic or posterior marginal perforation, presence of cholesteatoma, bone erosion, and a significant risk of intracranial complications (meningitis, cerebral abscess, lateral sinus thrombosis, facial nerve palsy); requires mastoidectomy.

The careful removal of wax, discharge, crusts, granulations, or debris from the external auditory canal and middle ear under direct oto-microscopic vision using suction (Zoellner), forceps (crocodile/Hartmann), and probes; preferred over blind syringing in chronic ear disease.

The largest and most anterior of the anterior ethmoidal air cells, forming the posterior wall of the hiatus semilunaris in the middle meatus; a key landmark in functional endoscopic sinus surgery.

An abnormal accumulation of desquamating keratinising stratified squamous epithelium in the middle ear or mastoid, appearing as white pearly debris; behaves destructively by enzymatic bone erosion, threatening the ossicular chain, facial nerve, labyrinth, tegmen, and sigmoid sinus.

An optical design in the operating microscope where the light beam and the line of observation share the same axis; eliminates shadows in the operative field, allowing even illumination of anterior recesses and deep canal structures that would be in shadow with an angled light source.

Immobility of a vocal cord due to invasion of the cricoarytenoid joint, paraglottic space, or intrinsic laryngeal muscles by carcinoma; a key laryngoscopic finding that upstages laryngeal carcinoma (from T1 mobile to T3 fixed) and changes treatment significantly.

Direct inspection of the nasal cavity and nasopharynx using a rigid Hopkins rod lens telescope (0°/30°/70°, 4 mm diameter) under topical anaesthesia; the gold standard for assessment of chronic rhinosinusitis, nasal polyps, and nasopharyngeal pathology.

Bilateral, multiple, grey semi-translucent outgrowths of the ethmoidal mucosa arising from the middle meatus; associated with allergy, CRS, and aspirin-sensitive asthma; treated with topical steroids and FESS if refractory.

A thin (3–4 mm) flexible fibre-optic or chip-tip endoscope passed through the nasal cavity to inspect the nasopharynx, pharynx, and larynx in an awake seated patient; the standard outpatient diagnostic instrument for laryngeal assessment including cord mobility during phonation.

The lateral pharyngeal recess posterior to the torus tubarius in the nasopharynx; the most common site of origin of nasopharyngeal carcinoma; inspected during Pass 1 of DNE.

Endoscopic surgical technique for chronic rhinosinusitis and nasal polyps that restores mucociliary drainage by widening the natural sinus ostia and removing obstructing tissue at the ostiomeatal complex, guided by pre-operative CT and intra-operative DNE.

Squamous cell carcinoma of the true vocal cord; presents early with hoarseness due to the vocal cord's role in phonation; poor lymphatic supply of the cord means late nodal spread; good prognosis when caught at T1 (mobile cord); treated by radiotherapy or CO2 laser resection.

The crescentic gap between the uncinate process (anteriorly) and the bulla ethmoidalis (posteriorly) in the middle meatus; the main drainage channel for the maxillary, anterior ethmoidal, and frontal sinuses.

An endoscope optical design by Harold Hopkins using long glass rods separated by short air spaces (reversing the conventional lens-air arrangement); transmits approximately four times more light than conventional telescopes, providing a brighter, sharper image.

An extremely vascular benign tumour of the nasopharynx occurring in adolescent males; presents with recurrent severe epistaxis and nasal obstruction; pulsatile vascular nasopharyngeal mass on endoscopy; DO NOT BIOPSY — diagnose with contrast CT/MRI; treat with embolisation and surgical excision.

Direct visualisation of the larynx using a flexible nasopharyngolaryngoscope (outpatient, awake), a rigid 70° Hopkins rod telescope (transoral, awake), or a rigid direct laryngoscope (under GA in theatre); the definitive investigation for hoarseness, suspected cord palsy, or laryngeal malignancy.

The triangular reflection of the examining light seen in the antero-inferior quadrant of the tympanic membrane — at approximately the 5 o'clock position on the right TM and 7 o'clock on the left; absent or distorted in retraction, effusion, or perforation.

Direct rigid laryngoscopy under general anaesthesia with the patient supine and neck extended, the laryngoscope held in suspension, and an operating microscope providing magnification for biopsy, laser treatment, or microsurgical resection of vocal cord lesions.

White chalky calcification in the fibrous layer of the tympanic membrane, appearing as discrete plaques; usually post-inflammatory or post-grommet; does not always impair hearing unless it restricts TM mobility.

The functional drainage unit of the anterior sinuses: comprises the maxillary sinus ostium, infundibulum, hiatus semilunaris, bulla ethmoidalis, and middle meatus; blockage of the OMC causes recurrent maxillary and frontal sinusitis.

Accumulation of non-infected mucoid fluid in the middle ear behind an intact tympanic membrane; oto-microscopically seen as a dull amber/grey TM with absent light reflex and sometimes a visible fluid level or air bubbles; common cause of conductive hearing loss in children.

Examination of the ear using a binocular operating microscope providing coaxial illumination and magnification from 6× to 40×; the gold standard for diagnosing chronic ear disease and performing aural toilet and middle-ear procedures.

The upper one-fifth of the tympanic membrane above the anterior and posterior malleolar folds; lacks the fibrous intermediate layer, making it lax and prone to retraction toward the attic — the site where atticoantral CSOM and cholesteatoma originate.

The lower four-fifths of the tympanic membrane anchored by the fibrocartilaginous tympanic annulus; composed of three layers (outer squamous epithelium, fibrous middle layer, inner mucosal layer); the site of central perforations in tubotympanic CSOM.

The motor nerve to all intrinsic laryngeal muscles except the cricothyroid; the left RLN loops under the aortic arch before ascending to the larynx (longer intrathoracic course), making it vulnerable to thoracic pathology; palsy produces unilateral vocal cord paralysis.

Ear pain referred from a laryngeal or pharyngeal lesion via Arnold's nerve (the auricular branch of the vagus); a classic symptom of supraglottic and hypopharyngeal carcinoma — unexplained unilateral otalgia with a normal ear on otoscopy mandates laryngopharyngoscopy to exclude head and neck malignancy.

Bilateral, diffuse, gelatinous swelling of the superficial lamina propria (Reinke's space) of both true vocal cords; strongly associated with chronic cigarette smoking; produces hoarse, rough, pitched-down voice; treatment: smoking cessation (mandatory first step), then surgical aspiration if needed.

The potential space between the squamous epithelium and the vocal ligament of the true vocal cord; its accumulation of gelatinous fluid in response to chronic smoke irritation produces Reinke's oedema — bilateral diffuse pale translucent cord swelling with a rough, lowered-pitch voice.

A localised inward indrawing of a segment of the tympanic membrane (most often postero-superior quadrant or pars flaccida) due to sustained negative middle-ear pressure; a precursor to cholesteatoma if it becomes a self-cleaning keratin-filled sac.

The space between the two true vocal cords; opens to a diamond shape on maximal abduction (inspiration) and closes completely on adduction (phonation and cough); asymmetry or incomplete closure on laryngoscopy indicates cord palsy or a mass on the free cord edge.

The association of aspirin-exacerbated respiratory disease (AERD), nasal polyps, and chronic rhinosinusitis; patients have severe bilateral ethmoidal polyps, underlying asthma, and sensitivity to aspirin and NSAIDs; relevant when a patient with polyps also reports asthma.

The bony spur of the posterior-superior bony canal wall (the lateral wall of the attic); its erosion on oto-microscopy is a reliable sign of cholesteatoma expanding laterally from the epitympanum.

The narrow space between the superior turbinate and the nasal septum, receiving drainage from the sphenoid sinus (via the sphenoidal ostium) and the posterior ethmoid air cells; examined in Pass 3 of DNE.

Application of a stroboscopic light source to a Hopkins rod laryngoscope to produce slow-motion visualisation of the vocal cord mucosal wave during phonation; reduced or absent mucosal wave over a lesion indicates mucosal stiffening and raises suspicion of malignant invasion.

Squamous cell carcinoma of the supraglottis (epiglottis, aryepiglottic folds, false cords); presents late with referred otalgia, dysphagia, and cervical lymphadenopathy because the rich lymphatic supply allows early bilateral nodal spread; hoarseness is a late feature; poorer prognosis than glottic carcinoma.

The cartilaginous elevation forming the posterior lip of the Eustachian tube orifice on the lateral nasopharyngeal wall; visible on endoscopy during Pass 1; the fossa of Rosenmüller lies posterior to it and is the common site for nasopharyngeal carcinoma.

The 'safe' type of chronic suppurative otitis media; characterised by a central perforation in the pars tensa, mucosal disease, no cholesteatoma, and a low (though not zero) risk of intracranial complications; managed medically or with myringoplasty.

The central depression of the tympanic membrane at the inferior tip of the malleus handle; the point of maximum TM concavity; an important anatomical landmark for orienting the four quadrant survey.

A thin curved bony projection from the lateral nasal wall in the middle meatus, forming the anterior and inferior boundary of the hiatus semilunaris; resected during uncinectomy as the first step in FESS.

Bilateral, symmetric, fibrous nodules at the junction of the anterior one-third and posterior two-thirds of the true vocal cords — the point of maximum vibratory impact; associated with chronic vocal abuse in teachers, singers, and coaches; treatment: voice therapy first, microlaryngoscopic excision if refractory.

Immobility of one true vocal cord due to RLN or vagal injury; on laryngoscopy, the affected cord lies in the paramedian or cadaveric position with no adduction or abduction; breathy voice, bovine cough; left-sided more common due to longer left RLN intrathoracic course.

Usually unilateral, pedunculated or sessile smooth mass at the free edge of one true vocal cord; associated with single episode of vocal overuse or trauma; produces unilateral hoarseness; treated by microlaryngoscopic excision under GA.

A topical alpha-adrenergic vasoconstrictor nasal decongestant (0.1% solution) used 10 minutes before DNE to shrink turbinate mucosa, widen the nasal airway, and reduce procedural bleeding.

A fine-bore angled metal suction cannula used during aural toilet under oto-microscopy; vacuum is modulated by a finger vent to avoid trauma to the TM or ossicles.