OSCE Notes in Otology Surgery by drtbalu

Station 1:

For grommet incison where will you site the incision ?

What should be the direction of the incision ?

gromm_cor

Grommet should always be sited in the antero inferior quadrant close to the eustachean tube orifice for better ventilatory function

inci.jpg

Incision should be made along the line parallel to the radial fibers of the ear drum. This will enable the radial fibers to hug the grommet in position. The drum also will heal well after extrusion of the grommet.

Station 2:

microscope.jpg

What is the focal length of the objective lens in a microscope used for otological surgeries ?

Name the major advantage of microscope in otological surgery ?

What is the of magnification used to examine the ear drum ?

200 mm

Both hands are free

6X

Station 3:

mollison.jpg

Name the instrument shown

Which surgery is it commonly used ?

Name the advantages of using this instrument ?

Mollison's self retaining hemostatic mastoid retractor.

It is used in mastoid surgeries.

When this retractor is applied it:

Retracts the soft tissue

It stops bleeding.

Allows both hands to be free

Station 4:

Name this instrument

Where do you use this ?

myringotome.jpg

It is a myringotome. (Myringotomy knife)

It is used to perform myringotomy

Station 5:

Enumerate the goals of cholesteatoma surgery

1. To remove all potentially erosive / invasive tissue

2. To create a smooth skin lined exteriorized cavity

3. To conserve residual hearing

4. To improve hearing if possible

Station 6:

Name the surgical procedure

Identify the numbered structures

cor_mas.jpg

Cortical mastoidectomy

1. Posterior canal wall (bridge)

2. Incus

3. Fossa incudis

4. Aditus

5. Mastoid cavity after exenteration of air cells

Station 7:

rosen.jpg

Name the incison used in this surgery

Name the instrument used

Name any two surgical procedures where this incision is used

Rosen's trancanal incision

Rosen's knife

Myringoplasty

Stapedectomy

Station 8:

corda.jpg

Name the flap elevated

Name the structure pointed with black dot

Which nerve's branch is it ?

Tympanomeatal flap

Chorda tympani nerve

Facial nerve

Station 9:

middle_ear.jpg

Identify the named structures

1. Chorda tympani nerve

2. Long process of incus

3. Stapedial tendon

4. Round window

Station 10:

over_hang.jpg

You are seeing bony over hang being curetted during stapedectomy.

How much of bony over hang should be removed ?

What instrument is used for this purpose ?

What are the dangers of bony overhang removal ?

Bony overhang should be removed till the whole of the pyramidal process comes into view.

House's curette is used for this purpose.

Incus dislocation should be guarded against.

Station 11:

type_1.jpg

Name the type of tympanoplasty procedure illustrated

What are the prerequisites for this procedure ?

The diagram shows Type I tympanoplasty.

Prerequisites for Type I tympanoplasty are:

1. Presence of mobile ossicles
2. Patent eustachean tube
3. Perforated ear drum

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