The following CBME core competencies are covered in this chapter. AN40.2: Describe and demonstrate the boundaries, contents, relations and functional anatomy of middle ear and auditory tube.

Eustachian tube dysfunction

Definition and Classification

It is described as an impairment of ET function, which leads to a variety of symptoms and physical findings. It is divided into acute or chronic:

• Acute ETD. It can occur during nasal congestion due to a common cold or allergic rhinitis, for example, and is generally transient.
• Chronic ETD. Symptoms lasting for more than 3 months consecutively are considered chronic. Chronic ETD can be due to obstruction of the  Eustachian tube or a Patulous (branching) Eustachian tube.

Obstruction of the Eustachian tube

Eustachian tube obstruction can be mechanical, functional or both. 

Mechanical obstruction. It can result from

Intrinsic causes (obstruction of the lumen of the tube):

• Inflammation from a viral or bacterial upper respiratory infection
• Allergic rhinitis causes mucosal swelling
• Nasopharyngeal acid reflux irritates the tubal lining

Extrinsic causes (compression of the eustachian tube):

• Deviated nasal septum
• Sinusitis or nasal polyps
• Hypertrophic adenoids (enlarged adenoids)
• Nasopharyngeal tumour or mass
• Granulomatous diseases
• Cystic fibrosis
• Samter’s triad
• Kartagener syndrome

Functional obstruction. One of the most common types of ET dysfunction is when the lumen of the cartilaginous portion of the tube fails to open during swallowing activity. This may be due to

1. Persistent collapse of the ET. The tube is too floppy and lacks stiffness. This happens in cleft palate, submucous cleft palate, or Down syndrome. 
2. An inefficient active opening mechanism. The tensor veli palatini muscle does not work well. This commonly occurs in a cleft palate.
3. Both defects coexist. The patient has both tubal collapse and poor muscle function.

Treatment of obstructive ETD. Cleft palate repair, adenoidectomy, elimination of nasal and nasopharyngeal inflammation, and treatment of nasopharyngeal tumours may be associated with improvement in ET function.

Patulous Eustachian Tube (PET)

In this condition, the eustachian tube is hyperpatent (abnormally open).

Symptoms:

• Autophony (patient hears own voice)
• Breath-synchronous tinnitus (patient hears own breath sounds)
• Aural fullness
• Hearing loss (may significantly impact quality of life)

Pathophysiology: Due to undue patency, the protective function is lost. Pressure changes and unwanted secretions from the nasopharynx gain easy access to the middle ear, causing the tympanic membrane to move synchronously with breathing. This sign is not always present but is diagnostic when seen.

Types of PET disorders:

1. PET type (true patulous): Lumen remains anatomically open even at rest
2. Semi-patulous type (less severe): Lumen anatomically closed at rest but, due to low tubal resistance, opens easily during physical activity

Aetiology: Mostly idiopathic, but associated with:

• Bariatric surgery
• Acute weight loss
• Pregnancy (especially the third trimester)
• Multiple sclerosis

Treatment:

1. Counselling.
2. An acute condition is generally self-limiting. No treatment required. 
3. In chronic cases, weight gain, oral administration of a saturated solution of potassium iodide, and oestrogen nasal drops have been used to induce swelling of the ET opening. Myringotomy and grommet insertion may sometimes alleviate symptoms. Other options are augmentation of the tympanic membrane with cartilage and cauterisation of the tubes.

Pathophysiology and Effects of Acute And Chronic ET Dysfunction/ Blockage

Basic Pathophysiology

ET dysfunction is most commonly involved in the pathogenesis of middle ear disease. Acute otitis media, otitis media with effusion, and chronic suppurative otitis media are the most frequent middle-ear diseases. Air (composed of oxygen, carbon dioxide, nitrogen and water vapour), normally fills the middle ear and mastoid. When the tube gets blocked, either due to anatomical obstruction or a functional obstruction, resorption of air from the middle ear. This results in negative pressure in the middle ear and retraction of the tympanic membrane. If the negative pressure is still further increased, it causes “locking” of the tube with a collection of transudate and later exudate and even haemorrhage.

Clinical Features of ET Blockage

Symptoms: Otalgia, hearing loss, autophony, popping sensation, crackling tinnitus, disequilibrium (may contribute to vertigo)

Signs (most cases):

• Tympanic membrane retracted, dull appearance with abnormal light reflex
• Congestion may be present
• Transudate behind TM → amber colour, sometimes fluid level seen
• Conductive hearing loss

Severe cases (e.g., barotrauma from scuba diving, air flight):

• Tympanic membrane strikingly retracted, congested, sometimes ruptured
• Air bubbles or haemorrhagic effusion in the middle ear

Effects of acute and chronic tubal blockage.

Acute	Chronic
Eustachian tube blockage ↓ Resorption of air from the middle ear ↓ Development of negative pressure in the middle ear ↓ Retraction of the tympanic membrane ↓ Transudate in ME/haemorrhage (acute OME)	Eustachian tube blockage/dysfunction ↓ OME (thin watery or mucoid discharge) ↓ Atelectatic ear/perforation ↓ Retraction pocket/cholesteatoma ↓ Erosion of the incudostapedial joint

Specific Disorders Related to ET Dysfunction

1. Adenoid Hypertrophy and ET Function

In the paediatric population, adenoid hypertrophy is the most common cause of ET dysfunction. It hinders aeration of the middle ear by:

• Mechanical obstruction of the nasopharyngeal orifice of the Eustachian tube
• Acting as a bacterial reservoir
• Mast cells release inflammatory mediators, causing tubal blockage

Consequence: Adenoid hyperplasia results in otitis media with effusion or recurrent acute otitis media.

Treatment: Adenoidectomy

2. Cleft Palate and Tubal Function

In infants and young children with cleft palate, otitis media is usually present due to failure of the tube’s opening mechanism from aberrations in paratubal muscles responsible for ET opening.

Structural abnormalities in cleft palate:

• High elastin density in torus tubarius → difficult to open
• Tensor veli palatini (primary ET opener) does not insert or insert firmly into torus tubarius → lacks anchorage to effectively open ET

Clinical consequence: Otitis media with effusion is common. Surgical repair of cleft palate does not always reduce incidence; many patients still require grommet insertion for middle ear ventilation.

3. Down Syndrome and Tubal Function

In Down syndrome, ET dysfunction occurs due to:

• Defective muscle tone of the tensor veli palatini
• Altered shape of the nasopharynx

Consequence: Failure in preventing reflux and infection from the nasopharynx into the Eustachian tube → repeated otitis media or otitis media with effusion

4. Barotrauma

Due to ET dysfunction, there is failure to equalise pressure between the middle ear and atmospheric pressure during sudden pressure changes (rapid descent during air flight, scuba diving, or hyperbaric oxygen therapy in a pressure chamber). This may result in middle ear or inner ear barotrauma.

(a) Middle Ear Barotrauma

Non-suppurative condition caused by sudden negative pressure in the middle ear, resulting in redness and retraction of TM, vessel engorgement, transudation, and haemorrhages. Severe cases may show fluid accumulation, haemotympanum, TM perforation, or ossicular damage.

Tympanic Membrane Appearance in Middle Ear Barotrauma:

Grade	Findings
0	Symptoms, no signs
1	Redness and retraction
2	Intratympanic membrane haemorrhage
3	Gross TM haemorrhage
4	Haemotympanum
5	Perforation

(b) Inner Ear Barotrauma

Usually seen when divers perform the Valsalva manoeuvre to equalise middle ear pressure, causing an increase in pressure in the inner ear.

Two mechanisms:

1. If forced, Valsalva opens ET: Middle ear pressure increases → rupture of the round window membrane or disruption of the stapes footplate
2. If forced Valsalva does NOT open ET: Increased intracranial pressure transmitted along patent cochlear duct or internal auditory meatus → disruption of round window or stapes footplate

Consequence in both situations: Perilymph fistula or damage to the intracochlear membrane → sensorineural hearing loss and balance disturbance

Mechanism of tubal locking: When atmospheric pressure is higher than middle ear pressure, air cannot enter the middle ear. If the difference exceeds the critical level of 90 mm Hg, it causes locking of the Eustachian tube.

Clinical Features of Barotrauma:

• Sensation of blocked ear
• Severe progressive otalgia
• Hearing loss (usually conductive; sensorineural type may also occur)
• Tinnitus
• Vertigo (uncommon; may occur due to sudden ingress of water into middle ear causing caloric vertigo)
• TM appears red and retracted; perforation may be present
• Middle ear may show fluid accumulation, haemotympanum, ossicular damage

Treatment Based on Severity:

Type	Findings	Treatment
Type 1	Symptoms only, no/minimal signs	No specific treatment
Type 2	Signs and symptoms present, no TM perforation	Conservative: decongestant nasal drops or oral decongestant with antihistamines. Myringotomy for fluid aspiration if conservative fails
Type 3	Perforation present	Myringoplasty if the perforation does not heal spontaneously

Prevention:

• No air travel or diving during or immediately after URI or allergy
• No occlusive earplugs when diving or flying
• Frequent swallowing (sips of drink, sweets, chewing gum) during ascent and descent
• Avoid sleeping during descent (normal swallowing decreases during sleep)
• Pressure-equalising manoeuvres (Valsalva, Toynbee)
• Treat deviated septum, nasal polyposis, sinus infections, and allergy
• Local vasoconstrictors, oral antihistamines, systemic decongestants (half hour before descent)

Methods of Clinical Examination of the Eustachian Tube

In addition to otoscopic examination, examination of the nasopharynx and middle ear reveals basic underlying pathology at both ends of the ET system.

1. Basic Office Examination

• Posterior rhinoscopy: Indirect mirror examination of the nasopharyngeal end of the ET system.
• Otoscopic examination: Assessment of tympanic membrane position, colour, degree of translucency, and mobility (including pneumatic otoscopy).

2. Endoscopic Examination

• Rigid nasal endoscope: For examination of the nasal cavity and nasopharyngeal end of the ET system.
• Flexible nasopharyngoscope: For examination of both ends of the ET system.
• Operating microscope or otoendoscope: For examination of the tympanic end of the ET system through pre-existing perforation; also reveals retraction pockets or fluid in the middle ear.

3. Advanced Endoscopic Techniques

• Eustachian tube endoscopy or middle ear endoscopy can be performed with very fine flexible endoscopes.

Eustachian Tube Function Tests

1. Valsalva Test

Principle: It evaluates patency of the eustachian tube by assessing the effect of high positive nasopharyngeal pressure on the ET system.

Technique: To create positive pressure in the nasopharynx, the patient pinches his nose between the thumb and index finger, takes a deep breath, closes his mouth and expires air forcefully and tries to blow air into the middle ear through the eustachian tube.

Interpretation: If the air enters into the middle ear, bulging of the tympanic membrane can be seen by otoscope or the microscope due to increased positive pressure in the middle ear, indicating normal tubal function. A hissing sound can be heard with the help of a stethoscope if there is a tympanic membrane perforation. A crackling sound is produced if the discharge is also present in the middle ear.

Unfortunately, Valsalva’s test results are not reliable, as only 65% of people can successfully perform this test. However, Valsalva can also be advised as a part of treatment when effusion or high negative pressure is present within the middle ear. This test should not be done if there is an atrophic tympanic membrane (as it is weak and thin), which can rupture, or patient is having a URI where infection can be pushed into the middle ear, causing otitis media.

2. Politzer Test

Principle: The principle is this test is the same as Valsalva, which is to create positive air pressure in the nasopharynx and transmit it into the middle ear through the eustachian tube.

Technique: Instead of using forceful expiration in this test, a Politzer’s bag is introduced into the patient’s nostril on one side and another nostril is closed, and the bag compressed while at the same time the patient swallows to close the velopharyngeal port (he can be given sips of water) or says the letter “K”. Significance of the test results is the same as with Valsalva’s test.

This test is done in children who are unable to perform the Valsalva test. The test is also used therapeutically to ventilate the middle ear.

3. Toynbee’s Test

Principle: Normally, negative pressure develops in the middle ear when swallowing with the nose closed.

Technique: Patient swallows with nose pinched manually.

Interpretation: Air is taken out from the middle ear, causing inward movement of the tympanic membrane, indicating tubal patency (visible with otoscope or microscope).

While Valsalva and Politzer use positive pressure, Toynbee uses negative pressure. Although a rather crude test, the results are more informative than Valsalva or Politzer.

4. Tympanometry

Tympanometry assesses Eustachian tube function and confirms the integrity of the auditory system. ET dysfunction plays a dominant role in the pathogenesis of suppurative and non-suppurative otitis media. Prognosis and treatment of both types depend upon ET function.

Technique: The impedance audiometer is programmed to measure middle ear pressure in three conditions:

1. Resting pressure (at beginning of test)
2. After swallowing (with nose pinched and mouth closed)
3. After performing Valsalva

Inference:

• Normal ET function: Middle ear pressure same as atmospheric pressure at rest, during swallowing, or Valsalva
• Impaired ET function: Pressure becomes negative during swallowing; does not become positive on Valsalva (or vice versa)
• Grossly impaired ET function: Pressure does not change at all in either situation

Jerger Classification (Correlated with ET function):

Tympanometry Type	Peak Pressure	Compliance	ET Function	Clinical Condition
Type A (normal)	0 daPa	Normal	Normal	Healthy ear
Type C (negative pressure)	-100 to -400 daPa	Normal	Mild to moderate ETD	Retraction, early OME
Type B (flat)	No peak	Flat	Severe ETD with effusion	OME, glue ear
Type As	0 daPa	Reduced	Not ET-related	Otosclerosis (normal pressure, reduced compliance)
Type Ad	0 daPa	Increased	Not ET-related	Ossicular discontinuity

 

• Type A (normal): Peak at 0 daPa → Normal ET function
• Type C (negative pressure): Peak at -100 to -400 daPa → Mild to moderate ET dysfunction
• Type B (flat): No peak → Effusion or severe ET dysfunction with middle ear fluid
• Type As (reduced compliance): Normal pressure but low peak → Otosclerosis (not ET-related – included for differentiation)

5. Sonotubometry

Principle: It is a non-invasive technique and provides information on active tubal opening.

Technique: A tone is delivered via a probe to the nose.  Sound is then measured in the external auditory canal, and fluctuations during swallowing are recorded.

Interpretation: If the tone is heard louder, it indicates a patent tubal system. The duration for which the tube remains open can also be noted.

The accessory sounds produced during swallowing interfere with the test results.

6. Catheterisation

In this test, we use a curved metallic eustachian tube catheter to insufflate air in the eustachian tube opening present on the lateral wall of the nasopharynx. 

Technique:

1. Anaesthetize the nose by packing with 4% xylocaine or a topical lignocaine spray.
2. Introduce the Eustachian tube catheter into the nasal cavity and move forward until it reaches the nasopharynx.
3. Rotate the catheter 90° medially and pull back slightly to engage the posterior free part of the nasal septum.
4. Rotate the catheter 180° laterally so the tip reaches the Eustachian tube opening.
5. Connect the Politzer bag to the outer opening of the catheter and push air.
6. Verify air entry into the middle ear by auscultation tube, indicating tubal patency.

Complications:

• Injury to the Eustachian tube opening → nasal bleeding and possible later scarring.
• Entry of infection from the nasopharynx into the middle ear → otitis media.
• Perforation of atrophic tympanic membrane (weak and thin).

7. Tests for Mucociliary Clearance and Drainage

These tests can only be done where there is a pre-existing perforation of the tympanic membrane. Different substances can be introduced into the middle ear, and the time they take to reach the nasopharynx is measured. This indicates the clearance/ drainage function of the eustachian tube. The following substances can be used:

• Saccharin solution drops – the time taken for a sweet taste to develop in the mouth is noted.
• Methylene blue dye – the time taken by the dye to stain the pharyngeal secretions is noted. 
• Antibiotic/steroid ear drops – the time taken to have its bad taste in the mouth is noted.

Comparison Table of Eustachian Tube Function Tests

Test	Principle	Technique	Interpretation	Best For
Valsalva	Positive pressure	Pinch nose + blow forcefully	TM bulges = patent	Adults who can cooperate
Politzer	Positive pressure	Politzer bag + swallow	Same as Valsalva	Children, therapeutic use
Toynbee	Negative pressure	Swallow with nose pinched	TM moves inward = patent	Quick bedside assessment
Tympanometry	Acoustic impedance	Measures pressure changes	Type A = normal, Type C = negative, Type B = flat	Most reliable, objective
Sonotubometry	Sound transmission	Tone in nose, measure in ear canal	Louder tone = patent	Research, active opening
Catheterisation	Direct insufflation	Catheter into ET opening + Politzer bag	Auscultation tube confirms entry	Therapeutic, historical
Mucociliary clearance	Dye/saccharin transit	Dye/saccharin in ME, time to taste/stain	Prolonged time = poor clearance	Only with TM perforation

———— End of the chapter ————

High-Yield Points for NEET PG & University Exams

• Most common cause of ET dysfunction in children = Adenoid hypertrophy
• Most common site of ET obstruction = Isthmus (narrowest part, 0.5 mm)
• Most reliable objective test for ET function = Tympanometry
• Test that can be used therapeutically to ventilate the middle ear = Politzer
• Patulous ET symptom that is diagnostic = TM moving synchronously with breathing
• Critical pressure difference causing tubal locking = 90 mm Hg
• Most common site of nasopharyngeal carcinoma = Fossa of Rosenmüller (behind torus tubarius)
• Primary muscle opening the ET = Tensor veli palatini (CN V3 innervation)
• Structures keeping ET closed at rest = Ostmann’s fat pad + Elastin hinge
• Barotrauma prevention during descent = Swallowing, Valsalva, decongestants 30 minutes before
• Jerger Type B curve = Middle ear effusion (flat, no peak)
• Jerger Type C curve = Negative middle ear pressure (ET dysfunction)
• Patulous ET symptoms mnemonic = A BAH (Autophony, Breath-synchronous tinnitus, Aural fullness, Hearing loss)
• Functions of ET mnemonic = V-P-D (Ventilation, Protection, Drainage)
• Barotrauma grades mnemonic = SIR GRIP (0=Symptoms, 1=Injected, 2=Retraction, 3=Gross haemorrhage, 4=In middle ear, 5=Perforation)

NEET PG-Style MCQs

1. A 4-year-old child with recurrent otitis media has a short, wide, and horizontal Eustachian tube. What angle does the tube make with the horizontal in this child?
   A. 45 degrees B. 30 degrees C. 10 degrees D. 60 degrees
2. Which of the following is the most reliable objective test for assessing Eustachian tube function?
   A. Valsalva test B. Politzer test C. Tympanometry D. Toynbee test
3. A patient complains of hearing his own voice and breathing too loudly. Symptoms improve when lying down. Most likely diagnosis:
   A. Otosclerosis B. Patulous Eustachian tube C. Meniere’s disease D. Secretory otitis media
4. The critical pressure difference (in mm Hg) that causes locking of the Eustachian tube is:
   A. 50 B. 70 C. 90 D. 110
5. Which muscle is the primary dilator of the Eustachian tube?
   A. Levator veli palatini B. Tensor veli palatini C. Salpingopharyngeus D. Tensor tympani
6. In Jerger tympanometry, a Type B curve with no peak is most consistent with:
   A. Normal ET function B. Otosclerosis C. Middle ear effusion D. Ossicular discontinuity
7. The most common cause of Eustachian tube dysfunction in the pediatric population is:
   A. Allergic rhinitis B. Adenoid hypertrophy C. Cleft palate D. Sinusitis
8. A scuba diver develops severe ear pain during ascent. On examination, the tympanic membrane shows gross haemorrhage but no perforation. What is the grade of barotrauma?
   A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4
9. Which of the following tests uses negative pressure to assess Eustachian tube patency?
   A. Valsalva B. Politzer C. Toynbee D. Sonotubometry
10. The fossa of Rosenmüller is a clinically important landmark because it is the most common site for:
    A. Adenoid hypertrophy B. Nasopharyngeal carcinoma C. Tubal tonsil hypertrophy D. Juvenile angiofibroma

Answers: 1:C, 2:C, 3:B, 4:C, 5:B, 6:C, 7:B, 8:C, 9:C, 10:B

Clinical Case Scenarios (For Viva & Practical Exams)

Case 1. A 35-year-old male presents with left ear fullness, hearing loss, and a popping sensation for 4 months. He has no otalgia or discharge. On otoscopy, the tympanic membrane is retracted, dull, and shows an amber discolouration with a visible fluid level. Pure tone audiometry shows conductive hearing loss of 30 dB.
Most likely diagnosis: Chronic otitis media with effusion (OME) due to Eustachian tube dysfunction.
Best next step: Tympanometry (will show Type B curve).
Best management: Myringotomy with ventilation tube insertion + treat underlying cause (e.g., adenoidectomy if adenoid hypertrophy present).

Case 2. A 28-year-old flight attendant complains that she hears her own voice too loudly, especially after a long-haul flight. She also hears her breathing in her left ear. Symptoms disappear when she lies down. Nasopharyngoscopy shows a patent Eustachian tube opening at rest.
Most likely diagnosis: Patulous Eustachian tube.
Best next step: Tympanometry (will show Type A with TM movement with breathing).
Best management: Reassurance, hydration, nasal saline drops; if severe, consider insertion of a grommet or injection of filler material into the tubal opening.

Case 3. A 22-year-old scuba diver presents with severe right ear pain immediately after a dive from 20 metres. On examination, the tympanic membrane is red, retracted, and shows a fluid level with visible blood behind it. No perforation is seen.
Most likely diagnosis: Middle ear barotrauma (Grade 4 – haemotympanum).
Best next step: Conservative management with decongestants and nasal drops. Avoid further diving until complete resolution.
Prevention advice: No diving during URI, perform Valsalva during descent, use decongestants 30 minutes before diving.

Case 4. A 4-year-old child with a repaired cleft palate presents with recurrent ear infections and hearing loss. Otoscopy shows a retracted TM with amber discolouration. Tympanometry shows a flat curve.
Most likely diagnosis: Chronic otitis media with effusion secondary to cleft palate-related ET dysfunction (poor tensor veli palatini function).
Best next step: Bilateral myringotomy with ventilation tube (grommet) insertion.
Why cleft palate cause ETD: The tensor veli palatini does not insert properly into the torus tubarius, so the tube cannot open effectively.

Frequently Asked Questions in Viva

• What is the difference between acute and chronic Eustachian tube dysfunction? Acute ETD lasts less than 3 weeks and is usually self-limiting (e.g., with a common cold). Chronic ETD lasts more than 3 months and requires investigation and targeted treatment.
• Why does the Valsalva test fail in 35% of normal people? Many individuals cannot generate sufficient nasopharyngeal pressure due to poor technique or anatomical variation. This does not necessarily indicate ET dysfunction.
• What is the most common cause of ET dysfunction in adults? Chronic allergic rhinitis or chronic sinusitis with persistent mucosal inflammation.
• Can ET dysfunction cause vertigo? Yes, negative middle ear pressure can cause disequilibrium. Additionally, sudden ingress of cold water into the middle ear (during diving) can cause caloric vertigo.
• When is adenoidectomy indicated for ET dysfunction? When adenoid hypertrophy causes mechanical obstruction, recurrent acute otitis media (≥3 episodes in 6 months), or chronic OME lasting >3 months with symptoms.
• What is the diagnostic sign of patulous Eustachian tube on examination? The tympanic membrane moves synchronously with the patient’s breathing – this is diagnostic when seen on otoscopy or tympanometry.
• What is the critical pressure difference that causes tubal locking? A pressure difference of 90 mm Hg or more between the middle ear and atmosphere causes the Eustachian tube to lock, preventing equalisation.
• Which Jerger tympanometry type is most concerning for cholesteatoma risk? Type C (persistent negative pressure) and Type B (effusion) with retraction pockets increase the risk of cholesteatoma formation over time.

———— End ————

Download full PDF Link:
Eustachian Tube Dysfunction Best Lecture Notes Dr Rahul Bagla ENT Textbook

Reference Textbooks.

• Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
• Glasscock-Shambaugh, Textbook of Surgery of the Ear.
• P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
• Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
• Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery
• Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
• Salah Mansour, Middle Ear Diseases – Advances in Diagnosis and Management.
• Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
• Rob and smith, Textbook of Operative surgery.
• Anirban Biswas, Textbook of Clinical Audio-vestibulometry.
• Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.

Author:

Dr. Rahul Bagla
MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
Fellow Rhinoplasty & Facial Plastic Surgery.
Renowned Teaching Faculty
Mail: msrahulbagla@gmail.com
India

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