COMMON ENT
PROBLEMS
&
MANAGEMENTS
ENT
•
•
•
Ear
Nose • 3 OF THEM ARE RELATED
Throa TOGETHER
t
OTOLOGIC
ANATOMY
Auricle
Ear canal
Tympanic
membran
e
Middle ear &
mastoid
Inner Ear
ESSENTIAL EQUIPMENT
• OTOSCOPE
• TORCH
• TONGUE
• DEPRESSO
R
• THUDICUM NASAL
SPECULUM
ARTERY FORCEPS
COMMON PROBLEMS IN EAR
• Pain
– Wax
– Furuncle
– Foreign body
• Ear discharge
FURUNCULOSIS OF EAR CANAL (OTITIS EXTERNA)
CAUSE : STREPTOCOCCAL / STAPHYLOCOCCAL INFECTION OF SKIN OF EAق
TREATMENT : ANTIBIOTICS, ANALGESICS
MAY BE ASSOCIATED WITH UNTREATED MIDDLE EAR INFECTION
WAX EAR TREATMENT : WAX OTOMYCOSIS
SOFTENING DROPS
FOLLOWED BY
SYRINGING AFTER
ONE WEEK
DISORDERS OF MIDDLE EAR
TRAUMATIC PERFORATION
•DIAGNOSIS
– HISTORY OF TRAUMA
– RAGGED EDGES OF PERFORATION
– FRESH BLEEDING
•TREATMENT
– NO EAR DROPS
– KEEP EAR DRY
– ORAL ANTIBIOTICS,
ANTIHISTAMINICS
– REVIEW AFTER
•IF DUE
ONETO NOISE OF
MONTH
WEAPONS… IT IS IMPULSE NOISE
TRAUMA… INNER EAR NEEDS
EVALUATION!
DISORDERS OF MIDDLE EAR
ACUTE SUPPURATIVE OTITIS MEDIA
•STAGES
– TUBAL OCCLUSION
– PRESUPPURATION
– SUPPURATION
– DISCHARGE/RESOL
UTION/
•TREATMENT
COMPLICATIONS
– ORAL ANTIBIOTICS
– ANALGESICS
– ANTIHISTAMINICS
– NASAL DECONGESTANTS
– FOLLOWUP
•SPECIAL CONSIDERATIONS
– ROLE OF EAR DROPS
– MYRINGOTOMY
DISORDERS OF MIDDLE EAR
EAR SEROUS OTITIS MEDIA GLUE
SYMPTOMS
– INSIDIOUS ONSET, LONG
STANDING CONDITON (3
MONTHS)
– HEARING LOSS
– OCCASSIONAL OTALGIA
– BUBBLING SOUNDS, ECHO OF OWN
VOICE
•TREATMENT
– CORTICOSTEROID / ANTIHISTAMINIC
NASAL SPRAYS
– ORAL DECONGESTANTS / ANTIHISTAMINICS
– CHEWING GUM, BLOWING BALLOONS
– MYRINGOTOMY AND GROMMET
INSERTION
•SPECIAL CONSIDERATIONS
– ROLE OF ADENOTONSILLECTOMY
– ROLE OF TEMPORARY HEARING AID
– DIFFERENTIATION FROM AOM WITH
COMMON PROBLEMS IN NOSE
•
Furuncle
•
• Epistaxis(bleeding)
• Cold(running nose)
•
• Sneezing(allergic rhinitis)
Sinusitis
Foreign body
INTRANASAL POLYPS
• DIFFERENTIATE HYPERTROPHIED
INFERIOR TURBINATE FROM
INTRANASAL POLYPS
• ALLERGIC POLYPS ARE USUALLY
BILATERAL, MULTIPLE, AND PALE
• MEDICAL POLYPECTOMY
– SHORT COURSE ORAL STEROID
– INTRANASAL CORTICOSTEROID
SPRAY
– ORAL ANTIHISTAMINICS
• SURGICAL MANAGEMENT : FESS
-:NASAL DEFORMITIES
SADDLE NOSE •
HUMP NOSE •
CROOKED NOSE(DEVIATED)NOSE C or S shaped •
.manner
SADDLE NOSE:-
• Depressed nasal dorsum may involve bony,
cartilaginous or both.
• Aetiology :- Nasal trauma causing depressed fractures,
excessive removal of septum in S.M.R, destruction of
septal cartilage by haematoma/abscess, syphilis, leprosy&
tuberculosis TREATMENT: :Augmentation rhinoplasty
HUMP NOSE:-
• This may also involve the bone or cartilage or both
bone and cartilage.
• TREAMENT :-Reduction rhinoplasty.
• Raising of nasal skin by vestibuar incision,removal
of hump & narrowing of lateral wall by osteotomies to
reduce the widening left by hump removal
EVIATED NASAL SEPTUM
etiology
Trauma
Developmental errors
Racial factors
Hereditary factors
produces mechanical nasal obstruction
other symptoms , an operation is indicated
SUBMUCOUS RESECTION OPERATION
SEPTOPLASTY
Symptoms:
• Unilateral foul smeling
discharge: mucopurulent
or
blood stained
• u/l nasal obstruction
• Pain
• Nasal bleed
• Excoriation of nasal
vestibular skin
FORIGEN BODY
In children 2-4
years
ACUTE SINUSITIS
• PRESENTATION
– ACUTE INFLAMMATION OF
SINUS MUCOSA DUE TO
INFECTION
– FEVER, HEADACHE,
PURULENT NASAL DISCHARGE,
ERYTHEMA AND TENDERNESS
OVER AFFECTED SINUSES
• TREATMENT
– ANTIBIOTICS
– ANALGESICS
– TOPICAL DECONGESTANTS
– ANTIHISTAMINICS
– STEAM INHALATION
• TYPE OF SINUSITIS
• ACUTE BACTERIAL SINUSITIS
< 30 DAYS COMPLETE RESOLUTION
• SUB-ACUTE BACTERIAL SINUSITIS
90 - 30 DAYS COMPLETE RESOLUTION
• RECURRENT ACUTE BACTERIAL SINUSITIS
EACH EPISODE <30 DAYS @ INTERVAL OF 10
DAYS
• CHRONIC SINUSITIS > 90 DAYS
PERSISTENT RESIDUAL
• ACUTE SINUSITIS SUPERIMPOSED TO
CHRONIC SINUSITIS
Dental complications
Sinusitis can give dental pain
Most obvious cause of oroantral fistulae
(OAF)
Tooth most frequntly involved:
Upper second molar,followed by first molar
to the floor of the maxillary sinus
Highest incidense: third-fourth decades of life
OAF closure is very challenging & depend on the
technique used, size & location of the defect
Orbital complications
Endoscopic closure or Caldwell-Luc procedure
Coronal CT scan
showing orbital spread
of infection from the
maxillary sinus
EMERGENCY MANAGEMENT OF EPISTAXIS
• FIRST AID
SIT THE PATIENT UPRIGHT AND PINCH THE NOSE (TROTTER’S METHOD)
• IF BLEEDING PERSISTS
FOR POSTERIOR NASAL BLEEDING INFLATE A FOLEY’S CATHETER IN NASOPHARY
FOR ANTERIOR NASAL BLEEDING DO ANTERIOR NASAL PACKING
WITH RIBBON GAUZE OR GELFOAM STRIPS
• IF BLEEDING STOPS SPONTANEOUSLY / MINOR BLEEDING
DECONGESTANT DROPS, ANTIHISTAMINICS, ANTIBIOTICS
IF ELDERLY PATIENT WITH HYPERTENSION
– CHECK BLOOD PRESSURE
– ELICIT MEDICATION HISTORY
– RESTART ANTIHYPERTENSIVES
EPISTAXISIS According to Age .
• Children;
• Foreign body, nose picking, nasal
diphtheria.
• Adults:
• Trauma, idiopathic.
• Middle age:
• tumors.
• Old age:
• hypertension.
TTT CAUTERIZATION
1) Chemicals;
• Silver Nitrate stick, chromic acid bead.
2) Electrical
• Apply ointment and advise against blowing and nose
picking.
Unable to control bleeding.
ANTERIOR PACKING
POSTERIOR PACKING
COMMON PROBLEMS OF THROAT
• Cough
• Throat pain
– Tonsilitis
– Peritonsil
ar abscess
– Pharangiti
• s
Mouth
ulcers
Adenoid Hypertrophy
Occupies large area of
nasopharynx age <6 Atrophies
and by age 15 ,little remains.
Recurrent URTI or allergies can
lead to
hypertrophy
Clinical
Nasal Obstruction; Mouth
breathing / Adenoid
Facies, chest infections,
pharyngeal infections,
sinusitis, snoring
Eustachian Tube; Recurrent
Otitis Media,
CSOM
Choanal Obstruction; OSA,
Tonsillitis
Commonest area of
infection of head and neck Complications;
Clinical; Sore throat and Acute Otitis Media (most
Odynophagia, Otalgia, common)
headache, malaise, Fever, Peritonsillar abscess
hyperaemic tonsils, cervical (Quinsy)
lymphadenopathy GAS
DDx; Post Strep GN
Viral Rhuematic Fever
Group A Streptococcus (20- Scarlet Fever; Strawberry
30%) tongue and scarlitiform
EBV; Palatal petechia rash
Diptheria; Unimmunised, Recurrent Tonsillitis
grey membrane Tonsillar Hypertrophy
Tx; Rest, paracetamol +/-
Follicular tonsillitis
Catarrhal tonsillitis
MEMBRENOUS Parenchymatous
TONSILLITIS tonsillitis
Tonsillectomy
Indications for surgery
Absolute
Airway obstruction
Suspicion of malignancy
Relative
Sleep apnoea, mouth
breathing, difficulty
swallowing
Recurrent tonsillitis >5
episodes
Any complications
Complications
Reactionary haemorrhage
Secondary haemorrhage
5-10 days post op
Due to fibrinolysis
Cold Methods
I -Dissection and snare (most common(
II -Guillotine method
III -Intracapsular (capsule preserving)
tonsillectomy with debridment
IV -Harmonic scalpel (ultrasound)
V -Plasma-mediated ablation technique
VI -Cryosurgical technique
Hot methods
I -Electrocautery
II -Laser tonsillectomy or
tonsillotomy (CO2 or KTP)
III -Coblation tonsillectomy
IV -Radio frequency
PERITONSILLAR
ABSCESS
• PRESENTATION
– VERY PAINFUL SORE THROAT
– HIGH FEVER
– MARKED ODYNOPHAGIA –
INABILITY TO
SWALLOW SALIVA
– HOT POTATO VOICE
– TRISMUS
– SWELLING OF SOFT PALATE,
ANTERIOR
PILLARS
– TONSIL MAY OR MAY NOT BE
ENLARGED
– DEVIATION OF UVULA TO
OPPOSITE SIDE
– TORTICOLLIS
– CERVICAL LYMPHADENOPATHY
• MANAGEMENT
Nasopharyngeal Carcinoma
Rare in Europe,Common in Asian countries
Pathology
Type I - “SCCA Squamous cell CA/ 25 % of
NPC similar to
other SCCA (keratin, intercellular bridges)
Type II - “non-keratinizing” carcinoma 12 % of
NPC
Type III - “undifferentiated” carcinoma 60 %
of NPC,
Aietology
C/P;
Unknown, however EBV plays a role
Most commonly
Others; ingestionas
oflump in the foods
preserved neck
Local; Nasal obstruction, blood stained
discharge
Neurological; Invasion of skull base causing
cranial
nerve palsies (V, VI, IX, X, XII)
Otological; Serous otitis media
Nasopharyngeal Carcinoma
• Ix;
Tissue sampling, CT/MRI, Staging
• Management
Radiotherapy with concominant
chemotherapy
Poorly amendable to surgery due to
anatomical
location
• DDx
Lymphoma,
cystic adenocarcinoma,
Infection
Benign Vocal Fold
Lesions
Reactive nodules (singers nodules)
Bilateral
Smooth, rounded/pedunculated
Small
Located on true vocal folds
;Treatment
Voice training, re-education
Rarely surgical if fibrosed, chronic
Virtually never give rise to malignancy
Cavity of the
larynx
2 Folds
1. False vocal
cord.
2. True vocal
cord.
3 parts
1. Vestibule.
2. Ventricle.
3. Subglottic
ALL THE INTRINSIC MUSCLES DEVELOP FROM 6TH ARCH,
spaceEXCEPT CRICOTHYROID WHICH DEVELOPS FROM 4TH
ARCH.
Enlargement of the
laryngeal
saccule is often referred
to as
a laryngocele.
STRIDOR:Noisy breathing through an area of
decrease caliber .
Subglottic (Infraglottic) Space:Narrowest area
in infants ,so edema obstruction & respiratory
Squamous Papilloma
Most common benign neoplasm of
larynx (84%)
Found on true vocal cords
Caused by HPV 6 and 11
Soft Raspberry like appearance
May ulcerate resulting
in haemoptysis
Usually Single in Adults
Multiple in Children (Laryngeal
Papillomatosis)
with extended growth and
recurrence
Squamous Cell Carcinoma
Most common malignancy of larynx
Male>Female 6;1x
all cancers in men 2.5%
Aeitology
:Tobacco
Alcohol: (x 2.2)
Radiation, asbestos
GORD
HPV
Glottic SCC most common(60%)
>supraglottic SCC(30%)>subglottic
SCC <10%
Sx: hoarseness, throat pain, cough,
,hemoptysis
referred otalgia, dysphagia
;Diagnosis
Laryngoscopy with FNA
Squamous Cell
Carcinoma
• Management
Eradication of disease
Restoration of function;
swallowing and speech
Radiation treatment
Especially early stage disease
Cure rates equivalent to surgery
Surgical Management
Emphasis on organ preservation
Partial Larygectomy
TRACHEOSTOMY
URGENCY EMERGENCY –vertical incision.
ELECTIVE ــــــــــــــــــــــــــــــــhorizontal incision.
TIME LIMIT
TEMPORARY (HIGH)
PERMANENT (LOW)
CRICOTHYROTOMY/MINI TRACHEOSTOMY
SURGICAL TRACHEOSTOMY
PERCTANEOUS DILATATION ALTRACHEOSTOMY
PROCEDURE
COMMONEST SITE OF TRACHEAL INCISION IN
TRACHEOSTOMY
BETWEEN 3RD & 4 TH TRACHEAL RINGS
TRACHEOSTOMY I N D I C AT I O N
Vocal cord paralysis Infections
• Operative • Ac. Epiglottitis
• complications Of • Ac. Laryngo-
Thyroid, cardiac Tracheobronchitis
&Esophageal surgeries • Laryngeal Diphtheria
• Bulbar palsy. • Ludwig’s Angina.
TRAUMA Foreign body
• KNIFE GUNSHOOT Impaction
WOUNDS • Swallowed or inhaled
• CORROSIVES Foreign bodies
• SMOKE
Impacted in upper
Malignancies Airway causing Stridor.
• Advanced tumors Of larynx, tongue ,Pharynx
with STRIDOR
dysphonia
