Professional Documents
Culture Documents
Progress Test in ENT
Progress Test in ENT
Itinerary
Welcome
Otolaryngology Staff
Tips and Resources
MCQ Pre-Test
The ENT History
The head and neck exam
Important ENT Topics
Otolaryngology Staff
Victoria
Dr. D. MacRae - Peds/Otology
Dr. M. Husein - Peds
Dr. J. Yoo - H&N
Dr. K. Fung - H&N
Dr. J. Franklin H&N
Dr. H. Lampe - H&N
Dr. S. Sukerman - General
University
Dr. L. Parnes - Otology
St. Josephs
Dr. E. Wright - Rhinosinology
Dr. V. Janzen - Rhinosinology
Dr. C. Moore - Facial Plastics
Dr. R. Ruby - Otology
Smoking/alcohol history
Numbers of infections (e.g. ear, sinus, throat) in last
1, 2, 3 yrs
You wont know what is normal until you see it many times
Hearing loss
Consistency?
Tinnitus
Vertigo
Otorrhea
Otalgia
Nasal:
Noise exposure
Drugs:
Ototoxic agents
Family History
tenderness, swelling,
nodules
landmarks
color, contour
perforations, mobility
all 4 quadrants
Examples of Abnormalities...
Tympanosclerosis
Osteoma
Otitis Externa
Cholesteatoma
2.
3.
Disease affecting
outer/middle ear
Disease affecting cochlea or
CN VIII
Response to questions
during history
Response to a whispered
voice
Tuning fork air/bone
conduction
Weber
Rinne
Expected
Findings
CHL
SNHL
No Lateralization
Lateralization to ear
with loss
Lateralization to
better hearing ear
Bone conduction
better than air
conduction (Rinne
negative)
Air Conduction
better than bone
conduction
Rhinorrhea
Nasal obstruction
Sneezing
Discharge
Olfaction
Allergies
Sinuses
Facial pain
Dental pain
Hearing loss
Post nasal drip
Olfaction
Congestion
Discharge
Flexible/Rigid Endoscopy
Sinusitis
Examples - Polyps
Septal Perforation
Nasopharyngeal Carcinoma
Pain
Bleeding
Dysarthria
Numbness/Dysgeusia
Referred otalgia
Dry mouth
Hypopharynx/Larynx
Swallowing:
Dysphagia
Solids vs liquids
Odynophagia
Aspiration
Reflux
Dysphonia
Dysphagia
Cough/hemoptysis
Pain
Shortness of breath
Stridor
Globus
Inspect teeth
size, consistency,
tenderness, warmth,
mobility
Pre-auricular
Post-auricular
Occipital
Jugulodigastric
Submental/submandibular
Facial
Anterior&Posterior Cervical
Supraclavicular
The NECK
Examine on deglutition
The Larynx
Indirect laryngoscopy
Direct laryngoscopy
Leukoplakia
Examples - Hypopharynx/Larynx
Foreign Body (Fish Bone)
Vocal Cords
Cyst
Papilloma
Nodule
Polyp
Leukoplakia
Hypopharynx/Supraglottis
Pyriform Sinus Ca
Epiglottitis
Cranial Nerves
Consider screening
neurological exam in dizzy
patients:
Mental Status
Cranial Nerves
Gross Motor
Gross Sensory
Reflexes
Cerebellar Tests (Rhomberg,
finger-to-nose, heel-shin, rapid
alternating hand movements)
Otitis Media
Otitis Media
Otitis Media
Why?
When to refer
Intracranial
Meningitis
Epidural abscess
Sigmoid sinus
thrombosis
Brain abscess
Otitis Externa
Otitis Externa
Debridement
ototopical agents (Ciprodex, Garasone, Sofracort) 3-7 days
PO antibiotics if severe (cellulitis/nodes)
analgesics
water precautions, pt education
Tinnitus
Tinnitus - DDx
Hearing Loss
Hearing Loss
Conductive
External Ear
congenital atresia
cerumen
foreign body
malformations
infections
neoplasms
Middle Ear
congenital
effusions (serous OM)
acute OM
neoplasms
otoclerosis
TM perforation
ossicular discontinuity
tympanoscerosis
otosclerosis
ossicular fixation
mastoiditis
Sensorineural
congenital
acquired
presbycuisis
noise-induced HL
head trauma
drug toxicity
Menieres
sudden SNHL
tumor
perilymphatic leak
CNS disease (e.g. MS)
labyrinthitis
Vertigo
Vertigo
Menieres Dz
Benign Paroxysmal
Positional Vertigo (BPPV)
Labyrinthitis/Vestibular
Neuronitis
sudden onset
lasts hrs, subsides over
days
hx viral infection
Central
Facial Paralysis
Electrophysiologic tests
Medical tx:
Surgical Tx:
Eye Care
Epistaxis
Epistaxis
Site of bleed -
Anterior 90%
Posterior 10%
Examination:
- ABCs and vitals (orthostatics)
- General exam (purpura, petechiae)
- Nasal exam (head light, suction, decongest,
determine bleeding site)
Reassure patient
IV hydration depending on extent of bleed
control HTN
Bloodwork CBC, INR/PTT, Group and Cross
Treatment
- depends on etiology
- those with systemic factors, conservative,
noncauterizing, cartilage-sparing techniques for
initial therapy
correct coags, d/c meds
Sinusitis
Sinusitis
Sinusitis - Classification
Sinusitis - bacterial
Acute
lasts 1 day 4 weeks
- management antbx for at least 7 days post-sx
- surgery rarely necessary complications
Subacute
lingers 4 weeks 3 months
- inflammation still reversible med. managet
Chronic
- persisted disease > 3 months
- generally irreversible damage to sinus drainage
- surgical managet
Sinusitis
Viral sinusitis:
Fungal sinusitis:
Complications of sinusitis
orbital
intracranial
need aggressive medical AND surgical tx
Obstructive Sleep
Apnea
OSA: Pathophysiology
OSA Management
Treatment
Oral Appliance
Neoplasms of the
Head and Neck
Peritonsillar
Abscess
Classic findings:
Peritonsillar abscess
Management:
Considerations
Severity of symptoms
? Immediate a/w
Hx tobacco/ETOH
Fevers/chills/pain
? Infection ? site
Hx previous intubation
angioedema
Severe hoarseness
Differential Diagnosis
Upper A/W obstruction
MISI BOVO
Malignant tumours (SCC, Adenoid cystic of trachea, thyroid Ca)
Infections (Epiglottitis, supraglottitis, Tracheitis, cellulitis FOM
Lugwigs, Retropharyngeal abscess)
fibromas)
Body (Foreign)
Differential Diagnosis
Upper A/W obstruction
Angioedema
Management:
- trauma protocol ABCs, C-spine
- Ear exam
- Assess facial nerve early (immediate vs
delayed)
- Assess hearing Audiogram, tuning forks
- Radiology Head CT (brain injury) + CT
temporal bone windows
Treatment:
immediate facial nerve paralysis OR to repair
delayed FN paralysis observe, steroids, eye
protection
CSF leak conservative bed rest, >90% resolve
in two weeks
SNHL hearing aid
conductive HL ossicular reconstruction
vertigo tx symptomatically, Serc, Meclizine, PT
Nasal Fracture
Hearing Loss
Sudden SNHL