Objectives

Medical and Surgical Management in Otolaryngology

1. History and Physical Examination
2. Oral Cavity, Oropharynx, Nasopharynx
3. Nasal and Sinus Disorders
4. Gastroesophageal and Pharyngeal Reflux Disease
5. AIDS and Otolaryngology

ANATOMY - COMPONENTS
1. Oral cavity
2. Pharynx – Oro and
3. Hypo pharynx or laryngopharynx
4. Larynx
5. Mouth/ Oral cavity

Extends from the lips to the oropharyngeal isthmus

Regions of the oral cavity;
Lips.
Vestibule.
Gums/ teeth.
Palate.
Buccal mucosa.
Retromolar trigone.
Tongue (oral).
Floor of mouth.
Buccal mucosa/ RMTOral cavity
Palate
 Hard palate
 Soft palate
Palatine aponeurosis
Muscles
Uvula
Sensory supply by V and IX
Motor supply by pharyngeal plexus (XI,X) and V CN.

Tongue
rd
1. Anterior 2/3 or oral (mobile) part
rd
2. Posterior 1/3 or pharyngeal part
3. Sulcus terminalis
4. Foramen caecum
5. Circumvallate papillae
6. Frenulam linguae
7. Submandibular duct opening
8. Dorsal lingual vein

The PHARYNX
Three parts, all opens anteriorly:
 1 - Nasopharynx.

2 - Oropharynx.

3 - Hypo/ Laryngopharynx.
Oropharynx
 Extends from soft palate to tip of epiglottis.
 Hypopharynx
 Opens anteriorly into the larynx through laryngeal inlet
 Extends from the tip of epiglottis to the esophageal opening (C6)
 Has three important areas:
1- Pyriform fossae
2- Post-cricoid area
3- Posterior pharyngeal wall
The LARYNX
Anatomy of Larynx-
Cartilages
extrinsic muscles
intrinsic muscles
subdivisions
 Supraglottis
 Glottis
 Subglottis
laryngeal inlet
 Vocal Cords - Breathing
 Vocal Cords - Speaking
 Vocal cords Positions

THROAT - PHYSIOLOGY
1. RESPIRATION
2. MASTICATION
3. DEGLUTITION
4. SALIVA PRODUCTION
5. TASTE
6. PHONATION
7. PROTECTION
Anatomy of the Nose & Paranasal sinuses
Nose and Paranasal Sinuses
Part of U.R.Tract.
External & Internal components.
Anterior opening is nostrils and posterior is choanae.
Nasal septum
Frontal Sinus
FUNCTIONS of the PARANASAL SINUSES

Nasal Respiration Airway

Air-conditioning, Humidification, Temperature regulation
Protection of Lower airway
Olfaction
Aesthetic
Resonance
Humidifying and warming inspired air
Regulation of intranasal pressure
Increasing surface area for olfaction
Lightening the skull
Resonance
Absorbing shock
Contribute to facial growth
Anatomy & Physiology of Ear

Ear
External Ear,
Pinna or Auricle
External auditory Canal
Tympanic Membrane
Middle Ear Cavity
Vestibule and cochlea
Auditory Pathway
Eighth Nerve
Cochlear Nucleus
Olive superior
Lateral leminiscus
Inferior colliculus
Medial geniculate body
Auditory radiation
Temporal Lobe

History Examination

CHIEF COMPLAINTS - EAR

1. Ear discharge /otorrhea
2. Impaired hearing/ hearing loss
3. Otalgia/ earache
4. Tinnitus
5. Vertigo
6. Ear Itching
7. Fullness of ear
8. Blocking sensation
9. Autophonia
10. Hyperacusis
11. Swelling/deformity

HISTORY OF PRESENT ILLNESS - EAR

HARD OF HEARING
1. Onset: acute / gradual / un-noticed
2. Duration: Short/Intermittent
3. Unilateral / bilateral
4. Progression:
5. Type: mild / moderate / severe
6. Aggravating / Relieving factors

CHIEF COMPLAINTS - NOSE

1. Nasal obstruction
2. Nasal discharge
3. Epistaxis
4. Disturbance of smell
5. Sneezing
6. Cough
7. Headache
8. Facial pain
9. External nasal deformity /swelling
10. Snoring
11. Change in voice –hyponasal/hypernasal

HISTORY OF PRESENT ILLNESS - NOSE

 COUGH WITH/WITHOUT EXPECTORATION
 CHANGE OF VOICE
 Rhinolalia Aperta
 Rhinolalia Clausa

CHIEF COMPLAINTS - THROAT

1. Pain
2. Sore throat
3. Difficulty in swallowing
4. Ulceration / Swelling
5. Bleeding from the gums
6. Pain during swallowing
7. Foreign body sensation
8. Difficulty in opening mouth / Trismus
9. Disturbance of taste
10. Altered speech
11. Mouth breathing
12. Respiratory difficulty
13. Hearing loss
14. Difficulty in Speech
15. Snoring
16. Cough
17. Aspiration
18. Chocking Spells
19. Hemoptysis
20. Regurgitation

• HISTORY OF PRESENT ILLNESS - THROAT

DIFFICULTY IN SWALLOWING / DYSPHAGIA
Onset
 Duration
Painful / Painless
For Solid / Liquid / Both
Persistent / Intermittent
Progression
Cough
Swelling in neck

HISTORY OF PRESENT ILLNESS - THROAT

CHANGE OF VOICE
1. Duration
2. Onset: gradual/sudden
3. Character : clear/husky/hoarse/hot potato
4. Loud/soft
5. Periodic/non-periodic
6. Fatigable/ non-fatigable
7. Diurnal variation
BREATHING DIFFICULTY
Duration
Onset
Progress
AGGRAVATING FACTORS
Relieving factors
PAST HISTORY
Similar Complaints in the past & treatment history
Surgeries , Abscesses, Blood transfusions
Hypertension
Diabetes
Tuberculosis
Epilepsy
Bronchial asthma
DRUG ALLERGY HISTORY
Drug allergies
Use of ototoxic drugs
PERSONAL HISTORY
Sleep & Appetite: Normal / poor / good
Profession
Addictions (if any):
FAMILY HISTORY
Similar complaints in family: Yes / no
Living conditions: Nuclear family / Joint family; No. of children in family
Socio-economic status: Poor / middle class / upper class

GENERAL EXAMINATION
Consciousness
Orientation
Build
Nourishment
Pallor / Icterus / Cyanosis / Lymphadenopathy
GENERAL EXAMINATION
Vital Data:
Pulse
Blood Pressure
Temperature
Respiratory rate

LOCAL EXAMINATION OF EAR

1. Pre auricular area
2. Pinna
3. Post auricular area
4. External Auditory Canal
5. Tympanic membrane
6. Middle ear
7. Facial nerve
FUNCTIONAL EXAMINATION OF EAR
TUNING FORK TESTS
Rinne Test:
WEBER TEST :
ABSOLUTE BONE CONDUCTION TEST
Nose-Local Examination
External frame work
Vestibule
Anterior rhinoscopy:
Posterior rhinoscopy:
Naso endoscopy

EXAMINATION OF PARANASAL SINUSES

MAXILLARY SINUS
Frontal Sinus
Etmoid sinus
Sphenoid Sinus
FUNCTIONAL EXAMINATION OF NOSE
PATENCY OF NOSE :
SENSE OF SMELL :
Common substances used to test the sense of smell are peppermint, coffee powder , essence of rose.
LOCAL EXAMINATION OFTHROAT
Mouth opening:
Lips:
Gums:
Teeth:
Hard palate:
Soft palate:
Tongue:
Floor of mouth
Anterior pillar
Tonsils
Posterior pillar
Uvula
Posterior pharyngeal wall
INDIRECT LARYNGOSCOPY :
ENDOSCOPY
Flexible endoscopy
Rigid endoscopy
Stroboscopy

ASSESSMENT OF VOICE
-Quality of voice: hoarse/ rough/ breathy/ bitonal/ dysphonic/ whispered / feeble.
LOCAL EXAMINATION OF NECK
INSPECTION:
Thyroid enlargement
Trachea midline/ not
Scars/Sinuses
Swelling / Any pulsations
PALPATION:
External laryngeal framework
Laryngeal crepitus
Thyroid
Carotids
Lymph nodes