Download Presentation

OTOLARYNGOLOGY
2014 PANRE Recertification Review
Joshua F. Smith, MMS, PA-C
Duke Otolaryngology, Head & Neck Surgery
Disclosure
 I am the chair of the Professional
Development Review Panel for the NCAPA
and am a paid speaker.
 I have no other financial disclosures or
conflicts of interest.
Goals
 Review ENT Anatomy and Physiology
 Discuss Common ENT Disorders
 Signs and Symptoms
 Physical Exam
 Diagnostics
 Treatment
 Answer 100% of ENT PANRE questions correctly
OTOLOGY
Cochlea
The Mechanism of Hearing
Sensorineural Hearing Loss




Presbycusis
 Ototoxicity
Noise induced SNHL
 Acute Labyrinthitis
Idiopathic Sudden SNHL  Meneire’s Disease
Acoustic neuroma
Presbycusis
•Age related hearing loss
•Bilateral, high frequency SNHL
•Onset is subtle, gradual, stable
•Difficulty with social situations
•Better in quiet environments
•Treat with hearing aids
Noise Induced SNHL
•Sudden or prolonged
Noise exposure
•Notched Audiogram
3000-6000Hz
•Recovery high frequency
•Unilateral or Bilateral
•Loss is permanent
•Advise Hearing protection
Acoustic Neuroma
•Slow growing, non-cancerous tumor arising from Schwann cells
CN 8 (vestibulocochlear nerve)
•Causes Asymmetric SNHL
•Symptoms: hearing loss, tinnitus, imbalance, poor speech discrimination
•Diagnosed with MRI of Internal Auditory Canals with contrast
•Treatment includes: observation, stereotactic radiation, and/or surgery.
Sudden SNHL

Any SNHL that has occurred within 72 hours



Possible causes






Usually has no warning or prodrome
Often patient complains of dizziness/vertigo, ear fullness and tinnitus
Viral Labyrinthitis
Autoimmune
Vascular compromise
An otologic emergency
Refer to ENT without delay
When in doubt, treat with steroids!
 Prednisone
 60mg x 8 days, 40mg x 2 days, 20mg x 2 days
Medications which can cause
Ototoxicity
• Aminoglycoside antibiotics
• (Streptomycin, Dihydrostreptomycin, Kanamycin,
Gentamicin, Neomycin, Amikacin, Tobramycin,
Netilmicin)
• Vancomycin
• Erythromycin
• Chemotherapy (Cisplatin, Nitrogen mustard)
• Loop diuretics (Furosemide)
• Salicylates
• Quinine
Sample PANRE question #1
Tina Tanner is a 62 year old female with gradual loss of
hearing in her right ear for more than a year. Associated
symptoms includes right sided tinnitus and imbalance. After
performing a proper history and physical exam, you astutely
decide to order an audiogram. The audiogram reveals an
asymmetric sensorineural hearing loss on the right side. What
is the next appropriate intervention?
a.
b.
c.
d.
e.
Order a contrasted MRI of the internal auditory canals
Place the patient on a 12 day course of prednisone
Order a non-contrasted CT of the temporal bone
Start Meclizine 25mg TID for her imbalance
Advise the patient to utilize a right sided hearing aid
Conductive Hearing Loss






EAC swelling/stenosis/obstruction
TM perforation
TM retraction/ETD
Middle ear effusion/infection
Otosclerosis
Cholesteatoma
EXTERNAL EAR
External Auditory Canal Obstruction
 Attempt to remove if it
appears you can get it on
the first try.
 If completely obstructing
EAC, if TM perf present, or
if touching the TM, consult
ENT
 Do not attempt to remove
batteries, consult ENT and
do not lavage.
Auricular Hematoma
 Physical trauma to the
auricle which causes
shearing of the tissues
and a perichondral
hematoma.
 The auricle will be very
swollen.
Auricular Hematoma
 Failure to treat early can
lead to permanent
remodeling of the auricle,
cauliflower ear.
 Treat with I&D, then
bolster both sides with
dental rolls.
Otitis Externa (OE)
 Infection or Inflammation of the external auditory canal
 Differential Diagnosis:
 Acute Bacterial
 Acute Fungal
 Chronic OE
 Associated Symptoms





Pain
Hearing Loss
Otorrhea
Fullness
Itching
 Physical Exam
 Tenderness of tragus/auricle
 Swollen EAC
 Purulent drainage
Otitis Externa (OE)
 Bacterial
 Streptococcus
 Staphylococcus
 Pseudomonas
 MRSA
 Fungal (otomycosis)
 Aspergillus
 Candida
Acute Bacterial OE
•Remove purulent debris
•Suction if possible
•If the canal is too narrow,
insert a wick
•Topical Antibiotic Drops:
•Neo/Poly/HC..use only
if TM is intact
•Fluoroquinolone
•Ciprofloxacin
•Ofloxacin
•Culture otorrhea
(aerobic and fungal) if
topical antibiotics fail
Acute Fungal OE
•Fungal ear infections are usually very itchy
•They can look like bacterial infections
•Suspect fungal infections if antibiotic drops
fail to resolve the problem
Treatment of Fungal OE
 Remove Debris if possible
 Topical
 Acetic acid ear drops
 Antifungal drops (clotrimazole)
 Powders
 CASH powder:




Chloramphenicol
Amphotericin B
Sulfamethoxazole
Hydrocortisone
Chronic OE
•A chronic skin condition, usually eczema
•Treat any acute infection first
•Then, treat underlying cause of OE
•Topical steroid cream for eczema
•Water and vinegar lavage (acidify canal)
•Avoidance of trauma (No more Q-tips!)
Malignant Otitis Externa

OE that causes temporal bone destruction

Aka Temporal Bone Osteomyelitis

Seen in diabetics and
immunocompromised patients

Usually caused by Pseudomonas
aeruginosa

Rads:
 MRI with contrast
 Gallium uptake
 CT Temporal Bone

Emergency, refer to ENT if suspected

Treatment


IV antibiotics
Mastoidectomy if not responsive
MIDDLE EAR DISORDERS
Normal Tympanic Membrane
Eustachian Tube Dysfunction
and tympanic membrane retraction
Causes:
•Nasal Allergy
•URI
•Nasopharynx mass
•Anatomic
Signs:
•TM retraction
Symptoms:
•Hearing Loss
•Ear Fullness
•Popping/Crackling
•Improvement with Valsalva
Eustachian Tube Dysfunction
 Treatment
 If acute ETD, counsel patience and time
 Nasal steroid spray
 If ETD is chronic and hearing loss is present,
bilateral myringotomy with tube placement
 ETD and TM retraction- Risk of cholesteatoma
Cholesteatoma
 Non-cancerous skin cyst
 Can arise from retraction pocket or after the middle ear is
seeded with skin cells following perforation
 Causes a conductive hearing loss
 Destroys bone through enzymatic action
 Requires surgical excision
Cholesteatoma
Otitis Media with Effusion
(aka Serous Otitis Media)
Caused by:
•Chronic ETD
•Acute OM
•Barotrauma
•Nasopharynx Mass
Signs:
• Bubbles
•Amber coloration
•Air-Fluid Line
•Immobile TM to pneumatic
Symptoms:
•Conductive Hearing Loss
•Ear Fullness
Otitis Media with Effusion
 This is treated very similarly to TM




retraction.
Counseling is very important!
 Hearing loss may be present for 3-4
months
 Patience is key!
Nasal steroids
Myringotomy with tube placement if not
better in 3-4 months.
Rule out Nasopharyngeal Mass/Tumor
Tympanostomy Tube
Acute Otitis Media (AOM)
Symptoms
 Ear Pain
 Hearing Loss
 Tinnitus
 Ear Fullness
 Sharp pain with
otorrhea -> perf
Treated with oral
antibiotics
Signs:
•Bulging ear drum
•White middle ear
mucus/pus
•Loss of landmarks
•Obscured malleus
Complications of AOM







Mastoiditis
Labyrinthitis
Meningitis/Intracranial abscess
TM perforation
Hearing loss
Tympanosclerosis
Facial nerve paralysis
Acute Mastoiditis
 Complication of OM and is
defined as spread of infection
to the mastoid air cells
 Physical exam findings
include fever, otalgia, post
auricular erythema, swelling,
and tenderness with
protrusion of the auricle.
 Treatment includes IV abx,
ENT consult, admission for
observation and often
mastoidectomy
Tympanic Membrane Perforation
TM Perforation
 Symptoms





Hearing loss
Tinnitus
Otorrhea
Ear pain if acute
Bleeding
 Treatment
 Watchful waiting
 Treat infections with topical drops (quinolones only)
 Tympanoplasty
 Paper patch
 Temporal muscle fascia graft
Acute TM perforation
Chronic TM perforation
Traumatic TM Perforation
 Usually posterior
 Bloody
 Symptomatic hearing
Loss
 Get audiogram
 Put on non-ototoxic ear
drops (ofloxacin,
ciprofloxacin)
 Keep ear dry and give TM
time to heal and recheck
hearing in 1-2 months
Barotrauma
 Rapid pressure changes cause negative pressure in the
middle ear resulting in effusion and ruptured blood vessels.
 Treat with nasal steroids and time, generally will resolve
 Audiogram will help determine if any significant hearing
loss occurred.
Bullous Myringitis
 Likely caused by Mycoplasma, H. Flu, or Strep pneumo
 Very painful, especially when coughing, sneezing
 Treat with antibiotics (macrolide like clarithromycin) and topical
antibiotics if vesicles rupture
 Pain management with opiate is acceptable for the short term.
Otosclerosis
•Caused by fusion of the stapes
footplate to the oval window
•Usually has family history
•Causes a conductive hearing loss
•Can be treated surgically with a
stapedectomy
•Otherwise, can be treated with
hearing aids
Sample PANRE question #2
Alice Cooperton is a 35 year old with Type 1 diabetes
mellitus. He has had multiple sets of pressure
equalization tubes in the past. He presents for an
evaluation of chronic ear drainage. He has been on
multiple oral and topical antibiotics without
improvement. His physical exam reveals an inflamed
retraction pocket in the pars flaccida with granulation
and keratinous debris. The most likely diagnosis is:
a.
b.
c.
d.
e.
Malignant otitis externa
Chronic otitis media with a TM perforation
Chronic fungal otitis externa
Pars flaccida cholesteatoma
Bullous Myringitis
MISCELLANEOUS
• Tuning Fork Tests
• Tinnitus
• Vertigo
Tuning Fork Test
 Weber
512c without weights
Tuning Fork Test
 Tuning Fork Test- Rinne
Interpreting Tuning
Fork Results
Fork
Placement
Normal Hearing
Conductive
Loss
Sensorineural
Loss
Test
Purpose
Weber
To determine
Conductive
versus
Sensorineural
loss in
unilateral loss
Midline
Midline
sensation;
tone heard
equally in
both ears
Tone louder in
poorer ear
Tone louder
in better ear
Rinne
To compare
patient’s
air and bone
Conduction
hearing
Alternately
between
patient’s
mastoid
and entrance
to ear canal
Positive Rinne:
Tone louder at
Ear.
(Air Conduct
> Bone Conduct)
Negative Rinne:
Positive Rinne:
Tone louder at
Ear.
(Air Conduction >
Bone Conduct)
Tone louder on
Mastoid.
(Bone Conduct
> Air Conduct)
Tinnitus
 Any abnormal sound in the ear
 Treatment Get a hearing test- Tinnitus may be a sign of hearing loss
 No studies have shown definitively that surgical or pharmacological
interventions help resolve benign tinnitus due to SNHL
 If tinnitus caused due to HL which is correctable, then often resolving the
HL will reverse the tinnitus (wax, fluid, TM perforation)






Patient Education
Anxiety relief
Background Noise
Stop medications which can cause Tinnitus
Avoid caffeine/nicotine
Tinnitus Retraining Therapy
Differential Diagnosis
Dizziness– caused by many, many conditions
 Cardiologic
 orthostatic HTN, arrhythmia,
CAD, etc.
 Neurologic
 Acoustic neuroma, TIA,
stroke, Parkinson's,
neuropathy, Migraine
 Hematologic
 Anemia
 Psychological
 Anxiety, panic
 Metabolic/Endocrine
 Hypothyroidism
 Menopause
 Orthopedic
 Cervical disk disease
 Lower extremity arthritis
 Geriatric
 Proprioception
 Center of balance
 Pharmacologic
 Polypharmacy
 Side effects
Differential Diagnosis
 Vertigo (a false impression of movement)
 Peripheral (otologic)
 Benign Paroxysmal Positional Vertigo (BPPV)
 Meniere’s Disease
 Acute Labyrinthitis / Vestibular Neuritis
 Central (Neurologic)
 MS, Migraine HA’s, benign intracranial hypertension
BPPV (Benign Paroxysmal
Positional Vertigo)
• Intermittent vertigo which lasts
less than a minute, usually
seconds
•Provoked by supine head
movements to the right or left
•Better when holding head still
•Caused by displaced otoliths in
the semicircular canals
•Positive Dix-Hallpike maneuver
•Treated with Epley maneuvers
Meniere’s Disease
•A disorder of increased endolymphatic fluid
pressure
•Classic Triad•Episodic SNHL, Vertigo x hours, and
Roaring Tinnitus
•Low-frequency SNHL, ascending, and
usually unilateral.
•Treatment:
•Diuretics
•Low sodium diet
•Anti-vertigo medication
•Surgery (to prevent vertigo)
•Surgical options include:
•Endolymphatic sac decompression
•Gentamicin injection
•Selective vestibular nerve resection
•Labyrinthectomy
Vestibular Neuritis/
Labyrinthitis

Infection or inflammation of the
inner ear.
 V. Neuritis- affects semicircular
canals only- vertigo only
 Acute Labyrinthitis- vertigo and
sudden hearing loss

Vertigo is severe, lasts 24-48
hours, is disabling.
 Vertigo subsides and the patient
will have several weeks of
imbalance
 Treat with physical therapy
 Treat sudden SNHL with high
dose prednisone
Vertigo Recap
 BPPV- lasts seconds, head movements, no
hearing loss
 Meniere’s- lasts several hours, associated
hearing loss, tinnitus, ear fullness
 Neuritis/Labyrinthitis- lasts 1-2 days, gradual
recovery
Sample PANRE question #3
Axel Rosenthal, age 43 presents with a complaint
of loss of hearing in his right ear. Tuning fork tests
revealed that air conduction is greater than bone
conduction bilaterally. The Weber test lateralized to
the left. What is the probable diagnosis?
a.
b.
c.
d.
e.
Right sided conductive hearing loss
Right sided sensorineural hearing loss
Left sided conductive hearing loss
Left sided sensorineural hearing loss
The patient has normal hearing
Sample PANRE question #4
Pat Benicar is a 75 year old female who presents
with momentary room-spinning vertigo which
occurs whenever she looks up or rolls over in bed.
She denies hearing loss, tinnitus, and ear fullness.
What is the appropriate treatment?
a.
b.
c.
d.
e.
Low salt diet, 1500-2000mg per day.
Meclizine 25mg TID
Prednisone, high dose x 12 days
Epley Maneuvers
Amoxicillin 500mg TID
RHINOLOGY
Epistaxis
 Anterior- Kiesselbach’s plexus
 Posterior- Woodruff’s plexus
 Local risk factors
 Digital manipulation
 Septal deviation
 Inflammation
 (allergies, infection)





Cold dry air
Foreign body
Juvenile angiofibroma
Septal perforation
Drug use
 Nasal steroids
 Illicit drugs
 Systemic Causes of Epistaxis
Systemic Causes of Epistaxis
 Clotting Disorder
 Hypertension
 Leukemia
 Liver disease
 Medication (aspirin, plavix, coumadin)
 Thrombocytopenia
 Wegner’s Granulomatosis
Epistaxis
 Treatment
 Manual compression
 Afrin
 Cautery
 Anterior/Posterior Packing
 Surgical
 Arterial Ligation
 Embolization
 Cauterization
RHINITIS
Allergic Rhinitis
 IgE mediated reaction causing mast cells and basophils
to release histamine, leukotriene, serotonin, and
prostaglandins
 Common allergens: Grass/Tree pollen, mold, dust,
dander
 This causes inflammation of the nasal mucosa.






Nasal congestion
Rhinorrhea
Sneezing
Itching
Watery eyes
Allergic Shiner
Allergic Rhinitis
Treatment
 Avoidance of allergens
 Nasal Saline lavage ------- >
 Nasal steroids
 (fluticasone, mometasone, budesonide)
 Antihistamines
 2nd generation (fexofenadine, cetirizine, loratadine)
 Topical
 nasal: (azelastine)
 eye: (olopatadine, azelastine)
 Leukotriene inhibitor (monteleukast)
 Immunotherapy (allergy shots)
Nasal Polyposis
 Seen with chronic rhinosinusitis,




Samter’s Triad, and cystic fibrosis
Treat allergies
Nasal steroids
Systemic steroids
Surgical if obstructive, frequent
infections, bony destruction
Samter’s Triad
 Triad consisting of
 Aspirin allergy
 Nasal polyposis
 Asthma
Often seen with allergic rhinitis and causes severe
pansinusitis due to severe nasal polyposis.
Vasomotor (Non-Allergic)
Rhinitis
 Similar to allergic rhinitis, but caused by non-
allergy mediated inflammation due to
irritation of nasal mucosa






Temperature
Exercise
Foreign body
Fumes
Food
Medication
Rhinitis Medicamentosa
 Drug induced rhinitis caused by overuse of
topical decongestants (phenylephrine,
oxymetazaline)
 Rebound congestion
 Treatment: STOP using the spray
 May substitute nasal steroids or antihistamine
 Afrin taper
 Prednisone taper
Viral Rhinitis
 Upper respiratory tract infection caused by adenovirus,
parainfluenza, corona virus, rhinovirus (and many more).
 Symptoms usually last <7 days







Sore throat
Nasal congestion
Rhinorrhea (may be yellow/green)
Fever
Cough (may be productive)
Malaise
Fatigue
 Treatment: Supportive and Time. OTC antihistamines,
decongestants, mucolytics, fluids, ibuprofen,
acetaminophen, rest.
SINUSITIS
Acute Bacterial Rhinosinusitis
ABRS

Signs and Symptoms
 Persistent Symptoms (>10 days)
 Localized Facial Pain
 Upper Tooth Pain
 Purulent nasal discharge
 Nasal congestion
 Severe Sx (3-4 days):
 Fever >102 AND
 Purulent discharge OR
 Facial pain
 Double Sickening (3-4 days)
 New onset of headache, fever, nasal d/c following viral URI which
was improving after 5-6 days
Acute Sinusitis

Primary Treatment

Empiric Antibiotics

Pathogens
Strep. pneumo, H. flu, M. catarrhalis, Staph. aureus

1st Line (5-7 days adults, 10-14 days children)

Amoxicillin-clavulanate (Augmentin)

2nd Line (10-14 days all)






High dose amox/clav (2g BID or 90mg/kg/day BID)
doxycycline (adults)
levofloxacin (adults)
moxifloxacin (adults)
clindamycin/3rd gen cephalosporin (option for children)
Not Recommended for empiric treatment: amoxicillin alone, azithromycin,
clarithromycin, TMP/SMX, 1st, 2nd gen cephalosporins
Subacute Sinusitis
 Sinusitis for 4-12 weeks
Chronic Sinusitis
Sinusitis for >12 weeks
Pathogens
• Same as acute (S. pneumo, H. flu, M. cat., S. aureus)
• Klebsiella, Pseudomonas, Proteus, Enterobacter,
MRSA
• Consider anaerobic and fungal etiologies
• Consider antibiotic resistance as cause
• Culture and sensitivity
• Consider structural abnormality: (non-contrasted CT
Sinus) obtained after appropriate antibiotics
Sinus CT
Nasal Foreign Body
•Seen often in pediatrics
•Consider if patient has foul nasal
odor, chronic nasal discharge, nasal
obstruction, sinusitis
•Chronic foreign bodies can cause
pressure ulcers, infection, abscess
•Once removed, treat with
antibiotics if signs of infection are
present
Sample PANRE Question #5
Small E. Biggs is one of your frequent patients who is
Notorious for asking for antibiotics whenever he is sick.
He complains of an itchy runny nose, nasal congestion,
cough and post-nasal drip. His symptoms have been
present for 2 months. What is the most effective
medication for this patient?
a.
b.
c.
d.
e.
Two pack of azithromycin 250mg
Diphenhydramine 25mg
Moxifloxacin 400mg a day
Guaifenisen/dextromethorphan elixir
Fluticasone nasal spray
PHARYNGITIS
Pharyngitis
 Differential Diagnosis









Post-nasal drip
Viral pharyngitis
Group A strep
Tonsillitis
Mononucleosis
Peritonsillar abscess
Cancer
HIV
Rare: gonorrhea, HSV
Viral Pharyngitis
 Pathogens

adenovirus, coronavirus, rhinovirus,
influenza, parainfluenza,
coxsackievirus
 Self-limiting illness
 Symptoms
 Erythema






Edema
Dysphagia
Pain
Fever
Lymphadenopathy
Upper respiratory illness symptoms
 Resolves in 3-7 days
 Treat with OTC supportive meds
Strep Pharyngitis
•Signs and Symptoms
•Sore throat
•Dysphagia and Odynophagia
•Erythema (w/ or w/o exudate)
•Airway obstructive symptoms
•Tender lymphadenopathy
•Fever and malaise
•Only a culture can distinguish between viral
tonsillitis and GABHS
•Rapid Strep Test
•If negative, 24 hour culture
•Treat initially with GP (strep/staph) coverage x 10
days
•1st Line: PenVK, Bicillin injection, Amox/clav
•2nd Line: 1st gen cephalosporin (not if PCN
allergy), clindamycin, clarithromycin
Acute Tonsillitis
Can be viral or bacterial
Common bacteria Group A Strep pyogenes
Peritonsillar Abscess
 A collection of mucopurulent material in the
peritonsillar space
 Often follows tonsillitis
 Signs/Symptoms







“Hot potato” voice
Severe throat pain and dysphagia
Inability to open jaw (trismus)
Asymmetric swelling of soft palate
Uvula deviation
Copious salivation
Fever, severe malaise
Peritonsillar Abscess
 Treatment
 Incision and
Drainage
 Antibiotics with
anaerobic coverage
 Amox/clav
 Clindamycin
Mononucleosis
 Pathogens


EBV- Epstein Barr Virus
CMV- Cytomegalovirus
 Most mono patients were asymptomatic
 Signs/Symptoms





Fatigue
Malaise
Severe sore throat with tonsillar edema/erythema/exudate
Lymphadenopathy
Hepatosplenomegaly
 Labs:


Monospot (heterophile antibody test)
CBC diff may show atypical lymphocytes
 Treatment: OTC, pain control, consider steroids, avoid contact
sports, seatbelt counseling
Parotitis/Sialadenitis
 Painful swelling of
parotid/salivary gland
 Can often express pus
from the parotid duct
(Stensen duct)
 Bacterial- usually staph
 Rarely: extrapulmonary TB
 Viral- Mumps
 Treat with antibiotics,
sialagogues and warm
compresses
Sialolithiasis
 Salivary duct calculus
 Most commonly located at




the submandibular
(Wharton’s) duct.
Intense swelling of the salivary
gland with salivation
Symptoms subside between
meals
Treat with hydration, warm
compresses, sialagogues.
If not better, may need
surgical removal.
Sample PANRE QUESTION #6
Will I. Amherst is a 40 year old male who is seen on an
urgent work-in for “sore throat” for the past 1 day. Upon
exam he appears ill, is sitting uncomfortably with his neck
extended. He speaks with a deep muffled voice. Upon
exam, he is febrile, has trismus. His right soft palate is
bulging, causing the uvula to shift past mid-line. The most
likely diagnosis is:
a.
b.
c.
d.
e.
Acute mononucleosis
Acute streptococcal pharyngitis
Acute peritonsillar abscess
Viral pharyngitis
Squamous cell carcinoma of the right tonsil
ORAL TUMORS AND LESIONS
Oral Candidiasis
 Candida albicans
 Usually when host flora is altered
 Antibiotics
 Steroid inhalers
 Immunocompromise
 Signs:
 Erythematous mucosa with white satellite
lesions
 Treat with antifungals
 Oral Nystatin solution
 5cc swish and swallow QID
 Fluconazole
 200mg day 1, 100mg po day 2-5
Squamous Papilloma




Caused by Human Papilloma Virus
Has the potential to become squamous cell carcinoma
Excisional biopsy is recommended
Often return despite biopsy
Leukoplakia
•
•
•
•
•
Precancerous white plaque on a
mucous membrane
Can have different levels of
dysplasia
• Mild/Moderate/Severe
Biopsy to confirm benign finding
and stratify risk based on dysplasia
Recommend routine monitoring
Smoking cessation
Aphthous Ulcers
•Idiopathic ulcerations of mucous membranes
•Benign and self limiting
•Very painful, lasting 10-14 days
Oral Herpes Simplex
 Caused by herpes simplex




virus. Very contagious.
Painful grouped vesicles,
located outside the oral
cavity.
Will crust over after 3-4
days
Symptoms usually last 2
weeks.
Treat with antivirals within
72 hours of symptoms
(oral or topical)
Squamous Cell Carcinoma
Lateral Surface of Tongue
Posterior Pharyngeal Wall
HOARSENESS
Hoarseness
 Duration of symptoms
 Acute or chronic
 Associated: sore throat, dysphagia, cough,
hemoptysis, reflux, heartburn, allergies
 Occupation (teacher, singer, phone operator)
 Smoking and alcohol
 Recent surgery
 Thoracic Surgery
Hoarseness
Differential Diagnosis
 Acute but benign
 Infectious Laryngitis
 (viral, bacterial, or fungal)
 Recent Intubation
 Acute and severe
 Vocal Fold Paralysis
 Vocal Cord Hemorrhage
 Chronic and benign





Allergic Post-Nasal Drip
LPR/GERD
Inflammation caused by irritants (smoking)
Vocal Abuse
Vocal Nodules, cysts, papilloma, and Polyps
 Chronic and severe
 Cancer
Acute Laryngitis
Normal Larynx





Acute Laryngitis
Usually self-limiting
Can be caused by viral infection, vocal misuse, or exposure to noxious agents
Treat with voice rest and fluids
Smoking cessation a must
Steroids and antihistamines not indicated
Squamous Cell Carcinoma of
the Larynx
 Risks include Tobacco and
ETOH
 Usually very hoarse
 Associated symptoms





Throat pain
Dysphagia/Odynophagia
Weight Loss
Ear pain
Hemoptysis
 Treated with a combination of
modalities: Surgery, chemo,
XRT
QUESTIONS?