Download Otorhinolaryngology

Otorhinolaryngology
What is otorhinolaryngology?
• Otorhinolaryngology: the study of the
ear, nose, and throat
– Derives from oto = ear; rhino = nose; and
laryn = throat
• Otolaryngology: abbreviated, mostcommonly used form
• Otolaryngologists (ENT physicians) are
trained in both medicine and surgery.
Anatomy of the Ear
• Two sensory systems:
– Auditory system: detection of sound
– Vestibular system: maintains equilibrium
• The Outer Ear
– Pinna or auricle: Visible part of the ear
– External auditory canal: Tubular passage
leading inward to the eardrum
– Tympanic membrane (eardrum)
• The Middle Ear
– Lies inside the skull with only small layer of
bone separating it from the brain
– The ossicular chain: Malleus (hammer), incus
(anvil), and stapes (stirrup), called ossicles that
connect the eardrum to the middle ear and
derived from Latin terms that describe their
shapes
– Oval window: Covers opening to the inner ear
– The eustachian tube: Equalizes air pressure
• The Inner Ear
– Also called the labyrinth, a word meaning “a
complex system of paths and tunnels.”
– Hearing: The cochlea and organ of Corti
– Balance: The utricle, saccule, and three
semicircular canals
• The Nose
– Components:
• Nasal bone
• Upper jaw bone (maxilla)
• Nasal septum made of bone and cartilage separating
right and left nostrils
• Paranasal sinuses
– “Sinus” means a hollow cavity or space in bone
or other tissue. “Nasal sinus” is an air-filled,
mucus-lined cavity within the cranial or facial
bone
•
•
•
•
Maxillary sinuses (cheeks)
Ethmoid sinuses (bridge of nose)
Frontal sinuses (forehead)
Sphenoid sinuses (behind nose deep in skull)
• Nares – name given to two nasal cavities
• Concha, or nasal turbinate – a long,
narrow shelf-like structure in the nose
which helps trap particles entering the
nasal cavity
– Three nasal turbinates on the sidewall of the
nose (superior, middle, and inferior turbinate)
• The Throat (pharynx)
– Nasopharynx (behind nose) and extends to the
uvula, the fleshy mass hanging form the soft
palate
– Oropharynx (back of mouth) and includes soft
palate, tonsils, posterior third of the tongue and
posterior wall of the throat
– Hypopharynx (bottom of pharynx), the part of
the throat that connects to the esophagus
• The Larynx: A tube-shaped structure leading from the
pharynx to the trachea (wind pipe)
– Epiglottis – a lid-like flap of cartilage that opens and
closes to help direct food and liquid into the esophagus
and protect the airway during swallowing
– Thyroid cartilage – largest cartilage of the thyroid, also
called the “Adam’s apple”
– Cricoid – lies below thyroid cartilage and encircles the
airway
– Arytenoids – paired cartilages lying on top of cricoid
– Corniculate and cuneiform cartilages – strengthen the
entrance of the larynx
• Vocal anatomy
– Vocal cords (or vocal folds or true vocal folds) –
two elastic folds of mucous membrane
stretched horizontally across the larynx,
involved in voice production
– False vocal folds – second set of folds above
the true vocal folds. Role in voice production is
minimal
– Glottis – the gap between the vocal folds
The Process of Hearing
• Air conduction:
–
–
–
–
–
Sounds captured by the pinna.
Pass through the external auditory canal
To the tympanic membrane
To the ossicles in the middle ear
To the cochlea in the inner ear and relayed to the
brain
• Bone conduction:
– Sound is carried directly to cochlea from vibrations of
bone, bypassing outer and middle ear
Common Otolaryngologic Diseases and
Treatments
• Rarely fatal but can be quite debilitating
– Nasal disorders can make breathing and
talking difficult
– Ear disorders can disturb hearing and
equilibrium
– Throat ailments can cause difficulty
eating, breathing, and talking
Ear Disorders
• Otitis Media: infection/fluid in the middle ear
– Eustachian tube becomes inflamed from a cold or
infection
– Treatments:
• Antibiotics for infection (amoxicillin, ampicillin) for
infection of ear canal or for otitis externa, or
swimmer’s ear, an infection of the external auditory
canal
• Myringotomy – surgical incision into the tympanic
membrane to relieve pain and drain fluid
• Tympanostomy tube – (pressure-equalization or PE
tube) inserted to help drain the fluid
• Vertigo – Sudden, brief feelings of dizziness and confusion
with change in position of the head
– Benign paroxysmal positional vertigo (BPPV) is most
common form
– Called “hallucination of movement” causing sensation of
room spinning
– Treatments:
• Antibiotics to eliminate underlying infection
• Medication to treat dizziness (Antivert)
• Radiation or surgery for vertigo caused by strokes or
tumors
• Ménière disease: a balance disorder of
the middle ear
– First described by French physician Prosper
Ménière in 1861
– Period episodes of vertigo, with hearing loss,
tinnitus, and sensation of fullness or pressure
– No known cause or cure
– Treatments to control symptoms:
• Reducing retention of fluids
• Medications used to treat vertigo
• Cholesteatoma: a sac of debris or dead
cells that accumulates in the middle ear
– Can destroy bones o the middle ear if not
treated and cause central nervous system
complications such as brain abscess and
meningitis
– Treatments:
• Ear cleaning and drainage of debris and fluid
• Antibiotics to control infection
• Surgical removal if large
• Hearing loss
– Conductive: Outer or middle ear; treatable
– Sensorineural: Inner ear; not treatable
– Mixed: Combination of both types
• Treatments for Hearing Loss:
–
–
–
–
Removal of debris buildup in the ear
Treatment of infection with antibiotics
Hearing aids
Cochlear implant
Nasal Disorders
• Deviated septum: An abnormal
configuration of the cartilage that divides
the two sides of the nose, causing
breathing difficulties and repeated sinus
infections
• Treatment:
– Septoplasty: A reconstructive procedure where
malformed portions of the septum are removed
or readjusted to straighten the deviation of the
nose and improve breathing
• Chronic sinusitis: continuous
inflammation of sinuses
– Treatments: Goal is to improve sinus drainage
and curing chronic infections
• Antibiotics for infections
• Nasal steroid sprays to clear congestion
• Endoscopic sinus surgery (ESS) – removing
blockages in the sinuses to allow proper drainage out
of the nose and improve breathing
• Epistaxis: Nosebleed where lining of the nose
is irritated or broken down enough to cause
bleeding
– Treatments:
• Packing to stop bleeding
• Cauterization of bleeding vessels, called electrocautery
or nasal cautery using silver nitrate to stop bleeding and
then application of cautery to stop bleeding in larger
vessels
• Reconstruction of nasal septum in more severe cases
• Nasal polyps: Fleshy outgrowths in the nose
as a result of inflammation
– Treatments:
• Corticosteroids and nasal sprays to reduce inflammation
• Surgical removal of the polyps
Disorders of the Throat
• Obstructive sleep apnea (OSA): A condition of
interrupted breathing during sleep
• From Greek word apnea which means “without breath
or air”
• Caused by obstruction of airway in several possible
sites or collapse of airway muscles during sleep
• Hypopnea: A decrease in the rate and depth of
breathing that is not as severe as apnea
• Treatments for Sleep Apnea:
– Significant weight loss
– Oral appliances (mandibular advance device) – a mouth
guard to move the jawbone forward and open the
airway or tongue-retaining device to pull tongue forward
and eliminate airway obstruction
– Continuous positive airway pressure (CPAP) and bilevel machine – blows air under pressure into the nose
via nose mask to keep airway open and unobstructed
– Bi-level machine (BiPAP) – blows air at two different
pressures
• Surgical Treatments for Sleep Apnea
– Uvulopalatopharyngoplasty (UPPP) – tissues at
the back of the throat are removed, including
uvula, tonsils, and parts of the soft palate,
widening airway
– Somnoplasty – Radiofrequency waves are used
to target tissues that need shrinking, resulting in
overall reduction in tissue volume and a wider
airway
• Laryngopharyngeal reflux disease (LRD): Backflow
of acid into esophagus
• Symptoms: Chronic cough; hoarseness, and
sometimes aspiration of acid into the trachea
(laryngospasm).
• Indications: Pachydermia or cobblestoning (abnormal
thickening of the larynx), swelling of vocal cords, or
ulcers on vocal cords
– Treatments:
• Behavior and diet modification
• Acid reflux medications (Nexium, Prilosec, Zantac)
• Vocal cord paralysis: Inability to move the muscles
that control the vocal cords
• Possible Causes: head trauma, stroke, tumor, or viral
infection
• Treatments:
• Voice therapy for the paralysis
• Phonosurgery to improve vocal cord function
Diagnostic Studies and
Procedures
• Acoustic Studies
– Purpose: To evaluate overall hearing
function
– Otologic Examination:
• Visual examination of outer ear and eardrum,
called otoscopy
• Valsalva maneuver – an attempt to forcibly exhale
while keeping the mouth and nose closed
• Audiometry – testing used to identify and diagnose
hearing loss
• Intensity of sound measured in decibels (dB) and
frequency of sound measured in Hertz (Hz), or cycles
per second
– Pure Tone Audiometry: sounds and pitches record
audio thresholds
– Tympanometry: air pressure evaluates middle ear
function
• Air and Bone Conduction Studies
– Also called “tuning fork tests” because vibrating
tuning forks are placed in contact with the head
to test hearing
• Rinne test – compares bone conduction to air
conduction by placing tuning fork against the bone
behind the ear
• Weber test – evaluates bone conduction by placing
tuning fork at various points along the midline of the
skull and face
• Otoacoustic emissions (OAE) – used to assess the
integrity and function of outer hair cells in the
inner ear (commonly used for newborns)
• Brainstem Auditory Evoked Response Test (BAER)
– analyzes brain’s response to sound
• Nasal Studies
– Nasal endoscopy, also called rhinoscopy
– Used to evaluate chronic and recurrent acute
sinusitis
– Small abnormalities can be identified and cultures
can be taken for examination
– Imaging studies used to view paranasal sinuses for
abnormalities: CT, MRI
• Laryngeal Studies
– Indirect laryngoscopy, also called “mirror exam” of
vocal folds using a mirror and reflected light
– Direct (fiberoptic) laryngoscopy, using a long, thin
tube to get a more magnified view of structures
– Videostroboscopy, uses a strobe light combined with
laryngoscopy to allow slow-motion view of vibrating
vocal folds with images recorded on videotape
–
Polysomnography (also called sleep study):
Measures variables obtained and recorded during
sleep