Ear, Nose, and Throat Disorders
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Approach to the Patient With Ear ProblemsEarache, hearing loss, otorrhea, tinnitus, and vertigo are the principal symptoms of ear problems.
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Approach to the Patient With Nasal and Pharyngeal SymptomsThe nose and pharynx (consisting of the nasopharynx, oropharynx, and hypopharynx) may be affected by inflammation, infection, trauma, tumors, and several miscellaneous conditions.
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External Ear DisordersDermatitis of the ear canal is characterized by pruritis, scaling, flaking, and erythema of the skin of the external auditory meatus and ear canal. Dermatitis can be caused by exposure to allergens (contact dermatitis) or can be spontaneous (chronic otitis externa, aural eczematoid dermatitis).
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Hearing LossWorldwide, about half a billion people (almost 8% of the world's population) have hearing loss ( 1). More than 10% of people in the US have some degree of hearing loss that compromises their daily communication, making it the most common sensory disorder. About 1/800 to 1/1000 neonates are born with severe to profound hearing loss. Two to 3 times as many are born with lesser hearing loss. During childhood, another 2 to 3/1000 children acquire moderate to severe hearing loss. Adolescents are at risk from excessive exposure to noise, head trauma, or both. Older adults typically experience a progressive decrease in hearing ( presbycusis), which is directly related to a combination of aging, noise exposure, and genetic factors. It is estimated that about 30 million people in the US are exposed to injurious levels of noise on a daily basis.
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How To Do Ear ProceduresAuricular hematomas are drained to prevent chronic deformity of the underlying cartilage.
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How To Do Nose ProceduresRemoval of a foreign body from the nose requires specific instruments and skills.
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How To Do Throat ProceduresMirror (indirect) laryngoscopy is viewing of the pharynx and larynx using a small, curved mirror.
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Inner Ear DisordersThe inner ear is in the petrous area of the temporal bone. Within the bone is the osseous labyrinth, which encases the membranous labyrinth. The osseous labyrinth includes the vestibular system (made up of the semicircular canals and the vestibule) and the cochlea.
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Laryngeal DisordersThe larynx contains the vocal cords and serves as the opening to the tracheobronchial tree. Laryngeal disorders include
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Middle Ear and Tympanic Membrane DisordersMiddle ear disorders may be secondary to infection, eustachian tube obstruction, or trauma. Information about objects placed in the ear and symptoms such as rhinorrhea, nasal obstruction, sore throat, upper respiratory infection, allergies, headache, systemic symptoms, and fever aid in making a diagnosis. The appearance of the external auditory canal and tympanic membrane often yields a diagnosis. The nose, nasopharynx, and oropharynx are examined for signs of infection and allergy and for evidence of tumors.
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Nose and Paranasal Sinus DisordersNasal vestibulitis is bacterial infection of the nasal vestibule, typically with Staphylococcus aureus. It may result from nose picking or excessive nose blowing and causes annoying crusts and bleeding when the crusts slough off. Mupirocin ointment applied topically 2 times a day for 14 days is effective.
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Oral and Pharyngeal DisordersHypertrophy or inflammation of the adenoids is common among children. Symptoms include nasal obstruction, sleep disturbances, and middle ear effusions with hearing loss. Diagnosis is enhanced by flexible fiberoptic nasopharyngoscopy. Treatment often includes intranasal corticosteroids, antibiotics, and, for significant nasal obstruction or persistent recurrent acute otitis media or middle ear effusion, adenoidectomy.
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Tumors of the Head and NeckHead and neck cancer develops in almost 65,000 people in the United States each year. Excluding skin and thyroid cancers, > 90% of head and neck cancers are squamous cell (epidermoid) carcinomas; most of the rest are adenocarcinomas, sarcomas, and lymphomas.
