Presentation on theme: "Introduction What is otolaryngology?"— Presentation transcript:
1Introduction What is otolaryngology? What subdivisions exist within the specialty?Is otolaryngology a medical or a surgical specialty?How can you learn otolaryngology well?
2What is otolaryngology? The specialty deals with diseases of the head and neck region, the region from eyebrows to the collarbonesThe specialty originally included the treatment of eye conditions and was commonly identified as EENT (eyes, ears, nose and throat)
3What is otolaryngology? As a result of the explosion of medical knowledge, ophthalmology split from otolaryngology many years agoThe American Academy of Otolaryngology recoginized the expanded breadth and changed the name to otolaryngology-head and neck suegery
4What subdivisions exist within the specialty? Initially, otology, laryngology, rhinology, and bronchoesophagology were recognizedWith increased medical knowledge, pediatric otolaryngology, otolaryngological allergy, facial plastic and constructive surgery, and head and neck surgery have been identified
5What subdivisions exist within the specialty? Otology has been expanded to include otology, neurotology, and skull-base surgeryOtolaryngologists are interested in neurolaryngology, microvascular surgery, chemosensation (taste and smell disorders), audiology, and speech disorders.
6Is otolaryngology a medical or a surgical specialty? Actually, it is both. Many conditions are managed medically and require no surgery, whereas others require surgeryIn common practice, for every 13 patients needing medical care, only one will require surgery
7How can you learn otolaryngology well? The breadth of the field and the complexity of the patients’ conditions make the specialty both challenging and stimulatingTo learn it well, you should pay special attention to the disease-associated anatomic and physiological knowledge of the ear, nose and throat, as well as head and neck region
8RhinitisRhinitis is tissue inflammation and nasal hyperfunction that leads to nasal congestion/obstruction, rhinorrhea, nasal itching, and/or sneezing.
9PathophysiologyNasal congestion arises from engorgement of blood vessels due to the effects of vasoactive mediators and neural stimuli.The autonomic nervous system mediates both vascular tone and gland secretions. Sympathetic innervation constricts the vessels, decreasing congestion, whereas the parasympathetic innervation dilates the vessels, enhancing congestion.
10CategoryRhinitis can be divided into allergic and nonallergic types
11Allergic rhinitisAllergic rhinitis is the most common of all atopic diseases, it affects up to 20% of the adult population in worldwideAllergic rhinitis is clinically defined as symptomatic disorder of nose, induced after allergen exposure, by an IgE mediated inflammation of the nasal membranes
13Immdiate Hypersensitivity For unknown reason, some individuals encounter with antigens such as plant pollens, animal dander, mold spores, dust mites, or the certain foods, or if they are exposed to certain drugs such penicillin, the dominent T cell response is the development of TH2 cells
14allergic response in allergic rhinitis HistamineserotoninLeukotriensprostaglandins
15Inflammation mediators such as histamine, serotonin, leukotrienes, and prostaglandinsDilating blood vessels, stimulating nerves, and which increase the glands secretion
16Symptoms of allergic Rhinitis sneezing, rhinorrhea, and nasal congestion appear promptly
17Diagnosis of Allergic Rhinitis Recurrent attacks of sneezing, watery rhinorrhea and nasal congestion, frequently with conjunctival irritation and consequently increased lacrimation, some with itching of soft palate.The nasal passages contain clear mucoid secretion, and nasal mucous membrane is congested and varies in color from pale to dull red
18Diagnosis of Allergic Rhinitis Skin prick test Whealing responseSerum specific IgE
19Treatment of allergic rhinitis Avoidance of the antigen exposurean important stepunfortunately it is often not practicalPharmacotherapy includesantihistamines (topical or systemic)topical corticosteroids,cromolyn sodium (stabilizes mast cell)Immunotherapy may beneficial in selected patients.
20ImmunotherapyThe primary indication is symptoms not adequately controlled by avoidance measures and pharmacotherapyPatients with perennial symptoms may prefer immunotherapy to yearlang daily medicationIt begins with low-dose injections of allergen extracts and builds to a maintenance dose.
23The causes of nonallergic rhinitis Decreased nasal airflow statesafter laryngectomy or tracheostomySystemic diseasesWegener's granulomatosisIdiopathic diseasevasomotor rhinitiseosinophilic or basophilic nonallergic rhinitis
24Clinic picture of nonallergic rhinitis Main complain is nasal obstructionTroublesome symptom is excessive rhinorrhoneaPost-nasal drip is sometimes a complaintOn clinical examination the predominant finding the inferior turbinate are usually enlarged
25Diagnosis and management Diagnosis of nonallergic rhinitis is not difficultNasal allergy must be excluded in all cases by a careful history, skin sensitivity testing or serum specific IgE determinationTreatment depends on associated factors
26Rhinitis medicamentosa Drug-induced rhinitisIt is caused by rebound nasal congestionIt is often associated with prolonged use of topical decongestants. With time, the strong vasoconstrictive effect of topical decongestants leads to the metabolic accumulation of vasodilators that are responsible for the rebound vasodilation.
27Structural abnormalities that can cause rhinitis Deviated nasal septumTurbinate hypertrophyNasal valve collapseIntranasal and extranasal deformitiesPolypsNeoplasms (e.g., papilloma, angiofibroma, malignancy)
28Atrophic rhinitisor ozena, is associated with atrophy of the nasal mucosa and turbinates in association with excessive crusting and mucopurulent discharge.This condition is marked by an extremely foul odor that can be easily detected by others.Patients often complain of epistaxis, nasal obstruction, headaches
29Atrophic rhinitisAlthough the cause is unknown, hereditary, infectious, developmental, nutritional, and endocrine factors have been implicated.Atrophic rhinitis may also be iatrogenic because it may be associated with excessive turbinate resection.
30Atrophic rhinitis Although no cure exists, treatment revolves around Frequent saline irrigation and topical antibioticsSurgical options have been aimed at narrowing the nasal cavity and nostril
31Treatment of nonallergic rhinitis Should be directed toward the specific causecorrection of structural problemstreatment of infectionSymptomatic treatment includes the use ofsteroidssympathomimetic agentsanticholinergics
32Surgery used in treating rhinitis directed toward mechanical-obstructive issuesSurgeries includeseptoplastypolypectomiesout-fracture of the inferior turbinatesresection of hypertrophic mucosa
33Sinusitis (Rhinosinusitis) Sinusitis is extremely prevalent disorder that has a significant impact on the quality of life of affected individuals
34Categories of sinusitis Clinical categories of rhinosinusitis are largely based on the duration of symptoms and include the following:acute up to 4 weekschronic > 12 weeksThis classification is symptom based and should serve only as a general guideline.
35Pathophysiology of sinusitis Mucosal edema of the paranasal sinuses is the basic event leading to both acute and chronic disease.Edema may lead to obstruction of the drainage routes of the sinuses, causing stasis of secretions.These local changes lead to impaired mucociliary clearance, alteration in local immune defenses, and ultimately bacterial overgrowth.
38Symptoms of acute bacterial sinusitis The early symptoms may be difficult to distinguished from the common cold or allergic rhinitisHeadache or facial pain, nasal obstruction, mucopurulent nasal discharge (if ostia patent)
39Symptoms of acute bacterial sinusitis The location of pain is related to the sinus involvedEthmoid—medial nose or retro-orbital painSphenoid—occipital, vertex,or parietal headachesMaxillary—suborbital tenderness, dental painFrontal—frontal headaches and tenderness
40Diagnosis of acute bacterial sinusitis in adults or children with a viral upper respiratory infection does not dissipate within 10 days (or worsens after 5-7 days) and is accompanied by some or all of those above symptoms.
41Common organisms Most common pathogens associated Streptococcus pneumoniae (20-40%)Haemophilus influenzae (20-35%)and Moraxella catarrhalis (2-10%)Less common pathogens includeStaphylococcus aureus (0-9%)anaerobes (0-9%)and streptococcal species (3-9%).
42Complications of sinusitis Complications includedisease extension into the orbit orintracranial structuresfacial cellulitescavernous sinus thrombosisosteomyelitisvisual changesmucocele formation.
43Complications of sinusitis Orbital complicationspreseptal or orbital cellulitisowing to easy extension of infection along the thin sinus bone surrounding the orbit on three sides.
44Complications of sinusitis Meningitis is usually regarded as the most common intracranial complication of sinusitis and can arise from the sphenoid or ethmoid sinusesEpidural and subdural abscesses are most commonly associated with frontal sinusitisA brain abscess may also occur in the setting of sinusitis and carries a high mortality rate (20-30%). It is most often associated with frontal or ethmoid disease.
45management of acute bacterial sinusitis In addition to antibiotics, the medical management should include adjunctive treatments directed at reducing mucosal inflammation. These commonly includenasal steroidstopical decongestants (for the ostia patent)mucolytics (for mucocillary cleaning)nasal saline irrigation.
46Symptoms of chronic sinusitis Nasal drainageNasal congestionFacial pain/pressurePostnasaldripHyposmia/anosmiaEar fullness/pressureNasal polyps
47Nasal polyps and sinusitis Apear as soft, smooth masses, varying in color, translucent, white, yellowish, pink, or fleshyCan arise from any part of the nasal and/or sinus mucosa, often bilateral, tend to be multiple, coexist with chronic sinusitis
48Nasal polyps and sinusitis Most commonly they are seen in the middle meatus, but they occur also on the medial surface of the middle turbinate
53Often involved sinusIn the majority of cases, the maxillary sinus and anterior ethmoid sinuses are involved.This can be predicted by the anatomy of the middle meatus or infundibulum, the location for drainage of the "anterior sinuses" (maxillary, anterior ethmoid, frontal sinuses)
56Treatment of chronic sinusitis The importance of bacterial infection in CRS still remains debatedTreatment options includeprolonged intranasal steroidsthe use of systemic steroidsleukotriene receptor antagonistsImmunotherapy/antibiotics for select patientsSurgery for select patients
57Surgical intervention For chronic or recurrent sinusitis, the role of surgery is to facilitate the natural drainage of the sinuses, when possible, through correction of identifiable anatomic aberrations.
58Surgical intervention Generally speaking, surgery is not a cure for CRS but an adjunctive treatment option for select patients.Medical management remains the primary option for sinusitis and is effective in the majority of patients.
59Surgical intervention For complicated acute sinusitis, such as subperiosteal or epidural abscesses, the role of surgery is acute decompression of the affected sinuses as well as the area of abscess.For chronic sinusitis with polyps, surgery is indicated
60Functional Endoscopic Sinus Surgery (FESS) Endoscopic sinus surgery has become the preferred technique for the surgical management of most forms of sinusitis.FESS describes a series of techniques that use nasal endoscopes for access to the paranasal sinuses rather than external approaches.
61Functional Endoscopic Sinus Surgery (FESS) The concept of functional surgery implies using techniques that facilitate the natural drainage patterns of the sinuses through the osteomeatal complex.
62Functional Endoscopic Sinus Surgery (FESS) The key concept is atraumatic surgical technique, mucosal preservation, and restoration of normal sinus physiology.FESS may be considered an option in patients with persistent symptoms of sinusitis combined with objective evidence of disease on endoscopy and/or CT despite maximal medical therapy.
63Fungal sinusitisSome form of sinusitis are caused by fungal microorganisms within the sinonasal tract. The fungal infection can be either invasive or noninvasive.
65Fungus balls or mycetoma usually present as a unilateral opacification of either the maxillary or sphenoid sinus.Patients are classically immunocompetent without evidence of atopy
66CSF LeaksCerebrospinal Fluid occur due to dural tears or areas of dural weaknessOtorrhea due to temporal bone fracturesRhinorrhea due to anterior or central skull base dural defects
67Important Questions Recent trauma History of recurrent meningitis Recent sinus surgery, endoscopic surgery, or neurosurgeryHistory of hydrocephalus, or increased intracranial pressure
68Diognosis and management Nasal endoscopyBeta-2-transferrin, or beta trace proteinImaging to localize defect. HRCT for bony defects, MRI for herniationsEndoscopic surgical repair provides 90% 1st time success