Presentation is loading. Please wait.

Presentation is loading. Please wait.

Introduction What is otolaryngology?

Similar presentations

Presentation on theme: "Introduction What is otolaryngology?"— Presentation transcript:

1 Introduction What is otolaryngology?
What subdivisions exist within the specialty? Is otolaryngology a medical or a surgical specialty? How can you learn otolaryngology well?

2 What is otolaryngology?
The specialty deals with diseases of the head and neck region, the region from eyebrows to the collarbones The specialty originally included the treatment of eye conditions and was commonly identified as EENT (eyes, ears, nose and throat)

3 What is otolaryngology?
As a result of the explosion of medical knowledge, ophthalmology split from otolaryngology many years ago The American Academy of Otolaryngology recoginized the expanded breadth and changed the name to otolaryngology-head and neck suegery

4 What subdivisions exist within the specialty?
Initially, otology, laryngology, rhinology, and bronchoesophagology were recognized With increased medical knowledge, pediatric otolaryngology, otolaryngological allergy, facial plastic and constructive surgery, and head and neck surgery have been identified

5 What subdivisions exist within the specialty?
Otology has been expanded to include otology, neurotology, and skull-base surgery Otolaryngologists are interested in neurolaryngology, microvascular surgery, chemosensation (taste and smell disorders), audiology, and speech disorders.

6 Is otolaryngology a medical or a surgical specialty?
Actually, it is both. Many conditions are managed medically and require no surgery, whereas others require surgery In common practice, for every 13 patients needing medical care, only one will require surgery

7 How can you learn otolaryngology well?
The breadth of the field and the complexity of the patients’ conditions make the specialty both challenging and stimulating To 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

8 Rhinitis Rhinitis is tissue inflammation and nasal hyperfunction that leads to nasal congestion/obstruction, rhinorrhea, nasal itching, and/or sneezing.

9 Pathophysiology Nasal 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.

10 Category Rhinitis can be divided into allergic and nonallergic types

11 Allergic rhinitis Allergic rhinitis is the most common of all atopic diseases, it affects up to 20% of the adult population in worldwide Allergic rhinitis is clinically defined as symptomatic disorder of nose, induced after allergen exposure, by an IgE mediated inflammation of the nasal membranes

12 Common allergens Pollens Animal dander Mold spores Dust mites

13 Immdiate 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

14 allergic response in allergic rhinitis
Histamine serotonin Leukotriens prostaglandins

15 Inflammation mediators
such as histamine, serotonin, leukotrienes, and prostaglandins Dilating blood vessels, stimulating nerves, and which increase the glands secretion

16 Symptoms of allergic Rhinitis
sneezing, rhinorrhea, and nasal congestion appear promptly

17 Diagnosis 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

18 Diagnosis of Allergic Rhinitis
Skin prick test Whealing response Serum specific IgE

19 Treatment of allergic rhinitis
Avoidance of the antigen exposure an important step unfortunately it is often not practical Pharmacotherapy includes antihistamines (topical or systemic) topical corticosteroids, cromolyn sodium (stabilizes mast cell) Immunotherapy may beneficial in selected patients.

20 Immunotherapy The primary indication is symptoms not adequately controlled by avoidance measures and pharmacotherapy Patients with perennial symptoms may prefer immunotherapy to yearlang daily medication It begins with low-dose injections of allergen extracts and builds to a maintenance dose.

21 The causes of nonallergic rhinitis
Pharmacology (rhinitis medicamentosa) Infection (commen cold) Structural abnormalities Irritation (formaldehyde) Hormonal factors (Pregnency) Atrophy

22 The causes of nonallergic rhinitis
Substance abuse ( cocaine, alcohol, nicotine) Foreign bodies Trauma Temperature Exercise Recumbency Emotions

23 The causes of nonallergic rhinitis
Decreased nasal airflow states after laryngectomy or tracheostomy Systemic diseases Wegener's granulomatosis Idiopathic disease vasomotor rhinitis eosinophilic or basophilic nonallergic rhinitis

24 Clinic picture of nonallergic rhinitis
Main complain is nasal obstruction Troublesome symptom is excessive rhinorrhonea Post-nasal drip is sometimes a complaint On clinical examination the predominant finding the inferior turbinate are usually enlarged

25 Diagnosis and management
Diagnosis of nonallergic rhinitis is not difficult Nasal allergy must be excluded in all cases by a careful history, skin sensitivity testing or serum specific IgE determination Treatment depends on associated factors

26 Rhinitis medicamentosa
Drug-induced rhinitis It is caused by rebound nasal congestion It 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.

27 Structural abnormalities that can cause rhinitis
Deviated nasal septum Turbinate hypertrophy Nasal valve collapse Intranasal and extranasal deformities Polyps Neoplasms (e.g., papilloma, angiofibroma, malignancy)

28 Atrophic rhinitis or 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

29 Atrophic rhinitis Although 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.

30 Atrophic rhinitis Although no cure exists, treatment revolves around
Frequent saline irrigation and topical antibiotics Surgical options have been aimed at narrowing the nasal cavity and nostril

31 Treatment of nonallergic rhinitis
Should be directed toward the specific cause correction of structural problems treatment of infection Symptomatic treatment includes the use of steroids sympathomimetic agents anticholinergics

32 Surgery used in treating rhinitis
directed toward mechanical-obstructive issues Surgeries include septoplasty polypectomies out-fracture of the inferior turbinates resection of hypertrophic mucosa

33 Sinusitis (Rhinosinusitis)
Sinusitis is extremely prevalent disorder that has a significant impact on the quality of life of affected individuals

34 Categories of sinusitis
Clinical categories of rhinosinusitis are largely based on the duration of symptoms and include the following: acute up to 4 weeks chronic > 12 weeks This classification is symptom based and should serve only as a general guideline.

35 Pathophysiology 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.

36 Ciliary epithelium

37 Symptoms of acute bacterial sinusitis
Nasal drainage Nasal congestion Facial pain/pressure Postnasaldrip Hyposmia/anosmia Fever, Cough Fatigue Maxillary dental pain Ear fullness/pressure

38 Symptoms of acute bacterial sinusitis
The early symptoms may be difficult to distinguished from the common cold or allergic rhinitis Headache or facial pain, nasal obstruction, mucopurulent nasal discharge (if ostia patent)

39 Symptoms of acute bacterial sinusitis
The location of pain is related to the sinus involved Ethmoid—medial nose or retro-orbital pain Sphenoid—occipital, vertex, or parietal headaches Maxillary—suborbital tenderness, dental pain Frontal—frontal headaches and tenderness

40 Diagnosis 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.

41 Common organisms Most common pathogens associated
Streptococcus pneumoniae (20-40%) Haemophilus influenzae (20-35%) and Moraxella catarrhalis (2-10%) Less common pathogens include Staphylococcus aureus (0-9%) anaerobes (0-9%) and streptococcal species (3-9%).

42 Complications of sinusitis
Complications include disease extension into the orbit or intracranial structures facial cellulites cavernous sinus thrombosis osteomyelitis visual changes mucocele formation.

43 Complications of sinusitis
Orbital complications preseptal or orbital cellulitis owing to easy extension of infection along the thin sinus bone surrounding the orbit on three sides.

44 Complications of sinusitis
Meningitis is usually regarded as the most common intracranial complication of sinusitis and can arise from the sphenoid or ethmoid sinuses Epidural and subdural abscesses are most commonly associated with frontal sinusitis A 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.

45 management of acute bacterial sinusitis
In addition to antibiotics, the medical management should include adjunctive treatments directed at reducing mucosal inflammation. These commonly include nasal steroids topical decongestants (for the ostia patent) mucolytics (for mucocillary cleaning) nasal saline irrigation.

46 Symptoms of chronic sinusitis
Nasal drainage Nasal congestion Facial pain/pressure Postnasaldrip Hyposmia/anosmia Ear fullness/pressure Nasal polyps

47 Nasal polyps and sinusitis
Apear as soft, smooth masses, varying in color, translucent, white, yellowish, pink, or fleshy Can arise from any part of the nasal and/or sinus mucosa, often bilateral, tend to be multiple, coexist with chronic sinusitis

48 Nasal polyps and sinusitis
Most commonly they are seen in the middle meatus, but they occur also on the medial surface of the middle turbinate

49 Nasal polyps and sinusitis

50 Nasal polyps and sinusitis

51 Nasal polyps and sinusitis

52 Nasal polyps and sinusitis

53 Often involved sinus In 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)

54 Opening of anterior sinuses

55 Opening of anterior sinuses

56 Treatment of chronic sinusitis
The importance of bacterial infection in CRS still remains debated Treatment options include prolonged intranasal steroids the use of systemic steroids leukotriene receptor antagonists Immunotherapy/antibiotics for select patients Surgery for select patients

57 Surgical 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.

58 Surgical 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.

59 Surgical 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

60 Functional 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.

61 Functional 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.

62 Functional 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.

63 Fungal sinusitis Some form of sinusitis are caused by fungal microorganisms within the sinonasal tract. The fungal infection can be either invasive or noninvasive.

64 The categories of fungal sinusitis
Acute fulminant invasive fungal sinusitis Chronic invasive fungal sinusitis Granulomatous invasive fungal sinusitis Fungus balls, or mycetomas Allergic fungal sinusitis Eosinophilic fungal rhinosinusitis

65 Fungus balls or mycetoma
usually present as a unilateral opacification of either the maxillary or sphenoid sinus. Patients are classically immunocompetent without evidence of atopy

66 CSF Leaks Cerebrospinal Fluid occur due to dural tears or areas of dural weakness Otorrhea due to temporal bone fractures Rhinorrhea due to anterior or central skull base dural defects

67 Important Questions Recent trauma History of recurrent meningitis
Recent sinus surgery, endoscopic surgery, or neurosurgery History of hydrocephalus, or increased intracranial pressure

68 Diognosis and management
Nasal endoscopy Beta-2-transferrin, or beta trace protein Imaging to localize defect. HRCT for bony defects, MRI for herniations Endoscopic surgical repair provides 90% 1st time success

69 Diognosis and management

70 Thanks !

Download ppt "Introduction What is otolaryngology?"

Similar presentations

Ads by Google