Pocket tutor: Otolaryngology Sonna Ifeacho, Henry Zhang, Abir Bhattacharyya
INDEX
ABCDEFGHIJKLMNOPQRSTUVWYZ
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Abducens nerve (CN VI) 33
Accessory auricles 2
Accessory nerve (CN XI) 35
Achalasia 177
Aciclovir
Ramsay Hunt syndrome 109
sensorineural hearing loss 126
Acid reflux 49
Acoustic neuroma 115, 127 see also Vestibular schwannomas (VS)
Acoustic reflex 10–11
Acute diffuse otitis externa 81–84, 82
Acute localised otitis externa (furuncle) 83
Acute mastoiditis 231
Acute otitis media 96, 96
bulging tympanic membrane due to 96
in children 97–99
clinical features 98, 98
complications 99–100, 100
and ear pain 43
non-suppurative 96
predisposing factors 97
recurrent 96
suppurative 96
treatment 98–99
Acute otitis media with mastoiditis, in children 229–231, 230
Acute suppurative otitis media 83
Acute vestibular failure
nystagmus in 88
and vertigo 87–89
Adenoidectomy 99
Adenotonsillar disease, in children 238–242
blood tests 240
causes of tonsillitis 239
Centor clinical prediction score 241
management 241–242
and obstructive sleep apnoea 239, 240
signs and symptoms 240
sleep study 240
throat swabs 240
tonsillectomy 241
white spots, in acute tonsillitis 239
Adenotonsillar hypertrophy 262
Airway compromise, in adult 181–183
differential diagnosis 182–183
microlaryngoscopy 182, 182
squamous cell carcinoma of larynx and 183
Airways, in child 51
Airway trauma, and airway obstruction 183
Allergic rhinitis 47
Amitriptyline, for midfacial segment pain 142
Amoxicillin–clavulanic acid, for acute otitis media 99
Amoxicillin, for acute otitis media 99
Anaphylaxis, and airway obstruction 183
Ankylosing rheumatoid arthritis 87
Anosmia 48, 140
Antibiotics
acute otitis media 99
chronic otitis media 103–104
chronic rhinosinusitis 150
necrotising otitis externa 91, 92
otitis media 231
salivary gland diseases 210
tonsillitis 188–189
Antihistamines, for rhinitis 146, 150
Antihistamine sprays 146
Antimicrobial and steroidal ear drops
chronic otitis media 103
otitis externa 94
Antipneumococcal vaccine, for tonsillitis prevention 189
Antrochoanal polyps 138, 151
Aphonia 198
Apnoea–hypopnoea index (AHI) 224
Arytenoid granuloma 183
Aspergillus niger 83
Audiological tests
pure tone audiometry 72–73, 73
tympanometry 73, 74
Auditory brainstem response (ABR) 247–248
Auditory pathway 8
Aural fullness and facial weakness 46
Azithromycin, for acute otitis media 99
B
Bacterial tonsillitis
in children 231–234
with parapharyngeal cellulitis or abscess 233
with peritonsillar cellulitis or abscess 233
with retropharyngeal cellulitis or abscess 233–234
Balance, physiology of 13, 13–15
Balloon sinuplasty, in chronic rhinosinusitis 150
Barany noise box 55
Bartonella henselae 179
Basilar membrane 11
Bell's palsy 46, 108 see also Facial palsy
Benign lesions, and hoarseness 175, 175
Benign oesophageal strictures 177
Benign paroxysmal positional vertigo (BPPV) 88, 120–124
abnormal particle movement in semicircular canal in 120
Brandt–Daroff home exercises 124
canalith repositioning for 123–124
as cause of vertigo 120, 121
classic 120
Epley's manoeuvre 123–124
Hallpike's manoeuvre 122, 122
investigation and diagnosis 122, 122–123
medical treatment 124
nystagmus with 121
rotational chair and home devices 124
Semont manoeuvre 124
Benzylpenicillin, for bacterial tonsillitis 234
Bernoulli principle 37, 38
Betahistine 119
Bilateral vocal fold palsy, and airway obstruction 183
Bone-anchored hearing aid (BAHA) 112
BPPV see Benign paroxysmal positional vertigo (BPPV)
Brain abscess 100
Branchial cyst 213, 214
Brandt–Daroff home exercises 124
C
Cacosmia 140
Candida albicans 83
Carotid arteries 17
external 18
internal 18
Carotid body tumour 181
Carotid sheath
neck 22
space 25, 27
Carotid triangle 22, 23
Catarrhal child 254–258
causes 255
clinical features 256
investigations 256, 257
management principles 257–258
Cat scratch disease 179
Cauliflower ear 129–130
Cefuroxime, for acute otitis media 99
Central hyposmia 139
Cerebellar infarction 89
Ceruminous glands 3
Choanal atresia 51, 262
Cholesteatoma 104
discharge in 45
Chorda tympani 6
Chorda tympani nerve 36
Chronic otitis externa 83
Chronic otitis media 100–104, 231
active squamous 104
causative organisms 101
clinical features 101, 102
complications 104, 105
management 102–104
microscopic examination of ear 101–102, 103
Chronic rhinosinusitis 147–150
clinical features 147–148, 149
investigation 148–149
with nasal polyposis 147
pathogenesis 147, 148
treatment 150, 150
Cinnarizine 119
Clarithromycin, for acute otitis media 99
Cochlea 7, 8
Collagen vascular disorders 177
Compound action potential 21
Conductive deafness 54
Conductive hyposmia 139
Congenital cholesteatoma 87
Congenital ear deformities 249–254
clinical features 252, 252
investigations 252, 253
microtia 249, 251, 251, 254
preauricular sinus or tags 249, 250, 251, 253
prominent ears 249, 250, 251, 252–253
Congenital hearing loss 50
Contact ulcers 200
Corneal reflex 69
testing 69, 69
Corroding watch battery 259
Corticosteroids
chronic otitis media 104
chronic rhinosinusitis 150
nasal polyps 152–153
tonsillitis 188
Cranial nerves 32, 33–35
Cricoarytenoid ankylosis 183
Cricopharyngeal muscle spasms 49
Croup 262
CSF rhinorrhoea 47
Cupula 14
Cystic fibrosis 137
D
Deafness, otosclerosis and 84–87
Diagnostic algorithm 75
facial weakness 76
hoarseness 77
nasal obstruction 79
otorrhoea 78
Digastric triangle 22, 23
Distraction test 248
Diuretics, for Ménière's disease 119
Double vision 46
Drug-induced hyposmia/dysosmia 139
Dysphagia 49, 176, 185
barium swallow 176–177, 177
differential diagnosis 177–178
malignant oesophageal strictures and 176–178
E
Earache (otalgia)
acute diffuse otitis externa and 81–84, 82
causes of 43–44, 44
Ear, anatomy of 1, 1
inner ear 2, 7–9, 8
middle ear 2, 4–6, 5
outer ear 1, 2–3
tympanic membrane 4, 5
Ear, clinical examination of 51–54
deafness, assessment of 54–58
facial nerve assessment 58–59, 60
fistula test and pneumatic otoscopy 59, 61
osteoma of ear canal 52, 53
otoscope for, use of 51–52, 53
tympanic membrane 52–53, 54
Ear discharge (otorrhoea)
differential diagnosis 90–91
necrotising ‘malignant’ otitis externa and 90–92
Ear trauma see Trauma to ear
Eczematous otitis externa 83
Endolymph 7
Endolymphatic hydrops 116
ENT instrument tray 52
Epiglottitis 262
Epistaxis 18, 50, 133–135, 134, 154–160
airway, breathing and circulation 157
anterior 135, 154, 156
blood tests 157
causes 134–135, 155, 155–156, 156
conservative management 157
in elderly patient 135
history taking in 47–48
and iron deficiency anaemia 156
nasal packing 158–159
posterior 154, 156
recurrent 156, 157
silver nitrate nasal cautery 158
surgical management 159
Epley's manoeuvre 123–124
Epworth sleepiness scale (ESS) 224
Ethmoidal infection 18
Eustachian tube 6, 235
blockage 7
Excitatory postsynaptic potentials (EPSPs) 12
External auditory canal (EAC) 1, 1, 2
F
Facial asymmetry 44, 46
Facial nerve (CN VII) 6, 34, 40 see also Facial palsy
assessment 58–59, 60
Facial nerve palsy 46, 100
Facial pain 47, 140–142
differential diagnosis 141–142
Facial palsy 104–110
in acute or chronic otitis media 107–108
causes 104, 107
course and branches of facial nerve 106, 106
idiopathic 108
investigations 107
Facial weakness 46
diagnostic algorithm for 76
First branchial cleft anomaly 252
Fistula test 59
Flexible laryngoscope, use of 65
Flexible nasendoscopy 63, 65
Follicular thyroid cancer 205
Foreign bodies in ear, nose and throat
in children 258–261
first attempt as best attempt 259
foreign bodies in ear 260
foreign bodies in throat 260, 260–261
neck and chest radiographs 259
Foreign body
and airway obstruction 183
in nose 227–229, 228
Frey's syndrome 210
Frontal sinusitis 47
Functional endoscopic sinus surgery 150
Fungal otitis externa 95
G
Gabapentin, for midfacial segment pain 142
Gastro-oesophageal reflux disease (GORD) 49
Gentamicin, for Ménière's disease 119
Globus pharyngeus 49, 178, 190–192
advice and medical treatment 191–192
barium swallow 191
causes 190, 190
laryngopharyngeal reflux and 190, 190
transnasal oesophagoscopy (TNO) 191
Glomus tympanicum tumour 87
Glossopharyngeal nerve (CN IX) 34, 37
Glottis 28, 29
lymphatic drainage of 30
GPA see Granulomatosis with polyangiitis (GPA)
Granulomatosis with polyangiitis (GPA) 163 see also Granulomatous conditions of nose and paranasal sinuses
Granulomatous condition, of middle ear 91
Granulomatous conditions of nose and paranasal sinuses 163–167
biopsy 166
blood tests 166
causes 164, 164
chest X-ray 166
clinical features 165, 165
culture and sensitivity 166
granulomatosis with polyangiitis 163, 165, 165
sarcoidosis 163–164, 165
treatment 166
Group A beta-haemolytic streptococcal (GABHS) infection 241
Gustatory sweating 210
H
Haematological investigations 69–70, 71
Hair cells 7
inner 7
outer 7
Halitosis (bad breath) 49
Hallpike's manoeuvre 122, 122
Head and neck 21–22
anatomical levels of neck 23, 24, 24
anterior triangle of neck 22, 22–23
fascia of neck 22
neck spaces and infections 25, 26–27
posterior triangle of neck 22, 23
Head and neck cancer
larynx 218–221
oropharynx 215–218
Head and neck examination 66
lump in neck 66
palpation of neck 66, 67
thyroid status 66–67
Head and neck pathology, cardinal presentations in 48
acid reflux and heartburn 49
dysphagia 49
globus pharyngeus 49
halitosis 49
hoarseness or change in voice 48
snoring 50
sore throat 48
stridor and stertor 50
swelling of neck 49–50
Hearing aids
Ménière's disease 119
otitis media with effusion 237
otosclerosis 112
presbyacusis 115–116
Hearing, clinical assessment of 54–58
free field speech testing 55
history-taking 54–55
tuning fork tests 55–58
type and degree of deafness by 54
Hearing loss 44, 45
conductive 45
nature of 45
paediatric (see Paediatric hearing loss)
sensorineural 45
Hearing, physiology of 9
inner ear 11–12
middle ear 9–11, 10, 11
outer ear 9
Hereditary haemorrhagic telangiectasia 156, 156
Herpes zoster oticus see Ramsay Hunt syndrome
Histological/cytopathological investigations 72
History taking 43
in children 50–51
in ear disease 43–46, 44
in head and neck pathology 48–50
in nasal and sinus pathology 46–48
Hoarseness (dysphonia) 48, 173
diagnostic algorithm 77
differential diagnosis 174–175, 175
glottal tumours and 173–176
microlaryngoscopy 174, 174
vocal fold lesions and 195
Hot potato voice 186 see also Tonsillitis and peritonsillar abscess
Hyperosmia 140
Hypogeusia 37
Hypoglossal nerve (CN XII) 35, 40
palsy 90, 91
Hyposmia 48, 138, 140
differential diagnosis 139
sensorineural hyposmia following trauma 138–140
I
Iatrogenic injury 109–110
Imaging modalities 70
CT scanning 70, 72
MRI scanning 70, 72
MRI with gadolinium contrast 72
plain radiography 70, 72
ultrasound 72
Immunotherapy, in rhinitis 146
Impedance audiometry see Tympanometry
Incus 5
Infectious mononucleosis 189
Inferior cornu 31
Inferior turbinate hypertrophy 153, 154
Inner ear 2, 7–9, 8
auditory pathway 8
cochlea 7, 8
embryology 2
physiology of hearing 11–12
semicircular canals 7–8
vestibular pathway 8–9
vestibule 7
Instruments, for clinical examination 52
Intranasal steroids, in rhinitis 145–146
Inverted papilloma 153
Investing fascia, neck 22
J
Juvenile nasopharyngeal angiofibroma 153
K
Kiesselbach's plexus 17, 17, 156
Killian's dehiscence 25, 192
L
Labyrinthine infarction 89
Labyrinthitis 100
Lamina papyracea 18
Laryngeal cancers 218–221
glottic cancer 218
hoarseness in glottic cancers 219
individualised treatment 219
microlaryngoscopy and biopsy 220
subglottic cancer 218
supraglottic cancer 218
symptoms 219
Laryngeal crepitus 66
Laryngeal inflammation 183
Laryngomalacia 51, 262
Laryngopharyngeal reflux 190, 190–192 see also Globus pharyngeus
Larynx and trachea 28
anatomy 28, 29
nerve supply 30–31
vocal folds 30
Laser-assisted uvulopalatoplasty (LAUP) 225, 225
Lateral cervical cysts (branchial cyst) 180
Lateral sinus thrombosis 100
Left recurrent laryngeal nerve 30
Leiomyosarcoma 168 see also Sinonasal tumours
Lemierre's syndrome 189
Leukotriene receptor antagonists, for nasal polyps 153
Little's area 17, 17, 18, 156
Ludwig's angina 212
Lupus pernio 165
Lymphadenitis 179, 180
Lymphovascular malformations 180, 262
M
Macrolide antibiotics
chronic rhinosinusitis 150
nasal polyps 153
Malignant tumours of larynx 174, 175
Malleus 5
Malleus and/or incus ossicular fixation 87
Masking 73
Mastoiditis 100
Maxillary sinusitis 47
McCormick toy test 248–249
Mechanical feedback amplification 11
Mediastinitis 189
Medullary thyroid carcinoma 205
Ménière's disease 46, 86, 88, 89, 116–120
attacks of vertigo 117
blood tests 117–118
crisis of Tumarkin 117
endolymphatic hydrops 116
MRI scanning 118
prevention of attacks 118–119
pure tone audiogram 117, 118
sensorineural hearing loss 117, 118
surgical management 119
Ménière's syndrome 116
Meniett device 119
Meningitis 100
Metastatic lymph node, as cystic neck mass 180
Microbiological tests 70
blood culture 70
fresh tissue samples 70
Micrognathia/macroglossia 262
Microscopic suction clearance, in otitis externa 95
Middle ear 2
anatomy 4–6, 5
embryology 2
Eustachian tube 6
facial nerve 6
ossicles 5
physiology of hearing 9–11, 10, 11
temporal bone 6
Midfacial segment pain 141, 142
Migrainous vertigo 89
Misting test 148
Mixed deafness 54
Modiolus 7
Multiple sclerosis 89
Muscular triangle 22, 23
Myringotomy 99
N
Nasal crusting 165
Nasal cycle 16
Nasal discharge see Rhinorrhoea
Nasal itching and sneezing 47
Nasal obstruction 47, 135–138, 151, 161, 169
diagnostic algorithm for 79
differential diagnosis 137
examination 136, 136
nasal polyp and 136, 136 (see also Nasal polyps)
Nasal polyps 136, 147, 151–154
allergy testing 152
antrochoanal polyps 138, 151
asthma and 151
bilateral 138
and cystic fibrosis in children 151, 152
differential diagnosis 152, 153
grading of 149
nasal polypectomy 154
and polypoidal inferior turbinates 153
rhinoscopy and nasal endoscopy 152
and sinonasal neoplasia 152
unilateral 138
Nasal steroid drops/sprays, for nasal polyps 152, 153
Nasal trauma 160–163
clinical history and examination 160–161, 161
closed reduction 162–163
nasal fracture 160, 162
septal haematoma 162
Nasal vestibulitis 135
Nasendoscopy 148
Neck lump 49–50, 178–181
branchial cyst 180, 181
differential diagnosis 180–181
fine-needle aspiration 179, 180
lump in left anterior triangle of neck 179, 179
Neck lumps, benign 211–214
blood tests 212
branchial/lateral cervical cysts 213, 214
causes 211, 211
clinical examination 212
dermoid cysts 213
history examination 211–212
lymphangiomatous malformations 214
paragangliomas 214
ultrasound scan with FNA cytology 212
Neck lymphadenitis 213
Necrotic lymph node 180
Necrotising fasciitis 189
Necrotising ‘malignant’ otitis externa 90
ear pain and discharge in elderly diabetic patient 90–92
treatment 92
Necrotising otitis externa 94
Needle aspiration, peritonsillar abscess 188
Neurological examination 68–69
corneal reflex, testing 69, 69
cranial nerve assessment 68
neurological tests 68
Newborn screening, for hearing 12
Nose, anatomy of 16, 16
blood supply 17, 17–18
choanae 16
internal nasal valve 16
lateral nasal wall 16–17, 17
nasal vestibule 16
Nose bleed see Epistaxis
Nose, clinical examination of 59, 61
interior of nose 61, 62
nasal lining and turbinates 63
patency of nasal airways 61, 62
O
Obstructive sleep apnoea (OSA) 221–226
apnoea–hypopnoea index (AHI) 224
CPAP rhinitis 225
Epworth sleepiness scale (ESS) 224
history and examination 222, 222–223
management options 224–225, 226
multidisciplinary team approach 225
nasal continuous positive airway pressure (CPAP) 225
potential consequences 222
risk factors 222
signs associated with 223
sleep nasendoscopy 224
sleep study 224
Obstructive sleep apnoea syndrome 50
Oculomotor nerve (CN III) 33
Odynophagia 185
Oesophageal web 178
Oesophagectomy 178
Olfactory bulb 21
Olfactory loss, due to trauma 140
Olfactory nerve (CN I) 33
Olfactory neuroblastoma 167 see also Sinonasal tumours
Olfactory system 19, 20
Ophthalmic artery 18
Optic nerve (CN II) 33
Oral and pharyngeal cancers 215–218
clinical presentation 216, 216, 217
investigation and diagnosis 217
lifestyle habits and risk factors 215–216
multidisciplinary team approach 218
surgery/radiotherapy 218
Organ of Corti 7
OSA see Obstructive sleep apnoea (OSA)
Ossicular discontinuity 86
Osteogenesis imperfecta (van der Hoeve's syndrome) 87
Osteomyelitis of skull base 83, 84
Osteoradionecrosis of the temporal bone 91
Otalgia see Ear pain
Otic hydrocephalus 100
Otic vesicle 2
Otitis externa 92–95, 230
causes 93
differential diagnosis 94
diffuse 92
localised 92
treatment 94–95, 95
Otitis media with effusion 85, 234, 234–238
clinical features 235, 236
grommet in tympanic membrane 237, 237
in infants 234
investigations 235, 236
management 236–237
tympanosclerosis and atrophy of tympanic membrane 237, 238
Otoacoustic emissions (OAEs) 12
screeners 12
Otology, cardinal symptoms in 43, 44, 81
aural fullness and facial weakness 46
hearing loss 45
otalgia 43–44
otorrhoea 44–45
tinnitus 45–46
vertigo 46
Otomycosis (fungal otitis externa) 83, 84
Otorrhoea (discharge) 44, 44–45
diagnostic algorithm for 78
from middle ear infection 94
Otosclerosis 84–87, 110–113
absent stapedial reflexes 85, 111
Carhart's notch on pure tone audiometry 85, 86, 111
conductive hearing loss 85
CT scan 111
differential diagnosis 85–87, 112
hearing aids, use of 112
low compliance on tympanometry 85, 86, 111
Schwartz's sign 87, 111
surgical management 87, 113, 113
Otoscope 51–52, 53, 227
Outer ear 1, 2–3
embryology 2
physiology of hearing 9
P
Paediatric hearing loss 245–249
age-appropriate hearing tests 247, 247–249
causes 246, 246
identification of 246–247
opportunistic hearing screening 246–247
pre-school screening 247
targeted screening 246
universal screening 246
Paget's disease 87
Papillae 32, 36, 36
Paracusis 111
Paraganglioma 181
Paranasal sinuses 18, 19
ethmoid sinuses 18
frontal sinus 18
maxillary sinuses 18
sphenoid sinuses 19
Parapharyngeal space 25, 26
Parkinson's disease, and bilateral vocal fold palsy 201
Parosmia 140
Patterson–Kelly–Brown/Plummer–Vinson syndrome 177
Perichondritis 83
Perilymph 7
Perinatal history 50
Peristaltic waves 41
Peritonsillar abscess 48, 184 see also Tonsillitis and peritonsillar abscess
Phantosmia 140
Pharyngeal arches, structures from 2, 3
Pharyngeal pouch 25, 178, 192–195
barium swallow 193, 194
diverticulectomy 194
endoscopic stapling of pouch 193, 194, 195
plain radiograph of neck and cervical spine 193
wait and watch policy 193
Pharynx 25, 28
hypopharynx 25, 28
nasopharynx 25
oropharynx 25
Phonosurgery 199, 200
Pinna 2, 4
blood supply of cartilage of 2
Pinna haematoma 132
Plasmacytoma 168 see also Sinonasal tumours
Play audiometry 248
Pneumatic otoscopy 59, 61
Polysomnography (PSG), for sleep apnoea 224
Postcricoid carcinoma 177
Postnasal drip 47
Preauricular abnormalities 2
Precancerous lesions, and hoarseness 175, 175
Prednisolone
Bell's palsy 108
sensorineural hearing loss 126
Presbyacusis 114–116
investigation 115, 115
management 115–116
pure tone audiometry 115, 115
Presbycusis see Presbyacusis
Pretracheal fascia, neck 22
Pretracheal space 25, 27
Prevertebral fascia, neck 22
Prochlorperazine 119
benign paroxysmal positional vertigo 124
Progressive chronic otitis media 91
Propranolol, for lymphangiomatous malformations 214
Proton pump inhibitors
globus pharyngeus 192
vocal fold paralysis 201
Protrusion of eye 46
Pseudomonas aeruginosa 83, 93
Pure tone audiometry 72–73, 73
Q
Quinsy see Peritonsillar abscess
R
Radioallergosorbent test (RAST) 152
Ramsay Hunt syndrome 46, 94, 109, 109
Recurrent laryngeal nerve 30, 37, 198, 201
re-innervation of 202
Reflux oesophagitis 49
Reinke's oedema 200, 200
Respiratory papillomatosis 262, 263
Retropharyngeal abscess 262
Retropharyngeal space 25, 27
Rhabdomyosarcoma 167 see also Sinonasal tumours
Rhinitis 142–146
allergic 142, 144
blood test 145
clinical features 143–144
with deviated nasal septum 137
immunotherapy 146
with inferior turbinate hypertrophy 137
non-allergic 142, 143
pharmacotherapy 145–146
of pregnancy 138, 140
skin-prick testing 144–145
SNOT (sino-nasal outcome test) 145
Rhinology, cardinal presentations in 46–47
alteration of sense of smell 48
epistaxis 47–48
nasal obstruction 47
rhinorrhoea 47
Rhinorrhoea 47, 227–229
Rhinosinusitis 47
with nasal polyposis 137
Rinne's tuning fork test 55, 56
false-negative 58, 59
S
Saline nasal douching
chronic rhinosinusitis 150
rhinitis 145
Saliva 37
Salivary gland diseases 206–211
blood tests 208
causes 207
clinical features 208
CT and MRI 209
interventional sialography 209–210
management 210
microbiological tests 209
parotid glands tumour 206, 206
plain radiographs 209
ultrasound-guided fine needle aspiration (FNA) 209, 209
Samter's triad 151
Sarcoidosis 163 see also Granulomatous conditions of nose and paranasal sinuses
Scarlet fever 185, 242
Scottish Bell's Palsy Study 109
Semicircular canals 7–8
Semont manoeuvre 124
Sensorineural deafness 54
Sensorineural hearing loss 124–127
causes 125, 125
drug history 125
management 126
Rinne's test 125
Weber's test 125
Sensorineural hyposmia 139
Serosanguineous discharge 45
Severe otitis externa, and ear pain 43
Sialadenitis 180
Sialolithiasis 180
Siegle speculum, for pneumatic otoscopy 59, 61
Silver nitrate nasal cautery 158
Singer's nodules 199
Sino-Nasal Outcome Test-22 Questionnaire (SNOT- 22) 149
Sinonasal tumours 167–171
cancer of maxillary antrum 169, 170
clinical features 168–169
CT scan 169, 170
diplopia 168
inverted papilloma 168, 169–170
juvenile angiofibroma 168–169, 170
MRI 169, 170
nasopharyngeal malignancies 171
tumour subtypes 167, 168
Sinus ostia 17, 17
Sjögren's disease 37
Sleep nasendoscopy 224
Smell, physiology of 19
olfactory cells 19–20
olfactory pathway 21
olfactory processes 20–21
Snoring 50, 221 see also Obstructive sleep apnoea (OSA)
Sodium fluoride, in otosclerosis 112
Sore throat 48
in children 231–234
Speech audiometry 248–249
Speech therapy, for singer's nodules 199
Stapedectomy 87, 113
Stapedius muscle 5, 10
Stapes 5
Staphylococcus aureus 93
Stereocilia, of cochlea hair cells 11, 12
Steroids
Ménière's disease 119
nasal polyps 153
sensorineural hearing loss 126
Stertor 50
Streptococcus pyogenes 185
Stridor 50
Subglottic haemangioma 262
Subglottic stenosis 262
Subglottis 28
Submandibular gland hypertrophy 180
Submandibular space 25, 26
Submandibular triangle 22, 23
Submental triangle 22, 23
Subperiosteal abscess 100
Supraglottis 28
Surgical labyrinthectomy 119
Swallowing, difficulty in see Dysphagia
Swallowing, physiology of 39
oesophageal stage 40, 41
oral stage 39, 39–40
pharyngeal stage 40–41
T
Taste, physiology of 32
taste buds 32, 36, 36, 36
taste pathways 36–37
Taste receptor cells (TRCs) 32
Temporal bone 1, 6
Tensor tympani 5, 11
Throat see Pharynx
Throat, examination of 63
fibreoptic endoscopy 63, 65
headlight and tongue depressor, use of 63, 64
indirect laryngoscopy 63
Thudicum's speculum 61, 62
Thyroglossal cysts 66, 180, 242–245
causes and pathogenesis 243, 243
clinical features 243–244, 244
embryology of 243
modified Sistrunk's procedure 245
surgical excision 244, 245
thyroid function tests 244
ultrasound-guided fine-needle aspiration 244
ultrasound scan of neck 244
Thyroid and parathyroid glands
anatomy 31, 31
embryology 31
neurovascular supply and lymphatic drainage 32
Thyroid cancer 203 see also Thyroid swellings
management of 204–205
Thyroid swellings 202–206
clinical features 202–203, 203
CT scan 204
fibreoptic flexible nasendoscopy 203
guided fine-needle aspiration (FNA) cytology 203, 204
referral in 204
thyroid function tests 203
thyroid nodules 202
thyroid ultrasound 203
Tinnitus 44, 45–46
dull, lower frequency, continuous 45
fluctuant 46
high-frequency hissing and ringing 45
pulsatile 45
Tinnitus retraining therapy 119
Tonsillitis and peritonsillar abscess 184–189
bacterial tonsillitis 184
Brodsky classification of tonsillar size 188, 188
Centor and FeverPAIN criteria 187, 187
chronic tonsillitis 186
clinical features 185, 185–186, 186
glandular fever with exudates 185, 185
management 188–189
peritonsillar cellulitis/abscess 186, 188
recurrent tonsillitis 186
skin rash by streptococcal sore throat 185–186, 186
tonsillectomy 189
viral tonsillitis 184
Toxoplasma gondii 179
Toxoplasmosis 179
Tracheomalacia 262
Transient otoacoustic emission (TOAE) test 247
in neonates 246
Trauma to ear 129–132
Battle's sign 130, 131
causes 130
clinical features 130, 131
CT scan 131, 132
external ear trauma 129–130, 131–132
inner ear trauma 130, 132
middle ear trauma 130, 132
pure tone audiogram 131
temporal bone fractures 129, 130, 132
Triangles of neck 22, 22
anterior triangle 22, 22–23
posterior triangle 22, 23
Trigeminal nerve (CN V) 33, 40
Trochlear nerve (CN IV) 33
Tuberculosis 175
Tumour, and airway obstruction 183
Tumours of nasal cavity 137
Tuning fork tests 55
Rinne's test 55, 56
Weber's test 57, 57–58, 58
Tympanic membrane 4, 5
derivation of 2, 3
light reflex 4, 5
pars flaccida 4, 5
pars tensa 4, 5
Tympanometry 10, 73, 74, 248
Tympanosclerosis 85
Tympanostomy tube 99
U
Ultrasound-guided FNA 72
Upper airway disorders, paediatric 261–265
causes 261, 262
chest and neck radiographs 263
CT/MRI 264
examination 263–264
history 261, 263
laryngotracheobronchoscopy under general anaesthesia 264
management 264–265
oxygen saturation monitoring 264
Upper airway resistance syndrome (UARS) 221
UPSIT test (University of Pennsylvania Smell Identification Test) 137
V
Vagus nerve (CN X) 34, 40
Vascular ring 262
Vasoconstrictor nasal sprays, long-term use of 140
Vertigo 46
acute vestibular failure and 87–89
causes 121
differential diagnosis 89
duration of 88
examination 88–89
history taking in 44, 46
Vestibular nerve section 119
Vestibular neuritis 89
Vestibular pathway 8
Vestibular reflexes 15
vestibulo-ocular reflex 15
vestibulospinal reflexs 15
Vestibular rehabilitation exercises 88
Ménière's disease 119
Vestibular schwannomas (VS) 127, 127–129
investigations and clinical findings 129
stereotactic radiation therapy 128
surgical approach 128–129
Vestibular sedatives 89, 119
Vestibular system
ampullae of semicircular canals 14–15, 15
utricle and saccule 14, 14
vestibular labyrinth 13
Vestibule 7
Vestibulocochlear nerve (CN VIII) 7, 34
Video endoscopic system, for evaluation of larynx 197, 197
Viral tonsillitis 233
Visual reinforcement audiometry (VRA) 248
Voice disorders and vocal fold pathology 195–202
causes of 196
chest X-rays and CT scans 198
contact ulcers 200
history and assessment 196–197
laryngeal evaluation 197, 197, 198
normal vocal cords 196
perceptual evaluation 198
Reinke's oedema 200, 200
thyroid function tests 198
video laryngo-stroboscopy 197, 197, 198
vocal fold nodules 199
vocal fold paralysis 201–202
vocal fold polyp 199, 199–200
Voice, physiology of 37
phonation 37, 38
pitch 37–38
VS see Vestibular schwannomas (VS)
W
Wax 3
Weber's tuning fork test 57, 57–58, 58
Wegener's granulomatosis see Granulomatosis with polyangiitis (GPA)
Y
Young's syndrome 137
Z
Zenker's diverticulum 192
×
Chapter Notes

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Otolaryngology
Otolaryngology
Second Edition
Abir Bhattacharyya MS DNB FRCS FACS FRCS (ORL-HNS) Training Programme Director London School of Surgery Consultant ENT Surgeon Whipps Cross University Hospital London, UK Sonna Ifeacho FRCS (ORL-HNS) Consultant ENT Surgeon Whipps Cross University Hospital London, UK Henry Zhang BMedSci BMBS MRCS DOHNS Specialty Registrar Royal National Throat, Nose and Ear Hospital Great Ormond Street Hospital London, UK
© 2020 Jaypee Brothers Medical Publishers
First edition 2012
Published by Jaypee Brothers Medical Publishers,
4838/24 Ansari Road, New Delhi, India
Tel: +91 (011) 43574357
Fax: +91 (011)43574390
Email: info@jpmedpub.com, jaypee@jaypeebrothers.com
Web: www.jpmedpub.com, www.jaypeebrothers.com
JPM is the imprint of Jaypee Brothers Medical Publishers.
The rights of Abir Bhattacharyya, Sonna Ifeacho and Henry Zhang to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission in writing of the publishers. Permissions may be sought directly from Jaypee Brothers Medical Publishers (P) Ltd. at the address printed above.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
9781909836884
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Development Editor:
Harsha Madan
Editorial Assistant:
Keshav Kumar
Cover Design:
Rakesh Kumar
Foreword
It is a great pleasure to write a foreword for the second edition of Pocket Tutor Otolaryngology. This handy-sized textbook is an ideal starting point for junior doctors who want more insight into disorders of the ear, nose and throat, and for anyone who wants to update their knowledge of otolaryngology.
The layout is very clear and the concise text and liberal use of illustrations make each topic highly accessible. The clinical scenarios that open each chapter, and the Clinical Insights and Guiding Principles boxes are a wonderful way of relating the subjects to readers’ past and future clinical experience.
New to this edition are the diagnostic algorithms in Chapter 3. These are a great aide to decision making. Even though I have been practising ENT for more than 30 years, I have learned things from this edition.
I recommend Pocket Tutor Otolaryngology to any doctor who wishes to learn about the underlying principles and practice of otolaryngology.
Anthony Narula MA FRCS FRCS Ed
Honorary Consultant ENT Surgeon
Imperial College Healthcare NHS Trust
Past President ENT–UK
Former Visiting Professor,
Middlesex University 2003–2018
May 2019
Preface
Otolaryngology has evolved since the first edition of Pocket Tutor Otolaryngology was published. Two new authors, Sonna Ifeacho and Henry Zhang, have brought fresh ideas and enthusiasm to meet the challenge of incorporating new material while keeping the book pocket-sized.
All chapters have been thoroughly updated. As before, the opening chapter explains anatomical concepts and physiological principles that underpin the subject; however, we have reordered it to present anatomy and physiology together for each region, to emphasise the link between them. In the second chapter, which summarises history, examination and investigative techniques; most of the photographs showing examination techniques are new and have been taken specifically for this book. There then follows an entirely new chapter which presents diagnostic algorithms for symptoms very commonly encountered in clinical practice; we hope these are useful guidance for working through differential diagnoses. The remaining chapters describe commonly seen clinical disorders.
Throughout the book we have updated the clinical scenarios: these introduce practical clinical thinking for applying the information in each chapter. As in the first edition, Clinical Insight and Guiding Principle boxes drawn from our personal experience will aid understanding of the concepts.
We have added new material on facio-plastics, sleep medicine and paediatrics, because mainstream otolaryngology truly extends from ‘dura to pleura’ and everything in between. Our overall selection of clinical topics cannot be exhaustive in a Pocket Tutor but we believe it covers both the more common problems seen in general practice and rarer but more severe conditions often seen in hospital-based practice.
We hope you enjoy the second edition of Pocket Tutor Otolaryngology.
Abir Bhattacharyya, Sonna Ifeacho, Henry Zhang
May 2019
Acknowledgements
The authors would like to thank Julian East, Senior Medical Photographer at Barts Health, Miss Elizabeth Maughan (ENT SpR), Dr Omer Khalid (ENT Registrar) and Dr Charlotte Murkin (ENT CST) for their help with the clinical photographs. Thanks to the many foundation doctors, medical students and GPs who have given written and verbal feedback on the first edition of the Pocket Tutor to improve the content of the second edition. The list is long and we apologise for not being able to individually acknowledge all of them.
Our thanks to Adam Rajah and Thomas Banister-Fletcher, and Richard Furn, Publishing Director, at JP Medical Ltd for their patience, constant encouragement and support with the second edition.
Last but not the least we acknowledge our families’ sacrifice in letting us burn the midnight oil and work at weekends ‘when deadlines were near’. Abir would like to thank his wife (Rinku) and his children (Anudeep and Amrita) for letting him complete his academic work unhindered.
AB