ENT Essentials
ENT Essentials
Editors
Elina M Toskala MD PhD MBA
Professor Department of Otolaryngology— Head and Neck Surgery Thomas Jefferson UniversityPhiladelphia, Pennsylvania, USA
David W Kennedy MD FACS FRCSI
Professor Department of Otorhinolaryngology—Head and Neck Surgery Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
Foreword
Michael J Ruckenstein MD MSc FACS
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ENT Essentials
First Edition: 2020
9789351529477
Printed at
Garrett, Kirin, Paavali and Aurora
- Sidrah M Ahmad MD
- Assistant Professor of Surgery
- Division of Otolaryngology—
- Head and Neck Surgery
- Stony Brook University Hospital
- Stony Brook, New York, USA
- Kamil Amer MD
- Lewis Katz School of Medicine
- Temple University Philadelphia, Pennsylvania, USA
- Samir Ketan Bhandutia DO
- Coney Island Hospital
- Brooklyn, New York, USA
- Anthony E Brissett MD
- Associate Professor of Otolaryngology—
- Head and Neck Surgery
- Baylor College of Medicine
- Houston, Texas, USA
- Norman Chan MD
- ENT-Otolaryngologist
- Mount Sinai School of Medicine
- New York City, New York, USA
- Michael S Cohen MD
- Assistant Professor of Otolaryngology
- Harvard Medical School
- Boston, Massachusetts, USA
- Jennifer R Cracchiolo MD
- Assistant Attending Surgeon
- Head and Neck Surgery
- Memorial Sloan Kettering
- Cancer Center
- New York City, New York
- USA
- Gillian R Diercks MD MPH
- Division of Pediatric
- Otolaryngology
- Massachusetts Eye and Ear
- Infirmary
- Wellesley, Massachusetts, USA
- Barbara Ebersole MA
- Speech-Language Pathologist
- Philadelphia, Pennsylvania, USA
- Christopher E Fundakowski MD FACS
- Attending Surgeon
- Head and Neck Oncology
- Fox Chase Cancer Center
- Assistant Professor of Otolaryngology—
- Head and Neck Surgery
- Temple University School of Medicine
- Philadelphia, Pennsylvania, USA
- Sarah A Gitomer MD
- Department of Otolaryngology (Ear, Nose and Throat)
- Baylor College of Medicine
- Houston, Taxes, USA
- Purva Gumaste MD
- Infectious Diseases
- Wagoner Medical Group
- CHI Health Saint Francis
- Grand Island, Nebraska, USA
- Samuel Hahn MD
- Maryland Center for Facial
- Plastic Surgery
- Baltimore, Maryland, USA
- George Harris IV MD
- Director of Pediatric
- Otolaryngology
- Summerville Pediatric
- Specialists
- Summerville Medical Center
- Summerville, South Carolina
- USA
- Kristen Hurst MD
- ENT-Otolaryngologist
- University of Iowa Hospitals and Clinics
- Iowa City, Iowa, USA
- Glenn Isaacson MD FAAP
- Professor
- Otolaryngology— Head and Neck
- Surgery and Pediatrics
- Lewis Katz School of Medicine
- Temple University
- Philadelphia, Pennsylvania, USA
- Fredric Jaffe DO FCCP FAASM
- Diplomate of the American
- Board of Sleep Medicine
- Associate Professor of Clinical Medicine
- Department of Thoracic
- Medicine and Surgery
- Temple University Hospital
- Philadelphia, Pennsylvania, USA
- Nausheen Jamal MD
- Residency Program Director and Clerkship Director
- Co-Director of ENT Curriculum
- PA Program
- Assistant Professor
- Department of Otolaryngology—
- Head and Neck Surgery
- Assistant Professor
- Department of Surgical Oncology
- Fox Chase Cancer Center
- Temple Head and Neck Institute
- Lewis Katz School of Medicine
- Temple University
- Philadelphia, Pennsylvania, USA
- Douglas R Johnston MD
- Assistant Professor Otolaryngology and Pediatrics
- Ann and Robert Lurie Hospital for Children
- Northwestern University Chicago, Illinois, USA
- Deborah S F Kacmarynski MD MS
- Paul N Johnson Associate
- Professor in Craniofacial Abnormalities
- Pediatric Otolaryngology
- Clinical Associate Professor
- Co-Director of Cleft and Craniofacial Team
- Department of Otolaryngology—
- Head and Neck Surgery
- Pediatrics and Biomedical Engineering
- University of Iowa lowa City, Iowa, USA
- Jarrod Keeler MD
- ENT-Otolaryngologist
- University of Pennsylvania
- Philadelphia, Pennsylvania, USA
- Lori A Lemonnier MD
- Assistant Professor and Program Director
- Director of Rhinology and Skull Base Surgery
- Department of Otolaryngology—
- Head and Neck Surgery
- Louisiana State University
- Health Sciences Center
- Shreveport
- Shreveport, Louisiana, USA
- Gary Linkov MD
- ENT-Otolaryngologist
- Philadelphia, Pennsylvania, USA
- Jeffrey C Liu MD FACS
- Associate Professor of Otolaryngology—Head and Neck Surgery
- Lewis Katz School of Medicine Temple University
- Associate Professor
- Head and Neck Surgery
- Fox Chase Cancer Center
- Philadelphia, Pennsylvania, USA
- Yuan F Liu MD
- ENT-Otolaryngologist
- David Geffen School of Medicine at UCLA
- Los Angeles, California, USA
- Benjamin Marcus MD
- ENT-Otolaryngologist
- University of Wisconsin
- Hospitals
- Middleton, Wisconsin, USA
- Katherine M McKee-Cole MD
- Physician, Colorado West Health Care System
- Adjunct Faculty Member
- University of Utah
- Division of Otolaryngology
- Salt Lake City, Utah, USA
- Sam P Most MD
- Chief, Division of Facial Plastic and Reconstructive Surgery
- Professor
- Departments of Otolaryngology—Head and Neck Surgery (Plastic)
- Stanford University School of Medicine
- Stanford, California, USA
- Taha Ahmad Mur MD
- Department of Otolaryngology—
- Head and Neck Surgery
- Boston Medical Center
- Massachusetts, New England
- USA
- Scott R Owen MD
- Director Facial Plastic and Reconstructive Surgery
- Department of Otolaryngology—
- Head and Neck Surgery
- University of Iowa Hospitals and Clinics
- Iowa City, Iowa, USA
- Robert C O'Reilly MD
- Physician in the Division of Otolaryngology
- Director of the Balance and Vestibular Program at Children's Hospital
- Philadelphia, Pennsylvania, USA
- Mariah Pate MD
- Ear, Nose and Throat Associates
- Clearwater, Florida, USA
- Natasha Pollak MD MS
- Associate Professor
- Department of Otolaryngology—
- Head and Neck Surgery
- Lewis Katz School of Medicine
- Temple University
- Philadelphia, Pennsylvania, USA
- Pamela C Roehm MD PhD
- Director
- Division of Otology and Neurotology
- Professor of Otolaryngology
- Department of Otolaryngology—
- Head and Neck Surgery
- Lewis Katz School of Medicine
- Temple University
- Philadelphia, Pennsylvania, USA
- Paul Sabini MD FACS
- Private Practice
- Newark, Delaware, USA
- Rafik Samuel MD
- Infectious Disease Specialist
- Fox Chase Cancer Center
- American Oncologic Hospital
- Philadelphia, Pennsylvania, USA
- Joseph Sciarrino MD
- Otolaryngologist
- South Carolina ENT Allergy and Sleep Medicine
- Lugoff, South Carolina, USA
- Ahmed M S Soliman MD
- Professor and Interim Chair
- Director, Head and Neck Institute
- Director, Voice, Airway, and Swallowing Center
- Department of Otolaryngology—
- Head and Neck Surgery
- Lewis Katz School of Medicine
- Temple University
- Philadelphia, Pennsylvania, USA
- Donald Solomon MD
- Assistant Professor of Surgery
- Cooper Rowan Medical School
- Attending Otolaryngologist
- Cooper Health Systems
- Specialty: Pediatric
- Otolaryngology
- Camden, New Jersey, USA
- Resha S Soni MD
- Department of Otolaryngology—
- Head and Neck Surgery
- Lewis Katz School of Medicine
- Temple University
- Philadelphia, Pennsylvania, USA
- Carly J Stewart MD
- Department of Otolaryngology
- University of Colorado School of Medicine
- Aurora, Colorado, USA
- Michael Teixido MD
- Otolaryngologist and Otologist/Neurotologist
- Department of Otolaryngology—Head and Neck Surgery with Jefferson
- Medical College
- Director at Balance and Mobility Center of Christiana Care and the Delaware
- Otology Medicine and Surgery Fellowship
- Wilmington, Delaware, USA
- Gabriela Timoney MD
- General Surgeon
- Temple University Philadelphia, Pennsylvania, USA
- Derrick Tint MD
- Temple Head and Neck Institute
- Philadelphia, Pennsylvania, USA
- Elina M Toskala MD PhD MBA
- Professor
- Department of Otolaryngology—
- Head and Neck Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Maria Elena Vega MD
- Assistant Professor of Medicine
- Department of Thoracic Medicine and Surgery
- Lewis Katz School of Medicine Temple University
- Philadelphia, Pennsylvania, USA
- Andrew A Winkler MD
- Otolaryngology, Plastic Surgery—
- Head and Neck
- Assistant Professor
- Facial Plastic and Reconstructive Surgery and Director, Visage Center
- Lone Tree, Colorado, USA
- Charles Woodard MD
- ENT-Otolaryngologist
- Duke Raleigh Hospital Durham, North Carolina, USA
- Helen Xu MD
- Associate Professor
- Department of Otolaryngology—
- Head and Neck Surgery
- Loma Linda University
- School of Medicine
- Loma Linda, California, USA
Why should I read this book?
Otolaryngology is a confusing medical specialty. Even its name is confusing! Officially, it goes by the long and somewhat convoluted names of Otolaryngology—Head and Neck Surgery or the even longer Otorhinolaryngology—Head and Neck Surgery. Colloquially, we are known as Ear, Nose and Throat doctors or ENTs for short. Because we are a regional subspecialty, we are involved in the treatment of disease processes in multiple different organ systems. Although we are surgeons, we treat many medical disorders. In order to do this, we use a variety of tools, including small, subspecialized endoscopes to access areas of the body not normally accessible on physical exam. Is it any wonder that our colleagues are often a bit mystified about what we do and how we do it?
Conservative estimates indicate that 10–20% of visits to a primary care physician result from ear, nose, and throat disorders. Yet medical students typically obtain a maximum of a 1 week of exposure to otolaryngology during their medical training. Many medical schools do not even offer that level of experience. Residency training programs for primary care physicians most often do not include any formal rotations in otolaryngology. For those students who do rotate on our services, and for Physician Assistant and Nurse Practitioners who work in our clinics, a concise, up-to-date, practical text on our specialty, has, until now, been lacking.
The editors have assembled an outstanding team of authors to create this symptom-based text. This approach provides a very readable and practical book that can be read cover to cover or referred to for help with specific clinical complaints. It is appropriate reading for medical students, junior residents, and mid-level providers who are seeking more in-depth knowledge typically provided in more basic, introductory texts. It should also serve as a valuable, readily available online reference that can be accessed from the clinic. The format of this text allows for rapid acquisition of material that is directly of interest to targeted readers. Particularly exciting are the case examples that are provided in the accompanying ‘app’ that offer an excellent interactive case review in the specified topics. I applaud the editors for providing all of us interested in medical education with a text that we can refer our students to with great enthusiasm!
Michael J Ruckenstein MD MSc FACS
Professor and Vice Chairman
Residency Program Director
Department of Otorhinolaryngology—
Head and Neck Surgery
University of Pennsylvania
Philadelphia, Pennsylvania, USA
Preface
The goal for this book is to create a symptom-based up-to-date text which can be easily referenced either electronically or in hard copy by students performing an elective in the specialty and residents at an early point in their residency, and mid-level providers who are specializing in otolaryngology. Further, the book aims to provide an easy symptom-based reference for those familiar with the specialty, but faced with a problem outside of their usual field of practice. Using a symptom-based format, the book significantly builds upon what is available as a basic text from the Academy, Primary Care Otolaryngology. ENT Essentials, available both in print and electronically, incorporates an interactive case-based app, and utilizes this wherever appropriate. This book is divided into sections based upon on regional anatomy; The Ear, The Face, The Nose, The Larynx, The Head and Neck, with additional section on Sleep Medicine and Pediatric ENT.
The chapters themselves are based on patient symptomatology and take the reader through the relevant physical examination, diagnosis and treatment utilizing these symptoms. The book incorporates images, cases and apps. Written by a broad spectrum of subspecialty academic authors each of whom are well recognized within their respective fields the text provides a wealth of basic knowledge. To ensure that the chapters are truly relevant to problems faced by students and residents, many senior authors also worked with residents closer to this point of their training. We believe that this first edition will fulfill an important niche within the otolaryngology educational pathway and sincerely hope that it will be helpful to those pursuing a career within the specialty.
Elina M Toskala MD PhD MBA
David W Kennedy MD FACS FRCSI
Acknowledgments
We would like to take this opportunity to thank all the authors for their untiring work on this project. Like most books the creation took more time than anticipated and they have worked with us to create a book that we believe should be truly beneficial to medical students and residents starting within the field. We would also like to thank Mr Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy) and Kritika Dua (Senior Development Editor) of M/s Jaypee Brothers Medical Publishers, New Delhi, India for their work, especially for creating the app for the different illustrative cases.