Introduction to ENT Medicine Aydin Mohammadi Introduction to ENT Medicine

Contents What is ENT Subspecialties Anatomy recap Common cases in daily medical practice Q&A

What is ENT Otorhinolaryngology Fairly recent specialty Came out of joint specialty with ophthalmology Has three main subspecialties: Otology Rhinology Laryngology (AKA head and neck surgeons)

Otology External, middle and inner ear disease Vestibular n. disorders (Schwannomas etc) Hearing impairment Work closely with audiologists, and often NeuroSx

Rhinology Nasal, paranasal sinus, and skull base pathologies Work closely with allergy and immunology specialists Endoscopic surgery (FESS) Work with NeuroSx for transphenoidal resections + skull base disease

Laryngology Work with the organ of voice More than just head and neck surgery Perform complex, often long operations on head and neck cancer patients Oral, oropharyngeal, upper oesophageal, laryngeal pathologies

Anatomy 1.

Anatomy 2.

Anatomy 3.

Common cases in ENT

Otitis Externa Caused by skin bugs Treatment: Staph + Strep Also pseudomonas  major cause Treatment: Swab ear Dry wicking to remove debris Otowick insertion Ototopical anti-pseudomonal Tx DRY EAR PRECAUTIONS Occasionally oral Abx

Otitis Media Caused by respiratory bugs S. pneumoniae, H. influenzae, M. catarrhalis Also by many viruses Little evidence for antibiotics except in severe disease – most are self limiting Need to identify at risk populations Recurrent OME  grommets

Sinusitis Most commonly allergic/polyposis Poor drainage of the sinuses via the OMC Initial treatment always medical: Oral antibiotics to cover URI bacteria Nasal steroids ++, saline washes 1-2 week course of oral steroids sometimes necessary Surgery - FESS

Tonsillitis Tonsils are “external” lymph organs Have ducts that allow antigen presentation – also allow bacterial infiltration Viral vs Bacterial Middle and long term issues (kidneys, heart) ∴ treat with 10 day course of Abx Recurrent or chronic infections need tonsillectomy referral

Peritonsillar abscess Trismus, high temperatures, odynophagia, and occasionally airway obstruction Require antibiotics and drainage Prompt treatment is important Complications: Spread to parapharyngeal and retropharyngeal space

Laryngeal cancer Hoarse voice or no voice, dysphagia, “lump” in neck, weight loss etc Often smoker +/- ETOH Smoker = RR 19 ETOH = RR 4 Smoker + ETOH = RR 37 (sometimes quoted as 100) Treatment depends on site, histolopathology, and patient factors

Treatments include: Radiotherapy +/- chemotherapy alone Surgery alone Surgery + chemorads LASERRRRR!!!!!!!!!!!!!!!!!!!!!!!

The End Any questions?