Primary Care Otolaryngology

The third edition of this popular handbook continues its goal of improving clinical judgment by teaching the basics of otolaryngology. Targeted to medical students and allied health professionals with an interest in otolaryngology — head and neck surgery this e-book helps readers manage uncomplicated clinical problems and recognize when to refer more serious conditions to an otolaryngologist.

Highlights include:

• New advice on presenting on rounds and evaluating patients
• Updated chapters reflecting current clinical practice guidelines
• Question and answer section at end of each chapter

 

Chapter Overviews

Chapter 1: Introduction to Clinical Rotation

To become a good clinician it is helpful to be carefully observant in important but unnoticed aspects, such as demeanor, comments, and interaction with other healthcare providers and patients. Students learn a lot through observing care of patients. The process starts with appearance, punctuality, composure, acceptance of responsibility, and interactions with patients and other members of the healthcare team.

Chapter 2: Keeping Track of Patients

Taking an otolaryngology history and performing a head and neck exam begins with a chief complaint followed by a description of the location, duration, frequency, and quality of the presenting symptoms. In addition, consider aggravating and relieving factors and associated symptoms.

Chapter 3: Presenting on Rounds

Patient presentations should be goal oriented and follow a specific format. The last sentence of a presentation should always start with "The plan is…" For postoperative patients you should always think of what needs to be done to send the patient home. The five Ws of post-operative fever are a useful memory tool when following patients after surgery.

Chapter 4: ENT Emergencies

ENT emergencies include but are not limited to airway emergencies such as tracheotomies, difficult intubations, deep neck infections, foreign bodies, mucormycosis, epistaxis, sudden hearing loss and necrotizing otitis externa.

Chapter 5: Otitis Media

Otitis media is simply defined as inflammation of the middle ear space due to any cause. It is the second most common disease diagnosed in young children. Otitis media can be classified by duration, patient symptoms, and physical exam findings.

Chapter 6: Hearing Loss

Hearing loss can be caused by a wide variety of factors. Patients may present with the complaint of being unable to hear or they may complain of difficulty understanding. Older individuals often complain tinnitus. Hearing loss in children may be particularly difficult to detect and is often confused with inattention or speech delay.

Chapter 7: Dizziness

People often come to the otolaryngologist with a complaint of dizziness including symptoms such as disequilibrium, syncope, lightheadedness, ataxia, and vertigo. As otolaryngologists, we focus on disease processes that produce true vertigo, which is primarily associated with balance organs of the inner ear.

Chapter 8: Facial Nerve Paralysis

Facial nerve paralysis is a devastating condition for the patient and their family. It may occur spontaneously, following trauma, surgical procedure, or as a result of malignant tumors of the pinna, the parotid gland, or the skull base.

Chapter 9: Rhinology, Nasal Obstruction and Sinusitis

Patients present to primary care providers with a variety of nasal complaints, ranging from rhinorrhea and postnasal drainage to obstruction and pain. Successful treatment of the varying causes of rhinorrhea and obstruction is based on the accurate diagnosis of the underlying cause.

Chapter 10: Allergy

Over 20 million Amercians suffer from inhalant allergies. Symptoms are nasal congestion, clear rhinorrhea, itchy watery eyes, and sometimes ear or palatal itching, post-nasal drip, and throat irritation. Allergic symptoms are initiated by inhalation of dander, pollen, mold spores, or other antigens. Allergies represent an abnormal immune response to an environmental protein tolerated by the majority of people.

Chapter 11: How to Read a Sinus CT Scan

The standard radiographic study for evaluation of sinus disease is the sinus CT scan performed in the coronal plane. There are four radiographic densities: air, fat, water, and bone. The best way to learn to look at any x-ray or imaging study is to carefully and systematically examine as many as possible.

Chapter 12: Maxillofacial Trauma

When treating maxillofacial trauma, the basic tenets of trauma management hold: secure the airway, breathing, circulation. The second rule is rule out a C-spine fracture and rule three is evaluate the patient completely. Any positive finding is an indication for further evaluation.

Chapter 13: Facial Plastic Surgery

Facial plastic surgery constitutes a significant part of the practice of otolaryngology. Otolaryngologists were the founding fathers of plastic surgery as a medical specialty. Common procedures vary from the functional such as reconstruction to purely cosmetic procedures such as facelifts.

Chapter 14: Salivary Gland Disease

A discussion of salivary glands should consider both the major (parotid, submandibullar, and sublingual) and minor salivary glands. It is estimated that normal individuals have 750-1,000 minor salivary glands located submucosally from the lips to the trachea.

Chapter 15: Thyroid Cancer

Thyroid cancer and the management of thyroid masses can be a confusing topic of discussion. While many thyroid nodules are benign and common, otolaryngologists often recommend and perform removal of nodules that have a reasonable risk of being cancerous, as determined by multiple factors.

Chapter 16: Head and Neck Cancer

Diagnosis and management of head and neck cancer is a broad topic. Head and neck cancer primarily refers to carcinomas of the larynx, naso-, oro-, and hypopharynges, paranasal sinuses, salivary glands, and the oral cavity.

Chapter 17: Skin Cancer

The great majority of skin cancers arising on the skin of the face, scalp, and neck are basal cell carcinoma, followed by squamous cell carcinoma, then malignant melanoma. Basal cell carcinoma is very common and most often occurs on the face, so the otolaryngologist – facial plastic surgeon sees many cases.

Chapter 18: Pediatric Otolaryngology

A high percentage of illnesses affecting children involve the ears, nose, and throat. Nearly all otolaryngologists treat children and some only treat children. The most common pediatric disorder seen is otitis media. Other pediatric conditions include tonsillectomy, stridor, congenital neck mass, tongue tie, and rhinosinusitis.

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This information is provided by the American Academy of Otolaryngology-Head and Neck Surgery for educational purposes only. Any information provided in this Web site should not be considered medical advice or a substitute for a consultation with a physician.