Otolaryngology, Head and Neck Surgery: An Introduction to the Specialty

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Otolaryngology, Head and Neck SurgeryAn
Introduction to the Specialty

• Amanda L. Muhs, MDUCI Medical Center
• Dept. of Head and Neck Surgery
• Medical Student Lecture
• July 23, 2007

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Otolaryngology, Head and Neck Surgery

• Characteristics of the Specialty
• Training and Specialization
• Examples of Common Disorders
• Summary

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What is Otolaryngology?

• Ear, Nose, And Throat Physicians (ENT)
• Otolaryngology, Head and Neck Surgery
• Medical and Surgical Specialists
• Diagnosis and management of diseases of the
  sinuses, larynx oral cavity, upper pharynx, neck
  and face
• Specialty-specific disorders and primary care
  problems

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Characteristics of Otolaryngology

• Intricate Anatomy

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Characteristics of Otolaryngology

• Wide Patient Variety

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Characteristics of Otolaryngology

• Medical and Surgical Management

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Characteristics of Otolaryngology

• Treating the Special Senses

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Characteristics of Otolaryngology

• Opportunity to Collaborate with other Experts

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The E

• Disorders related to the Ear
• Hearing loss
• Ear infections
• Balance disorders
• Tinnitus
• Nerve pain, facial and cranial nerve disorders
• Congenital disorders

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The N

• Disorders of and related to the Nose
• Sinusitis
• Allergies
• Breathing and airway management

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The T

• Disorders of and related to the Throat
• Communication and Speech
• Larynx
• Upper aerodigestive tract
• Swallowing disorers

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Head and Neck Surgery

• Disorders of the Head and Neck
• Infectious diseases
• Benign and malignant tumors
• Facial trauma
• Congenital deformities
• Cosmetic plastic and reconstructive surgery

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Training in Otolaryngology

• 5-7 years
• General Surgery Internship
• 4 years of clinical residency in Otolaryngology
• Research
• 4 months to 2 years
• Program specific
• Matching
• 270 positions
• Regular Match

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Fellowship Training

• Pediatric otolaryngology
• Otology/neurotology
• Allergy
• Facial plastic and reconstructive surgery
• Head and neck
• Laryngology
• Rhinology
• Microvascular surgery
• Plastic Surgery

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Students of Otolaryngology

• Medical vs. Surgical Patients
• Altered Physiology
• Complex Hospital Course
• Thinking like a surgeon
• What are the indications for a procedure?
• What is the relevant anatomy?
• What are the major steps of the procedure?
• What complications could arise?
• What postoperative course is expected?

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Students of Otolaryngology

• The Head and Neck Exam
• Head
• Eyes
• Ears
• Nose
• Throat
• Neck
• Special Insrtuments
• Microscopy, Laryngoscopy
• Mirrors and Speculae
• Tuning Forks

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Common ENT Problems

• Otitis Media
• Disease Process
• Inflammatory disease
• of the mucosal lining of
• the middle ear
• Common in children
• Streptococcus pneumoniae
• Haemophilus influenzae in infants
• Symptoms
• Abrupt onset, ear pain, fullness
• Fever,irritability, vomiting, loose stools
•  

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Common ENT Problems

• Otitis Media
• Diagnosis
• Red TM with bulging and loss of normal landmarks
• Spontaneous perforation may occur in the first
  24-48 hours, resulting in alleviation of pain
• Pneumatic otoscopy to determine the presence of
  fluid in the middle ear

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Common ENT Problems

• Otitis Media
• Treatment
• Antibiotics
• Drainage
• Myringotomy

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Common ENT Problems

• Hearing Loss
• Sensorineural hearing loss (nerve-related)
• Aging, pre-natal and birth-related problems,
  infections, heredity, trauma, exposure to loud
  noise, fluid backup, or a benign tumor in the
  inner ear
• Conductive hearing loss (outer and middle ear)
• Blockage of wax, punctured eardrum, birth
  defects, ear infection, or heredity
• Can be effectively treated medically or
  surgically.
• Mixed hearing loss
• Combination of conductive and sensorineural loss
• Central hearing loss
• Damage or impairment to the nerves or auditory
  nuclei of the central nervous system

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Common ENT Problems

• Tonsillitis
• Signs/Symptoms
• Severe sore throat,
• difficult or painful
• swallowing, headache,
• fever/chills
• Enlarged, tender nodes
• Loss of voice

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Common ENT Problems

• Tonsillitis
• Etiology
• Viral (EBV)
• Bacterial (S. pyogenes)
• Diagnosis
• Physical Exam
• Culture
• Complications
• Abscess formation, loss of airway, sepsis
• Nephritis, rheumatic fever

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Common ENT Problems

• Tonsillitis
• Treatment
• Antibiotics
• Tonsillectomy
• 7 or more episodes of tonsillitis in one year
• 5 or more episodes of tonsillitis a year for two
  years
• Airway concerns, OSA
• Abscess formation

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Common ENT Problems

• Tracheostomy
• Congenital abnormality of the larynx or trachea
• Severe neck or mouth injuries
• Inhalation of corrosive material smoke or steam
• Airway occlusion
• Paralysis of the muscles
• Ventilator Dependence

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Common ENT Problems

• Thyroid Disease
• Papillary Carcinoma 80
• Resection, Neck Dissection
• Radioactive Iodine
• Follicular Carcinoma 15
• Commonly Invasive
• Resection, Radioactive Iodine
• Medullary Carcinoma 6-10
• Familial (MENIIa and IIb)
• Sporadic
• Resection
• Anaplastic Carcinoma
• Worst prognosis
• Rarely cure, secure airway

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Common ENT Problems

• Neck Dissection
• Radical
• Removal of all Lymph Nodes
• SCM, IJV, Accessory Nerve, all LN levels
• Modified Radical
• Removal of all Lymph Nodes
• Preservation of 1 or more additional structures
• Selective
• Preservation of 1 or more Node groups

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Common ENT Problems

• Salivary Gland Disease
• Benign
• Sialolithiasis
• Stone removal, Sialogogues
• Parotitis
• S. Aureus
• Sialogogues, Antibiotics
• Malignant
• Pleomorphic Adenoma (most common)
• Adenoid Cystic Carcinoma (CNVII involvement)
• Mcuepidermoid Carcinoma

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Common ENT Problems

• Maxillofacial Trauma
• Securing an Airway
• Bony Reconstruction
• Facial Lacerations
• Neurologic and Ophthalmic Sequelae
• Cosmetic and Functional Results

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Common ENT Problems

• Facial Plastic Surgery
• Septoplasty
• Rhinoplasty
• Blepharoplasty
• Skin Resurfacing
• Skin Cancer
• Squamous Cell Ca
• Disease resection
• Use of flaps and Grafts for closure

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What is Otolaryngology?

• A medical and surgical subspecialty
• Expert care of disorders of the Ear, Nose,
  Throat, Head and Neck
• Attention to form and function
• Treatment of a range of patient problems and
  demographics
• A truly enjoyable and satisfying specialty!

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Thank you, and Welcome!