Introduction to Otolaryngology AKA: Otorhinolaryngology ENT Ear Nose and Throat

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Introduction to OtolaryngologyAKAOtorhinolaryng
ologyENTEar Nose and Throat

• Greg Krempl, MD FACS
• Chairman Dept of ORL

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Objectives

• Introduction to the specialty
• Focus by site for common problems
• History
• Physical examination
• Labs commonly ordered
• Imaging commonly ordered
• Making the Diagnosis
• Treatment plans

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Case driven
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First - AIDET

• Acknowledge
• Introduce
• Duration
• Explanation
• Thank You

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Ear Infection
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Ear Infection History

• Age
• 2 year old

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Ear Infection History - HPI

• Age
• Symptoms
• Pain
• Hearing loss
• Tugging On Ears
• Speech Delay
• Drainage

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Ear Infection History

• Age
• Symptoms
• Risk Factors
• Past Medical History
• Social History
• Medications
• Allergies

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Ear Infection Examination

• General
• Ears
• External Ear
• Ear canal and TM

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Ear Infection Examination

• General
• Ears
• External Ear
• Ear canal and TM
• Hearing

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Ear Infection Examination

• General
• Ears
• Nose
• Throat
• Neck

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Ear Infection Studies

• Culture ?
• Hearing Test ?

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Differential Diagnosis

• Common is common
• Infections
• Systemic Disorders
• Syndromes

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Differential Diagnosis

• Common is common
• Infections
• Systemic Disorders
• Syndromes
• Neoplastic

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Treatment Plan

• Antibiotics or not?
• Duration of disease
• Complicated infection?
• Social Issues
• Follow up
• Tubes

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Questions?
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Hearing Loss

• Age 65

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Hearing Loss History - HPI

• Symptoms
• Timing of Onset
• Pain / Fullness
• Unilateral vs. Bilateral
• Severity
• Tinnitus
• Vertigo
• Risk Factors
• Noise Exposure
• Trauma

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Hearing Loss History

• Symptoms
• Risk Factors
• Past Medical History
• Antibiotics for Severe Infection
• Family History
• Medications
• Allergies

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Hearing Loss Physical Exam

• General
• Hypertension
• Ear Exam
• Ear Canal
• Tympanic Membrane
• Pneumatic Otoscopy
• Tuning Forks
• Weber
• Rinne

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Hearing Loss Testing
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Hearing Loss Differential Diagnosis

• Conductive
• Fluid
• Tympanic membrane
• Ossicular Chain

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Hearing Loss Differential Diagnosis

• Conductive
• Sensorineural
• Idiopathic (Aging)
• Iatrogenic
• Noise Induced

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Hearing Loss Treatment

• Conductive Loss
• Treat Eustachian Tube Dysfunction
• Hearing Aids
• Surgery

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Hearing Loss Treatment

• Conductive Loss
• Treat Eustachian Tube Dysfunction
• Hearing Aids
• Surgery
• Sensorineural
• Hearing Aids
• Cochlear Implant

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Questions?
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Nasal Obstruction

• Age 44

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Nasal Obstruction History - HPI

• Symptoms
• Onset
• Severity
• Unilateral vs Bilateral
• Rhinorhea
• Change in Smell
• Headache
• Exacerbating Factors
• Anything help?

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Nasal Obstruction History - HPI

• Symptoms
• Previous Treatment
• Previous Trauma
• Seasonal Allergies

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Nasal Obstruction History

• Symptoms
• Previous Treatment
• Previous Trauma
• Past Medical History
• Past Surgical Treatment
• Medications
• Allergies

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Nasal Obstruction Physical Exam

• Tools of the Trade

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Nasal Obstruction Physical Exam

• Ears
• Nose
• Outside Appearance
• Septum
• Turbinates
• Mucosa
• Smell
• Pharynx

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Nasal Obstruction Physical Exam

• Ears
• Nose
• Outside Appearance
• Septum
• Turbinates
• Mucosa
• Pharynx
• Nasopharynx
• Neck

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Nasal Obstruction Testing

• Cultures
• Allergy testing
• CT scans
• MRI?
• Immunoglobulin
• Cilliary Biopsy
• Histology
• Smell

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Nasal Obstruction Differential Diagnosis

• Congenital
• Inflammatory
• Physiologic / Anatomic
• Traumatic / Acquired
• Neoplastic
• Benign
• Malignant

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Nasal Obstruction Treatment

• Specific to the underlying cause
• Allergy Treatment
• Nasal Steroids
• Antihistamines
• Mast Cell Inhibitors
• Decongestants
• NO AFRIN
• Immunotherapy
• Injections
• Sublingual

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Nasal Obstruction Treatment

• Specific to the underlying cause
• Allergy Treatment
• Supportive Care
• Breathe Right
• Avoidance
• Surgery
• Septoplasty
• Septorhinoplasty
• Turbinate Reduction
• Nasal Polypectomy
• Sinus Surgery
• Tumor Surgery

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Questions?
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Nose Bleed

• Age 13

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Nose Bleed History HPI

• Frequency
• Duration
• Severity
• Precipitating events? Trauma?
• Treatments Tried
• Other bleeding

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Nose Bleed History

• Past Medical History
• Family History
• Medications
• Risk Factors
• Bleeding disorders
• Hypertension
• Anticoagulants

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Nose Bleed Physical Exam

• General
• Hypertension
• Ears
• Nasal Cavity
• Nasopharynx
• Oropharynx

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Nose Bleed Testing

• Bleeding Disorders
• CT / MRI Scan

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Nose Bleed Differential Diagnosis

• Ideopathic
• Anatomy?
• Hypertensive
• Trauma
• Digital
• Blunt
• Anticoagulant s
• Tumors
• Benign
• Malignant

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Nose Bleed Treatment

• Control the Underlying Process
• Nasal Decongestant
• Pressure
• Cautery
• Packing
• Angiography with Embolization
• Surgery
• Cautery Endoscopically
• Septoplasty
• Vessel Ligation
• Tumor Removal

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Questions?
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Sore Throat

• Age 10

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Sore Throat History HPI

• Symptoms
• Severity
• Unilateral or bilateral
• Otalgia
• Dysphagia
• Fever
• Malaise/Fatigue
• Duration
• Stiff Neck
• Exposure
• Voice Change

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Sore Throat History

• Medical History
• Medications
• Allergies

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Sore Throat Physical Exam

• Complete examination
• Oral Cavity
• Lips
• Gums
• Teeth
• Floor of Mouth
• Tongue
• Hard Palate

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Sore Throat Physical Exam

• Complete examination
• Oral Cavity
• Oropharynx
• Soft Palate
• Tonsils
• Neck

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Sore Throat Testing

• Throat Culture
• Imaging?

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Sore Throat Differential Diagnosis

• Strep Throat
• Non-Strep Pharyngitis
• Mono

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Sore Throat Treatment

• Antibiotics ?

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Sore Throat

• Age 62
• 3.5 months
• Otalgia
• Dysphagia
• 20 pound wt loss

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Sore Throat History HPI

• Same
• Risk factors
• Tobacco
• Marijuana
• Alcohol
• HPV?
• Previous Malignancies
• Radiation Exposure

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Sore Throat History

• Past Medical History
• Comorbidities
• Meds
• Blood thinners
• Alllergies
• Social history support system

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Sore Throat Physical Exam

• Complete examination
• Oropharynx
• Fiberoptic examination?
• Neck

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Sore Throat Testing

• Biopsy
• CT scan
• CXR
• PET Scan
• Exam Under Anesthesia

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Sore Throat Differential Diagnosis

• Malignancy
• Benign Tumor
• Infectious/Inflammatory
• Reflux
• Foreign Body

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Sore Throat Treatment

• Specific to the etiology
• Take the Tumor out
• Radiation therapy
• Antibiotics
• Reflux disease

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Questions?

• If a dog barks in the forest and no one hears it
  did it make a sound?

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Hoarseness

• Age 18

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Hoarseness History HPI

• Duration
• Severity
• Onset
• Exacerbating factors
• Voice Use / Abuse
• Voice Training
• Heartburn?
• Tobacco / Marijuana
• Allergies
• Trauma / Recent Surgery
• Voice Rest?

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Hoarseness History

• Past Medical History
• Past Surgical History
• Recent? Related?
• Medications
• Allergies

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Hoarseness Physical Exam

• Complete Examination
• Video stroboscopy

http//www.videostroboscopy.com/
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Hoarseness Testing

• Swallowing Evaluation
• Allergy Testing
• Reflux Testing
• CT scan

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Hoarseness Differential Diagnosis

• Congenital
• Inflammatory
• Physiologic
• Vocal Cord Paralysis
• Infectious
• Trauma
• Neoplastic
• Benign
• Malignant

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Hoarseness Treatment

• Treat the Condition
• Speech Therapy
• Voice Rest
• Surgery
• Polyp Removal
• Medialization
• Treat the Cancer

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Questions?
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Wrap up

• Otolaryngology Starts with history
• Age
• Complete Head Neck Examination
• Generate your differential
• Order Appropriate tests
• Treatment based upon confirmation

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ORL at OU

• Rotate during the 3rd or 4th year

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Thanks for your attention