ENT Lecture Key Topics Overview

Aug 19, 2024

ENT Lecture Notes

Nasal Cavity and Deviated Nasal Septum (DNS)

  • Division of Nasal Cavity:
    • Two sides divided by the nasal septum.
    • Problems occur with asymmetrical division.

Causes of DNS

  1. Trauma:
    • Abnormal pressure on nasal septum causes deviation (e.g., being hit in the nose).
  2. Developmental Abnormalities:
    • High arched palate can lead to nasal septum deviation.
  3. Racial Predisposition:
    • Certain races (e.g., Caucasians) exhibit higher incidence.
  4. Hereditary Factors:
    • Family history may increase risk.

Types of DNS

  1. Anterior Dislocation:
    • Septum dislocated into one nasal chamber.
  2. C-Shaped Dislocation:
    • Deviation in a curve with compensatory turbinate hypertrophy on the other side.
  3. S-Shaped Deformity:
    • Results in bilateral nasal obstruction.
  4. Spurs:
    • Shelf-like projections causing headaches.

Clinical Features of DNS (Mnemonic: NASEEM)

  • N: Nasal obstruction
  • A: Anosmia (loss of smell)
  • S: Sinusitis (obstruction of sinus openings)
  • E: Epistaxis (nosebleeds)
  • E: External deformity (concern for aesthetics)
  • M: Middle ear infections (due to Eustachian tube obstruction)

Treatment of DNS

  • Minor Cases: No treatment required.
  • Severe Cases: Septoplasty at age 17 for severe deviation; removal of deviated parts and repositioning.
  • Submucous Resection: More radical surgery for severe cases.

Allergic Rhinitis

  • Definition: Inflammation of the nose caused by allergens.

Mechanism

  • Allergens bind to IgE antibodies on mast cells, causing histamine release leading to:
    • Inflammation and swelling of nasal mucosa.
    • Increased mucus production.

Symptoms

  1. Nasal congestion and obstruction.
  2. Watery eyes.
  3. Stuffed ears.
  4. Nasal drip.
  5. Sneezing.
  6. Difficulty breathing.

Diagnosis

  1. Patient History: Symptoms and timing.
  2. Skin Prick Testing: Allergy confirmation through skin reaction.
  3. Blood Tests: Elevated eosinophils and total serum IgE.
  4. Nasal Smear Test: Secretions analysis.

Treatment Options

  1. Avoid Allergens: Precautionary measures during pollen season.
  2. Decrease Inflammation: Steroids for nasal mucosa.
  3. Anti-Histamines: Block histamine receptors.
  4. Mast Cell Stabilizers: Prevent histamine release.
  5. Immunotherapy: Allergy shots for desensitization.

Sinusitis

  • Definition: Inflammation of the sinuses.

Anatomy of Sinuses

  • Four paired paranasal sinuses: maxillary, frontal, ethmoid, sphenoid.

Causes

  • 98% viral infections, can also be bacterial or fungal.
  • Predisposing Factors: Allergic rhinitis, smoke exposure, anatomical abnormalities.

Types of Sinusitis

  1. Acute Sinusitis: Lasts up to 4 weeks.
  2. Subacute Sinusitis: 4 to 12 weeks.
  3. Chronic Sinusitis: More than 12 weeks.
  4. Recurrent Sinusitis: Multiple episodes in a year.

Symptoms

  • Pain, tenderness on tapping sinuses, nasal discharge, cough, headache, fever, altered smell/taste.

Diagnosis

  • Based on symptoms; imaging via CT scan is gold standard.

Treatment

  • Acute Viral Sinusitis: Symptomatic treatment, nasal decongestants, mucolytics, hydration, pain relief.
  • Acute Bacterial Sinusitis: Antibiotics for 10-14 days.
  • Chronic Sinusitis: Longer antibiotics or surgery for severe cases.

Tonsillitis and Tonsillectomy

  • Definition: Inflammation of tonsils, often infected.

Symptoms

  • Sore throat, ear pain, odynophagia, cough, fever, swollen glands, halitosis.

Diagnosis

  • Physical examination, throat culture.

Treatment

  • Mild cases: Rest, hydration, pain relief.
  • Severe cases: Antibiotics or tonsillectomy if recurrent infections occur.

Tonsillectomy Procedure

  1. Patient placed in rose position.
  2. Mouth gag inserted.
  3. Tonsil grasped and dissected from surrounding tissue.
  4. Tonsil removed and bleeding points tied off.

Epistaxis (Nosebleeds)

  • Definition: Bleeding from inside the nose.

Causes

  • Trauma, infections, DNS, increased blood pressure.

Management

  • First Aid: Pinch nose to control bleeding.
  • Cauterization: If bleeding point is identified.
  • Nasal Packing: Anterior or posterior, depending on the severity.

Nasal Polyps

  • Definition: Non-cancerous growths in nasal lining.

Causes

  • Swollen mucosa due to infections or allergies.

Symptoms

  • Nasal congestion, runny nose, reduced sense of smell.

Types

  1. Antrochoanal Polyps: Unilateral, common in children.
  2. Ethmoidal Polyps: Bilateral, common in adults.

Diagnosis

  • Based on symptoms, nasal endoscopy, CT scan.

Treatment

  1. Steroids: To reduce polyp size.
  2. Surgery (Polypectomy): For removal of larger polyps.

Management of Deaf Children

  • Importance of early identification and rehabilitation to aid speech development.

Assessment Techniques

  1. Screening Procedures: Behavioral response to sound.
  2. Behavior Observation Audiometry: Changes in behavior in response to sound.
  3. Conditioning Techniques: Play audiometry.

Rehabilitation Strategies

  1. Hearing Aids: To amplify residual hearing.
  2. Speech and Language Development: Through auditory oral communication or sign language.
  3. Education: Specialized schools or integration into mainstream education.

Acute Otitis Media

  • Definition: Inflammation of middle ear.

Stages of Acute Otitis Media

  1. Tubal Occlusion: Blockage of Eustachian tube.
  2. Pre Suppuration: Infection onset.
  3. Suppuration: Pus formation.
  4. Resolution: Symptoms subside.
  5. Complication Stage: Potential spread of infection.

Treatment

  • Antibiotics, decongestants, analgesics, and myringotomy if severe.

Adenoids

  • Definition: Lymphoid tissue in nasopharynx.

Clinical Features

  • Nasal obstruction, mouth breathing, sinusitis, ear infections.

Diagnosis

  • Examination and imaging.

Treatment

  • Observation for mild cases; adenoidectomy for severe symptoms.

Acute Epiglottitis

  • Definition: Inflammation of supraglottic structures.

Causes

  • Typically caused by H. influenzae in children.

Symptoms

  • Abrupt onset, sore throat, dyspnea, fever.

Treatment

  • Hospitalization, antibiotics, steroids, hydration, airway management.

Acute Laryngo-Tracheo Bronchitis

  • Definition: Inflammation affecting larynx, trachea, bronchi.

Causes

  • Usually viral infections in young children.

Symptoms

  • Croupy cough, stridor, fever.

Treatment

  • Hospitalization, hydration, antibiotics, humidification, and steroids.

Ludwig's Angina

  • Definition: Life-threatening cellulitis of the submandibular space.

Causes

  • Dental infections, injuries.

Signs and Symptoms

  • Facial swelling, dysphagia, drooling.

Treatment

  • IV fluids, antibiotics, incision, and drainage if necessary.

Otosclerosis

  • Definition: Disease of the ear ossicles leading to hearing loss.

Causes

  • Often hereditary, more common in women.

Symptoms

  • Conductive hearing loss, tinnitus.

Diagnosis and Treatment

  • Audiometric testing; treatment includes hearing aids or stapedectomy.

Anatomy of Facial Nerve

  • Course: Intracranial (through brainstem) and extracranial (branching in the face).
  • Branches: Supply muscles of facial expression.

Vertigo

  • Definition: Sense of spinning or movement.

Types

  • Peripheral (inner ear disorders) vs. Central (brain disorders).

Diagnosis and Treatment

  • Based on clinical history; treatment varies based on underlying cause.

Dysphagia

  • Definition: Difficulty swallowing.

Symptoms & Causes

  • Includes odynophagia, reflux, aspiration, etc. Causes may include structural or motility disorders.

Management

  • Focus on hydration, nutrition, and addressing underlying issues.

Tracheostomy

  • Definition: Procedure to create an opening in the trachea for breathing assistance.

Indications

  • Upper airway obstruction, inability to clear secretions, respiratory insufficiency.

Procedure and Care

  • Requires careful technique, post-procedure care to avoid complications.

These notes cover the main topics discussed in the ENT lecture and can be used for review and study.