DIMS Lectures ENT PDF
Introduction to ENT
Ear, Nose, and Throat (ENT) medicine focuses on the diagnosis, treatment, and management of disorders affecting the head and neck region.
Anatomy of the Ear, Nose, and Throat
Anatomy of the Ear
External Ear:
Auricle (Pinna): Collects sound waves.
External Auditory Canal: Channels sound to the tympanic membrane.
Tympanic Membrane (Eardrum): Converts sound waves into mechanical vibrations.
Middle Ear:
Ossicles (Malleus, Incus, Stapes): Transmit vibrations from the tympanic membrane to the inner ear.
Eustachian Tube: Equalizes pressure between the middle ear and nasopharynx.
Inner Ear:
Cochlea: Converts mechanical vibrations into neural signals for hearing.
Semicircular Canals: Regulate balance and spatial orientation.
Vestibule: Contains the utricle and saccule for balance.
Anatomy of the Nose and Paranasal Sinuses
External Nose:
Nasal Bone and Cartilage: Provides structural support.
Nostrils (Nares): Entry point for air.
Nasal Cavity:
Nasal Septum: Divides the nasal cavity into two.
Turbinates (Conchae): Increase the surface area for humidification and filtration.
Olfactory Region: Houses the olfactory nerve for the sense of smell.
Paranasal Sinuses:
Maxillary Sinus: Largest sinus, drains into the middle meatus.
Frontal Sinus: Located above the eyes.
Ethmoid Sinuses: Between the eyes, honeycomb-shaped.
Sphenoid Sinus: Located behind the nasal cavity.
Anatomy of the Pharynx and Larynx
Pharynx:
Nasopharynx: Posterior to the nasal cavity; contains the adenoids and opening of the Eustachian tube.
Oropharynx: Posterior to the oral cavity; includes the tonsils and soft palate.
Laryngopharynx: Connects the oropharynx to the esophagus and larynx.
Larynx (Voice Box):
Epiglottis: Prevents food from entering the airway during swallowing.
Vocal Cords: Produce sound through vibration.
Cartilages (Thyroid, Cricoid, Arytenoid): Provide structure and support.
Otitis Media
Definition:
Inflammation of the middle ear, commonly due to infection.
Types:
- Acute Otitis Media (AOM): Sudden infection, often bacterial or viral.
- Chronic Otitis Media (COM): Persistent middle ear infection leading to perforation.
- Serous Otitis Media (OME): Fluid accumulation without infection.
Clinical Features:
- Ear pain, hearing loss, fever (AOM).
- Ear discharge (COM).
- Muffled hearing, no pain (OME).
Diagnosis:
- Otoscopy: Bulging tympanic membrane in AOM, perforation in COM.
- Tympanometry: Assess middle ear function.
Management:
- AOM: Amoxicillin, analgesia.
- COM: Ear hygiene, topical antibiotics.
- OME: Observation, ventilation tubes if persistent.
Otosclerosis
Definition:
A progressive conductive hearing loss due to abnormal bone remodeling in the middle ear.
Clinical Features:
- Gradual hearing loss (bilateral).
- Tinnitus.
- Carhart’s notch on audiogram.
Diagnosis:
- Audiometry: Conductive hearing loss.
- CT Scan: Detects bony overgrowth.
Management:
- Hearing aids for mild cases.
- Stapedectomy for severe cases.
Rhinosinusitis
Definition:
Inflammation of the paranasal sinuses, commonly due to viral or bacterial infections.
Types:
- Acute: Less than 4 weeks.
- Chronic: More than 12 weeks.
Clinical Features:
- Facial pain, nasal congestion.
- Purulent nasal discharge.
- Headache, postnasal drip.
Diagnosis:
- Clinical examination.
- Nasal endoscopy for chronic cases.
- CT scan for complications.
Management:
- Saline nasal irrigation, analgesia.
- Amoxicillin-clavulanate for bacterial cases.
- Surgical drainage for chronic sinusitis.
Nasal Polyps
Definition:
Benign soft tissue growths in the nasal mucosa, often associated with chronic inflammation.
Clinical Features:
- Nasal obstruction.
- Anosmia (loss of smell).
- Postnasal drip.
Diagnosis:
- Nasal endoscopy.
- CT scan for extent of polyps.
Management:
- Intranasal steroids (Fluticasone, Budesonide).
- Surgical removal in refractory cases.
Laryngitis
Definition:
Inflammation of the larynx, commonly due to infection or vocal strain.
Clinical Features:
- Hoarseness.
- Dry cough.
- Throat pain.
Diagnosis:
- Laryngoscopy if symptoms persist.
Management:
- Voice rest, hydration.
- Steam inhalation.
- Antibiotics only for bacterial cases.
Tonsillitis
Definition:
Infection or inflammation of the tonsils, most commonly due to viral or bacterial causes.
Clinical Features:
- Sore throat, fever.
- Tonsillar exudates.
- Cervical lymphadenopathy.
Diagnosis:
- Throat swab for Group A Streptococcus.
Management:
- Symptomatic relief (NSAIDs, hydration).
- Penicillin for bacterial cases.
- Tonsillectomy for recurrent infections.
Head and Neck Cancer
Definition:
A group of malignant tumors affecting the oral cavity, pharynx, larynx, and salivary glands.
Risk Factors:
- Smoking, alcohol use.
- HPV infection.
- Prolonged GERD (for laryngeal cancer).
Clinical Features:
- Persistent hoarseness.
- Non-healing ulcers.
- Neck mass.
Diagnosis:
- Biopsy.
- CT/MRI for staging.
Management:
- Surgery, radiation, chemotherapy depending on stage.
Case Example:
1.A 55-year-old smoker presents with progressive hoarseness for 3 months. Examination reveals a mass on laryngoscopy.
2.A 25-year-old male presents with ear pain, decreased hearing, and purulent discharge from the right ear for the past 2 weeks. He reports a history of recurrent ear infections since childhood. Examination reveals a perforated tympanic membrane with mucopurulent discharge, and otoscopy shows a central perforation without granulation tissue or cholesteatoma.
3.A 30-year-old male presents with recurrent nasal congestion, facial pressure, and headaches for the past 6 months. He reports thick nasal discharge and postnasal drip. Symptoms worsen in cold weather and after exposure to dust. Examination reveals bilateral swollen, pale, and edematous nasal mucosa with clear mucoid discharge.
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1.Diagnosis: Laryngeal Cancer (Most Likely Squamous Cell Carcinoma - SCC)
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