What Does ENT- Head And Neck Surgery And Otolaryngology Mean:
Branch of medicine dealing with the diagnosis and treatment planning of diseases of ear, nose and throat collectively is known ENT, the medical term being otolaryngology. To put in the proper technical terms, otology is the study of ears, rhinology the study of nose and laryngology the study of throat. As a result of a deep connection between these parts internally, they are grouped in a common strata of medicine and studied.
Causes Of Otolaryologic Disorders:
- Involving the Ear: Middle ear infections can occur due to bacterial/fungal/viral growth resulting in otitis media. Otitis externa is the infection of the ear canal due to the same cause. Infected maxillary sinus may also spread to the ear. Eustcahian tube blockages also can occur owing to swelling and infection. Pathologies may also spread to the parotid gland situated adjacent to the ears.
- Involving the Nose: Bacterial and viral infections most commonly affect the nasal passage. Nasal deformities can occur due to deviated nasal septum since birth, fractures or trauma later in life. Maxillary sinuses present around nose may show fluid accumulation, infections with bacteria, viruses. Nasal/maxillary sinus polyps are benign tumors which arise due to abnormal cell multiplication. Adenoid enlargement also occurs due to allergies and infections.
- Involving the Throat: Infections and allergies most commonly lead to tonsillitis, pharyngitis and laryngitis which is the inflammation of tonsils, pharynx (upper part of esophagus) and larynx (upper part of trachea) respectively. Infections of the neck spaces such as supra and sub sterna, carotid and par pharyngeal occur due to pus accumulation and inadequate lymph drainage.
- Involving the thyroid and parathyroid glands are the hormonal diseases which occur mainly due to hyper and hypo secretion of the thyroid and parathyroid hormones respectively. Tumors of these glands have an unknown etiology. Hemorrhages and bursting of internal and external carotid arteries may occur due to stabbing/trauma.
Signs & Symptoms Of Otolarynology Diseases:
Involving the Ear:
- Pain and tenderness in and around the ears
- Fluid discharge from the ears
- Tingling sensation known as tinnitus, ringing in the ears
- Pain in the Eustachian tube (located in the lower jaw line)
- Loss of balance, gait, ataxia
Involving the Nose:
- Pain and tenderness in and around nose
- Nasal obstruction/congestion, difficulty in breathing
- Running nose in case of common cold
- Pus/blood/cerebrospinal fluid discharge in case of facial fractures/traumas
- Obvious nasal deformity, crooked nose
- Depressed/swollen paranasal areas
Involving the throat:
- Pain on swallowing, sore throat
- Palpable and tender lymph nodes
- Mild to high grade fever, nausea, vomiting, pale appearance
- Painful and difficult breathing
- Impaired calcium metabolism in case of thyroid and parathyroid dysfunction
Diagnostic Tests For Head And Neck Surgery/Otolaryngology Diseases:
Clinical examination and case history: The physician physically examines and observes the nasal passages, ear canals and throat. Auscultation using a stethoscope for any abnormal chest sounds, palpation of the nose/ear/lymph nodes/tonsils/throat for any tenderness is done.
- Blood/urine tests: These samples are examined for the presence of any pus cells, increased white blood cell count indicative of infections. However site specific examination cannot be done. Thyroid function tests are quite valuable in cases of thyroid disorders.
- Smear examination/culture: Swabs can be collected from the nasal, ear and throat regions and sent for histological examination to determine the type, nature and progress of any growth, if present.
- Endoscopy: In this procedure a long catheter like tube in inserted into the nose or the throat to which a small camera is attached. As the tube travels inside the organs, the images are captured outside on a screen and studied by the physician.
- Hearing test: In this particular type of test, patient is made to listen a range of voices and volumes and the respond to these is noted. This gives an estimation of the degree of the hearing of the patient.
- Tympanometry/pressure test: This test is done to determine the fluid levels in the ear causing pressure. It helps to gauge the presence of fluid, whether in the middle ear or in the ear canal.
- Radiologic examination: Most commonly used technique is the PA view skull which helps in visualizing the entire face in one go. Face can be studied for any fractures, cysts and tumors, sinusitis. TMJ disorders, neck space infections. Cone beam computed tomography CBCT gives a three dimensional image of the object in the focus. Similarly computed tomography CT and magnetic resonance imaging MRI can also be done to study the hard and soft structures of head and neck respectively. Ultrasound USG is another imaging technique used to determine the pathology in glandular structures such as parotid, thyroid and parathyroid gland.
Types Of Otolaryngology Diseases:
- Involving the ear:
- Otitis media and otitis externa are the inflammations of the middle ear and external ear canal respectively. Both lead to variable degrees of ear pressure due to fluid entrapment, fever and hearing impairment. Labyrinthitis is a disorder of the internal ear in which the nerves sending sensory impulses to the brain become swollen. This causes dizziness, drowsiness and loss of spatial configuration. Presbycusis is the ultimate loss of hearing in old age, occurring as a result of genetic transmissions or environmental etiologies. Ototoxicity ie toxin accumulation in the cochlear part of the ear may occur as a side effect of drug, causes temporary discomfort is hearing and is reversible.
- Involving the nose:
- Common cold resulting due to infections and allergies, nasal congestion, rhinorrhea ie running nose and rhinitis ie inflammation of the nose are quite common nasal diseases. Nasal septum deviation is the shifting of the bony septum of nose to either side, resulting in unequal volumes and asymmetry of the nostrils. Choanal atresia is a congenital disorder in which the posterior (back) portion of the nasal passage is blocked by some soft/hard tissue masses. Nasal polyps are masses of unnecessary tissue growth found in the nose, obstructing the breathing cycle, may or may turn into malignancy.
- Involving the larynx:
- Laryngitis is the acute/chronic inflammation of the larynx due to infections and allergies. Laryngocele is a congenital disorder in which an air sac communicates with the body of the larynx and bulges outward in the neck. Laryngomalacia is a congenital disorder of softening of the vocal cords which gives a noisy breathing sound in infants. Laryngo-pharyngeal reflux is a condition in which the acid from the stomach travels up the esophagus and directly into the larynx causing irritation and soreness. Human papilloma virus HPV infection may cause papillomatosis in the laryngeal tract which is often a precancerous condition.
- Involving the pharynx:
- Yet again, pharyngitis is the inflammation of the organ due to infections and allergies causing pain, soreness and difficulty in swallowing causing dysphagia. Retrophayngeal abscess is a serious neck infection which occurs in the posterior wall of pharynx, often goes unnoticed due to its poor visibility. Zenker’s diverticulum is a rare condition in which a sac like structure is formed between the pharyx and the esophagus. In a condition termed as velophayngeal insufficiency, the soft palate fails to close against the posterior pharyngeal wall during speech. As a result, hoarseness in voice occurs due to air from nasal passage hitting the vocal cords.
- Involving the neck:
- A deep neck infection often is an accumulation of pus and improper lymph drainage near the muscles, blood vessels and nerves causing extreme pressure on them. Cellulitis on the other hand is a bacterial infection of the skin over the neck, which enters the neck through a breach causing excessive swelling, pain and pus discharge. An important endocrine gland called thyroid and parathyroid present in the neck may also undergo malformation leading to disturbed secretion of thyroid and parathyroid hormones.
Treatment Of Otolaryngology Diseases/ Head And Neck Surgery:
Treatment of ear diseases:
A majority of these are treated by giving medications in oral doses and ear drops form. Antibiotics, analgesics, anti-inflammatory and antihistamines are the drugs of choice to be administered. Cochlear implants may be the choice of surgical approach in internal ear disorders in order to restore hearing. Also prosthetic ears can be fabricated to replace the missing ears, lost due to severe infections and/or trauma.
Treatment of diseases of nose:
Medications in the form of tablets, lozenges, nasal drops are available to cure the nasal obstruction due to rhinitis, runny nose. Surgical approaches are needed in cases of tumors and cancer. As for example if the nasal septum deviation is quite severe so as to cause heavy breathing problems, rhinoplasty is done to correct its position. This may also be the approach in cases of gross deformities of nasal bone structure which gives it a crooked appearance. Nasal polyps are excised surgically from the site and observed for recurrence. In case of facial fractures involving the nose, LeFort I and II osteotomy is the choice of surgical approach along with nasal reconstruction.
Treatment of larynx diseases:
In high grade tumors of larynx, cysts and abscess, surgical removal is the only choice followed by restoration of the vocal cords for maintaining speech normalcy. Benign and low grade tumors however can be treated with radiation therapy and chemotherapy. Surgery becomes mandatory is cases of laryngocele too. Laryngeal abscess requires insertion of a needle, puncturing of the cystic cavity and drainage of the contents followed by fine suturing.
Treatment of pharynx diseases:
A heavy antibiotic coverage is required for the acute and chronic onset of pharyngitis. Heavy dose of analgesics often is also needed to treat dysphagia. Para and retro pharyngeal space infections are treated by a surgical method in which a needle is used to drain the abscess. Velopharyngeal insufficiency is treated by repairing the defects in the soft tissues and sealing it against the posterior pharyngeal wall to restore normal speech. Laryngopharyngeal reflux also needs suturing of the junction with the defect in order to prevent the acids from reaching the larynx.
Treatment of neck diseases:
- Neck space infections are deep in nature, quite commonly go unnoticed and may prove fatal in a very short interval of time. The initial course of action is always surgery which drains the entire abscess with the help of a needle. The second line of treatment is the antibiotic coverage prescribed for quite a chronic time until all the symptoms subside.
- Thyroid gland dysfunctions mostly affect the calcium metabolism causing increased or decreased blood calcium levels, excessive or reduced bone calcium depositions. These are always monitored and controlled by the medications. Thyroid tumors require surgical resection, if no signs of regression are seen with radiation and chemotherapy.
Risk Factors For Head And Neck Surgey/Otolaryngology Diseases:
- Cysts and benign tumors like nasal polyps have a tendency to recur. These should be excised carefully without leaving behind any margins.
- Uncontrolled diabetes and hypertension have a tendency to complicate the surgical approach.
- Drainage of neck abscess often causes puncture of the carotid artery leading to profuse bleeding
Success Rate Of In India:
Abscess drainage is absolutely a fail safe method and bring about symptomatic relief. Idiopathic damage to adjacent vital structures are encountered in 5 percent of cases. Surgical resection of nasal and laryngeal tumors have a tendency to recur in almost 55.78 percent of cases.
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