Key Points Essentials of diagnosis of otitis media: Middle ear effusion must be present as diagnosed by pneumatic otoscopy or tympanometry with Moderate to severe bulging of the tympanic membrane or new otorrhea not associated with otitis externa or Mild bulging of the tympanic membrane and less than 48 hours of otalgia or erythema of the tympanic membrane Pearls 1. For a diagnosis of acute otitis…
Key Points 1. Younger patients with post-lingual deafness and a shorter duration of severe to profound hearing loss have a greater likelihood of detecting speech after cochlear implantation. 2. Broadly speaking, individuals who have significant hearing loss and limited benefit from hearing aids are candidates for cochlear implantation. In addition, they should have a cochlear nerve, no significant middle ear pathology, and be healthy enough to…
Key Points 1. A hearing aid consultation with an audiologist is recommended for any patient who exhibits hearing loss and complains of difficulty communicating. 2. The patient’s type, configuration, and severity of hearing loss, their communication needs, and lifestyle all contribute to determining the best individualized amplification option. 3. Indications for a bone conduction hearing aid include conductive or mixed hearing loss, chronically draining ear, or…
Key Points 1. Characteristics of Nystagmus in Benign Paroxysmal Positional Vertigo (BPPV): nystagmus in posterior canal BPPV is a torsional, up-beating positional nystagmus triggered by the Dix-Hallpike test with the affected ear down. It has a paroxysmal quality, building to a peak and then disappearing over several more seconds. There is a latency of a few seconds before it appears, and it fatigues with repeated Dix-Hallpike…
Key Points 1. Tinnitus is a relatively common disorder, with up to 15% of the population suffering from some degree of abnormal perception. 2. Most subjective tinnitus is hypothesized to result from changes in peripheral auditory function leading to central neural hyperexcitability and cortical reorganization. 3. Though most patients with tinnitus have hearing loss, up to 10% may show no changes in hearing sensitivity on standard…
Key Points 1. When evaluating a patient with hearing loss, perform tuning fork tests (Weber and Rinne) to help determine the type of hearing loss. If this does not agree with the audiogram, discuss with the audiologist. 2. It is important to workup speech delay in children with audiometry and a comprehensive ear exam. 3. Medical clearance for hearing aids should be performed in every patient…
Key Points 1. There are two main types of hearing loss: conductive and sensorineural. Mixed hearing loss has both conductive and sensorineural components. 2. The patient’s ability to understand speech is measured by word and sentence recognition tests. 3. The auditory brainstem response (ABR) evaluates electrical conductivity of the hearing signal through the brainstem. Pearls 1. Decibel (dB) measurements of sound intensity are on a logarithmic…
Key Points 1. The ear is anatomically divided into the outer, middle, and inner ear. The outer ear begins at the auricle and ends at the tympanic membrane; the middle ear consists of the tympanic cavity, with the ossicular chain bridging the tympanic membrane to the cochlea; and the inner ear contains the organs of hearing and balance and the vestibulocochlear nerve (CN VIII). 2. The…
Key Points 1. Endoscopic sinus surgical techniques have advanced to include the treatment of select orbital pathology due to the close proximity of the orbit to the paranasal sinuses, advances in surgical instrumentation, and a working relationship with ophthalmologists. 2. Endoscopic approaches to the orbit require a deep knowledge and an accurate intraoperative identification of orbital anatomy. 3. Excess tearing (epiphora) can result from hypersecretion or…
Key Points 1. Trauma is the most common cause of CSF leaks. 2. Endoscopic repair of CSF leaks is effective and offers decreased morbidity compared to open approaches. 3. Meticulous technique is key to success in repair of skull base defects. 4. Materials used and procedures employed are less important than the quality of the repair. Pearls 1. The lateral lamella of the cribriform plate is…
Key Points 1. The goals of sinus surgery include atraumatic surgical technique, mucosal preservation, and restoration of normal sinus physiology. 2. The most common major complications of sinus surgery include hemorrhage, intracranial injury/cerebrospinal fluid (CSF) leak, and intraorbital injury. 3. Measures used to help improve visualization and decrease blood loss during sinus surgery include total intravenous anesthesia (TIVA), head of bed elevation >15 degrees, topical alpha-1…
Key Points 1. The various approaches to septoplasty include endonasal (Killian, hemitransfixion, transfixion incisions), open, endoscopic, and endoscopic-assisted. Many techniques exist for performing inferior turbinate reduction. Surgery on nondiseased middle turbinates is not commonly performed. 2. During septoplasty, care should be taken to leave at least a 1.5-centimeter strut of dorsal and caudal septal cartilage during resection to avoid loss of nasal tip support and saddle…
Key Points 1. Chronic rhinosinusitis (CRS) in both adults and children is defined based on specific guidelines including both subjective and objective criteria. 2. CRS is a multifactorial inflammatory process characterized by a dysfunctional host–environment interaction. 3. Medical management of CRS involves nasal saline irrigation, topical anti-inflammatory agents, oral antibiotics, and systemic corticosteroids. 4. Patients with CRS who fail to respond to appropriate medical therapy may…
Key Points 1. Antibiotics are frequently administered to treat acute rhinosinusitis. Guidelines for appropriate antibiotic use should be followed. 2. Infectious complications of rhinosinusitis extending beyond the paranasal sinuses are rare. These include orbital, intracranial, and, less commonly osseous complications. 3. Acute invasive fungal sinusitis must be suspected in immunocompromised patients with acute, rapidly progressive disease and must be managed expeditiously. Pearls 1. Acute rhinosinusitis is…
Key Points 1. Allergic rhinitis can present with seasonal or perennial symptoms. 2. Beta 2- transferrin present on nasal discharge indicates cerebrospinal fluid (CSF) leak. 3. Rhinitis medicamentosa is associated with the use of over-the-counter intranasal decongestants that contain α-adrenergic compounds for more than 3 to 5 days. 4. Allergen immunotherapy is the only disease-modifying treatment available for allergic rhinitis. Pearls 1. There is a strong overlap…
Key Points 1. Anterior epistaxis is the most common and often originates from Little’s area in Kiesselbach’s plexus, whereas posterior bleeds commonly originate from the sphenopalatine artery distribution. 2. The most important initial evaluation is a rough gauge of epistaxis severity and, if needed, status of ABCs (airway, breathing, and circulation) and vital signs. This plays the key initial role in evaluation and planning. 3. There…
Key Points 1. While there can be great variation in sinus anatomy, the drainage patterns of the sinuses are fairly consistent. 2. Embryologic patterns of pneumatization of the paranasal sinus lamellae aid in understanding of related anatomy. 3. The blood supply to the nose and sinuses originates from both internal and external carotid branches. Knowledge of the arterial blood supply to the nose and sinuses facilitates…
Key Points 1. Radiation therapy (RT) uses ionizing radiation to locally treat cancers, while systemic therapy uses cytotoxic chemotherapy or molecular targeted biologics to systemically treat cancers. 2. Compared to surgical treatment of head and neck (HN) cancers, radiation potentially offers a curable alternative or adjunct, sometimes with the added benefit of organ preservation. 3. Prompt dental evaluation with necessary tooth extractions and optimal lifetime dental…
Key Points 1. Painless lymph node enlargement is the most common head and neck manifestation of lymphoma. 2. Hematologic malignancies can involve extranodal tissues of the sinuses, salivary glands, and thyroid. 3. “B” symptoms include fever, weight loss, and night sweats. They are associated with poor prognosis. 4. Excisional lymph node biopsy is the preferred method of obtaining tissue diagnosis in lymphoma, although flow cytometry from…
Key Points 1. Proper selection of the surgical approach requires thorough evaluation to meet the surgical goals, while attempting to minimize injury to adjacent neurovascular structures. 2. A multidisciplinary team is helpful in the management of skull base tumors, including an otolaryngologist, neurosurgeon, head and neck or neuroradiologist, neuropathologist, radiation oncologist, and medical oncologist. 3. The nasoseptal flap is a popular method of reconstruction that can…