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Diagnosis And Management Of Eye- Ear- Nose- And Throat Disorders Essay Paper

Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

This timely contribution will be welcomed by physicians practicing in these special fields, for it is a serious effort to present in a rational manner the possibilities as well as the limitations of this method of treating disease of the eye, ear, nose and throat. The mystery that always surrounds the use of the roentgen ray and radium emanations, as well as the use of electricity in any form, has made the use of such agents as physiotherapy particularly attractive to the medical charlatan. Witness the exploitation that has been carried on among those who are suffering from incurable deafness, the result of degenerative processes, by the irradiation of the pituitary body.

Physiotherapy in these special fields seems to find its greatest usefulness in the treatment of such serious diseases as malignant growths and tuberculosis. That there are several other conditions in which the application of this method of treatment Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

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There are many ENT disorders, and even more signs and symptoms associated with each one. The following is a list of symptoms of 4 of the most common ENT disorders. Not all people will experience the same set of symptoms, and you may have only some of the symptoms on the list.

ENT problems are the most common reason for a visit to a doctor in both rural and urban communities. In many developing countries, there is a lack of ENT specialists and overburdened hospital facilities. To date, there is no comprehensive study that has evaluated the spectrum of ENT disorders in a rural community. Methods. A prospective study was done for a period of three years to profile the cases presenting to the outpatient clinic in a secondary care hospital and in the camps conducted in tribal areas in Vellore District of Tamil Nadu, India. Trained community volunteers were used to identify ENT conditions and refer patients. Results. A total of 2600 patients were evaluated and treated. Otological symptoms were the most commonly reported with allergic rhinitis being the second most commonly reported. Presbycusis was the most common disability reported in the rural community. The other symptoms presented are largely related to hygiene and nutrition. Conclusion. Using trained community workers to spread the message of safe ENT practices, rehabilitation of hearing loss through provision of hearing aids, and the evaluation and surgical management by ENT specialist helped the rural community to access the service.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

The most common problems warranting a visit to a doctor or a health care provider in developing countries are related to ear nose and throat (ENT) [1, 2]. ENT problems are the most common problems for which there are home remedies to medical treatments which are available, and most individuals manage their problem in the community without seeking help. In addition, due to the lack of specialist professionals in this field, these problems are treated by community practices. The studies done have looked at the prevalence of ENT diseases in children [3, 4] and have shown that the disease burden is due to otitis media and its sequelae which are the most common causes of preventable hearing loss in children in developing countries [5, 6]. The prevalence of traditional practices increased the disease morbidity requiring surgical management. Postal survey using questionnaire methods was used to assess the prevalence of ENT-related disorders in a community. There is no data on the prevalence of otorhinolaryngological diseases in a rural community in India. The present study was undertaken to determine the prevalence of ENT disorders in population presenting to a secondary care hospital with emphasis on primary care in rural communities and tribal area. This is the first study done in a developing country as proper understanding of the magnitude of ENT diseases and the factors associated with their occurrence in the community is important to enable the formulation of health care services aimed at early detection and treatment.

A prospective study was done for a period of three years (2009–2012) to profile the cases presenting to the ENT clinic which was conducted once a week in a secondary care hospital, and once a month in tribal areas of Vellore District. The ENT team comprised of ENT specialist, audiologist, and community workers. The population covered was four lakhs, and the tribal population consisted of thirty thousand. These communities are predominantly farming community. 40% live below the poverty line. Literacy of women is 40% and of men is 60%. 25% are under 15 years. Elderly form 6% of the population. The male : female ratio is 1000 : 980. Being farmers, they are dependent on the rainfall for agriculture, and work is seasonal.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

The clinic in secondary care hospital was well equipped with an operating microscope and ENT instruments. An initial programme of training community volunteers was conducted in rural and tribal villages. These community volunteers were taught about safe ear care practices, the harmful effects of prevalent traditional practices, and the treatment options available. They were taught to identify the symptoms of ear, nose, and throat diseases, namely, ear pain with/without discharge, recurrent upper respiratory tract infections, throat pain difficulty swallowing, associated with fever in the community and refer them to the camps conducted periodically. Community hearing workers preferably graduates with science subjects were trained to do hearing assessment using a portable audiometer for adults and fit hearing aids (semidigital, trimmer model) in the community. Children with learning disabilities and delay or lack of speech were identified in the community with the help of school teachers and community hearing workers and were referred to tertiary hospital for detailed evaluation to rule out other disabilities and for rehabilitation. Questionnaire method of data collection was used to know the prevalence of ENT-related conditions in the tribal community, and referred patients received treatment in the camps; surgical cases were referred to secondary and tertiary hospital for further management.

All the patients had undergone a complete clinical examination by the ENT specialist, and appropriate investigations were done depending on the merit of the presenting complaint.

Patients were seen by community health physicians in the secondary care hospital and were referred to the ENT clinic which was conducted once a week. Emergency cases which were referred to the tertiary hospital were not taken for analysis.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

2.1. Statistical Methods

All the data was entered into Microsoft Excel format and SPSS software. The mean number of patients, both adults and children, calculated, and the ratio of prevalence among both the groups was arrived at. Pearson’s chi-square test was done to compare the relationship of otitis media in children with various factors leading to chronic condition. The level of significance was set at less than 0.05.

3. Results

In our study, a total of 2600 patients both adults and children were seen during the years 2009–2011, which included a total number of 20 camps that were conducted in tribal areas.

Otological symptoms were the most commonly reported (60%), with pain and ear discharge being reported in pediatric and adult population followed by acute rhinitis due to allergy and infectious causes (Figure 1). Hearing loss was most commonly reported in patients over 50 years of age with moderately severe to severe hearing loss needing rehabilitation.

Roughly a fifth of respondents reported currently having hearing difficulties, including difficulty following conversations when there is background noise and hearing problems causing worry or upset; few wore a hearing aid regularly. A fifth reported noises in head or ears (tinnitus) lasting more than five minutes. In the previous year, between 13 and 18% of respondents reported persistent nasal symptoms or hayfever, 7% sneezing or voice problems and 31% had at least one episode of severe sore throat or tonsillitis. Nearly 21% of all respondents reported ever having had dizziness in which things seemed to spin around the individual; 29% unsteadiness, light-headedness or feeling faint; 13% dizziness in which the respondent seemed to move. Important gender, age, occupation and deprivation differences existed in the occurrence of these ENT symptoms. There was considerable variation in the proportion of individuals consulting their GP or being referred to hospital for different problems.

ENT problems occur frequently in the community, and most are managed without consulting medical services. Whilst reasonable for many problems, there are likely to be important groups in the community with ENT problems that might benefit from modern interventions.

Breathing through a narrow air passage leads to turbulent airflow, vibration and snoring. This can be due to one or more areas of the upper airway, including large inferior turbinates, a floppy, low lying palate or large tonsils and adenoid. Complete obstruction of the airway results in OSA. Weight gain and decreased muscle tone can further worsen the narrow airway.

In OSA, the poor airflow leads to a drop in oxygen levels in the body, resulting in interrupted, restless sleep as the patient struggles to maintain oxygen levels. A patient with OSA is rarely aware of having difficulty breathing and is often brought to medical attention by the partner. Apnoea episodes are characterized by snoring, followed by a period of silence as airflow ceases. This leads to choking or gasping as the patient tries to breathe to restore oxygen levels in the body. This can occur repeatedly throughout the night, leading to poor sleep quality and daytime fatigue. The fluctuating oxygen levels result in increased risks of stroke, hypertension and ischemic heart disease. In children, OSA may manifest differently and they may be hyperactive with poor memory, learning difficulties and failure to thrive.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Evaluation of snoring and OSA requires a sleep study to determine the presence and severity of OSA as well as an upper airway evaluation with endoscopy to identify the narrow areas. Treatment is dependent on severity, involving weight loss for patients who are overweight. Definitive options would need to be individualized depending on the severity of the OSA, daytime fatigue and snoring noise. This can range from minor surgical procedures under local anaesthesia for mild cases to CPAP (continuous positive airway pressure) devices and comprehensive surgical options for severe OSA. Factors to consider about undergoing surgery include the risks versus the long-term benefits of surgery. In some adults, there may be multilevel areas of narrowing. In some cases, surgery is used to facilitate more comfortable use of CPAP instead of being curative.

Acute rhinosinusitis (ARS)

Sinusitis is often loosely used to mean bacterial rhinosinusitis. Strictly speaking, amajority of rhinosinusitis are due the viral infections, with secondary bacterial infection occurring in only 2 percent at most. The diagnosis of bacterial rhinosinusitis in primary care is mainly symptom-based. In ARS, there is a sudden onset of two or more of the following symptoms lasting for up to 4 weeks:

i) Nasal obstruction or congestion

ii) Purulent nasal discharge (anterior or postnasal drip)

iii) Facial pain or pressure

iv) Hyposmia or anosmia

In a primary care setting, we expect the common cold (viral rhinosinusitis) to resolve within 5 days. As such, an increase in symptoms after 5 days or persistent symptoms after 10 days (Figure 1) can be presumed to be due to bacterial rhinosinusitis, requiring antibiotics. Examination often shows thick mucopus coming from the sinuses. Imaging is generally not required for the diagnosis of ARS. Plain X-rays should not be done as they lack sensitivity and specificity. In patients with unilateral maxillary sinusitis, a dental cause needs to be excluded.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

ARS may lead to orbital and neurological complications. Though uncommon, sinusitis patients with warning signs like drowsiness, eye swelling, diplopia and reduced visual acuity require urgent assessment. Ethmoid sinusitis can cross the thin lamina papyracea leading to orbital cellulitis, orbital abscess, subperiosteal abscess or cavernous sinus thrombosis. Intracranial spread of sinusitis can cause meningitis, epidural abscess and subdural abscess. These orbital and intracranial complications are emergencies, requiring immediate attention of the ENT specialist.

Medical treatment in ARS

When indicated, antibiotics should be given for 5 to 10 days. Amoxicillin with or without clavulanate should be considered as the first-line antibiotic in ARS.

In addition to antibiotics, nasal steroid spray twice daily has been shown to help improve symptoms. Routine use of oral steroids in ARS should be avoided. Anti-histamines are generally not recommended but may be useful in patients with allergic rhinitis. Though there is no clear evidence, topical decongestants and saline irrigation can be useful for symptomatic relief.

Patients with persistent symptoms despite treatment should be referred to an ENT specialist for further management. This may include taking an endoscopic guided swab for bacterial culture and the use of second-line antibiotics. Should symptoms persist, the patient may benefit from endoscopic sinus surgery to drain the trapped mucopus and ventilate the sinuses.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Acute sinusitis with pus streaming out of left middle meatus. (Photo courtesy of Dr Jason Hwang)

Allergic rhinitis

Allergic rhinitis is characterized by symptoms of nasal obstruction, watery rhinorrhoea, sneezing and nasal itch. It is important that patients understand that treatment does not change the underlying allergy but is targeted at reducing and controlling the symptoms of the allergy.

The most common allergen in South East Asia is undoubtedly the house dust mite. This is often confirmed using skin prick tests. Environmental measures include keeping the house and bedroom clean, removal of carpets and soft toys, use of a vacuum cleaner with a HEPA filter and antidust mite covers for the mattresses and pillows.

Medications for allergic rhinitis are broadly divided into steroid sprays and antihistamines. Steroid spray is the first-line treatment for monotherapy as it has a better overall effect on all symptoms of allergic rhinitis. Antihistamines work well for rhinorrhoea and sneezing but have minimal effect on nasal obstruction. Nasal decongestants are helpful for the initial treatment period but keep in mind the risk of rhinitis medicamentosa with prolonged use. It is important to explain to patients that the medication does not change the underlying allergy and symptoms will recur on cessation of medication.

Immunotherapy involves the exposure of patients to previously identified allergen. The sublingual route has significantly less risk of adverse effects compared with the subcutaneous route. However, it requires substantial commitment from the patient, as the beneficial effect only starts 6-12 months after starting treatment and requires 4 years of daily treatment for optimal effect. Despite this, long-term data shows recurrence of symptoms after 8 years, with a need for additional booster doses. These issues should be clearly explained to patients before they commit to a long and relatively expensive treatment regime.

Surgery can relieve the symptoms of allergic rhinitis. However, it must be made clear to the patient that it does not change the fact that they have an allergy. For those who are noncompliant or unhappy with the use of medication, surgery may be considered. This may include radiofrequency turbinate reduction, turbinoplasty and septoplasty.

There are various ear, nose, and throat (ENT) conditions which present to the GP’s clinic. Pearl Toh spoke with Dr Jason Hwang, an ENT Consultant from the Department of Otolaryngology at Gleneagles Hospital in Singapore, on how the majority of the conditions can be effectively managed at the primary care level seeing that these can be treated medically without the need for surgical intervention.

Acute rhinosinusitis (ARS)

i) Nasal obstruction or congestion

ii) Purulent nasal discharge (anterior or postnasal drip)

iii) Facial pain or pressure

iv) Hyposmia or anosmia

Medical treatment in ARS

When indicated, antibiotics should be given for 5 to 10 days. Amoxicillin with or without clavulanate should be considered as the first-line antibiotic in ARS.

Acute sinusitis with pus streaming out of left middle meatus. (Photo courtesy of Dr Jason Hwang)

Allergic rhinitis

Otitis externa

Otitis externa usually presents with otalgia and ear discharge. If the discharge occludes the ear canal, patients will also report hearing loss. Diabetic patients with severe otalgia may have malignant otitis externa due to Pseudomonas infection. This can potentially spread along the skull base as a form of osteomyelitis and usually requires ENT referral and intravenous antibiotic treatment.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Examination shows purulent discharge in the ear canal and there may be oedema and erythema of the ear canal. In otomycosis, there is often a creamy layer of debris with fungal spores seen. In patients with recurrent or refractory symptoms, taking a swab for bacterial and fungal culture can be useful.

Otitis externa generally responds to eardrops without the need for oral medication. However, if the ear canal is obstructed, either due to a swollen ear canal or if filled with discharge, ear drops are unable to penetrate deep into the ear canal. Aural toilet for cleaning the ear canal by an ENT specialist may be required to allow effective use of ear drops. In patients with oedematous ear canals, an ear wick may be used to help with penetration of the ear drops. A 2010 Cochrane review analysed 19 randomized controlled trials and concluded that (i) topical treatment is sufficient for uncomplicated cases (ii) most topical treatments are equally effective (iii) choice of treatment is determined by various factors including risk of ototoxicity, cost and availability. [Cochrane Database Syst Rev 2010;(1):CD004740]

Otitis media

Acute otitis media. (Photo courtesy of Dr Jason Hwang)

Middle ear infections present as acute otitis media (AOM) or chronic suppurative otitis media (CSOM). AOM is often associated with an upper respiratory tract infection (URTI) and fever. Besides URTI symptoms, the patients commonly experience otalgia (often severe) and hearing loss. The tympanic membrane tends to be erythematous and bulging, which may result in tympanic membrane perforation with the relief of pain and onset of ear discharge. These perforations are usually small and heal spontaneously with resolution of the infection. In patients with persistent infection, it can result in nonhealing and CSOM.

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Most AOM start as a viral inflammation and may not require antibiotics in the initial period. The associated URTI can be treated symptomatically. However, the American Academy of Paediatrics recommends that antibiotics should be initiated for young patients with definite AOM who are under 2 years of age. For children above 2 years old, they can be monitored and started on antibiotics if there is no improvement after 48 to 72 hours.

In children, it is common for middle ear effusion to occur after resolution of AOM. Though 90 percent resolve spontaneously, these patients require follow up to ensure resolution. A persistent middle ear effusion can affect speech development and requires drainage via a grommet tube.

Left middle ear effusion with fluid level. (Photo courtesy of Dr Jason Hwang)

Sudden sensorineural hearing loss (SSNHL)

SSNHL is defined as a hearing impairment occurring over 72 hours, in one or both ears. The majority of cases (up to 90 percent) are idiopathic. Patients with bilateral sudden hearing loss, neurological signs or recurrent episodes should be flagged for possible central causes.

Oral steroids should be given as early as possible after the onset of hearing loss in order to reverse the condition. There is no good evidence to support the use of antivirals, antioxidants or supplements, though these are often given in an attempt to salvage hearing. Patients with incomplete recovery after oral medication should be referred to an ENT specialist for second-line treatment with intratympanic steroid injections. This can be done under local anaesthesia and gives an additional 30–40 percent chance of hearing recovery.

Tonsils and adenoid

Together with the adenoid, the tonsils form the mucosa associated lymphoid tissue in the pharynx. Not surprisingly, they are inflamed during periods of infection, resulting in swelling and pain. The most common issues with the tonsils and adenoid are: (i) infection or (ii) size.

Tonsillitis

The clinical features of acute tonsillitis are fairly typical and make diagnosis straightforward. Fever, sore throat, and swallowing difficulty will quickly alert the physician to examine the throat. This will show inflamed tonsils, sometimes with purulent exudate in the tonsillar crypts. The adenoids are likely to be inflamed as well, but remain tucked away in the nasopharynx and usually not visible.

Treatment includes antibiotics, hydration, and symptomatic treatment. Antibiotics from the penicillin group or macrolides (for patients with penicillin allergy) can be given orally. Patients with severe symptoms may require hospital admission for intravenous hydration and antibiotics. Symptomatic treatment would include topical preparations (eg, gargle, sprays, lozenges) as well as paracetamol and ibuprofen for fever and pain control. The use of amoxicillin may cause a rash in cases of infectious mononucleosis.

A peritonsillar abscess (quinsy) is a collection of pus between the tonsil and the pharyngeal muscles. This presents with fever, trismus and unilateral or asymmetrical throat pain. Examination reveals swelling not of the tonsil itself but mainly in the adjacent superolateral area of the oropharynx. The abscess requires transoral incision and drainage, often under general anaesthesia in young children and under local anesthesia in older children and adults.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

What are the causes of ear infection?

The ears can become infected when there is an infection of the nose or throat. The same microorganisms that cause infection in the nose or throat are also the ones that cause infection of the ear. The bacteria most commonly responsible are Streptococcus pneumoniae and Haemophilus influenzae.

Signs and symptoms of ear problems:

A child with an ear problem has some or all of the following signs and symptoms:

Pain
Fever
Pus discharge from the ears

The dangers of ear infection: Infections of the ear rarely cause death. However, they can cause many days of sickness in children. If an ear infection is not identified and treated early, it can put the child in danger of the following:

Infection of the mastoid bone behind the ear called mastoiditis;
Meningitis or encephalitis (infection of the brain);
Deafness;
Developmental and learning problems.

To diagnose an ear infection, you must assess the child correctly and follow the steps below:

STEP ONE: ASSESS THE CHILD

Assess the child by asking the mother the following questions:

Does the child have ear pain? Ear pain may mean an infection
Does the child have pus draining from the ear? If so, for how long?

Pus draining from the ear is a sign of infection even if the child no longer has pain.

b. Look and Feel

Inspect the pinna for any boils or sores;
Pull the ear gently in all directions. If this causes pain, then that is a clue that the infection is probably in the outer ear;
Look for pus draining from the ear or for a red immobile eardrum (you can use an otoscope if you have one);
Look to see if a foreign object is in the ear;
Feel for tender swelling behind the ear;
In young infants, the swelling may be above the ear.

c. Examine the ear:

To examine the ear, the patient is placed correctly on the mother’s lap. The child is secured firmly by the mother holding the child’s hands with one hand and his head with her other hand. See Figure 13.2a.

If you have an assistant, he/she can help you to hold the child’s head. You should sit at the side of the patient with your eyes at the same level as the child’s ears (the organ to be examined). The distance is usually 30cm from the patients head. The hand holding the otoscope is placed on the child’s head. Should the child move the head, the otoscope moves with the head, thus avoiding perforating an inflamed tympanic membrane.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Ear Infections

Ear infections are one of the most prevalent ENT disorders. They occur when germs become trapped inside the inner ear. The Eustachian tube, a tiny tube that originates in the ear and drains into the back of the throat, usually keeps unwanted germs out. If this tube is too small or becomes clogged by fluid and mucus, bacteria or other microbes may be able to enter the ear and cause an infection. Signs and symptoms of an ear infection include:

recent history of an upper respiratory infection
pain and pressure
fever
loss of balance
difficulty hearing
nausea and vomiting
fluid discharge from the ear (this indicates perforation of the tympanic membrane)

Ear infections are more common in children. In fact, it is the most common infection in infants and toddlers. If your child has an ear infection, it may be difficult to detect. Here are some things you may notice about your child:

pulling or tugging on the ears
increased fussiness, especially at bedtime
fails to startle at loud noises or does not consistently respond to name
eating or drinking abnormally
Strep Throat

Strep is an abbreviation for a family of bacteria called “streptococci.” Strep throat occurs when the throat and surrounding structures become infected with this germ. While strep throat is a common infection, many other infections have the same symptoms. You must have an actual strep test at your doctor’s office to be certain that your symptoms are associated with a streptococcal infection versus a different bacterial or viral infection. Symptoms are usually abrupt in onset including:

red, sore throat
difficulty swallowing
enlarged tonsils
enlarged lymph nodes
white patches on the tonsils or in the back of the throat
fever
body aches
fatigue
skin rash (rare)

Notably absent in strep throat are a runny nose and cough. You may also suspect strep throat if you have been exposed to someone with a strep infection in the last two weeks. Children between the ages of 5 and 15 are most at risk. You are also more likely to get a strep infection during the winter months.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Sinusitis

Sinusitis occurs when a germ finds its way into the hollow recesses of the skull that surround your eyes and nose. The infection can then become trapped there, causing inflammation, pressure, and pain. Acute sinusitis is often secondary to a common cold, so you are more likely to get sinusitis during the winter months. Chronic sinusitis is sometimes an inflammatory disorder caused by untreated allergies or conditions, such as bronchial asthma. Sinusitis can last from weeks to years if left untreated. Symptoms of sinusitis are:

headache
cough
nasal discharge of various colors and consistency
congestion
toothache
fever
fatigue
Sleep Apnea

Apnea is a medical term meaning to stop breathing. Sleep apnea is a disorder causing one to stop breathing for brief periods of time while sleeping. Sleep apnea is a common disorder and can cause severe health problems if left untreated. If you suspect that you have sleep apnea, see a doctor. Symptoms include:

waking up frequently in the middle of the night
feeling unrefreshed upon awakening
daytime drowsiness
mood swings
depression
waking up with a dry, sore throat
morning headaches

In addition to these symptoms, many individuals with sleep apnea have often been told by a spouse or other family member that they snore, gasp or choke while sleeping. Family members may have observed an episode in which you stopped breathing while asleep. You are more likely to have sleep apnea if you are overweight, have enlarged tonsils, take sedatives at bedtime or have inherited a shorter airway than the general population. People who are obese and have uncontrolled hypertension are more likely to have obstructive sleep apnea.

The majority of people will experience one or more of these disorders in their lifetime. While visiting with your physician, discussion of your symptoms may help your doctor to come up with a diagnosis of an ENT disorder.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

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Our Pediatric Otolaryngology team is recognized for its expertise in diagnosing, treating and managing a wide range of conditions that impact the airway, voice, hearing, speech and sinuses. Some of the conditions and areas we specialize in include:

Ear Disorders

Hearing loss
Ear infections (otitis media)
Cholesteatoma (Skin cyst in middle ear)
Ruptured eardrum
Microtia and external ear deformities
Cochlear implantation

Nasal Problems

Chronic rhinorrhea or runny nose
Nasal obstruction
Nasal mass
Sinusitis (sinus Infection)
Nosebleeds (epistaxis)

Throat Disorders

Sleep apnea
Tonsillitis and recurrent sore throats
Hoarseness and voice disorders
Vocal cord dysfunction
Vocal cord lesions
Vocal cord paralysis
Swallowing problems
Drooling
VPI or velopharyngeal insufficiency
Tongue tie

Head and Neck Disorders

Head and neck masses
Enlarged or diseased lymph nodes in the neck
Hemangiomas and other vascular malformations
Salivary gland masses
Thyroid tumors or masses
Facial paralysis

Airway Disorders

Stridor and noisy breathing
Laryngomalacia
Vocal cord paralysis
Recurrent respiratory papilloma
Laryngeal and tracheal stenosis
Tracheostomy
Foreign body in throat

Otolaryngology is a medical specialty that treats conditions of the ears, nose, and throat. Specialists in this field have training in surgery as well as medicine.When you are referred to an ENT clinic, a named consultant will be responsible for your care. This consultant will usually oversee a small team of doctors who report back. So when you attend your appointment at the clinic, you may be seen by any member of the team.

The most common form of dizziness and balance disorder is BPPV (Benign Paroxysmal Positional Vertigo), a disorder of the inner ear resulting in episodes of intense dizziness on certain head movements.

Other causes include side effects from medication or alcohol, brain disorders such as stroke, concussion or cerebellar degeneration, cardiac problems and anxiety.

What is vestibular rehabilitation?

VR is an exercise-based programme to encourage the central nervous system to compensate for problems in the inner ear. Following thorough examination, specialist physiotherapists develop personalised exercise-based management plans including home exercise programmes.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

A management plan may include:

Eye and head movement exercises
Exercises to improve standing balance and walking
Specific techniques to reposition fragments in the inner ear which cause dizziness in BPPV
Education and advice on activities of daily living to improve confidence & function
Advice on falls reduction/prevention.

Significant improvement is achieved in:

80 per cent of patients with unilateral vestibular loss (e.g. labyrinthitis, acoustic neuroma surgery)
80 per cent of patients with BPPV after one treatment session
Patients with a central cause (e.g. stroke) may show some improvement
Use of VR in concussion, migraine, and nonspecific balance loss of the elderly may be helpful.

Physiotherapists are ideally placed to provide early screening and intervention to minimise the impact on daily life of balance and dizziness disorders.

Specialist physiotherapists provide personalised VR programmes which are clinically effective reducing distressing symptoms and improving quality of life.

Otorhinolaryngology or ENT (ear, nose and throat) diseases is a medical field specialising in the diagnosis and treatment of patients with symptoms, diseases or injuries in the ears, nose, paranasal sinuses, mouth, pharynx, larynx or neck.

Malignant tumours of the head and neck region, benign tumours in the parotid gland, severe middle-ear infections and troublesome nosebleeds are typical conditions requiring hospitalisation. Some pharyngeal and laryngeal infections may also require short-term hospitalisation.

Conditions such as hearing loss, maxillary sinusitis, chronic rhinitis and middle ear cholesteatoma are treated at outpatient clinics.
The most common surgical procedures include tonsillectomy, adenoidectomy and the insertion of tympanostomy tubes.

Patient groups requiring the most demanding care

In ENT diseases, tumours in the head and neck area (e.g. cancers), rehabilitation of deafness and inflammatory processes in the skull base are conditions requiring demanding specialist medical care.

Emergency care

Nosebleeds, peritonsillar abscesses and nasal fractures are the most common conditions requiring emergency care.

Typical forms of treatment

The treatment of ENT (ear, nose and throat) diseases is usually provided at outpatient clinics, or requires only short-term hospitalisation. Most operations are performed in day surgery where the patient is admitted to the unit in the morning and discharged later the same day.

ENT services in the HUS area

Hospitals offering ear, nose and throat treatment include

the HUS Ear, Nose and Throat at the Surgery Hospital
the Children’s Hospital and
the Töölö Hospital’s Cleft Lip and Palate Unit.

Within the Uusimaa region, services are also provided at Länsi-Uusimaa, Hyvinkää, Lohja and Porvoo hospitals.

In the HUS area, patient groups requiring the most demanding care are treated at the Surgery Hospital. In addition to physicians and nurses, the hospital’s interdisciplinary teams include audiometricians, speech therapists, psychologists, social workers, physiotherapists and rehabilitation supervisors.

Patient groups requiring the most demanding care

In ENT diseases, tumours in the head and neck area (e.g. cancers), rehabilitation of deafness and inflammatory processes in the skull base are conditions requiring demanding specialist medical care.

Emergency care

Nosebleeds, peritonsillar abscesses and nasal fractures are the most common conditions requiring emergency care.

Typical forms of treatment

ENT services in the HUS area

Hospitals offering ear, nose and throat treatment include

the HUS Ear, Nose and Throat at the Surgery Hospital
the Children’s Hospital and
the Töölö Hospital’s Cleft Lip and Palate Unit.

Within the Uusimaa region, services are also provided at Länsi-Uusimaa, Hyvinkää, Lohja and Porvoo hospitals.

In a study conducted in Framingham, MA, 1.48 % of the population claimed to have a history of Ménière’s disease. This relatively large prevalence likely derives from a tendency of many physicians to lump all cases of recurrent vertigo into the category of Ménière’s disease. Mayo Clinic reported prevalence in 1980 in the Rochester, MN population of 218.2 cases/100,000 people, and an incidence rate of new cases of 15.3/100,000 per year. They also reported a diagnosis rate basically proportional to age up to the age of 60, with a decline thereafter. Ménière’s disease in the ears bilaterally was found in 34% of their group.[1]

Etiology/Causes

This disorder has an unknown cause but is thought to be due to increased fluid pressure in the inner ear or to the constriction of blood vessels of the inner ear similar to what causes migraine headaches.[4] The pressure stretches the membranes that divide the inner ear. This stretching causes tinnitus and a decrease in ability to hear. The rupture of these membranes and the mixture of fluids with different concentrations is thought to lead to vertigo. This repeated process of rupturing and healing is what is thought to cause the eventual loss of ability to hear low frequencies.[5]

Also known as endolymphatic hydrops, Ménière’s disease is a disorder that affects the semicircular canals and cochlea (collectively known as the labyrinth) of the inner ear. The labyrinth contains organs of balance (semicircular canals and otolithic organs) and hearing (cochlea). These canals help to interpret the bodies position in space and help to maintain balance. [1] [2] Meniere’s disease causes a disruption of the flow of fluid within the ear.[3] When fluid builds up in the inner ear, signals to the brain are disrupted which in turn causes the dizziness and tinnitus.[4] Primarily a unilateral disorder, however, the opposite ear can be affected in 2-50% of people diagnosed with Meniere’s disease.[3]

A laryngoscopy is an exam that gives your doctor a close-up view of your larynx and throat. The larynx is your voice box. It’s located at the top of your windpipe, or trachea.

It’s important to keep your larynx healthy because it contains your vocal folds, or cords. Air passing through your larynx and over the vocal folds causes them to vibrate and produce sound. This gives you the ability to speak.

A specialist known as an “ear, nose, and throat” (ENT) doctor will perform the exam. During the exam, your doctor place a small mirror into your throat, or insert a viewing instrument called a laryngoscope into your mouth. Sometimes, they’ll do both.

When you arrive for your appointment, you might first be referred to the on-site audiologist for a hearing test before you see the ENT doctor. If this is the case, the audiologist will look in your ears with an otoscope before testing your hearing using an audiometer. The audiologist may also want to check the condition of your middle ear with a tympanometer test if they feel it necessary. The audiologist will then pass your test results to the ENT doctor who will usually ask you questions about your hearing and any family history of hearing loss before they look in your ears with an otoscope (or occasionally with a special microscope for a more detailed look).Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Office-Based Laryngology Procedures

All of these procedures are performed with topical (spray) and occasionally local anesthesia. Sedation medicine is rarely required. The visit takes 30 minutes in total, but the procedure itself is usually much shorter than that.

Patients can return to work after the procedure and eat or drink one hour after the procedure. Blood thinners (e.g. Aspirin, Plavix, Coumadin) might need to be discontinued before some procedures. One to two weeks after some procedures, voice therapy is recommended.

Many of these procedures used to be performed only in the operating room and required general anesthesia. However, general anesthesia carries a higher risk of complications and requires more recovery time than office-based procedures. Patients who undergo office-based procedures can drive themselves home and rapidly return to work. Complications such as bleeding are very rare.

Laser Procedures

New and exciting lasers are available for use in the office. The lasers are able to access the larynx (voice box) by being passed through a flexible camera (endoscope) that goes through a nasal passage. These lasers function well because they treat diseased tissue and limit damage to the natural tissues. This feature means that disease can be treated and voice function is protected.

The lasers are used for treatment of:

Leukoplakia: These are white patches on the vocal cords producing hoarseness. These patches usually are not cancerous but usually are pre-cancerous (on the way to becoming cancer). These lesions often are found in people with tobacco and/or alcohol exposure and can be found even if those exposures stopped many years ago. Periodic treatments usually are required to reduce the leukoplakia; these treatments are designed to prevent progression to cancer and to improve voice.
Papilloma: These are benign growths on the larynx (voice box), usually on the vocal cords, that reduce the size of the air passage and impair voice quality. This disease can occur in children and adults. Papilloma almost will certainly return, so many treatments could be required over time to control disease.
Reinke’s Edema: This condition results in abnormally large vocal cords and a low pitched and rough voice, and usually is found in adult female smokers. Stopping smoking is ideal but even that will not allow the vocal cords to return to normal and treatment is required for voice improvement. In rare occasions, the vocal cords become so large that they cause restriction of the airway.
Small Polyps, Ectasias and Varices: These are abnormally large and/or prominent blood vessels on the surface of the vocal cords, which often are seen in people with heavy voice use – singing or speaking. The blood vessel changes can increase in size, making hoarseness worse, or can rupture, causing bleeding within the vocal cord.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Vocal Fold Injections

This procedure is designed to deliver a temporary filler material into one or both vocal folds to move them closer together. When the vocal folds are closer together, better voice, swallowing and an effective cough can be generated.

This procedure usually is performed effectively through the mouth using special instruments. It also can be done with a small needle through the neck, or through the nose using a flexible camera (endoscope). Immediate return to work is possible and eating and drinking can resume one hour after the procedure.

Vocal fold injections sometimes are used for treatment of:

Vocal Cord Paralysis: When the nerves or muscles controlling the movement of the vocal cord back and forth are injured and the vocal cord no longer moves, it is considered vocal cord paralysis. Patients will experience a weak, breathy voice that requires effort to produce. They also could experience coughing and choking when eating and drinking as well as a weak cough. In severe cases, patients might have pneumonias from aspirating food or liquids and could lose weight.
Vocal Cord Paresis: This condition is a less severe case of vocal cord paralysis (see above) in which some motion of the affected vocal cord is preserved. Symptoms are similar to vocal cord paralysis, but usually less severe.
Vocal Cord Scar: When the normally soft and elastic surface of the vocal cord is replaced by firm scar, people experience a breathy, effortful and soft voice quality. This condition is very difficult to cure, but some treatments – including vocal cord injection – offer relief.
Aging Vocal Cords: As we age, our vocal cords become smaller and therefore don’t meet easily when we try to use our voice. Speaking becomes effortful and patients experience a soft voice easily drowned out by surrounding noise. Injections move the vocal cords closer together for easier voice production. Voice therapy also is helpful in conjunction with vocal cord injections or other more permanent surgical options.

The ENT doctor will also ask you a few questions about how well you are able to hear in different everyday situations and what difficulties you have been experiencing. Click here to see a form that will give you some idea of the type of questions you may be asked . You may want to consider your answers to these questions before going to your appointment. You can print this form and take it with you to your appointment as a reminder.

The ENT doctor will then explain the results of the hearing tests and discuss the possibilities available. If they recommend hearing aids, they will refer you back to the audiologist to discuss this further. However, if they think that your hearing loss can be treated with medication or surgery, they will discuss the options with you – although these treatments will only be appropriate for a minority of people who have particular types of conductive hearing loss.

ENT surgeons often treat conditions that affect the senses such as hearing and balance disorders or smell and taste problems. They also treat patients with conditions that affect their voice, breathing and swallowing as well as those with head and neck tumours including the skull base and interface with the brain.

ENT surgeons may treat people of all ages from newborn babies to elderly people. They see more children than most other surgeons, apart from paediatric surgeons. One of the attractions is that they treat a wide spectrum of ages and diseases.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

A proportion of an ENT surgeon’s time is spent in outpatient clinics and managing conditions medically without the need for surgery. The use of microscopes & endoscopes in outpatients allows treatment/ diagnosis in the clinic. ENT has possibly the widest range of operations of any speciality from major head & neck procedures with flaps & complex reconstructions to microsurgery on the ear.

ENT surgeons treat a very wide range of conditions. These include:

ear conditions
nose conditions
throat conditions
head and neck conditions
facial cosmetic surgery

Ear conditions include:

otosclerosis (a condition of the middle ear that causes hearing loss) and other problems with hearing and deafness
otitis media with effusion – a common condition of childhood (also known as glue ear) in which the middle ear becomes blocked with fluid
age related hearing loss
tinnitus (ringing in the ears) and eustachian tube dysfunction
dizziness and vertigo
ear infections
perforated ear drum and cholesteatoma
protruding ears

Nose conditions include:

sinus infection and rhino-sinusitis, including in children
nasal injuries
nasal polyps
tumours of the nose
nasal obstruction
disorders of the sense of smell

Throat conditions include:

adenoid problems – surgical removal of these small glands in the throat at the back of the nose is sometimes needed, and is usually performed in childhood
tonsillitis, sometimes requiring surgical removal of the tonsils, usually in childhood
hoarseness and laryngitis
swallowing problems
upper airway breathing problems
snoring and obstructive sleep apnoea (when breathing stops during sleep)

Head and neck conditions include:

cancer affecting the mouth, oral cavity, throat (pharynx), voice box (larynx), salivary glands, skull base, or the nose and sinuses
thyroid and parathyroid problems
facial skin lesions including skin cancer

Facial cosmetic surgery is also part of ENT surgery and includes:

rhinoplasty (nose surgery)
otoplasty (ear surgery)
blepharoplasty (removal of excess skin and fat pads around the upper and lower eyelids)
facial reconstruction following trauma or cancer

“ENT is an extremely varied specialty and my role has given me the opportunity to work on the ward”. Francesca Kum, Trainee in core surgical training, Guy’s and St Thomas’s NHS Foundation Trust.

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ENT surgeons use many different surgical procedures including:

insertion of grommets for glue ear – this involves a very small incision in the ear drum and is typically carried out on children. The grommets help to ventilate the middle ear and resolve middle ear effusions
tonsillectomy (removal of tonsils) or adenoidectomy (removal of adenoids), most often in children
septoplasty – correction of nasal septum to prevent obstruction and enable clear breathing
microlaryngoscopy – a short metal tube (laryngoscope) is inserted into the larynx (voice box). This is used for examination and can also be used to perform a biopsy or surgery
oesophagoscopy – a long metal or flexible tube (oesophagoscope) is inserted through the mouth into the oesophagus
endoscopic sinus surgery – a tiny telescope is inserted into the nasal passages to diagnose and treat difficult sinus conditions. Technically refined instruments are then used to restore proper function
tympanomastoid surgery to reconstruct and remove epithelial inclusions (cholesteatoma) within the middle ear
open operations to remove neck lumps, and salivary gland tumours
tracheostomy

ENT surgery has been at the forefront of the latest medical technologies and minimally invasive procedures are common. This has many benefits including less scarring and shorter recovery periods Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Sub-specialties

Most ENT surgeons develop a sub-specialty and these include:

otology – diagnosis and treatment of infection, disease and damage to the ear to improve hearing and balance. This includes cochlear implant surgery, which is the implantation of a small complex electronic device in to the inner ear (cochlea) which stimulates the auditory nerve. This can provide a sense of sound for deaf people
rhinology – treatment of all aspects of nose and sinus disorders including allergy, infection, inflammatory conditions and tumours. Specialists will also operate on rare tumours of the skull base including pituitary tumours.
laryngology – treatment of diseases and disorders of the larynx and throat, such as vocal fold nodules, voice problems (including overuse/misuse) and cancer
head and neck surgery – the treatment of benign and malignant diseases of the head and neck, including lymph, salivary, thyroid and parathyroid glands
skull base surgery/neurotology – treatment of disorders of the skull base and acoustic neuromas (benign, non-cancerous growths on the vestibulocochlear nerve which controls hearing and balance)
facial plastics – aesthetic procedures including rhinoplasty (correcting and reconstructing the form, function and aesthetic appearance of the nose) and pinnaplasty (correction of protruding ears). The work also includes reconstruction of facial defects. Plastic and oral and maxillofacial surgeons may also perform this type of surgery
thyroid and parathyroid surgery – diagnosis and surgical treatment of thyroid and parathyroid tumours
paediatrics – some ENT conditions are congenital and treatment is needed at a very young age. Treatments are wide ranging and include cochlear implants and other implantable hearing devices, head and neck surgery and treatment for rare conditions including choanal atresia (where the back of the nasal passage is blocked by bone or tissue)

Because otolaryngology involves the ears, nose, and throat, these specialists are known as ear, nose, and throat (ENT) doctors.

For an ENT physician, the ear, nose, throat, larynx, and the sinuses are in the scope of treatment areas.

Unlike physicians who can only medically treat conditions involving these areas and structures, ENT doctors can treat and also perform surgery on the structures involved, if necessary.

Surgery will be necessary when non-invasive treatments and medications cannot improve the condition in question.

ENT surgery may also be harnessed to address injuries and deformities.

Medical Conditions

Among the conditions that ENT doctors can address are:

Sinusitis
Nose infections and injuries
Ear infections
Various sleep disorders, including sleep apnea
Vertigo
Head and neck pain
Speech and swallowing disorders
Tonsillitis

ENT doctors can specifically perform these types of procedures:

Sinus surgery
Snoring/sleep disorder surgery
Corrective breathing surgery
Tonsil removal

Sinus surgery may be the last resort when therapeutics cannot effectively treat chronic sinus infections.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

The ENT surgeon performs the procedure to make the sinus openings larger so that they can drain. This procedure optimizes the way the sinuses function and lessens the potential for infection.

Sinus surgery is minimally invasive and is often performed on an outpatient basis. Different types of sinus surgery include:

Endoscopic sinus surgery in which the ENT physician examines the snus openings for obstructive or unusual growths or tissues, which are then removed.
Image guided surgery, which combines computed tomography and endoscopy to improve the surgeon’s visualization of the target area. Imagery is very helpful during procedures that are correcting older sinus surgeries or for procedures addressing abnormal sinus anatomy.
The removal of irreversibly damaged mucosa of the maxillary sinus, which may be undertaken to connect the maxillary sinus, is located under the eye, to the nose to optimize its drainage.
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A more common ear surgery is the insertion of a tube into the ear to drain accumulated fluid in the middle ear.

Accumulated fluid is often the cause of chronic infections and can potentially cause hearing issues.

Another type of ear surgery is reconstructive. Tympanoplasty is reconstructive surgery involving the eardrum. In stapedectomy, a surgeon removes at least part of the bone in the middle ear.

Malignancies in the head and neck – such as larynx, oral, and temporal bone cancers – may require ENT surgery. The procedure used may entail reconstructive or micro-blood vessel surgery.

A direct laryngoscopy could be diagnostic or surgical in nature. A scope will be used to examine or operate on the larynx.

This procedure is geared toward those who have vocal cord issues or whose airway has narrowed because of abnormalities, including tumors.

A tracheotomy may be appropriate when one has problems breathing. The ENT surgeon will cut an opening in the wind pipe so that air reaches the lungs.

Another ENT procedure straightens the septum of the nose, which is a structure that separates the nasal cavities.

The septum is composed of thin bone and cartilage. Any abnormalities of the septum, such as its deviation, could inhibit one’s breathing ability. The procedure called septoplasty will best correct the situation.

Some cutting and removal of components of the septum may be required. They are then reinserted in their proper position.

Other procedures include adenoidectomy (removal of the adenoids) and tonsillectomy (removal of the tonsils). Both of these procedures are often performed on pediatric patients.

These surgeries are usually prescribed in cases of chronic inflammation or infection. Sometimes, the tonsils are removed when treating sleep apnea. In such instances, the tonsils obstruct, to some extent, a person’s upper airway.

If you know what the medical specialty otolaryngology, or otorhinolaryngology, is, you’re either a medical professional or you’ve had a lot of problems with your ears, nose or throat.

Otolaryngologists are more commonly known as ENTs — doctors who are ear, nose and throat specialists. These skilled physicians provide medical and surgical services for children and adults who have disorders or diseases of the head and neck.

ENT Specialists Kenya. An ENT Specialist is a medical specialist who is concerned with the diagnosis and treatment of disorders of the head and neck, including particularly the ears, nose, and throat. ENT doctors are also called otolaryngologists.

Otolaryngologists diagnose and manage diseases of the ears, nose, sinuses, larynx (voice box), mouth, and throat, as well as structures of the neck and face.ENT Clinics Kenya Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Ears
The unique domain of otolaryngologists is the treatment of ear disorders. They are trained in both the medical and surgical treatment of hearing loss, ear infections, balance disorders, ear noise (tinnitus), and some cranial nerve disorders.

Nose
Care of the nasal cavity and sinuses the primary skills of otolaryngologists. Problems in the nasal area include allergies, smell disorders, polyps, and nasal obstruction due to a deviated septum.

Throat
Specific to otolaryngologists is expertise in managing diseases of the throat, larynx (voice box), and the upper aero-digestive tract or oesophagus, including voice and swallowing disorders. ENT clinics Kenya

Head and neck
In the head and neck area, otolaryngologists are trained to treat infections, benign (non-cancerous) and malignant (cancerous) tumours, facial trauma, and deformities of the face. They perform both cosmetic plastic and reconstructive surgery.

What Does it Take to Become an Otolaryngologist in Kenya?

An otolaryngologist has to undergo a minimum of 12 years of study and training at a university medical school. Training consists of six years of undergraduate education at a medical school followed by a year of internship. Doctors aspiring to become an otolaryngologist need to complete five years or more of clinical speciality training at a university. Some individuals may pursue a further one or two year training period to establish a career in a sub-speciality.

Our ENT department consists of a highly skilled team of ENT specialists comprising of a Surgeon, Audiologist and a Nurse who deliver high quality care to adult and paediatric patients. We provide treatment for symptoms affecting the ear, nose or throat, as well as a range of audiological investigations and rehabilitation for patients through different clinics:

Hearing and Deafness Clinic. The unit is best placed to handle all types of ailments associated with ear, the common one being deafness/ hearing loss. It has a state-of-the-art audiology laboratory with an Expert Audiologist who looks into the needs of patients and works hand-in-hand with the ENT Surgeon to diagnose and treat a range of ear complications. The unit performs even the most complex ear procedures such as the cochlear implant, dispensing and fitting of hearing aids. We have also been able to treat common ear diseases through medical and surgical management.
Vertigo (Giddiness) Clinic. Giddiness/imbalance is very common in the modern society. We run vertigo clinic all days of the week where we diagnose the cause of giddiness and manage them accordingly.
Voice Clinic. We run a voice clinic where all voice related problems are examined, majority of them originating from the larynx (voice box). We perform video laryngoscopy to examine these problems and treat them through micro laryngeal surgery. Facility of evaluation of vocal cord movements by Stroboscope helps us in diagnosing the voice disorders accurately.
Nasal and Nasal Allergy Clinic. The polluted airs of urban areas have given rise to nasal allergy problems and as such many individuals are prone to sinusitis. The basic cause for sinusitis is the narrow opening of the sinuses in the nose. We perform a very short and simple procedure of widening these openings which prevents frequent attacks of sinusitis. The unit has the best equipment possible for the nasal endoscopic surgery including the micro debrider by which nasal surgery can be done with great accuracy and great outcomes.
Allergies

Allergies affecting the eye are fairly common. The most common allergies are those related to pollen, particularly when the weather is warm and dry. Symptoms can include redness, itching, tearing, burning, stinging, and watery discharge, although they are not usually severe enough to require medical attention. Antihistamine decongestant eyedrops can effectively reduce these symptoms, as does rain and cooler weather, which decreases the amount of pollen in the air.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

An increasing number of eye allergy cases are related to medications and contact lens wear. Also, animal hair and certain cosmetics, such as mascara, face creams, and eyebrow pencil, can cause allergies that affect the eye. Touching or rubbing eyes after handling nail polish, soaps, or chemicals may cause an allergic reaction. Some people have sensitivity to lip gloss and eye makeup. Allergy symptoms are temporary and can eliminated by not having contact with the offending cosmetic or detergent.

Conjunctivitis (Pink Eye)

This describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. Conjunctivitis can spread from one person to another and affects millions of Americans at any given time. Conjunctivitis can be caused by a bacterial or viral infection, allergy, environmental irritants, a contact lens product, eyedrops, or eye ointments.

At its onset, conjunctivitis is usually painless and does not adversely affect vision. The infection will clear in most cases without requiring medical care. But for some forms of conjunctivitis, treatment will be needed. If treatment is delayed, the infection may worsen and cause corneal inflammation and a loss of vision.

Corneal Infections

Sometimes the cornea is damaged after a foreign object has penetrated the tissue, such as from a poke in the eye. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant.

As a general rule, the deeper the corneal infection, the more severe the symptoms and complications. It should be noted that corneal infections, although relatively infrequent, are the most serious complication of contact lens wear.

Minor corneal infections are commonly treated with anti-bacterial eye drops. If the problem is severe, it may require more intensive antibiotic or anti-fungal treatment to eliminate the infection, as well as steroid eye drops to reduce inflammation. Frequent visits to an eye care professional may be necessary for several months to eliminate the problem.

Dry Eye

The continuous production and drainage of tears is important to the eye’s health. Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable.

The tear film consists of three layers — an outer, oily (lipid) layer that keeps tears from evaporating too quickly and helps tears remain on the eye; a middle (aqueous) layer that nourishes the cornea and conjunctiva; and a bottom (mucin) layer that helps to spread the aqueous layer across the eye to ensure that the eye remains wet. As we age, the eyes usually produce fewer tears. Also, in some cases, the lipid and mucin layers produced by the eye are of such poor quality that tears cannot remain in the eye long enough to keep the eye sufficiently lubricated.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

The main symptom of dry eye is usually a scratchy or sandy feeling as if something is in the eye. Other symptoms may include stinging or burning of the eye; episodes of excess tearing that follow periods of very dry sensation; a stringy discharge from the eye; and pain and redness of the eye. Sometimes people with dry eye experience heaviness of the eyelids or blurred, changing, or decreased vision, although loss of vision is uncommon.

Dry eye is more common in women, especially after menopause. Surprisingly, some people with dry eye may have tears that run down their cheeks. This is because the eye may be producing less of the lipid and mucin layers of the tear film, which help keep tears in the eye. When this happens, tears do not stay in the eye long enough to thoroughly moisten it.

Dry eye can occur in climates with dry air, as well as with the use of some drugs, including antihistamines, nasal decongestants, tranquilizers, and anti-depressant drugs. People with dry eye should let their health care providers know all the medications they are taking, since some of them may intensify dry eye symptoms.

People with connective tissue diseases, such as rheumatoid arthritis, can also develop dry eye. It is important to note that dry eye is sometimes a symptom of Sjögren’s syndrome, a disease that attacks the body’s lubricating glands, such as the tear and salivary glands. A complete physical examination may diagnose any underlying diseases.

Artificial tears, which lubricate the eye, are the principal treatment for dry eye. They are available over-the-counter as eye drops. Sterile ointments are sometimes used at night to help prevent the eye from drying. Using humidifiers, wearing wrap-around glasses when outside, and avoiding outside windy and dry conditions may bring relief. For people with severe cases of dry eye, temporary or permanent closure of the tear drain (small openings at the inner corner of the eyelids where tears drain from the eye) may be helpful.

That’s a summary description of a specialty that treats a big range of ailments. Here are some highlights:

Eye Sockets

Your eye sockets are the recesses in your skull that are the homes of your eyes. ENTs treat issues such as breaks in the bones around the eye sockets.

Facial Trauma

This includes injuries to your face or jaw. ENTs treat serious cuts or fractures of your skull, cheekbones or jawbone.

Head and Neck Cancer

A variety of cancers are treated by the ENT specialist. These include head and neck melanoma, cancers of the mouth, throat and salivary glands, along with sinus cancer.

Hearing Disorders

Two health care specialties focus hearing: audiologists and ENTs. Audiologists treat problems such as age related hearing loss and tinnitus (ringing in the ears).

ENTs treat hearing problems that are caused by issues such as infections, tumors, eardrum injuries and inner-ear problems.

Larynx and Voice Disorders

Your voice is created by muscles that can become fatigued, injured or diseased. That can cause problems with your voice. Common problems with the larynx and voice include cancer; vocal cord nodules, polyps or cysts; and hoarseness brought on with age.

Nasal and Sinus Disorders

Sinus and nasal conditions are pretty common. Problems can arise due to allergies and hay fever, nasal membrane or sinus inflammation, or a deviated septum (your nasal septum is the membrane that divides your nasal cavity in half. In most people, it’s a bit off center, but if it’s far off center, it can create breathing problems and cause repeated sinus infections).

Neck Disorders

The thyroid is a gland near the base of your neck. It makes hormones that control a lot of functions in your body, including your metabolism. ENTs treat thyroid diseases such as cancer, hyperthyroidism (when the thyroid is overactive) and hypothyroidism (when the thyroid under produces.)

Snoring and Sleep Apnea

Some might consider snoring to be a simple nuisance. But if it prevents you from getting a good night’s sleep, it can be detrimental to your health.

Sleep apnea is common. It causes your breathing to temporarily stop or get shallow while you sleep and causes long term strain on your heart and lungs.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

Both of these issues can be diagnosed and treated by an ENT.

Trachea and Esophagus Conditions

Your throat is divided into two “pipes.” Your windpipe – your trachea – carries air to your lungs. Your esophagus carries food to your stomach. Swallowing disorders can develop in this part of your body.

The ENT

As you can see, an ear, nose and throat specialist can help you with a lot of medical concerns. This list only touches on some of the ways an ENT can help you live well.

If you have questions about the health of your ears, nose or throat, see a otolaryngologist — an ear, nose and throat specialist.

Ear, nose and throat specialists, also called ENTs, ENT doctors and otolaryngologists, specialize in otolaryngology (pronounced ō-tō-la-rən-gä-lə-jē). Otolaryngologists diagnose, manage and treat disorders of the head and neck, including the ears, nose throat, sinuses, voice box (larynx) and other structures. Otolaryngology is a surgical specialty and ENTs are trained in the medical and surgical management of disease.

People also refer to otolaryngologists as ear, nose, and throat (ENT) doctors. They provide both medical and surgical care.

According to the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), otolaryngology is the oldest medical specialty in the United States. Otolaryngological diseases and disorders can occur in people of any age or gender.

In the U.S., people made an estimated 20 million visits to non-federally employed otolaryngologists over the course of 2010. Adults aged between 45 and 64 years old were the most common visitors of otolaryngology clinics, although people under the age of 15 years made of 20 percent of visitors.

The most common reasons for otolaryngology visits were problems with hearing, earache or ear infection, and nasal congestion.

Most otolaryngological conditions can be diagnosed through physical examination, meaning that otolaryngologists take a hands-on approach to patient care.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

What is otolaryngology?

The study of otolaryngology has expanded over the past 50 years and now focuses on the head and neck.

The word, despite its length, is actually an abbreviation of otorhinolaryngology.

Ears: The treatment of hearing disorders is unique to otolaryngologists.
Nose: Chronic sinusitis is one of the most common medical complaints in the U.S., with around 35 million adults receiving a diagnosis for this illness each year. Management of the nasal cavity also includes treating allergies and problems with sense of smell.
Throat: The diagnosis and treatment of laryngeal and upper esophageal diseases fall under the responsibility of otolaryngologists, including vocal difficulties and swallowing problems.
Head and neck: Otolaryngologists can also treat diseases and disorders that affect the face, head, and neck, including infectious diseases, trauma, deformities, and cancers. In this area, otolaryngology might cross over with other specialties, such as dermatology and oral surgery.

The field of otolaryngology focuses on seven different areas. Some otolaryngologists will undertake additional study to specialize in one of them and limit their services to their specialty.

These include:

treating allergies using medication, immunotherapy, or avoidance of triggers
performing surgery on the face, neck or ear for cosmetic, functional, or reconstructive purposes
treating or removing tumors of the head and neck, including in the nose and throat
managing disorders of the throat
treating ear problems, including infections, tumors, and nerve pathway disorders affecting hearing and balance
attending to ENT diseases in children, including congenital anomalies and developmental delays
managing disorders of the nose and sinuses Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

To receive full certification from the American Board of Otolaryngology (ABOto), applicants must complete 4 years of college and then 4 years of medical school.

They must then complete a residency program of 5 further years. A substantial amount of time within the first year will be spent training in basic surgery, emergency medicine, critical care, and anesthesia.

An ENT resident will then have an additional 51 months of progressive education in the specialty. They must spend the final year of the program as a chief resident within an approved institution.

After this training, a trainee otolaryngologist can take the American Board of Otolaryngology (ABOto) examination for board certification, consisting of both a written and oral exam.

Otolaryngologists can also choose to continue their studies and complete a fellowship. A fellowship is a 1-or-2-year course of extensive training that focuses on one of eight subspecialties.

Otolaryngologists test for and treat hearing loss among many other conditions.

Otolaryngologists provide care for a diverse range of conditions, using both medical and surgical skills to treat their patients.

They will have a firm understanding of medical science relevant to the head and neck, the upper respiratory and upper alimentary systems, communications systems, and chemical senses.

The American College of Surgeons (ACS) states that:

“An otolaryngologist-head and neck surgeon is a physician who has been prepared by an accredited residency program to provide comprehensive medical and surgical care of patients with diseases and disorders that affect the ears, the respiratory and upper alimentary systems, and related structures of the head and neck.”

The following list is a selection of common conditions that fall within the remit of otolaryngologists.

1) Airway problems

Breathing difficulties can range from mild, such as stridor, to life-threatening, such as severe airway obstructions. A variety of different underlying conditions can cause these problems.

2) Cancer

According to the AAO-HNS, more than 55,000 people will develop cancer of the head and neck in the U.S. this year, and nearly 13,000 of these people will die from the disease.

3) Chronic sinusitis

This condition involves chronic inflammation and swelling of the nasal passages, with a build-up of mucus and breathing difficulties through the nose. Infection, the growth of polyps within the nose, or a deviated septum can all contribute to chronic sinusitis.

4) Cleft lip and cleft palate

This is a split in the mouth in which the lip, palate, or both do not fully develop during fetal growth. Clefts can vary in size, ranging from those that cause minor problems to those that seriously interfere with eating, speaking, and breathing.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

5) Deviated nasal septum

The nasal septum is the wall that divides the nasal cavity.

A deviated septum is one that has drastically shifted away from the midline, typically resulting in breathing difficulties and chronic sinusitis.

A deviated septum can be present from birth. However, an injury to the nose can cause the septum to deviate later in life.

6) Drooping eyelids

Excessive sagging of the upper eyelid can be part of the natural aging process, but several different underlying conditions might also be responsible, such as diabetes mellitus, stroke, and tumors that affect nerves or muscle reactions.

Drooping eyelids might sometimes obstruct vision.

7) GERD

Gastroesophageal reflux disease (GERD) is a condition in which stomach acid and other contents from the digestive tract travel up into the esophagus.

A ring of muscle known as the sphincter at the bottom of the esophagus usually prevents the contents of the stomach traveling upwards. In people with GERD, this sphincter may be dysfunctional, which can lead to heartburn, chest pains, and difficulty swallowing.

8) Hearing loss

Loss of hearing can occur in people of all ages and has a variety of possible causes. Aging, exposure to loud noise, viruses, heart conditions, head injuries, stroke, and tumors might all lead to gradual hearing loss.

9) Swallowing disorder

People of any age can have difficulty moving food, liquid, and saliva from the mouth to the stomach. This condition is called dysphagia and may cause discomfort, impair nutrition, and lead to coughing and choking.

10) Tinnitus

Roughly 1 in 10 adults in the U.S. has experienced tinnitus lasting at least five minutes in the past year.

Tinnitus is the perception of sound when no external source of that sound is actually present. Roughly 1 in 5 people with the condition experience bothersome tinnitus, a more severe form that can cause distress and negatively impact on quality of life and functional health.

11) Tonsil or adenoid infection

The tonsils and adenoids in the throat are part of the immune system. Their role is to sample bacteria and viruses that enter the body through the nose and mouth, but they can be prone to recurrent infections, which might lead to surgery.

12) Vertigo and dizziness

Dizziness is a general term for describing sensations of light-headedness and imbalance. Vertigo is a specific form of dizziness involving a spinning sensation or a feeling of falling when there is no motion.

Conditions affecting the central nervous system and organs in the inner ear can cause vertigo.

13) Voice disorders

Many conditions, including injury to the vocal cords, viruses, cancer, and recurrent chronic acid reflux, can result in voice disorders. Diseases can result in hoarseness, lower vocal pitch, vocal fatigue, and complete loss of the voice.

Otolaryngologists must be able to perform a wide range of procedures to address the large number of medical problems within their specialty.

These procedures range in scale and complexity, from complex microvascular reconstruction to surgery that encompasses the entire neck.

The following list of procedures offers an overview of the vast scope of their work.

1) Blepharoplasty

This is the repair of droopy eyelids by removing excess skin, muscle, or fat that may be impairing vision. This procedure often occurs for cosmetic reasons and rarely requires a hospital stay.

2) Endoscopic sinus surgery

An otolaryngologist often performs this to treat infectious and inflammatory sinus diseases, such as chronic sinusitis or polyp growth. Otolaryngologists insert an instrument called an endoscope into the nose, which allows them to look at the sinuses.

They can then insert and use surgical instruments, including lasers, in order to remove material that is blocking the sinuses. The procedure can occur under local or general anesthetic.

3) Excision and biopsy

A surgeon will perform a biopsy to identify suspicious lesions and tumors. These can develop anywhere in the body, and identification is essential for defining an effective course of treatment.

They can often perform the removal of small lesions and superficial skin cancers under local anesthetic in an outpatient setting.

4) Facial plastic surgery

This type of surgery can be either reconstructive or cosmetic. Otolaryngologists can repair congenital anomalies, such as cleft palates, or conditions that are the result of accidents, previous surgery, or skin cancer.

They can also enhance the appearance of the facial structures, including the correction of wrinkles.

5) Myringotomy and pressure equalization (PE) tube placement

Otolaryngologists can perform a range of ear surgeries.

For people experiencing recurrent middle ear infections or hearing loss due to fluid in the ear, the surgeon can place tubes through the eardrum to allow air into the middle ear.

PE tubes can be short- or long-term.

A myringotomy is a procedure in which the otolaryngologist makes a small incision in the eardrum to relieve pressure resulting from the excessive build-up of fluid.

They can also help to drain pus from the middle ear.

6) Neck dissection

This is a major form of surgery to remove cancerous lymph nodes from the neck, performed under general anesthetic. The extent of the surgery depends on the spread of the cancer.

Radical neck dissection requires the removal of all tissue from the jawbone to the collarbone on the side of the neck, along with the muscles, nerves, salivary glands, and major blood vessels from this area.

7) Septoplasty

This is surgery to correct a deviated septum or to allow greater nasal access nose for the removal of polyps. The procedure can take place under local or general anesthetic and involves the otolaryngologist separating the lining of the nasal passage from underlying cartilage.

They will then straighten the bent cartilage as necessary.Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

8) Surgery for snoring or obstructive sleep apnea (OSA)

Otolaryngologists have a number of surgical solutions for snoring and OSA. They can remove excess soft palate tissue to open up the airway, such as with radiofrequency thermal ablation to reduce tissue bulk.

They can also make the palate stiffer with injections or by inserting stiffening rods to reduce vibration and the risk of collapse.

9) Thyroid Surgery

The thyroid sits just below the larynx. Otolaryngologists can remove all or part or all of the thyroid gland in cases of thyroid cancer, suspicious lumps, obstruction of the windpipe or esophagus, or hyperthyroidism.

10) Tonsillectomy or adenoidectomy

Tonsillectomy is the surgical removal of tonsils, and adenoidectomy is surgical removal of the adenoids. They are commonly necessary for treating recurrent infections or breathing problems.

The procedure typically occurs under general anesthetic, but the patient will not usually need to stay in the hospital.

11) Tracheostomy

This is a procedure to create an opening through the neck into the windpipe. The otolaryngologist can insert a tube into this opening to provide an airway or remove secretions from the lungs.

Tracheostomy may be necessary to treat several health problems, including cancer of the neck and severe laryngeal disease.

12) Tympanoplasty

This type of surgery can repair any defect in the eardrum with a graft or address middle-ear bone disease. Tympanoplasty serves to close perforations, improve hearing, and eradicate disease from the middle ear.

The procedure can take place in an outpatient setting.

When to see an otolaryngologist

The AAO-HNS states that otolaryngologists are the most appropriate physicians for treating disorders of the ears, nose, throat, and any structures related to the head and neck.

As they specialize in both medicine and surgery, they normally do not need to refer patients to other physicians for follow-up treatment.

Otolaryngology is a wide-ranging medical specialty focusing on health problems in the ears, nose, throat, head, and neck.

An otolaryngologist must spend 4 years at college, a further 4 years at medical school, and then 5 years after that on a residency program specializing in this area. They will move on to 51 months of progressive education on the specialty, after which they take the ABOto board certification exam.

They will then treat a variety of medical problems, including airway difficulties, cancers of the head and neck, and chronic sinusitis. An otolaryngologist also helps with vertigo and dizziness, structural problems in the nose, and hearing loss, among many other medical issues.

Their training is extensive and covers a range of surgeries, including blepharoplasty, endoscopic sinus surgery, and tumor removal. They will also be able to perform plastic surgery of the face, myringotomy, and thyroid surgery, as well as removal of the adenoids and pancreas.

Otolaryngologists may see adults and children and treat a variety of conditions, such as:

Hearing loss and ear disorders (e.g., ear infection, dizziness, tinnitus)
Allergies (e.g., hay fever, seasonal rhinitis)
Infections (e.g., sinusitis, tonsillitis)
Injuries
Congenital (present at birth) or acquired abnormalities (e.g., cleft palate, cleft lip, deviated septum, drooping eyelids, loss of smell)
Swallowing disorders (e.g., difficulty swallowing)
Speech disorders (e.g., hoarseness, laryngitis)
Benign (non-cancerous) growths and malignant (cancerous) tumors of the nose, sinuses, mouth, throat, larynx, upper esophagus, thyroid gland and parathyroid (e.g., nasal polyps, head and neck cancer)
Certain nerve disorders (e.g., Bell’s palsy)
Sleep disorders (e.g., sleep apnea, snoring)
Ear, Nose and Throat Specialist Education, Training and Certification

ENT physicians must complete about 15 years of education and training, including a 4-year undergraduate program, 4-year medical program, at least 5 years of specialty training and a 1- to 2-year residency program (e.g., General Surgery). Then, physicians must undergo peer evaluations and pass oral and written examinations administered by the American Board of Otolaryngology.

After attaining board certification, otolaryngologists may pursue a one- or two- year fellowship for extensive training and examinations in a subspecialty area. Otolaryngology subspecialties include:

Allergy
Facial Plastic and Reconstructive Surgery
Head and Neck Surgery
Laryngology
Otology/Audiology
Pediatric Otolaryngology
Rhinology
Neurotology
Sleep Medicine

Board certification is valid for 10 years. To revalidate their certification, ENTs must meet guidelines established by the American Board of Medical Specialties and complete a Maintenance of Certification Program. This process emphasizes professional standing, lifelong learning and self-assessment, cognitive expertise and evaluation of performance in practice. Diagnosis And Management Of Eye, Ear, Nose, And Throat Disorders Essay Paper

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