Download Cummings Review of Otolaryngology%2c 1e-Original PDF PDF

TitleCummings Review of Otolaryngology%2c 1e-Original PDF
File Size17.8 MB
Total Pages315
Table of Contents
                            Front Cover
IFC
CUMMINGS REVIEW OF OTOLARYNGOLOGY
CUMMINGS REVIEW OF OTOLARYNGOLOGY
Copyright
Contributors
Foreword
Preface
Acknowledgments
Contents
1 - Preparing for Clinical Rounds and Board Examinations
	INTRODUCTION
	ORAL EXAMINATIONS
		PEARLS FOR SUCCESS ON ORAL EXAMS
	DIFFERENTIAL DIAGNOSIS
AND CLINICAL ROUNDS
		PEARLS FOR SUCCESS ON WRITTEN EXAMSAND CLINICAL ROUNDS
2 - OTOLOGY AND NEUROTOLOGY
	TEMPORAL BONE ANATOMY
	THE AURICLE
	EAR CANAL
	MIDDLE EAR
	MASTOID AND PETROUS APEX
	AUDITORY ANATOMY AND PHYSIOLOGY
	VESTIBULAR ANATOMY AND PHYSIOLOGY
	AUDIOLOGIC TESTING
	OTITIS EXTERNA
	CHRONIC OTITIS MEDIA, MASTOIDITIS, APICITIS, AND COMPLICATIONS OF THE OTITIS MEDIA
	TEMPORAL BONE TRAUMA
	HEARING LOSS IN ADULTS
	INFECTIONS OF THE LABYRINTH
	CENTRAL NEURAL AUDITORY PROSTHESES
	HEARING AID AMPLIFICATION
	APPLIED VESTIBULAR PHYSIOLOGY
	PERIPHERAL VESTIBULAR DISORDERS
	CENTRAL VESTIBULAR DISORDERS
	SURGERY FOR VERTIGO
	CLINICAL DISORDERS OF THE FACIAL NERVE
	LATERAL SKULL-BASE SURGERY
3 - Facial Plastic and Reconstructive Surgery
	EVALUATION
	FACIAL RESURFACING
	INJECTABLES
	BROW LIFT
	BLEPHAROPLASTY
	FACE LIFT
	HAIR RESTORATION
	RHINOPLASTY
	OTOPLASTY
	CLEFT LIP
	SCAR REVISION
	SOFT-TISSUE TRAUMA
4 - RHINOLOGY AND ENDOSCOPIC SINUS SURGERY
	ANATOMY OF THE PARANASAL SINUSES
	RHINITIS
	NASAL OBSTRUCTION
	NASAL SEPTAL PERFORATION
	EPISTAXIS
	OLFACTORY PHYSIOLOGY AND DISORDERS
	CEREBROSPINAL FLUID RHINORRHEA
	RHINOSINUSITIS
	CHRONIC RHINOSINUSITIS
	SINONASAL NEOPLASMS
	SURGERY OF THE PARANASAL SINUSES
	ENDOSCOPIC DACRYOCYSTORHINOSTOMY
5 - Head and Neck Surgery
	PRINCIPLES OF RADIATION THERAPY
	PRINCIPLES OF CHEMOTHERAPY
	MANAGEMENT OF THE NECK
	ORAL CAVITY MALIGNANCIES
	OROPHARYNGEAL MALIGNANCIES
	LARYNGEAL MALIGNANCIES
	HYPOPHARYNGEAL MALIGNANCIES
	NASOPHARYNGEAL MALIGNANCIES
	SINONASAL MALIGNANCIES
	SALIVARY NEOPLASMS
	MELANOMA
	THYROID MALIGNANCIES
	PARATHYROID DISORDERS
6 - PEDIATRIC OTOLARYNGOLOGY
	HEAD AND NECK
	NOSE AND PARANASAL SINUS DISEASE
	CRANIOFACIAL
	SINUS
	(NOT PREVIOUSLY DESCRIBED)
	ADENOTONSILLAR PATHOLOGY
7 - Laryngology
	NEUROLOGIC EVALUATION OF THE LARYNX
	NEUROLOGIC DISORDERS OF THE LARYNX
	BENIGN VOCAL FOLD MUCOSAL DISORDERS
	SPECIFIC BENIGN VOCAL FOLD MUCOSAL DISORDERS
	ACUTE AND CHRONIC LARYNGITIS
	CHRONIC ASPIRATION
	LARYNGEAL AND ESOPHAGEAL TRAUMA
	SURGICAL MANAGEMENT OF UPPER-AIRWAY STENOSIS
	DISEASES OF THE ESOPHAGUS
8 - OTOLARYNGIC ALLERGY
	ALLERGENS
	HISTORY AND PHYSICAL EXAM OF PATIENT WITH ALLERGIES
	RHINITIS
	ALLERGIC RHINITIS EVALUATION
	SKIN TESTING
	ALLERGIC RHINITIS TREATMENT
	IMMUNOTHERAPY
9 - SLEEP MEDICINE
	OBSTRUCTIVE SLEEP APNEA
	SNORING
	UPPER-AIRWAY RESISTANCE SYNDROME
	OBSTRUCTIVE SLEEP APNEA SYNDROME
	CENTRAL SLEEP APNEA
	OTHER PEDIATRIC SLEEP DISORDERS
10 - ORAL SURGERY
	PEDIATRIC DENTITION
	ADULT DENTITION
	OCCLUSION
	MALOCCLUSION CLASSES
	DENTOFACIAL DEFORMITIES
	INNERVATION OF TEETH/GINGIVA
	DENTAL ANESTHESIA
	ODONTOGENIC INFECTIONS2
	FIBRO-OSSEOUS LESIONS6
	HIGH-FLOW MALFORMATIONS
11 - Head and Neck Pathology
	PREFACE
	ORAL CAVITY AND OROPHARYNX
	SELECTED ODONTOGENIC CYSTS AND TUMORS
	LARYNX AND HYPOPHARYNX
	NOSE, PARANASAL SINUSES, AND NASOPHARYNX
	SALIVARY GLANDS
	EAR
	THYROID AND PARATHYROID GLANDS
12 - Head and Neck Radiology
	TEMPORAL BONE
	SKULL BASE
	SINONASAL CAVITY
	PHARYNX
	SALIVARY GLANDS
	NECK
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
	X
	Z
IBC
                        
Document Text Contents
Page 157

CHAPTER 6 | PEDIATRIC OTOLARYNGOLOGY 143

Upslanting palpebral fissures
Epicanthic folds
Narrow ear canals
Abnormally small ears
Small nose
Hypotonia
Increased association with leukemia
Increased incidence of subglottic stenosis
Midface hypoplasia
Large fissured lips
Dental abnormalities
Short neck
Atlantoaxial subluxation and instability␣

APERT (ACROCEPHALOSYNDACTYLY),
CROUZON (CRANIOFACIAL DYSOSTOSIS),
AND PFEIFFER SYNDROMES

Autosomal dominant, and most cases of Apert are spontaneous
Findings

Craniosynostosis
Hypertelorism
Exophthalmos
Midface hypoplasia
Mandibular prognathism
Parrot-beaked nose
Syndactyly and cervical fusion seen in Apert syndrome
Pfeiffer is different from Apert: a different type of hand
malformation and digital broadening in Pfeiffer syndrome

Cognitive function ranges from normal to severe mental
retardation␣

GOLDENHAR SYNDROME (PART OF THE
OCULOAURICULOVERTEBRAL SPECTRUM)

Most cases occur sporadically, and are autosomal recessive
or dominant
Characterized by hemifacial microsomia

Unilateral microtia/atresia with conductive loss
Facial asymmetry
Retrognathia/micrognathia
Asymmetric mandibular hypoplasia
Microstomia
May have a cleft lip/palate

Also with vertebral anomalies and epibulbar dermoids␣

HURLER SYNDROME
Autosomal recessive, as is the case with most mucopoly sa cch-
ari doses
Leads to visceromegaly
Mucopolysaccharidosis type I: deficiency of α-L-iduronidase
Facies: coarse facial features and forehead prominence
Dwarfism
Mixed hearing loss
Macroglossia
Short neck
Mental retardation
Skeletal disorders with joint stiffness
May develop severe obstructive sleep apnea (OSA)
Progressive neurologic dysfunction␣

HUNTER SYNDROME
Similar to Hurler, but is an X-linked disorder
Incurable syndrome with multiple organ system
mucopolysaccharidosis infiltration, usually dying as a
teenager from cardiomyopathy

Mucopolysaccharidosis type II: iduronate sulfatase
deficiency
Facies: prominent supraorbital ridges, large flattened nose,
low-set ears, and large jowls
Short stature
May develop severe OSA
Potential difficult airway

Short neck
Tracheal deposits of glycosaminoglycan leading to
airway obstruction␣

BECKWITH-WIEDEMANN SYNDROME
Macroglossia, omphalocele, visceromegaly, and cytomegaly
of the adrenal cortex
Result of genomic imprinting
“Overall growth syndrome,” with sporadic occurrence
Macroglossia may cause airway obstruction or chronic
alveolar hypoventilation
Tongue reduction is effective for those unable to keep the
tongue in the mouth␣

CHARGE SYNDROME
1. Coloboma (75-90%)
2. Heart defects (50-85%)
3. Atresia of the choanae (35-65%)
4. Retardation of growth and/or development
5. Genital hypoplasia/genitourinary defects (50-70%)
6. Ear anomalies and/or deafness (over 90%)␣

ADENOTONSILLAR PATHOLOGY
ADENOID HYPERTROPHY

Most common cause of nasal-airway obstruction in
children, but not the most common etiology in the neonate

Daycare, chronic allergies, and secondary-smoke
exposure cause chronic inflammation
Best to assess the degree of obstruction with
nasopharyngoscopy; lateral neck film is acceptable but
is not as comprehensive and has the risk of radiation
exposure

Blood supply
Major bleeding after adenoidectomy is rare and can be
indicative of an underlying bleeding disorder
Pharyngeal branch of the internal maxillary (major
supply)

Innervation: CNIX and CNX; very little pain should be
expected after adenoidectomy
Chronic adenoiditis predisposes to bacterial sinusitis
Typical child has 6-8 viral URI/year32
Techniques for removal: (1) suction cautery, (2) coblation,
and (3) microdebrider␣

BLOOD SUPPLY TO THE TONSIL
1. Facial artery (tonsillar branch, ascending palatine branch)
2. Dorsal lingual branch of the lingual artery
3. Internal maxillary artery (descending palatine and greater

palatine artery)
4. Ascending pharyngeal artery␣

COMMON CAUSES OF TONSILLITIS AND
PHARYNGITIS

Viral URI (rhinovirus, influenza, parainfluenza, and
adenovirus)
EBV (infectious mononucleosis)

Head & Neck Surgery Books Full





























http://surgerybook.net/head-and-neck-surgery-otolaryngology

Page 158

CHAPTER 6 | PEDIATRIC OTOLARYNGOLOGY144

Transmitted via mucous membrane contact
Diagnosis with monospot, heterophile agglutination test
Can develop hepatosplenomegaly, so contact sports
must to be avoided33
May develop a rash with amoxicillin
Nonsteroidal antiinflammatory drugs (NSAIDs) for pain
Consider steroids for obstructive tonsillar hypertrophy

Group A β-hemolytic Streptococcus
15-30% of children who present with tonsillitis
Streptococcal carrier may convert to active infection or
spread the infection to another person
Diagnosis with rapid antigen detection test and/or
throat culture
If rapid detection test is negative, proceed with throat
culture
Antibiotics for a 10-day course
Consider tonsillectomy for repeat infections
Complications

Scarlet fever: generalized, nonpruritic, erythematous
macular skin rash lasting 3-7 days, with strawberry
tongue, fevers, and arthralgias
Rheumatic fever is now rare today; bacterial
vegetation grows on mitral and tricuspid valves,
resulting in heart murmur, relapsing fevers, and valve
regurgitation or stenosis
Acute poststreptococcal glomerulonephritis results
in generalized edema, hypertension, and hematuria/
proteinuria
Pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections (PANDAS)

PFAPA (periodic fever, aphthous stomatitis, pharyngitis,
and adenitis) syndrome

Constellation of symptoms, fevers lasting several days,
constitutional symptoms
Critical to exclude autoimmune disorders and
immunodeficiency (HIV) before arriving at PFAPA
diagnosis
High fevers every 3-8 weeks
Associated with pharyngitis, aphthous stomatitis, and
cervical adenitis
Treat with NSAIDs and consider steroids and
tonsillectomy
Adenotonsillectomy is highly effective at resolving this
condition34␣

PERITONSILLAR ABSCESS AND ITS
MANAGEMENT

Symptoms: severe unilateral sore throat, odynophagia,
severe pain when ipsilateral soft palate is probed with a
tonsil blade, drooling, muffled voice, trismus, and referred
otalgia
Exam: uvular deviation, drooling, and muffled voice
Initial management of peritonsillar abscess

Hydration
Pain control
Antibiotics
Steroids to improve trismus
Incision and drainage or needle aspiration
Quinsey tonsillectomy

Subsequent management for recurrence
CT scan
Repeat incision and drainage
Quinsey tonsillectomy

Complications
Dehydration
Airway obstruction
Sepsis

Spread to other neck spaces
Great vessel injury (external and internal carotid artery)␣

CAUSES OF SUBACUTE OR CHRONIC
UNILATERAL TONSILLAR HYPERTROPHY

Ideopathic
Neoplastic: lymphoma
Infectious

Mycobacterium tuberculosis
Atypical mycobacteria
Actinomycosis
Fungal␣

GENERAL CRITERIA FOR ABNORMAL
POLYSOMNOGRAM IN PEDIATRIC
OBSTRUCTIVE SLEEP APNEA

Apnea hypopnea index (AHI) >1
Mild: 1-5
Moderate: 5-10
Severe: >10

Oxygen desaturation to below 92%
Peak end tidal CO2 >53 mm Hg
Elevated end tidal CO2 >50 mm Hg >10% of total sleep
time␣

COMMON FACTORS INFLUENCING
PEDIATRIC OSA

Hypertrophied adenotonsillar tissue
Obesity
Craniofacial abnormalities particularly involving the
mandible or maxilla (midface)
Neuromuscular disease␣

HIGH-RISK GROUPS FOR PEDIATRIC OSA
Obesity, body mass index >30
Craniofacial abnormalities: achondroplasia, Pierre Robin
sequence, and hemifacial microsomia
Neuromuscular disease: cerebral palsy
Down syndrome
Mucopolysaccharidoses: Hunter or Hurler syndromes␣

DIFFERENCES IN ADULT AND PEDIATRIC
OBSTRUCTIVE SLEEP APNEA

FTT and enuresis seen in pediatrics
Academic, social, emotional, and behavioral changes seen
in pediatrics (poor school performance, hyperactivity,
attention deficit, and aggression)␣

INDICATIONS FOR TONSILLECTOMY
Infection

Recurrent acute infections 7 in 1 year, 5 per year for 2
years, and 3 per year for 3 or more years
Recurrent acute infections with complications (cardiac
valve disease and febrile seizures)
Streptococcus carrier
Peritonsillar abscess
Mononucleosis with obstructing tonsils unresponsive to
therapy
Chronic tonsillitis associated with halitosis, persistent
sore throat, and cervical adenitis (controversial)

Obstruction

Head & Neck Surgery Books Full

http://surgerybook.net/head-and-neck-surgery-otolaryngology

Similer Documents