What is ENT?

meltem tarafından 19 Ocak 2013 tarihinde gönderildi

ent

Ear nose throat (ENT) doctors (Otolaryngologists) are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structure of the head and neck.

Their special skills include diagnosing and managing diseases of the sinuses, larynx (voice box), oral cavity, and upper pharynx (mouth and throat), as well as structures of the neck and face. Otolaryngologists diagnose, treat, and manage specialty-specific disorders as well as many primary care  problems in both children and adults.

The common diseases and conditions treated by ENT specialist or Otolaryngologist include:

Hearing:Perforated Ear Drum,Conductive hearing loss,Sensori – Neural hearing loss,Profound sensori – Neural hearing loss,Unilateral sensorineural hearing loss,Sudden Sensorineural Hearing Loss,Weak tympanic membrane,Otitis media,Otospongiosis,Granulation of External Auditory Canal,Granulation of Tympanic membrane,Keloid,Narrow External Auditory Canal with Osteoma

Voice:Vocal cord polyp,Vocal cord cyst,Vocal cord palsy,Vocal cord nodules, larynx cancer

Nose And Sinus:Preauricular Sinus – Infection,Deviated Nasal Septum,Puss filled sinus infection,Perforated Septum,Polyps within Sinuses,Fractured Nasal bone,Fluid collection in Septum,Spur on Septum,Ethmoidal Polyps,CerebroSpinal Fluid (CSF) leak,Antroconal Polyps

Head And Neck:Growth in Larynx & Trachea,Thyro Glossal Cyst,Ranula below tongue,Tongue tie,Salivary gland disoders,Tongue-tie release,Thyroid disorders and Neck swelling,Enlarged Lymph node,Parotid gland disorders,Tonsil disorders,Foreign body in Head and Neck region,Foreign body in Oesophagus,Head and Neck trauma,Narrowing of food pipe,Lymphnode enlargement

Sleep And Snoring

Balance Disorders-Giddiness

Tinnitus treatment

 

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Neck Abcess

meltem tarafından 27 Ocak 2013 tarihinde gönderildi

Neck abcess neckabcess

A neck abscess is a collection of pus in the neck. Typically, the abscess is caused by an infection. As the pus continues to accumulate, the abscess will grow larger and form a mass. This can create other significant problems. Uncommonly large neck abscesses can push on other structures in the neck, such as the throat and windpipe, and lead to problems swallowing and breathing.

An individual with a neck abscess should have it evaluated by a health care professional as soon as it is discovered.

There are many possible causes of a neck abscess. Generally, an infection, commonly in the head or neck can lead to an abscess. An ear infection, the common cold and sinus infections are some common contributors to this condition. Another possible cause is tonsillitis, or inflammation of the tonsils. If any of these infections extends into the tissues within the neck or throat, an abscess may form.

Other Symptoms

The most common symptom is an irritated throat, which may appear sore, red and swollen. Other symptoms can include a fever, chills, stiffness and pain in the neck and overall feeling unwell.

Treatment

Antibiotics are typically the first line of defense against a neck abscess. If antibiotics fail to cure the infection, an abscess drainage will be necessary. The drainage procedure will generally mean having a surgical incision made to drain the pus from the neck. From this drainage, the doctor will be able to identify the specific cause of the infection by examining the pus under a microscope. After the exact cause is found, a more specific type of antibiotic will be prescribed as a follow-up treatment.

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Facial Paralysis

meltem tarafından 27 Ocak 2013 tarihinde gönderildi

facial paralysis2

Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of the face.

Facial paralysis is an ENT emrgency because the early you treated, the successful the recover will be.

Causes

Facial paralysis is almost always caused by:

  • Damage or swelling of the facial nerve, which carries signals from the brain to the muscles of the face
  • Damage to the area of the brain that sends signals to the muscles of the face

In people who are otherwise healthy, facial paralysis is often due to Bell’s palsy, a condition in which the facial nerve becomes inflamed.

Symptoms

The symptoms of facial paralysis are: the eye on paralyzed side can’t close properly and tears easily; paralyzed face can’t laugh properly; paralyzed side can’t chew food properly

Treatment

Treatment options depends on your age, your symptoms, the degree of facial paralysis you is experiencing and any associated condition you may have. Typically, treatment for facial nerve paralysis will range from surgery to non-invasive support services to a combination of the two.

Medications

corticosteroid medications: taken orally, these medications reduce inflammation and help control severe symptoms

non-steroidal anti-inflammatory drugs (NSAIDs): taken orally, these medications also help control inflammation and symptoms without some of the side effects of other steroids.

 

Static slings

In some cases, we may elect to create what is called a static sling—a piece of the patients own tissue that is transplanted in order to prop up the drooping skin around the lips (the “smile area”) or eyelids.

“Smile surgery”

You may have read or heard about a procedure called “smile surgery” or “the smile operation,” also known as functional muscle transfer. This is an operation that takes muscle from elsewhere in the patients body (usually the thigh) and grafts it onto the corners of his mouth, giving him the ability to smile.

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Sudden Hearing Loss

meltem tarafından 26 Ocak 2013 tarihinde gönderildi

Sudden hearing loss (SHL) or sudden deafness is a rapid loss of hearing all at once or over a period of up to 3 days. It should be considered a medical emergency. A person who experiences SSHL should visit a doctor immediately. Generally SHL affects one ear, but both ears may involved. Many people notice it when they wake up in the morning. Others first notice it when they try to use the deafened ear, such as when they make a phone call. Still others notice a loud, alarming “pop” just before their hearing disappears. People with SSHL often experience dizziness or a ringing in their ears (tinnitus), or both.

Causes

In only 10-15 % of patients it is known what causes their loss. There  are hundreds of possible causes of sudden deafness. Some of them are:

– infections; viral infections like flu

– trauma, such as head injury

– ototoxic durgs (drugs that harm the ear)

– circulatory problems

– neurologic causes

Treatment

Urgent treatment is needed to ensure the best outcome.

If you notice a hearing loss you should see a physician immediately. If he/she is not available, go to the nearest emergency room. Even if you are not sure and even if it is at night you should appeal.

If no treatment is pursued, there is a ~50% chance that hearing will improve back to normal without any intervention. However, the chance of improvement back to normal is higher and faster if treatment is pursued.

It is very important to diagnose the deafness as early as possible. The early the treatment begins the chance of the recovery will increase.

Treatment should be administered by an ear, nose and throat (ENT) specialist.

Also audiometric evaluation should be performed immediately. 

The treatment for cases with known etiologies involve adressing the underlying condition .

The most common therapy for SHL, especially in cases with an unknown cause, is treatment with steroids. May be antiviral drugs and/or antibiotics could be added. Volume expanders are even us like low molecular weight dextran

Another common therapy is the carbogen inhalation. Carbogen is a mixture of oxygen and carbon dioxide that seems to help air and blood flow better inside the ear.

Intra-tympanic steroid injection is also offered. Intra-typmpanic steroid injection is performed by inserting a needle through the eardrum and injecting about 1.5cc of highly concentrated steroids directly into the middle ear space. It is a very easy to carry out, it doesn’t cause any pain so only local anestesia is enough.

Another common method that may help some patients is a diet low in salt.

Some patients recover completely without medical intervention, often within the first 3 days. This is called a spontaneous recovery. Others get better slowly over a 1 or 2 week period.

In some cases, the hearing will resolve, but the tinnitus and/or dizziness remain. In others, the hearing, tinnitus and dizziness disappear, but the ear loses its ability to understand speech. There is no method of predicting how much recovery will occur, but the longer one waits to be treated, the more likely the symptoms will become permanent.

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Nose Bleeds

meltem tarafından 25 Ocak 2013 tarihinde gönderildi

nosebleed

Nosebleed (Epistaxis) is the blood draining out from the nose.  Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting. It is rarely fatal.

The causes of nosebleeds

  • Blunt trauma (usually a sharp blow to the face such as a punch, sometimes accompanying a nasal fracture)
  • dry air, or heated indoor air
  • Foreign bodies (such as fingers during nose-picking)
  • Inflammatory reaction (e.g. acute respiratory tract infections, chronic sinusitis, allergic rhinitis or environmental irritants)
  • Anatomical deformities (e.g. septal spurs or Hereditary hemorrhagic telangiectasia)
  • Insufflated drugs (particularly cocaine)
  • Intranasal tumors (e.g. Nasopharyngeal carcinoma or nasopharyngeal angiofibroma)
  • Low relative humidity of inhaled air (particularly during cold winter seasons)
  • Nasal cannula O2 (tending to dry the olfactory mucosa)
  • Nasal sprays (particularly prolonged or improper use of nasal steroids)
  • Otic barotrauma (such as from descent in aircraft or ascent in scuba diving)
  • Consumption of tainted whey protein supplements that contain arsenic
  • Surgery (e.g. septoplasty and Functional Endoscopic Sinus Surgery)
  • Leech infestation
  • Drugs — Aspirin, Fexofenadine/Allegra/Telfast, warfarin, ibuprofen, clopidogrel, prasugrel, isotretinoin, desmopressin, ginseng and others
  • Alcohol (due to vasodilation)
  • Anemia
  • Liver diseases – Hepatic cirrhosis
  • Connective tissue disease
  • Blood dyscrasias
  • Envenomation by mambas, taipans, kraits, and death adders
  • Heart failure (due to an increase in venous pressure)
  • Hematological malignancy
  • Idiopathic thrombocytopenic purpura
  • Pregnancy (rare, due to hypertension and hormonal changes)
  • Vascular disorders
  • Vitamin C and Vitamin K deficiency
  • von Willebrand’s disease
  • Recurrent epistaxis is a feature of Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu syndrome)
  • Mediastinal compression by tumours (raised venous pressure in the nose)
  • Vicarious Menstruation

 

Treatment/How to stop nosebleed

1. Hold a tissue or soft cloth to your nose

2. Lean forward and pinch your nostrils shut for 10 minutes

nosebleed1nosebleed2

 

 

NEVER tilt your  head back.

nosebleed3

3. Apply a cold compress over the bridge of your nose

4. Know when to call a doctor. Most nosebleeds aren’t serious, and don’t require emergency medical care. Some do, though, so here’s when you should get help:

  • You’re still bleeding after 20 minutes.
  • Bleeding started after a head injury.
  • Your nose was hit, and you suspect it’s broken

 

5. Once the bleeding stops, DO NOT bend over; strain and/or lift anything heavy; and DO NOT blow, rub, or pick your nose for several days.

 

How to prevent nosebleed

1. Combat dryness.

  • Run a humidifier. Humidifiers are available cheaply, and they’re easy to manage. Run one while you sleep and turn it off while you’re gone during the day.
  • Use a nasal saline spray. Saline spray doesn’t have anything in it but — you guessed it — salt, so its primary purpose is simply to wet your nasal passages. Use it a few times a day.

 

2. Keep your cool. Heat can sometimes lead to nosebleeds, so take steps to keep your body and your environment a little cooler.

  • Run fans or air conditioning inside your house.
  • Wear breathable cotton clothing.
  • Stay hydrated and drink cool water.
  • Run cool water over your wrists.

 

3. Don’t Pick! Picking often leads to nose bleeds

 

Nosebleeds in Children / What To Do?

  • Don’t panic. It is much easier for your child to listen to your instructions if you appear calm.
  •  Hold a tissue or soft cloth to your childs nose
  •  Lean his/her forward and pinch your childs nostrils shut for 10 minutes
  • NEVER tilt your child’s head back. This will only make the blood flow down the throat to the stomach, or into the lungs. Your child may vomit blood later due to irritation of blood in the stomach.
  • After 5-10 minutes release the pressure. If the bleeding has not stopped then repeat pinching your child’s nose for another 10 minutes.
  • Don’t pick the nose after a nosebleed.
  • After the bleeding is controlled, do NOT let your child blow the nose or the clot may be released and the bleeding may reoccur.
  •  If the bloody nose follows an accident or injury to the head then seek medical attention immediately.
  •  If your child’s nosebleed does not stop after a second or third try, please seek medical attention immediately.

How might an emergency room doctor treat the nosebleed?

The doctor will ask you questions about your nosebleed and examine your nose to try to determine the source of the nosebleed. He or she will use a small speculum to hold the nose open and can use various light sources or an endoscope (lighted scope) to see inside your nasal passages. Your doctor may use topical medications to anesthetize (numb) the lining of the nose and to constrict blood vessels. The doctor is also likely to remove clots and crusts from inside your nose. This can be unpleasant but need not be painful. Occasionally x-rays or blood tests are ordered.

Treatments, depending on the cause, could include:

  • Cauterization – the application of a chemical substance (silver nitrate) or heat energy (electrocautery) to seal the bleeding blood vessel.
  • Nasal packing – the placement of strips of gauze into the nasal cavity to create pressure on the bleeding site. Alternately, other materials that promote clotting may be used.

nosebleed4

  • Medication adjustments – reducing or stopping the amount of blood thinning medications can be helpful. In addition, medications for controlling blood pressure may be necessary.

 

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Sinus Disorders

meltem tarafından 25 Ocak 2013 tarihinde gönderildi

sinus

Paranasal sinuses, which are air cavities in the cranial bones, especially those near the nose and connecting to it. Each individual has four paired cavities located in the cranial bone or skull.

Paranasal sinuses (each a pair) are:

  • Maxillary
  • Ethmoid
  • Sphenoid
  • Frontal

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Voice Disorders

meltem tarafından 24 Ocak 2013 tarihinde gönderildi

voicebox2

The larynx, commonly called the voice box, is involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume. The larynx houses the vocal cords, which are essential for phonation.

  • Polyps and nodules are small bumps on the vocal folds caused by prolonged exposure to cigarette smoke and vocal misuse, respectively.
  • Two related types of cancer of the larynx, namely squamous cell carcinoma and verrucous carcinoma, are strongly associated with repeated exposure to cigarette smoke and alcohol.
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Snoring/Sleep Apnea

meltem tarafından 23 Ocak 2013 tarihinde gönderildi

snoring

Snoring is the vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA).  Generally speaking the structures involved are the uvula and soft palate. 

The irregular airflow is caused by a passageway blockage and is usually due to one of the following:

  • Throat weakness, causing the throat to close during sleep.
  • Mispositioned jaw, often caused by tension in the muscles.
  • Fat gathering in and around the throat.
  • Obstruction in the nasal passageway.
  • Obstructive sleep apnea
  • The tissues at the top of airways touching each other, causing vibrations.
  • Relaxants such as alcohol or drugs relaxing throat muscles.
  • Sleeping on one’s back, which may result in the tongue dropping to the back of the mouth.

Obstructive sleep apnea (OSA) or obstructive sleep apnea syndrome is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe. These pauses in breathing, called “apneas” (literally, “without breath”), typically last minimum 10 seconds. OSA is commonly accompanied with snoring.  Sufferers who generally sleep alone are often unaware of the condition, without a regular bed-partner to notice and make them aware of their symptoms. As the muscle tone of the body ordinarily relaxes during sleep, and the airway at the throat is composed of walls of soft tissue, which can collapse, and breathing can be obstructed during sleep.

Symptoms/signs of OSA: Unexplained daytime sleepiness, restless sleep, and loud snoring (with periods of silence followed by gasps). Less common symptoms are morning headaches; insomnia; trouble concentrating; mood changes such as irritability, anxiety and depression; forgetfulness; increased heart rate and/or blood pressure; decreased sex drive (libido); unexplained weight gain; increased urination and/or nocturia; frequent heartburn or gastroesophageal refluxdisease; and heavy night sweats. The most typical individual with OSA syndrome suffers from obesity, with particular heaviness at the face and neck. Typically, an adult or adolescent with severe long-standing OSA will fall asleep for very brief periods in the course of usual daytime activities if given any opportunity to sit or rest.

 OSA in children, unlike adults, is often caused by obstructive tonsils and adenoids and may sometimes be cured with tonsillectomy and adenoidectomy. Adults are generally heavy, with particularly short and heavy necks. Young children, on the other hand, are generally not only thin, but may have poor growth.

The Diagnosis of OSA

Polysomnography in diagnosing OSA characterizes the pauses in breathing. To grade the severity of sleep apnea, the number of events per hour is reported as the apnea-hypopnea index (AHI). An AHI of less than 5 is considered normal. An AHI of 5-15 is mild; 15-30 is moderate and more than 30 events per hour characterizes severe sleep apnea.

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Enlarged adenoids

meltem tarafından 22 Ocak 2013 tarihinde gönderildi

childrenent

Some of the ear nose throat problems are specially more frequent in chidhood or is to manage different in them. Thus we take these in a separate link.

Enlarged adenoids

adenoid

Children with enlarged adenoids often breathe through their mouth because their nose is blocked. Mouth breathing occurs mostly at night, but may be seen during the day.

Mouth breathing may lead to the following symptoms:

  • Bad breath
  • Cracked lips
  • Dry mouth
  • Persistent runny nose or nasal congestion

Enlarged adenoids may also cause sleep problems. A child may:

  • Be restless while sleeping
  • Snore a lot
  • Have episodes of not breathing during sleep (sleep apnea)

Children with enlarged adenoids may also have more frequent ear infections.

Adenoid removal

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Adenoid removal is surgery to take out the adenoid glands. The adenoid glands sit behind your nose above the roof of your mouth. Air passes over these glands when you take a breath.

The adenoids are often taken out at the same time as your tonsils. (See also: Tonsillectomy)

Adenoid removal is also called adenoidectomy. The procedure is most often done in children.

Description

Your child will be given general anesthesia before surgery. This means they will be asleep and unable to feel pain.

  • During surgery, the doctor places a small tool into your child’s mouth to keep it open.
  • The surgeon removes the adenoid glands using a spoon-shaped tool (curette) or another tool that helps cut away soft tissue.
  • Some surgeons use electricity to heat the tissue, remove it, and stop bleeding. This is called electrocautery. A newer method uses radiofrequency (RF) energy to do the same thing. This is called coblation.
  • Absorbent material, called packing material, is also used to control bleeding.

Your child will stay in the recovery room after surgery until they are awake and can breathe easily, cough, and swallow. Most patients can go home a few hours after surgery.

Why Adenoid removal is Performed

Adenoid surgery (adenoidectomy) – Adenoid removal is required when:

  • Enlarged adenoids are blocking your child’s airway. Symptoms in your child can include:
    • Snoring a lot
    • Difficulty breathing through the nose (nasal obstruction)
    • Episodes of not breathing during sleep (sleep apnea)
  • Your child has chronic ear infections that:
    • Cause him or her to miss school a lot
    • Continue despite using antibiotics
    • Happen 5 or more times in a year
    • Happen 3 or more times a year during a 2-year period

Adenoidectomy may also be recommended if your child has tonsillitis many times, or if it keeps coming back.

The adenoids normally shrink as children grow older. Adults rarely need to have them removed.

Risks

Risks for any anesthesia are:

  • Reactions to medicines
  • Breathing problems

Risks for any surgery are:

  • Bleeding
  • Infection

After the Procedure

Your child will go home on the same day as surgery. Complete recovery takes about 1 to 2 weeks.

 

Outlook (Prognosis)

After this procedure, most children:

  • Breathe better through the nose
  • Have fewer and milder sore throats
  • Have fewer ear infections

* Rarely, adenoid tissue may grow back. This does not usually cause problems.

Snoring in children: Enlarged tonsils and adenoids are the commonest cause of snoring in children. Removal of the adenoid and tonsils is the first line of treatment for children with sleep disordered breathing. Removal of the tonsils and adenoid cures snoring in 85 to 90% of children.

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Head and Neck Anatomy

meltem tarafından 22 Ocak 2013 tarihinde gönderildi

Head and neck anatomy focuses on the structures of the head and neck of the human body, including the brain, bones, muscles, blood vessels, nerves, glands, nose, mouth, teeth, tongue, and throat. Nevertheless, the ent doctor doesn’ study brain.

Lymphatic system:

Lymph nodes line the cervical spine and neck regions as well as along the face and jaw.

The tonsils also are lymphatic tissue and help mediate the ingestion of pathogens. Tonsils in humans include, from superior to inferior: nasopharyngeal tonsil (also known as adenoid), palatine tonsils, and lingual tonsils.

Together this set of lymphatic tissue is called the tonsillar ring or Waldeyer’s ring.

Oral cavity:

The mouth, also called the oral cavity or buccal cavity, is the entranceway into the digestive system containing both primary and accessory organs of digestion. The mouth is designed to support chewing, (mastication) and swallowing (deglutition), and speech (phonation). Two rows of teeth are supported by facial bones of the skull, the maxilla above and the mandible below. Teeth are surrounded by gingiva, or gums, part of the periodontium, support tissue of oral cavity protection. In addition to the teeth, other structures that aid chewing are the lips, cheeks, tongue, hard palate, soft palate, and floor of the mouth.

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Ear wax (cerumen), symptoms, cause, removal

meltem tarafından 22 Ocak 2013 tarihinde gönderildi

Ear wax (cerumen): Earwax is produced by glands in the ear canal. Its purpose is to trap dust and other small particles and prevent them from reaching, and potentially damaging, the eardrum. Normally the ear have a self cleaning process by the help of jaw movement.

The most common cause of impactions is the use of cotton swabs (Q-tips) which can remove superficial wax but also pushes the rest of the wax deeper into the ear canal. Hearing aid and earplug users are also more prone to earwax blockage.

Excess or impacted cerumen usually hindering hearing.

Treatment

– Softeners

– Ear irrigation

– Curette

– Ear candles and vacuuming

– Complications of removal

 

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