Module 3 - Ear, Nose and Throat

ENT or otorhinolaryngology is a unique specialty where a broad range of

diseases will be encountered in patients of all ages. The skills needed to treat
patients are diverse, ranging from microsurgery to treat middle and inner ear
conditions to major surgery of the head and neck. Rhinoplasty, grommet
insertion, adenoidectomy and tonsillectomy are only part of a diverse range of
surgical procedures. I have worked in this specialty for many years, both in
private practice and as an NHS secretary.
A large part of an ENT surgeon's practice is outpatient-based, which is where
many procedures are carried out and diagnoses are made. Surgeons use rigid
endoscopes, flexible fibre-optic endoscopes or microscopes.
Subspecialties
Facial plastic and reconstructive
surgery

Head & neck surgery

Otology/neuro-otology

Paediatrics

Laryngology

Rhinology

Conditions
The following list of diseases or medical conditions are some of the medical
problems that may be treated by the Otorhinolaryngologist/Ear Nose and Throat
Surgeon
Ears
Acoustic Neuroma - is a noncancerous (benign) and usually slowgrowing tumor that develops on the main nerve leading from your inner
ear to your brain. Because branches of this nerve directly influence your
balance and hearing, pressure from an acoustic neuroma can cause
hearing loss, ringing in your ear and unsteadiness.
Auditory Processing Disorder- also known as central auditory
processing disorder (CAPD), is an umbrella term for a variety of
disorders that affect the way the brain processes auditory information.
Individuals with APD usually have normal structure and function of the
outer, middle and inner ear (peripheral hearing). However, they cannot
process the information they hear in the same way as others do, which
leads to difficulties in recognizing and interpreting sounds, especially the
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sounds composing speech. It is thought that these difficulties arise from

dysfunction in the central nervous system (i.e., brain)
Balance disorders- is a condition that makes you feel unsteady or dizzy.
If you are standing, sitting, or lying down, you might feel as if you are
moving, spinning, or floating. If you are walking, you might suddenly feel
as if you are tipping over.
Everyone has a dizzy spell now and then, but the term dizziness can
mean different things to different people. For one person, dizziness might
mean a fleeting feeling of faintness, while for another it could be an
intense sensation of spinning (vertigo) that lasts a long time.
Bat ear- Prominent ears are an inherited problem affecting 1-2% of the
population (although its diagnosis is somewhat subjective and this figure
depends on what is considered to be a prominent ear). It may be
unilateral or bilateral and arises as a result of lack (or malformation) of
cartilage during primitive ear development in intrauterine life. The ear
subsequently has abnormal helical folds or grows laterally. Occasionally,
folds seen at birth resolve spontaneously.
Benign paroxysmal positional vertigo (BPPV)- is one of the most
common causes of vertigo the sudden sensation that you're spinning
or that the inside of your head is spinning.
Benign paroxysmal positional vertigo is characterized by brief episodes
of mild to intense dizziness. Symptoms of benign paroxysmal positional
vertigo are triggered by specific changes in the position of your head,
such as tipping your head up or down, and by lying down, turning over or
sitting up in bed. You may also feel out of balance when standing or
walking.
Cholesteatoma - is a destructive and expanding growth consisting of
keratinizing squamous epithelium in the middle ear and/ormastoid
process. Although these are not strictly speaking tumours or cancers they
can still cause significant problems because of their erosive and
expansile properties resulting in the destruction of the ossicles as well as
their possible spread through the base of the skull into the brain. They
are also often infected and result in chronically draining ears.
Dizziness -Light-headedness is a feeling that you are about to faint or
"pass out." Although you may feel dizzy, you do not feel as though you or
your surroundings are moving. Light-headedness often goes away or
improves when you lie down. If light-headedness gets worse, it can lead
to a feeling of almost fainting or a fainting spell (syncope). You may
sometimes feel nauseated or vomit when you are lightheaded.
Earache Pain in the ear. This can occur because of conditions within the
ear itself, the ear canal, or the visible external portion of the ear. Acute
infection of the middle ear, medically called acute otitis media (AOM), is
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inflammation of the middle ear and is the most frequent diagnosis in sick
children in the US. The eustachian tube is shorter in children than adults
which allows easy entry of bacteria and viruses into the middle ear,
resulting in acute otitis media in childhood. Infection of the ear canal
(otitis externa) is also called swimmer's ear. Otitis externa is typically
caused by bacterial infection. Earache can also be due to pain and
inflammation of the outer portion of the ear.
Ear infection - An ear infection (acute otitis media) is most often a
bacterial or viral infection that affects the middle ear, the air-filled space
behind the eardrum that contains the tiny vibrating bones of the ear.
Children are more likely than adults to get ear infections.
Ear infections frequently are painful because of inflammation and buildup
of fluids in the middle ear.
Ear trauma (injury) - Acoustic trauma is injury to the hearing
mechanisms in the inner ear due to very loud noise
Acoustic trauma - is an injury to the inner ear that is often caused by
exposure to a high decibel noise. This injury can be related to a single
very loud noise or by exposure to a lower decibel noise over a long
period of time. Some injuries to the head can cause acoustic trauma if
the eardrum is ruptured, or if other injuries to the inner ear occur.
The eardrum protects the middle and inner ear. It also transmits signals
to the brain by way of small vibrations. Acoustic trauma can damage the
way that these vibrations are handled, causing hearing loss. Sound
moving into the inner ear can cause what doctors sometimes call a
threshold shift, which can trigger hearing loss.
Eustachian tube dysfunction - Eustachian tube dysfunction (ETD) can
cause dulled hearing. It is usually a temporary problem that lasts a week
or so and most commonly occurs during and after a cold. There are
various other causes and sometimes it lasts longer. Often, no treatment
is needed but decongestants, antihistamines, or a steroid nasal spray
sometimes help.
Glue ear - is a condition where the middle ear fills with glue-like fluid
instead of air. This causes dulled hearing. In most cases it clears without
any treatment. An operation to clear the fluid and to insert grommets may
be advised if glue ear persists.
Hearing loss - A hearing impairment that prevents a person from totally
receiving sounds through the ear. If the loss is mild, the person has
difficulty hearing faint or distant speech. A person with this degree of
hearing impairment may use a hearing aid to amplify sounds.

Labyrinthitis - is an inflammation of the inner ear that is often a

complication of otitis media. It is caused by the spread of bacterial or viral
infections from the head or respiratory tract into the inner ear.
Mastoiditis - is an infection of the spaces within the mastoid bone. It is
almost always associated with otitis media, an infection of the middle ear.
In the most serious cases, the bone itself becomes infected. The
mastoid is a part of the side (temporal bone) of the skull. It can be felt as
a bony bump just behind and slightly above the level of the earlobe. The
mastoid has been described as resembling a "honeycomb" of tiny
partitioned-off airspaces. The mastoid is connected with the middle ear,
so that when there is a collection of fluid in the middle ear, there is
usually also a slight collection of fluid within the airspaces of the mastoid.
Meniere's disease - is a disorder of the inner ear that causes
spontaneous episodes of vertigo a sensation of a spinning motion
along with fluctuating hearing loss, ringing in the ear (tinnitus), and
sometimes a feeling of fullness or pressure in your ear. In many cases,
Meniere's disease affects only one ear.
Middle ear infection (otitis media)- Inflammation of the middle ear
characterized by the accumulation of infected fluid in the middle ear,
bulging of the eardrum, pain in the ear and, if eardrum is perforated,
drainage of purulent material (pus) into the ear canal.
Otitis externa - Infection of the skin covering the outer ear canal that
leads in to the ear drum, usually due to bacteria such as streptococcus,
staphylococcus, or pseudomonas. Swimmer's ear is usually caused by
excessive water exposure. Infection with a fungus may also occur. When
water pools in the ear canal (frequently trapped by wax), the skin will
become soggy and serve as an inviting culture media for bacteria.
Otosclerosis - The abnormal formation of new bone in the middle ear
that gradually immobilizes the stapes (stirrup bone) and prevents it from
vibrating in response to sound, causing a progressive conductive loss of
hearing. Otosclerosis usually affects both ears. It is a common disorder,
especially among young women. Pregnancy may trigger it.
Perforated eardrum - A perforated eardrum exists when there is a hole
or rupture in the eardrum, the thin membrane that separates the outer
ear canal from the middle ear. A perforated eardrum may cause
temporary hearing loss and occasional discharge.
Polychondritis - A condition characterized by inflammation and
deterioration of cartilage. Although the disease usually causes pain and
deformity if unrecognized and untreated, it can be life-threatening when
respiratory tract, heart valves or blood vessels are affected
Presbyacusis - A gradual hearing loss in both ears that commonly
occurs as people age. This form of gradual hearing loss can be mild,
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moderate, or severe. Presbycusis that leads to permanent hearing loss

may be referred to as nerve deafness
Sensorineural deafness - A type of hearing loss. It occurs from damage
to the inner ear, the nerve that runs from the ear to the brain (auditory
nerve), or the brain.
Perforated (hole) eardrum - Exists when there is a hole or rupture in the
eardrum, the thin membrane that separates the outer ear canal from
themiddle ear. A perforated eardrum may cause temporary hearing loss
and occasional discharge.
Tinnitus ringing or noise in the ear - The medical term for "hearing"
noises in your ears when there is no outside source of the sounds. The
noises you hear can be soft or loud. They may sound like ringing,
blowing, roaring, buzzing, hissing, humming, whistling, or sizzling. You
may even think you are hearing air escaping, water running, the inside of
a seashell, or musical notes.
Vertigo and motion sickness - A disorder of the sense of balance and
equilibrium and, hence, the sense of spatial orientation that is caused by
repeated motion such as from the swell of the sea, the movement of a
car, or the motion of a plane in turbulent air. Motion sickness is due to
irritation of a portion of the inner ear called the labyrinth. The symptoms
of motion sickness include nausea, vomiting, and vertigo. Other common
signs of motion sickness are sweating and a general feeling of discomfort
and not feeling well (malaise). Symptoms usually stop when the motion
that causes it ceases. However, some people suffer symptoms for even a
few days after the trip is over.

Module 3 - Nose and mouth

Allergic rhinitis - More commonly referred to as hay fever, is an
inflammation of the nasal passages caused by allergic reaction to
airborne substances.
Atrophic rhinitis - A nasal condition, a form of chronic rhinitis, in which
there is inflammation and atrophy of the mucous membrane of the nose,
resulting in failure of the ciliary function and drying and crusting of the
lining of the nasal passages. This may reduce the sense of smell. It
commonly occurs as a result of viral infection such as the common cold
but can also be caused by allergies. rhinitis is inflammation of the nasal
mucous membrane.
Broken nose - Also called a nasal fracture, is a break or crack in a bone
in your nose often the bone over the bridge of your nose. Common
causes of a broken nose include contact sports, physical fights, falls and
motor vehicle accidents that result in facial trauma. A broken nose can
cause pain, along with swelling and bruising around your nose and under
your eyes. Your nose may look crooked, and you may have trouble
breathing. Treatment for a broken nose may include procedures that
realign your nose. Surgery usually isn't necessary for a broken nose.
Catarrh - An excessive build-up of thick phlegm or mucus in one of the
airways or cavities of the body. It is usually found in the sinuses (the two
small, air-filled cavities either side of your nose), but it can also occur in
the throat, ears or chest.
Common cold - A viral infection of the upper respiratory system,
including the nose, throat, sinuses, eustachian tubes, trachea, larynx,and
bronchial tubes. Although more than 200 different viruses can cause a
cold, 30-50% are caused by a group known as rhinoviruses.Almost all
colds clear up in less than two weeks without complications.
Deviated septum - A deviated septum occurs when the thin wall (nasal
septum) between your nostrils is displaced to one side. In many people,
the nasal septum is displaced or deviated making one nasal
passage smaller. When a deviated septum is severe, it can block one
side of your nose and reduce airflow, causing difficulty breathing. The
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additional exposure of a deviated septum to the drying effect of airflow

through the nose may sometimes contribute to crusting or bleeding in
certain individuals. Nasal obstruction can occur from a deviated nasal
septum, from swelling of the tissues lining the nose, or from both.
Treatment of nasal obstruction may include medications to reduce the
swelling or adhesive strips that may help open the nasal passages. To
correct a deviated septum, surgery is necessary.
Hayfever - A seasonal allergy to airborne particles characterized by itchy
eyes, runny nose, nasal congestion, sneezing, itchy throat, and excess
mucus.
Nasal congestion or "stuffy nose" - Occurs when nasal and adjacent
tissues and blood vessels become swollen with excess fluid, causing a
"stuffy" feeling. Nasal congestion may or may not be accompanied by a
nasal discharge or "runny nose." Nasal congestion usually is just an
annoyance for older children and adults. But nasal congestion can be
serious in infants, who might have a hard time nursing or breathing as a
result.
Nasal polyps - Are soft, painless, noncancerous growths on the lining of
your nasal passages or sinuses. They hang down like teardrops or
grapes. They result from chronic inflammation due to asthma, recurring
infection, allergies, drug sensitivity or certain immune disorders.
Nosebleeds or epistaxes - The nose is a part of the body that is very
rich in blood vessels (vascular) and is situated in a vulnerable position on
the face. As a result, any trauma to the face can cause bleeding, which
may be profuse. Nosebleeds can occur spontaneously when the nasal
membranes dry out, crust, and crack, as is common in dry climates, or
during the winter months when the air is dry and warm from household
heaters. People are more susceptible if they are taking medications
which prevent normal blood clotting (warfarin [Coumadin], clopidogrel
bisulfate [Plavix], aspirin, or any anti-inflammatory medication). Other
predisposing factors include infection, trauma, allergic and non-allergic
rhinitis, hypertension, alcohol abuse, and inherited bleeding problems.
"Epistaxis" is a Greek word meaning "a dripping," especially of blood
from the nose.
Obstructive sleep apnoea - A potentially serious sleep disorder in which
breathing repeatedly stops and starts during sleep. Several types of
sleep apnoea exist, but the most common type is obstructive sleep
apnoea, which occurs when your throat muscles intermittently relax and
block your airway during sleep. The most noticeable sign of obstructive
sleep apnoea is snoring.
Polychondritis - A condition characterized by inflammation and
deterioration of cartilage. Although the disease usually causes pain and
deformity if unrecognized and untreated, it can be life-threatening when
respiratory tract, heart valves or blood vessels are affected
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Postnasal drip - Mucous accumulation in the back of the nose and

throat leading to or giving the sensation of mucus dripping downward
from the back of the nose.
Raynaud's phenomenon Rhinitis - Excessively reduced blood flow in
response to cold or emotional stress, causing discoloration of the fingers,
toes, nose and occasionally other areas. This condition may also cause
nails to become brittle with longitudinal ridges. Named after French
physician Maurice Raynaud (18341881), the phenomenon is believed to
be the result of vasospasms that decrease blood supply to the respective
regions.
Rhinophyma - A large, bulbous, ruddy nose caused by granulomatous
infiltration, commonly due to untreated rosacea. Rhinophyma is
characterised by prominent pores and a fibrous thickening of the nose,
sometimes with papules. It is associated with the common skin condition
rosacea.
Rhinosinusitis - Defined as inflammation of the paranasal sinuses and
nasal cavity. The term rhinosinusitis is preferred because sinusitis is
typically associated with inflammation of the nasal mucosa.
Rhinosinusitis can be categorized based on the duration of infection, and
then further subdivided by the causative pathogen.
Septoplasty - A surgical procedure to correct a deviated nasal septum
a displacement of the bone and cartilage that divides your two nostrils.
During septoplasty, your nasal septum is straightened and repositioned in
the middle of your nose. This may require your surgeon to cut and
remove parts of your septum before reinserting them in the proper
position.
Sinusitis and polyps - Nasal polyps are soft, painless, noncancerous
growths on the lining of your nasal passages or sinuses. They hang
down like teardrops or grapes. They result from chronic inflammation due
to asthma, recurring infection, allergies, drug sensitivity or certain
immune disorders. Small nasal polyps may not cause symptoms. Larger
growths or groups of nasal polyps can block your nasal passages or lead
to breathing problems, a lost sense of smell, and frequent infections.
Nasal polyps can affect anyone, but they're more common in adults.
Medications can often shrink or eliminate nasal polyps, but surgery is
sometimes needed to remove them. Even after successful treatment,
nasal polyps often return
Snoring - The hoarse or harsh sound that occurs when your breathing is
partially obstructed in some way while you're sleeping. Sometimes
snoring may indicate a serious health condition. In addition, snoring can
be a nuisance to your partner. As many as half of adults snore
sometimes. Snoring occurs when air flows past relaxed tissues in your
throat, causing the tissues to vibrate as you breathe, which creates those
irritating sounds. Lifestyle changes, such as losing weight, avoiding
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alcohol close to bedtime or sleeping on your side, can help stop snoring.
In addition, medical devices and surgery are available that may reduce
disruptive snoring. However, these aren't suitable or necessary for
everyone who snores.
Taste and smell disorders - Our ability to taste occurs when tiny
molecules released by chewing, drinking, or digesting our food stimulates
special sensory cells in the mouth and throat. These taste cells, or
gustatory cells, are clustered within the taste buds of the tongue and roof
of the mouth, and along the lining of the throat. Many of the small bumps
on the tip of your tongue contain taste buds. At birth, we have about
10,000 taste buds, but after age 50, we may start to lose them. Smelling
disorders are disturbances of the olfactory sense, which is known as the
sense of smell. These nasal dysfunctions range from the total loss of
smell (anosmia) to dysosmia, a distorted sense of smell.
Tumours or growth in the mouth - Oral cavity cancer, or just oral
cancer, is cancer that starts in the mouth (also called the oral cavity).
Oropharyngeal cancer starts in the oropharynx, which is the part of the
throat just behind the mouth. Many types of tumours (abnormal growths
of cells) can develop in the oral cavity and oropharynx. They fit into 3
general categories:
Some are benign, or non-cancerous, which means they do
not invade other tissues and do not spread to other parts of
the body.
Some growths start off harmless but can later develop into
cancer. These are known as pre-cancerous conditions.
Other tumours are cancerous. They can grow into
surrounding tissues and spread to other parts of the body.
Vasomotor rhinitis - Inflammation of the nose (rhinitis) due to abnormal
nerve control of the blood vessels in the nose. Vasomotor rhinitis is not
allergic rhinitis. Decongestant medications are used to temporarily
reduce swelling of sinus and nasal tissues leading to an improvement of
breathing and a decrease in obstruction.
Wegener's granulomatosis - (VEG-eh-nerz gran-u-loe-muh-TOE-sis)
An uncommon disorder that causes inflammation of your blood vessels.
This inflammation restricts blood flow to various organs. Wegener's
granulomatosis, which is also called granulomatosis with polyangiitis
(GPA), often affects your kidneys, lungs and upper respiratory tract. The
restricted blood flow to these organs can damage them. Wegener's can
affect other organs, but this isn't as common, and generally isn't as
serious. Wegener's granulomatosis also produces a type of inflammatory
tissue known as a granuloma that's found around the blood vessels.
Granulomas can destroy normal tissue. There is no known cause for
Wegener's granulomatosis.
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Module 3 - Throat and voice

Allergic reactions - Are sensitivities to substances called allergens that
come into contact with the skin, nose, eyes, respiratory tract, and
gastrointestinal tract. They can be breathed into the lungs, swallowed, or
injected.
Cancer of the pharynx and larynx - Cancer that forms in tissues of the
pharynx (the hollow tube inside the neck that starts behind the nose and
ends at the top of the windpipe and esophagus). Throat cancer includes
cancer of the nasopharynx (the upper part of the throat behind the nose),
the oropharynx (the middle part of the pharynx), and the hypopharynx
(the bottom part of the pharynx). Cancer of the larynx (voice box) may
also be included as a type of throat cancer. Most throat cancers are
squamous cell carcinomas (cancer that begins in thin, flat cells that look
like fish scales). Also called pharyngeal cancer.
Dysphagia (Difficulty swallowing) - Means it takes more time and effort
to move food or liquid from your mouth to your stomach. Difficulty
swallowing may also be associated with pain. In some cases, you may
not be able to swallow at all. Occasional difficulty swallowing usually isn't
cause for concern, and may simply occur when you eat too fast or don't
chew your food well enough. But persistent difficulty swallowing may
indicate a serious medical condition requiring treatment.
Gastroesophageal reflux - The return of stomach contents back up into
the esophagus This frequently causes heartburn because of irritation of
the esophagus by stomach acid. Gastroesophageal reflux disease
(GERD) can lead to scarring and stricture of the esophagus, requiring
stretching (dilating) of the esophagus. 10% of patients with
gastroesophageal reflux disease develop Barrett's esophagus which
increases the risk of cancer of the esophagus. 80% of patients with
gastroesophageal reflux disease also have a hiatal hernia
Globus pharyngeus - Globus sensation is the term used when a person
has the feeling of a lump in their throat when actually there is no lump
present when the throat is examined. The sensation can come and go. It
does not interfere with eating and drinking. The exact cause of globus
sensation is uncertain but it may be due to a problem with the coordination of the muscles involved in swallowing. Examination and
investigations may be carried out to exclude any other underlying
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problem. Reassurance that there is no serious underlying problem may

be all that is needed in terms of treatment.
Hoarseness - A term referring to abnormal voice changes. Hoarseness
may be manifested as a voice that sounds breathy, strained, rough,
raspy, or a voice that has higher or lower pitch. There are many causes
of hoarseness, including viral laryngitis, vocal cord nodules, laryngeal
papillomas, gastroesophageal reflux-related laryngitis, and environmental
irritants (such as tobacco smoking). An accumulation of fluid in the vocal
cords associated with hoarseness has been termed Reinke's edema.
Reinke's edema may occur as a result of cigarette smoking or voice
abuse (prolonged or extended talking or shouting). Rarely, hoarseness
results from serious conditions such as cancers of the head and neck
region.
Laryngitis - An inflammation of the larynx. Inflammation of the larynx is
most often caused by viral infections. In these cases, other symptoms,
such as a sore throat, cough, difficulty swallowing, and fever, generally
occur. The voice changes may persist after the fever and other
symptoms of acute infection have resolved. Laryngitis can also occur as
a result of irritation to the vocal cords. People such as singers,
cheerleaders, or even small children after bouts of screaming may find
that they become hoarse or speak with a 'gravelly' voice after prolonged
overuse. Environmental causes of irritation of the airway that can result in
inflammation of the larynx include exposure to tobacco smoke or other
chemicals.
Laryngopharyngeal reflux (LPR) - Similar to another condition -- GERD
-- that results from the contents of the stomach backing up (reflux). But
the symptoms of LPR are often different than those that are typical of
gastroesophageal reflux disease (GERD). With laryngopharyngeal reflux,
you may not have the classic symptoms of GERD, such as a burning
sensation in your lower chest (heartburn). That's why it can be difficult to
diagnose and why it is sometimes called silent reflux.
Obstructive sleep apnoea (OSA) - Obstructive sleep apnoea is a
potentially serious sleep disorder in which breathing repeatedly stops and
starts during sleep. Several types of sleep apnoea exist, but the most
common type is obstructive sleep apnoea, which occurs when your throat
muscles intermittently relax and block your airway during sleep. The most
noticeable sign of obstructive sleep apnoea is snoring. Anyone can
develop obstructive sleep apnoea, although it most commonly affects
middle-aged and older adults and people who are overweight.
Pharyngitis - Often simply referred to as a sore throat - is inflammation
of the pharynx, the portion of the throat that lies just beyond the back of
the roof of the mouth and stretches to the Adam's apple (pharynx). It
usually occurs when viruses (or sometimes bacteria) from a cold, flu, or
sinus infection involve the throat.

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Postnasal drip (PND) - Also termed upper airway cough syndrome,

UACS, or post nasal drip syndrome, PNDS, occurs when excessive
mucus is produced by the nasal mucosa. The excess mucus
accumulates in the throat or back of the nose.
Quinsy - The abscess (collection of pus) forms between one of your
tonsils and the wall of your throat. This can happen when an infection
spreads from an infected tonsil to the surrounding area.
Sore throat - Pain, scratchiness or irritation of the throat that often
worsens when you swallow. A sore throat is the primary symptom of
pharyngitis inflammation of the throat (pharynx). But the terms "sore
throat" and "pharyngitis" are often used interchangeably. The most
common cause of a sore throat is a viral infection, such as a cold or the
flu. A sore throat caused by a virus resolves on its own with at-home
care. Strep throat (streptococcal infection), a less common type of sore
throat caused by bacteria, requires additional treatment with antibiotic
drugs to prevent complications.
Tonsil and adenoid infections - Your tonsils and adenoids are part of
your lymphatic system. Your tonsils are in the back of your throat. Your
adenoids are higher up, behind your nose. Both help protect you from
infection by trapping germs coming in through your mouth and nose.
Sometimes your tonsils and adenoids become infected. Tonsillitis makes
your tonsils sore and swollen and causes a sore throat. Enlarged
adenoids can be sore, make it hard to breathe and cause ear problems.
Tonsillitis - Tonsillitis is an infection and swelling of the tonsils, which are
oval-shaped masses of lymph gland tissue located on both sides of the
back of the throat. The tonsils normally help to prevent infections. They
act like filters to trap bacteria and viruses entering the body through the
mouth and sinuses. The tonsils also stimulate the immune system to
produce antibodies to help fight off infections. Anyone of any age can
have tonsillitis; however, it is most common in children between the ages
of five and 10 years.
Voice disorders (dysphonia) - Functional voice disorders may account
for up to 40% of the cases of dysphonia referred to a multidisciplinary
voice clinic. Altered laryngeal muscle tension is believed to result in
altered laryngeal performance despite normal anatomy. As a result, the
term muscle tension dysphonia (MTD) has become the preferred term for
functional dysphonia. An Italian study found that approximately 90% of
children with dysphonia from a vocal fold lesion had an underlying
functional dysphonia.
Vocal cord paralysis - Occurs when the nerve impulses to your voice
box (larynx) are interrupted. This results in paralysis of the muscle of the
vocal cords. Vocal cord paralysis can affect your ability to speak and
even breathe. That's because your vocal cords, sometimes called vocal
folds, do more than just produce sound. They also protect your airway by
12

preventing food, drink and even your saliva from entering your windpipe
(trachea) and causing you to choke. There are a number of causes of
vocal cord paralysis including damage to nerves during surgery and
certain cancers. Vocal cord paralysis can also be caused by a viral
infection or a neurological disorder.
Vocal cord cancer - Throat cancer refers to cancerous tumors that
develop in your throat (pharynx), voice box (larynx) or tonsils. Your throat
is a muscular tube that begins behind your nose and ends in your neck.
Your voice box sits just below your throat and is also susceptible to throat
cancer. The voice box is made of cartilage and contains the vocal cords
that vibrate to make sound when you talk. Throat cancer can also affect
the piece of cartilage (epiglottis) that acts as a lid for your windpipe.
Tonsil cancer, another form of throat cancer, affects the tonsils, which are
located on the back of the throat.
Vocal cord nodules and polyps- Are benign (noncancerous) growths
on both vocal cords that are caused by vocal abuse. Over time, repeated
abuse of the vocal cords results in soft, swollen spots on each vocal
cord. These spots develop into harder, callous-like growths called
nodules. The nodules will become larger and stiffer the longer the vocal
abuse continues. Polyps can take a number of forms. They are
sometimes caused by vocal abuse. Polyps appear on either one or both
of the vocal cords. They appear as a swelling or bump (like a nodule), a
stalk-like growth, or a blister-like lesion. Most polyps are larger than
nodules and may be called by other names, such as polypoid
degeneration or Reinke's edema. The best way to think about the
difference between nodules and polyps is to think of a nodule as a
callous and a polyp as a blister.

13

Module 3 - Head and Neck

Facial nerve disorders (Bells Palsy) - A form of facial paralysis
resulting from a dysfunction of the cranial nerve VII (the facial nerve)
causing an inability to control facial muscles on the affected side. Several
conditions can cause facial paralysis, e.g., brain tumour, stroke,
myasthenia gravis, and Lyme disease. However, if no specific cause can
be identified, the condition is known as Bell's palsy. Named after Scottish
anatomist Charles Bell, who first described it, Bell's palsy is the most
common acute mononeuropathy (disease involving only one nerve) and
is the most common cause of acute facial nerve paralysis (>80%). Bell's
palsy is defined as an idiopathic unilateral facial nerve paralysis, usually
self-limiting.
Head and neck cancer - A group of cancers found in the head and neck
region. This includes tumors found in:
The oral cavity (mouth). The lips, the tongue, the teeth, the gums,
the lining inside the lips and cheeks, the floor of the mouth (under
the tongue), the roof of the mouth and the small area behind the
wisdom teeth are all included in the oral cavity.
The oropharynx (which includes the back one-third of the tongue,
the back of the throat and the tonsils).
Nasopharynx (which includes the area behind the nose).
Hypopharynx (lower part of the throat).
The larynx (voice box, located in front of the neck, in the region of
the Adam's apple). In the larynx, the cancer can occur in any of
the three regions: the glottis (where the vocal cords are); the
supraglottis (the area above the glottis); and the subglottis (the
area that connects the glottis to the windpipe).
The most frequently occurring cancers of the head and neck area are
oral cancers and laryngeal cancers. Almost half of all the head and neck
cancers occur in the oral cavity, and a third of the cancers are found in
the larynx. By definition, the term "head and neck cancers" usually
excludes tumors that occur in the brain.
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Salivary gland disorders - A number of diseases can affect your

salivary glands. These range from cancerous tumors to Sjgrens
syndrome. While some go away with time or antibiotics, others require
more serious treatments, including surgery.
Thyroid cancer - Occurs in the cells of the thyroid a butterfly-shaped
gland located at the base of your neck, just below your Adam's apple.
Your thyroid produces hormones that regulate your heart rate, blood
pressure, body temperature and weight. Although thyroid cancer isn't
common in the United States, rates seem to be increasing. Doctors think
this is because new technology is allowing them to find small thyroid
cancers that may not have been found in the past. Most cases of thyroid
cancer can be cured with treatment.
Sleep Centres
Some larger hospitals have a Sleep Centre where patients can be referred for
sleep studies. Sleep problems that may be diagnosed and treated at a sleep
centre/sleep clinic include:
Insomnia
Restless Leg Syndrome
Narcolepsy
Sleep Apnoea
Delayed Sleep Phase Syndrome/Disorder
Snoring

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Module 3 - Audiology Department

The Audiology Department is closely associated with the Ear Nose and Throat
Department and many patients are referred by ENT consultants.
The Audiology Department offers a comprehensive range of diagnostic and
rehabilitative services to people requiring help with their hearing and/or balance.
Audiology Department services include:
Advanced audiological testing
Direct referral hearing aid clinics
Hearing aid fitting clinics
Hearing aid reassessment clinics
Hearing aid repair clinics
Paediatric hearing assessment clinics
Paediatric hearing aid review clinics
Vestibular (balance) testing
Hearing Therapy is also under the umbrella of the Audiology Department. This
service provides tinnitus and hearing aid counselling, hearing aid rehabilitation,
vestibular rehabilitation, lip-reading and advice on environmental aids.
Tests and Investigations
Audiometry
Air and bone conduction thresholds
Pure tone audiogram
Speech in noise
Chest x-ray
CT scan
Cranial nerve examination
Flexible nasendoscopy
Free field voice testing
Haematological investigations
Indirect laryngoscopy
MRI scan
Otoacoustic emissions test
Otoscopy
Rinnes test
Rombergs test
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Speculum examination
Tuning fork tests
Unterbergers test
Webers test
OPERATIVE PROCEDURES
External ear
Total excision of pinna
Excision of pre-auricular sinus
Excision accessory auricle/pre-auricular appendage
Excision/biopsy of lesion of pinna
Removal of multiple bony exostoses external auditory canal
Removal of solitary osteoma of external auditory canal
Reconstruction of external ear using cartilage graft
Bony meatoplasty
Soft tissue meatoplasty of external auditory canal
Repair of pinna
Removal of foreign body from external auditory canal
Excision of lesion of external auditory canal
Reconstruction of external auditory canal
Middle ear and mastoid
Combined approach tympanoplasty
Exploration of facial nerve, mastoid segment
Exploration of middle ear
Insertion of bone anchored implant
Mastoidectomy
Meatoplasty
Myringoplasty
Myringotomy
Ossiculoplasty
Petrosectomy
Repair of peri-lymph fistula
Stapedectomy
Stapedotomy
Suction clearance of middle ear
Tympanic neurectomy
Tympanotomy
Inner ear
Acoustic and cerebello-pontine angle neuroma surgery
Insertion of cochlear implant
Membranous labyrinthectomy
Operation on endolymphatic sac
Osseous labyrinthectomy
Transtympanic chemical labyrinthectomy
Nose and nasal cavity

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Correction of congenital atresia of choana

Division of adhesions of turbinate of nose
Nasal septum cauterisation
Polypectomy
Reduction turbinates of nose (laser, diathermy, out fracture etc)
Reduction turbinates of nose (trim, radical excision)
Rhinoplasty following trauma or excision of tumour
Submucous resection of nasal septum
Septoplasty
Septorhinoplasty
Nasal sinuses
Antral puncture and wash-out
Bone flap to frontal sinus
Caldwell-Luc operation
Closure of oro-antral fistula
Cranio-facial resection
Dacryocysto-rhinostomy (endoscopic/laser assisted)
Diagnostic endoscopy of sinus
Endoscopic uncinectomy
Ethmoidectomy
External frontoethmoidectomy
FESS
Intranasal antrostomy
Intranasal ethmoidectomy
Manipulation under anaesthesia (MUA) of fractured nose
Transantral ethmoidectomy
Trephining of frontal sinus
Transnasal repair of leaking CSF
Vidian neurectomy
Throat
Adenoidectomy
Adenotonsillectomy
Diagnostic endoscopic examination of pharynx/larynx
Drainage of peritonsillar abscess ("quinsy")
Endoscopic laryngo-pharyngoscopy as outpatient procedure
Operation on pharyngeal pouch (exterior approach)
Pharyngeal pouch - endoscopic procedures
Pharyngectomy
Repair of pharynx
Therapeutic endoscopic operation on pharynx
Tonsillectomy
Larynx and trachea

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Cordectomy (endoscopic)
Glottoplasty
Laryngectomy
Laryngofissure and cordectomy of vocal cord
Laser surgery to vocal cord (including microlaryngoscopy)
Microlaryngoscopy/laryngoscopy +/- endoscopic excision of lesion of
larynx
Pharyngeal myotomy
Pharyngolaryngectomy
Tracheoplasty
Tracheostomy
FIBREOPTIC ENDOSCOPIC PROCEDURES (GA OR LA)
Diagnostic bronchoscopy
Dilatation of tracheal stricture including insertion of stent
Fibreoptic examination of trachea including biopsy/removal of foreign
body
Therapeutic bronchoscopy (including laser, cryotherapy, lavage, snare,
dilatation of stricture, insertion of stent)Therapeutic bronchoscopy for
removal of foreign body
Outpatient procedures
Aural toilet
Brandt-Daroff exercises
Epley manoeuvre
Microsuction (ears)
Commonly prescribed drugs in ENT
Afrin
Allegra
Amoxicillin
Atrovent
Augmentin
Avamys
Azelastine
Azithromycin
Benadryl
Cetirizine
Chlor-Trimeton
Ciprofloxacin
Clarithromycin
Desloratadine
Claritin
Dexamethasone
Dexa-Rhinaspray
Dimetane
Drixoral
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Emcur nasal douch

Fexofenadine
Flixonase
Fluticasone
Loratidine
Methylprednisolone
Montelukast
Nasacort
Nasonex
Ofloxacin
Omnaris
Prednisolone
Rinatec
Rhinocort
Stemetil
Sudafed
Tavist
Triamcinolone
Veramyst
Glossary of terms used in ENT
Anosmia - Absence of the sense of smell
Attic - Cavity on wall of the tympanic membrane
Autophony - is the unusually loud hearing of a person's own voice, breathing
or other self-generated sounds.
Barotrauma - Injury due to excessive pressures usually to structures of the ear
Bells palsy- Facial paralysis due to lesion of the facial nerve
Biopsy - Taking a biopsy involves removing a very small piece of tissue from
the area of concern and sending it for histology
Cerumen - Ear wax
Choana - The passageway from the back of one side of the nose to the throat
Cholesteatoma - Cyst-like mass commonly occurring in the middle ear and the
mastoid region
Concha - Hollow of the auricle of the external ear
Coryza - Common cold

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Diathermy - Used to stop bleeding or to cut tissue with less bleeding than
conventional methods. A high voltage current is used to coagulate bleeding
vessels to stop bleeding.
Diplacusis - Perception of a single auditory stimulus as two separate sounds
Dissection - Dissection is the process of separating tissues.
Eustachian tube -The tube that connects the middle ear to the back of the
nose and upper part of the throat.
Grommets -Tiny tubes that are placed surgically through a small cut in the
tympanic membrane. They are used to ventillate the middle ear. Hyperacousis
increased sensitivity to loud noise
Glue ear - Fluid in the middle ear that can cause a decreased level of hearing.
Histology - Histology is the science of diagnosing disease from views of tissue
under the microscope
Hyperthyroidism - Overproduction of thyroid hormone by the thyroid gland.
Labyrinthitis - an inflammation of your inner ear (the labyrinth), which can
cause severe dizziness
Mal de Dbarquement Syndrome (MdDS) - an imbalance or rocking sensation
that occurs after exposure to motion.
Medical management - Treatment of a disease with medications only includes topical medication eg. drops.
Mnires disease - a disorder of the inner ear that can affect hearing and
balance to a varying degree.
Obstructive Sleep Apnoea (OSA) - This condition is caused by the soft tissues
of the neck and mouth collapsing into the airway during sleep and preventing
proper breathing taking place.
Otitis externa (also known as Swimmer's ear) is an inflammation of the outer
ear and ear canal.
Otitis interna is an inflammation of the inner ear and is usually considered
synonymous with labyrinthitis. Otitis media glue ear is inflammation of the
middle ear, or middle ear infection.
Polyps - Polyps are grape-like swellings that protrude into the nose.
Referred pain - Pain felt in a region of the body that is some distance away
from the actual cause of the pain.

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Rinnes test Hearing test with tuning fork: positive in normal or sensory neural
deafness, negative in conductive deafness.
Soft palate -The soft part at the back of the roof of the mouth.
Thyroid gland - The thyroid gland is situated in the lower part of the neck (in
the middle) over the windpipe. It produces thyroid hormone.
Vocal cords - The vocal cords are the two ligaments in the voice box that
vibrate to produce sounds/speech.
Tracheostomy - A tracheostomy is a breathing tube placed through a surgical
incision directly into the windpipe, below the level of the vocal cords.
Thyroid Hormone - Thyroid hormone is responsible for various functions on
the body. An important function is the control of the metabolic rate of the body.
Tympanic membrane - Ear drum
Paranasal sinuses - The air-filled cavities that surround the nasal passages.
Presbyacusis age related hearing loss
Retraction pocket - When the Eustachian tube is not working properly, the
pressure in the middle ear drops and sucks the ear drum inwards. The pockets
in the ear drum that form as a result are called retraction pockets.
Sinusitis - Inflammation of the nasal sinus cavities. Acute sinusitis is usually
from an infection and is severe.
Sialadenitis - Inflammation of a salivary gland.
Tonsillitis - Tonsillitis is the term used to describe inflammation of the tonsils,
usually due to infection.
Tragus - Cartilaginous projection anterior to the external opening of the ear
Unterberger's test and Unterberger's stepping test - a test used in
otolaryngology to help assess whether a patient has a vestibular pathology.
Valsalva manouvre - Forcible exhalation against closed nostrils and mouth
causing increased pressure in Eustachian tubes and middle ear.
Webers test - Hearing test with tuning fork, result referred to as central, right or
left

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Module 3 - Assignment
Welcome to your Module 3 Assignment.
Please note that all your work for this assignment should be saved in one
document and it should follow the following title requirements:
Medical Secretary_ Module 3_Your Name
For this assignment you are required to research all the common side effects of
the Commonly prescribed drugs in ENT, using the Module 2 Assignment
document uploaded in your reference materials.
You are required to research all the drugs listed in the module.
You may use the internet and resources such as: http://www.drugs.com/ to help
with your research.
Please read below before submitting your assignment:
1. You must ensure that you have COMPLETED the assignment and all the requirements before
submitting your work.
2. In order to successfully complete your module you are required to achieve a minimum pass
mark of 75%.
3. By submitting your assignment you indicate that you have understood the following statements:
This assignment is my own original work, except where I have appropriately cited the original
source ( References for text or images used )
This assignment has not previously been submitted for assessment in this or any other subject.
If it is deemed that my assignment includes unoriginal work that is not referenced, my assignment
will be failed with no option to resubmit.

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