Surgical specialty with significant medical component
tarix 07.03.2017 ölçüsü 480 b. #10728
Surgical specialty with significant medical component Head and neck excluding eye and brain E.g. acute airway emergencies, ear surgery, sinus surgery, neck surgery, microsurgery, short cases, long cases, neonates to geriatrics, cancer and benign disease, hearing 5 year residency +/- fellowship 600 practicing Otolaryngologists in Canada Informal survey 2012: 20% > 65 Significant collaboration with: neurosurgery, thoracic surgery, plastic surgery, ophthalmology, respirology, allergy, endocrinology, anesthesia, audiology, speech language pathology Underserviced in many communities Global Health Opportunities available UNIT 1 UNIT 1 UNIT 2 ORAL CAVITY/OROPHARYNX/NECK SWALLOWING AND SALIVARY GLANDS THYROID AND PARATHYROID INTEGRATION UNIT Recognize the pathway of air travel from the environment through the nose to the lung Recognize the pathway of air travel from the environment through the nose to the lung Describe the vascular and nerve supply to the nose List and briefly describe the four main physiological functions of the nose including filtration and protection, humidification and warming, olfaction, vocal resonance Define anosmia and hyposmia and create a short differential diagnosis (2 per category) for anosmia based on the following: neural etiology, obstructive etiology Recognize how a loss of olfaction may lead to a loss of sense of taste WARM THE AIR WARM THE AIR Highly vascular Vessels superficial HUMIDIFY THE AIR OLFACTION FILTER THE AIR So that I can taste my food So that I can taste my food It can help me avoid harmful situations (e.g. fire) It can warn me if food shouldn’t be eaten It helps me decide if I’m attracted to someone All of the above None of the above SAFETY SAFETY PLEASURE DETERMINES FLAVOUR OF FOOD AND BEVERAGES OTHER AESTHETICS Definition: Definition: Other terminology: Anosmia: loss of sense of smell Hyposmia: reduced sense of smell Dysosmia: olfactory distortion Presbyosmia: olfactory loss, sensorineural in nature, related to aging CN I (OLFACTORY) CN I (OLFACTORY) Mediates “smell”—provides flavour Aggregate of 40 nerve bundles that course from olfactory epithelium through cribiform plate to brain Large number of receptor cells (second only to vision) CN V (TRIGEMINAL) Dispersed throughout nasal mucosa Mediate: chemical and non chemical stimuli Somatosensory sensations (irritation, burning, cooling, tickling) Induces reflexes (e.g. mucous secretion , inhalation cessation) to prevent /minimize injury to nose/lungs Neuroepithelium: Neuroepithelium: Pseudostratified columnar epithelium Comprised of 6 different cell types including the receptor cell (Bipolar Cell) First cell (Bipolar cell): Bipolar receptor cell Projects from nasal cavity into brain without an intervening synapse Cilia have transmembrane receptors that interact with odorant ligands Provides major route of viral, fungal and bacterial invasion into CNS 22 cm2 in human; 7m2 in german shepherd 1000 types of receptors are present within the epithelium Glomerulus Decreased number with age Location of synapse between bipolar cells and second order neurons (mitral and tufted cells) Olfactory bulbOlfactory tractolfactory cortex (primary and secondary) CONDUCTIVE CONDUCTIVE Airflow to olfactory receptor cells is blocked Usually treatable SENSORINEURAL MIXED Combination of conductive and sensorineural List is very very long! List is very very long! Always think: CONDUCTIVE Is there anything blocking airflow? SENSORINEURAL Could there be something wrong with the nerve conduction? HISTORY HISTORY Onset Gradual suggests conductive Duration If present >6 months and sensorineural is unlikely to return Complete or partial Partial suggests better chance of recovery Preceeding illness E.g. URTI—most common reason Aggravating factors Relieving factors E.g. Improved with warm day, exercise, topical steroid suggests rhinitis Taste (sweet, sour, bitter, salty) vs flavour Presence of nasal obstruction Presence of other nasal symptoms TREAT THE CAUSE TREAT THE CAUSE Good prognosis for conductive losses if treated Poor prognosis for sensorineural losses if complete and >6 months Smoking—extent of recovery is directly related to duration since cessation of smoking Reassurance Safety CO, smoke detectors Check food expiry dates Some evidence for a trial of prednisone if URTI/idiopathic 40 year old female presents with 4 month history of hyposmia and taste change 40 year old female presents with 4 month history of hyposmia and taste change Esthesioneuroblastoma (conductive/sensorineural) Esthesioneuroblastoma (conductive/sensorineural) Nasal polyps (conductive) Age (sensorineural) URTI (sensorineural) Tobacco use (sensorineural) Choose all that apply: Choose all that apply: DC Tobacco Tell them it’s all in their head Explain the natural history of hyposmia (e.g. statistics, likelihood for improvement) Urgent MRI Complete blood count (CBC) 50 year old male presents with anosmia and nasal congestion of 3 years duration 50 year old male presents with anosmia and nasal congestion of 3 years duration Anterior rhinoscopy Esthesioneuroblastoma Esthesioneuroblastoma Nasal polyps (chronic sinusitis) Normal exam—this is likely because of an URTI Presbyosmia 89 year old male presents with decreased taste (can’t taste his wine anymore) and decreased smell 89 year old male presents with decreased taste (can’t taste his wine anymore) and decreased smell Choose all that apply: Choose all that apply: URTI—Tell him to use Dristan Likely nasal tumor—inform him and discuss poor prognosis Presbyosmia—discuss statistics with him and reassure that this is a normal aging process Let him know that most of the time decreased olfaction is because of chronic sinusitis/nasal polyposis and treat him with antibiotics and steroids 50 year old male presents with 3 month history of loss of sense of smell 50 year old male presents with 3 month history of loss of sense of smell No—most anosmia/hyposmia is related to age or a previous URTI. No—most anosmia/hyposmia is related to age or a previous URTI. Yes—he has some worrisome symptoms Since progressive this is likely conductive Since progressive this is likely conductive Radiology ordered Diagnosis: Esthesioneuroblastoma Dostları ilə paylaş:
