Surgical specialty with significant medical component



Yüklə 480 b.
tarix07.03.2017
ölçüsü480 b.



Surgical specialty with significant medical component

  • 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

  • Approximately 25 residency positions

  • 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

    • EAR


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

  • Recognize otolaryngology as a specialty





WARM THE AIR

  • WARM THE AIR

    • Highly vascular
    • Vessels superficial
  • HUMIDIFY THE AIR

    • Mucous glands
  • OLFACTION

    • CN I and CN V
  • FILTER THE AIR

    • Hair and cilia












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:

    • Sense of smell
  • 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 bulbOlfactory tractolfactory 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

  • Anterior rhinoscopy



Esthesioneuroblastoma

  • Esthesioneuroblastoma

  • Nasal polyps (chronic sinusitis)

  • Foreign body in nose

  • 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

  • Since associated with headaches, papilledema and change in EOM, concern re neoplasm

  • Radiology ordered

  • Diagnosis: Esthesioneuroblastoma





Yüklə 480 b.

Dostları ilə paylaş:




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©azkurs.org 2020
rəhbərliyinə müraciət

    Ana səhifə