Otolaryngology

(Otolaryngology head and neck surgery)

Yang Yucheng Ph.D. Prof.

Department of Otolaryngology
The First Affiliated Hospital
Chongqing Medical University
2017
 Content

• Overview

• Applied Anatomy of the Nose

• Acute Rhinitis

• Allergic Rhinitis
 Overview

Definition
Otolaryngology (otolaryngology-head＆ neck surgery)

• the study on anatomy, physiology and diseases of

organs:
ear, nose, pharynx, throat, trachea, esophagus, neck
• and their functions:
audition, balance, olfactory sensation, breathing ,
swallowing , pronunciation and language
 Overview

Characteristics of Otolaryngology
ENT/ear, nose, pharynx, throat, trachea, esophagus, neck

• Anatomy: connected
• Physiology: correlated
• Pathology: influenced
• Examination: commonality
• Treatment: assisted
 Overview

Special examination equipment

ear speculum frontal mirror

 Overview

Special diagnosis desk

Overview
 Overview

Learning focus

• Important diseases:
otitis media, rhinitis and sinusitis, pharyngitis
and tonsillitis, laryngitis , hearing loss

• Three critical diseases ：

laryngeal obstruction
foreign body in the trachea
otogenic complications
 Overview

Development
• Otology：ear surgery and otoneurosurgery,
ossicular reconstruction, cochlear implantation
• Nasology：nasal endoscopic skull base surgery,
related operations of nose and eyes
• Pharyngology and laryngology：obstructive sleep apnea-
hypopnea syndrome(OSAHS）
• Head and Neck Surgery ：tumor resection ,lymphadenectomy,
repair and reconstruct
 Overview

Endoscopic sinus surgery with navigational aids

American GE company InstaTrak ENTrak 3500

electromagnetic imaging navigation system
 Applied Anatomy of the Nose

• the first part of the upper respiratory tract

• located in the centre of face
• composed of three parts
 Applied Anatomy of the Nose

• external nose
A. Nasal vestibule

B. Nasal cavity proper

• nasal cavities
C. The Mucous Membrane

D. Vessels
• paranasal sinuses
 Applied Anatomy of the Nose

Nasal cavity
• The nasal cavities are situated on either side of the
median plane

• They open in front through the nares, and

communicate behind through the choana with the
nasopharynx.
 Nasal cavity

• The nasal cavity in each side is divided into

two parts:
A. nasal vestibule
B. nasal cavity proper

Nasal cavity proper

Limen nasi

Nasal vestibule
 Nasal cavity

A. Nasal vestibule
Nasal vestibule is the anterior and inferior part
of nasal cavity.
B. Nasal cavity proper
The nasal cavity proper is separated from the
vestibule anteriorly by limen nasi ,the most narrow
portion of nasal cavity, and opening posteriorly
through the choana to nasal pharynx.
Nasal cavity proper

Limen nasi Choana

Nasal vestibule
 Nasal cavity proper

View of nose on CT scan

anterior rhinoscopy
 Nasal cavity proper

Nasal cavity proper

 Nasal cavity proper

Each nasal cavity has :

a. a lateral wall
b. a medial wall
c. a roof
d. a floor
 Nasal cavity proper

a. Lateral Wall:
On the lateral wall are the superior, middle,
and inferior nasal concha or turbinate, and
below and lateral to each concha is the
corresponding nasal passage or meatus.

Superior turbinate
Middle turbinate
Superior meatus
Middle meatus

Lateral wall

Inferior turbinate
Inferior meatus
 Nasal cavity proper

Fig.3 Lateral Wall of the nose

 Nasal cavity proper

b. Medial Wall:
The medial wall or septum is a
partition of bone and cartilage between
the nasal cavities.

Nasal septum
 Nasal cavity proper

c. The roof:
The roof of the nasal cavity is narrow from
side to side, except at its posterior part, and may
be divided, from behind forward, into sphenoidal,
ethmoidal, and frontonasal parts, after the bones
which form it.
 Nasal cavity proper

d. The floor:
The floor is concave from side to side and
almost horizontal antero-posteriorly; its anterior
three-fourths are formed by the palatine
process of the maxilla, its posterior fourth by
the horizontal process of the palatine bone.
 Nasal cavity

C. The Mucous Membrane

The nasal mucous membrane lines

the nasal cavities, and is intimately
adherent to the periosteum or
perichondrium.
 Nasal cavity

D. Vessels
a. Arteries:
• internal carotid artery (ICA)
anterior ethmoidal branches
ophthalmic artery

posterior ethmoidal branches

• external carotid artery (ECA) sphenopalatine branch

 Vessels

Blood supply of the

nasal septum
 Vessels

b. Kieselbach’s plexus(Little’s area):

In the anterior part of the septum,
anastomosis of the external carotid artery (ECA)
and internal carotid artery (ICA) branches form
Kieselbach’s plexus at Little’s area, which is the
commonsest site for epistaxis.
 Applied Anatomy of the Nose

Paranasal sinuses
• The paranasal sinuses are a series of
membrane lined cavities within the bones of
the face.
• Four pairs of sinuses are the frontal, maxillary,
ethmoid, and sphenoid.

1. frontal sinus
2. ethmoid sinus 1
3. maxillary sinus 2 4
4. sphenoid sinus
3
 Paranasal sinuses

Fig.6 The paranasal sinuses

 Paranasal sinuses

A. The frontal sinus: The frontal sinus lies in the

frontal bones above the orbit and can be quite extensive.
It communicates with the nasal cavity by an opening in
the anterior end of the middle meatus.

B. The maxillary sinus: The maxillary sinus is

quite large and occupies most of the maxilla. It lies
lateral to the nasal cavity and just above the upper molar
teeth. It communicates with the nasal cavity via the
middle of the middle meatus.
 Paranasal sinuses

C. The ethmoid sinus: The ethmoid sinus

includes really a series of small, interconnected sinuses
called air cells.

D. The sphenoid sinus: The sphenoid sinus lies

in the body of the sphenoid bone. It opens into the nasal
cavity in a small triangular space just above the superior
concha known as the sphenoethmoidal recess.
 Physiological functions of the nose
 Respiration Air flows superiorly into the nares,
determined by its position and the anterior nasal valve.
The airstream then turns posteriorly approximately
90°and flows into the nasopharynx.
 Olfaction As the sensory organ of olfaction, the
nose allows perception of different odours.
 Resonance The nose modifies speech by allowing
some amount air to escape from it thereby adding
resonance to the sound produced and improving the
quality of speech.
 Protection: warm, humidify, clean the air
 Cosmetology : beauty, handsome
Acute Rhinitis
(Common Cold)
 Acute Rhinitis

Definitions
 An illness that is short in duration,
usually less than two weeks.
 Colds usually begin abruptly.
 The common cold causes irritation
and drainage in any or all of the
airways including the nose, sinuses,
throat, voice box, and often the
bronchial tubes.
 Acute Rhinitis

Causes
Viruses: Many different viruses can
cause the common cold. Well over 100
types of cold viruses are known.
Bacteria: Bacteria that live in the nose
and throat can gain a foothold and
cause secondary infection such as ear
infections, bacterial sinusitis and
bacterial bronchitis.
 Acute Rhinitis

Symptoms and Signs

Throat discomfort
Sneezing
Runny nose, mucous becomes
thick
Nasal congestion
Decreased energy level
 Symptoms and Signs

Acute Rhinitis
 Symptoms and Signs

 Fever fever is unusual, but children and

infants may have fever up to 102 degrees.
 Coughing If present, coughing can last
two to three weeks.
 Secretions green or yellow septum or
nasal secretions suggest a secondary
bacterial bronchitis or sinusitis
 Acute Rhinitis

Diagnosis

If the disease comes on quickly, is

not too severe and resolves in one to
two weeks, it is usually the common
cold.
 Acute Rhinitis

Different Diagnosis
The common cold can be mistaken
for hay fever (allergy) or bacterial
disease such as a sinus infection or
strep throat.
 Different Diagnosis

The flu: Fever and more severe

symptoms, muscle aches, cough,
suggest the flu.
Allergies: Allergies usually recur and can
last for entire seasons.
Bacterial sinusitis: Bacterial sinus
infections are usually limited to the nose
and usually will not resolve unless
antibiotics are given.
 Acute Rhinitis

Treatment
Antibiotics don’t help, they can treat or
prevent secondary bacterial infections.
Pain should be treated using Advil or
Tylenol, especially for sore throat.
Nasal congestion and trouble breathing
should be treated with Sudafed or Afrin
nasal spray. Can only be used for three
or four days.
Allergic Rhinitis
• Have you suffered from watery
discharge, nasal obstruction,
sneezing and itching?
 Definition
• Allergic Rhinitis:
It is an IgE-mediated immunologic
response of nasal mucosa to allergens

allergen exposure
Ig E
nasal mucosa
 Classification
pollinosis

• Seasonal classify traditionally

• Perennial

• ARIA classification
• duration: intermittent
• continued
• severity: mild
• moderate-severe
 Cause
Inhalant allergens are often the cause：
pollen, animals, house dust, debris from insects
and house mite……
Genetic predisposition:
 Clinical Features

• The main symptoms include suddenly

sneezing, nasal obstruction, watery nasal
discharge and itching in the nose.
 Clinical Features
• Others:
persistently stuffy nose, lose of sense of
smell, postnasal drip, chronic cough, hearing
lose……
 Physical examination
• Signs of allergy may be seen in the nose, eyes,
ears, pharynx and larynx.
• Nose:
 pale and edematous of nasal mucosa
 swollen turbinate
 thin, watery or mucoid discharge
 Physical examination
• Ocular signs: conjunctivitis
edema of lid, congestion
• Otologic signs:
retracted tympanic membrane or serious
otitis media
• Pharyngeal signs:
granular pharyngitis
 Lab tests
• Skin test : prick,scrach,intradermal
tests

use standard allergen, place a drop of extract

on the forearm skin, pricking a needle
through the epidermis under the drop,
observe the result 15-20minutes later.

notice: positive and negative controls

must be used.
 Lab tests

• IgE antibody concentration on serum.

an elevated total/specificity IgE level
not used alone to establish allergic rhinitis
• Total blood eosinophilia count:
an elevated eosinophilia count
 Diagnosis

• Detailed history and physical examination

• Possible allergen
 Complications
• Recurrent sinusitis because of obstruction
to the sinus ostia
• Nasal polyp
• Secretory otitis media
• Bronchial asthma: one airway, one
disease!
• Most patients with allergic (80%) and non-allergic (50%)
asthma have rhinitis, and many patients with rhinitis (20–30%)
also have asthma
 Treatment
• Treatment can be divided into:
 avoidance of allergen
 treatment with drugs
 immunotherapy

The best treatment is to avoid the allergen

remove of a pet ,encasing the pillow, change
a place of work……
 Treatment
• Drugs
 antihistamine: oral or nasal
 corticosteroids: oral
nasal steroids
(budesonide, fluticasone, mometasone)
 decongestant drug:
 Treatment
•Drugs
These medications are used to treat allergic
rhinitis:
a. Antihistamines: Antihistamines block
the action of the histamine. They compete
with histamine for histamine receptor type 1.
b. Decongestants: Decongestants
stimulate vasoconstriction by directly
activating alpha-adrenergic receptors of the
respiratory mucosa, can give short-term relief
from nasal stuffiness.
 Treatment
c. Corticosteroids: Corticosteroids may
lessen allergic reaction by preventing body
cells from responding to inflammatory
mediators (histamine).
Nasal corticosteroids: Nasal steroid
sprays are highly efficacious in treating
allergic rhinitis. They are safe to use and
not associated with significant systemic
adverse effects in adults.
 Treatment
. Immunotherapy
Immunotherapy (or allergy shots) is
used in cases whose symptoms are
not well controlled with avoidance
measures and pharmacotherapy.
 Treatment
• Immunotherapy
 allergen is given in gradually increasing
doses till the maintenance dose is reached
 suppresses the formation of IgE
 long time
 Prevention
• Confine your pet to a particular area of
your home
• Avoiding outside activity during pollen
season
• Check the material of your home supplies
• Avoid dust and mold
• Exercise regularly
 Review
• What are the typical symptoms of AR?
nasal obstruction, watery discharge, sneezing,
itching

• How to diagnosis the disease of AR?

history+ lab examination

• How to cure the disease of AR?

avoid allergen, drugs, immunotherapy
 Review

 Important diseases of Otolaryngology

 Three critical diseases of Otolaryngology
 What is little area ?
 Sinuses
 The function of nose.
 Symptoms and Signs of acute Rhinitis.
Thanks