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QUICKREFERENCE OTOLARYNGOLOGY
Guide for APRNs, PAs, and Other Health Care Practitioners
Kim ScottConsultants
Richard F. Debo
Alan S. Keyes
David W. Leonard
for
IMAGE BANK
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FIGURE 1.1 Normal tympanic membrane.
© Springer Publishing Company
Physical ExaminationDocumentation of Normal and Abnormal Findings From the Ear, Nose, and Throat Examination
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HelixScaphoid
fossaCrura ofantihelix
Triangularfossa
Crus of helix
Tragus
Externalauditory meatus
Intertragicnotch
Antitragus
Lobule
Auriculartubercle
Cymba ofconcha
Concha ofauricle
Cavum ofconcha
Antihelix
Helix
FIGURE 1.2 Pinna.
© Springer Publishing Company
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Auricle(pinna)
External ear Middle ear Inner ear
(not to scale)
Malleus Incus
Auditory ossicles
Stapes
Temporalbone
Externalauditorymeatus
Tympanicmembrane
Semicircularcanals
Oval window
Facial nerve
Acousticnerve (VIII)
Vestibularnerve
Cochlearnerve
Vestibule
Round window
Eustachian tube
FIGURE 1.3 External, middle, and inner ear.
© Springer Publishing Company
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FIGURE 1.4 Tympanic membrane.
© Springer Publishing Company
Pars flaccida
Incus
Pars tensa
Umbo
Cone of light
Handle of malleus
Short process
of malleus
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FIGURE 1.5 Central tympanic membrane perforation.
© Springer Publishing Company
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FIGURE 1.6 Tympanosclerosis.
© Springer Publishing Company
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Frontal bone
Nasal bones
Upper lateralnasal cartilages
Septal cartilage anddorsum of the nose
Tip
Lower lateralnasal cartilages
Greater alar cartilage
Medial crus
Septal cartilage
Columalla
Alla
Alargroove
Lateral crus
FIGURE 1.7 External nose.
© Springer Publishing Company
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FIGURE 1.8 Paranasal sinuses.
© Springer Publishing Company
Cribriform plateof ethmoid
Frontalsinus
Ethmoid air cells
Orbit
Uncinate process
Maxillary sinus
Inferior turbinateand meatus
Vomer
Middle turbinateand meatus
Superior turbinateand meatus
Lamina papyracea(ethmoid)
Orbital plate(frontal bone)
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Parotidsalivary gland
Stensen’sduct
Masseter muscle
Sublingual ducts
Sublingualsalivary gland
Submandibular salivary gland
Wharton’s duct
FIGURE 1.9 Salivary glands.
© Springer Publishing Company
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FIGURE 1.10 Oral cavity and oropharynx.
© Springer Publishing Company
Superior lip
Superior labialfrenulum
Palatoglossal arch
Palatopharyngeal arch
Posterior wallof oropharynx
Tongue
Lingual frenulum
Gingivae (gums)
Inferior labial frenulum
Vestibule
Duct ofsubmandibular gland
Palatine tonsil
Uvula
Soft palate
Hard palate
Gingivae (gums)
Inferior lip
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0Surgically removed tonsils
3Tonsils are beyond
the pillars
4Tonsils extend to midline
1Tonsils hidden within
tonsil pillars
2Tonsils extending to
the pillars
FIGURE 1.11 Tonsil size scoring.
© Springer Publishing Company
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FIGURE 1.12 Oropharynx, hypopharynx, trachea, and larynx.
© Springer Publishing Company
Frontal sinus
Sella turcica
Adenoid
Pharyngeal opening ofauditory (eustachian) tube
Thyroid cartilage
Vocal fold (cord)
Transverse arytenoid muscle
Cricoid cartilage
Trachea
Esophagus
Sphenoid sinus
Soft palate
Hard palate
Incisive canal
Uvula
Oral cavity
Body of tongue
Palatine tonsil
Lingual tonsil
Base of tongue
Epiglottis
Hyoid bone
Thyrohyoid membrane
Nasopharynx
Oropharynx
Hypopharynx
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FIGURE 1.13 Larynx landmarks.
© Springer Publishing Company
Epiglottis
Base of tongue(lingual tonsil)
Ventricular folds(false cords)
Vestibule
Aryepiglottic fold
Ventricle
ArytenoidEsophagus
Interarytenoidnotch
Piriform recess
Trachea
Glottic aperature
Vocal folds(true cords)
Vallecula
Median glosso-epiglottic fold
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FIGURE 1.14 Omega-shaped epiglottis and vallecula.
© Springer Publishing Company
OMEGA-SHAPED EPIGLOTTIS
VALLECULA
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FIGURE 1.15 Cartilages of larynx.
© Springer Publishing Company
Epiglottis
Hyoid bone
Thyrohyoid membrane
Larynx location
Superior horn ofthyroid cartilage
Arytenoid cartilage(behind thyroid cartilage)
Thyroid cartilage
Cricothyroid ligament
Inferior horn ofthyroid cartilage
Cricoid cartilage
Trachea
Anterior View
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FIG
UR
E 1.
16
Nec
k: L
ymp
hat
ic s
yste
m a
nd
no
de
gro
up
s.
© S
prin
ger
Pub
lishi
ng C
ompa
ny
Sup
erfic
ial p
arot
id n
odes
(dee
p pa
rotid
nod
es d
eep
to p
arot
id g
land
)
Occ
ipita
l nod
es
Mas
toid
nod
es
Sub
paro
tid n
ode
(Lev
el II
)
Man
dibu
lar
and
subm
andi
bula
rno
des
(Lev
el I)
Sub
men
tal n
odes
(Le
vel I
)
Sup
rahy
oid
node
(Le
vel I
)
Inte
rnal
jugu
lar
chai
n of
nod
es(d
eep
late
ral c
ervi
cal n
odes
) (L
evel
s II
and
III)
Ant
erio
r de
ep c
ervi
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pret
rach
eal a
ndth
yroi
d) n
odes
(de
ep to
str
ap m
uscl
es)
(Lev
el V
I)
Ant
erio
r su
perf
icia
l cer
vica
l nod
es(a
nter
ior
jugu
lar
node
s) (
Leve
l VI)
Sup
racl
avic
ular
nod
es (
Leve
l IV
)
Faci
al n
odes
(buc
cal n
odes
)
Jugu
lodi
gast
ric n
ode
(Lev
el II
)
Dee
p la
tera
l nod
es(s
pina
l acc
esso
ry n
odes
) (L
evel
V)
Infe
rior
deep
cer
vica
l(s
cale
ne)
node
(Le
vel I
V)
Tran
sver
se c
ervi
cal
chai
n of
nod
es (
Leve
l V)
Leve
l I n
odes
Leve
l II n
odes
Leve
l III
node
s
Leve
l IV
nod
esLe
vel V
nod
esLe
vel V
I nod
es
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Ear, Nose, and Throat Anatomy and PhysiologyNormal Findings
Frontal bone
Nasal bone
Zygomatic
arch
Maxilla
Mandible
Temporal bone
Occipital bone
Sphenoid bone
Parietal bone
Styloid
process
Mastoid
process
FIGURE 2.1 Skull bone landmarks.
© Springer Publishing Company
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FIGURE 2.2 Trigeminal nerve and facial nerve branches.
© Springer Publishing Company
Temporalbranch
Ophthalmicbranch (V1)
Zygomaticbranch
Maxillarybranch (V2)
Mandibularbranch (V3)
Trigeminalnerve
Facialnerve
Buccalbranch
Mandibularbranch
Cervicalbranch
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Superior andinferior ganglia
To pharynx
Glossopharyngealnerve
To stylopharyngeusmuscle
To carotid bodyand carotid sinus
To tongue for tasteand general sensation
To palatine tonsil
To parotid gland
FIGURE 2.3 Glossopharyngeal nerve.
© Springer Publishing Company
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FIGURE 2.4 Middle and inner ear.
© Springer Publishing Company
Dura mater
Ampullae
Endolymphatic sac
Endolymphatic ductin vestibular aqueduct
Utricle
Saccule
Cochlear aqueduct
Vestibule
Auditory(eustachian) tube
Round (cochlear) window(closed by secondarytympanic membrane)
Tympanic membrane
External acoustic meatus
Tympanic cavity
MalleusIncus
Stapes in oval(vestibular) window
Lateral semicircularcanal and duct
Common crus and duct
Posterior semicircularcanal and duct
Anterior (superior) semicircular canal and duct
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FIGURE 2.5 Maxillary sinuses.
© Springer Publishing Company
MMAXILLARY SINUS CAVITIES
NASAL SEPTUM
SINUS CT SCAN: CORONAL VIEW
MAXILLARY SINUS CAVITIES
NASAL SEPTUM
SINUS CT SCAN: CORONAL VIEW
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Nasal septumturned superiorly
Septal branch of facial artery
Branches of posteriorethmoidal artery
Septal branch ofnasopalatine artery
Nasopalatine artery
Sphenopalatineforamen
Lateral nasal branchof nasopalatine artery
Maxillary artery
External carotid artery
Lesser palatine arteryLateral wall of nasal cavity
Greater palatine artery
Anastomosis betweenseptal branch of
nasopalatine artery andgreater palatine artery
in incisive canal
Lateral nasalbranches offacial artery
Kiesselbach’sPlexus
Branches of anteriorethmoidal artery
FIGURE 2.6 Arteries of nasal cavity.
© Springer Publishing Company
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FIGURE 2.7 Olfactory nerve.
© Springer Publishing Company
Olfactory bulb
Olfactory nerves
Olfactory tract
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FIGURE 2.8 Frontal, ethmoid, and sphenoid sinuses.
© Springer Publishing Company
SINUS CT SCAN: SAGITTAL VIEW SINUS CT SCAN: SAGITTAL VIEW
ETHMOID ETHMOID SINUSES SINUSES
FRONTAL SINUSES FRONTAL SINUSES
SPHENOID SINUSES SPHENOID SINUSES
SINUS CT SCAN: SAGITTAL VIEW
ETHMOID SINUSES
FRONTAL SINUSES
SPHENOID SINUSES
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Epiglottis
Palatine tonsil
Apex
Base oftongue
Body
Medianglossoepiglottic fold
Lateralglossoepiglottic fold
Vallecula
Lingual tonsil(lingual follicles)
Foramen cecum
Sulcus terminalis
Vallate papillae
Foliate papillae
Filiform papillae
Fungiform papilla
Median sulcus
FIGURE 2.9 Oral cavity, tongue, and oropharynx.
© Springer Publishing Company
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FIGURE 2.10 Mallampati Classifi cation Score.
© Springer Publishing Company
I II
IVIII
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PIRIFORM RECESS
TRUE VOCAL FOLDSFALSE VOCAL FOLDS
ANTERIOR COMMISSURE
ARYTENOIDARYEPIGLOTTIC FOLD
FIGURE 2.11 Larynx.
© Springer Publishing Company
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FIGURE 2.12 Anomalous neural and vascular anatomy of the larynx.
© Springer Publishing Company
Left vagusnerve (X)
Left commoncarotid artery
Left inferiorlaryngeal nerve
Left recurrentlaryngeal nerve
Left subclavian artery
Anomalous (retroesophageal)right subclavian artery originatingfrom left side of aortic arch
Left recurrentlaryngeal nerve
Anterior View
Arch of aorta
Right commoncarotid artery
Anomalous (retroesophageal)right subclavian artery
Anomalous right inferiorlaryngeal nerve (not recurrent)
Right vagusnerve (X)
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A B C
D E F
Foodbolus
FIGURE 2.13 Normal swallowing.
© Springer Publishing Company
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FIGURE 3.1 Cranial nerves.
© Springer Publishing Company
Physical Examination of theCranial Nerves for the Head and Neck
Olfactory
Oculomotor
Trochlear
Abducens
Vestibulocochlear
Optic
Trigeminal
Facial
Glossopharyngeal
VagusHypoglossal
Accessory
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Superior palpebral conjunctiva:tarsal (Meibomian) glands
shining through
Superior lacrimalpapilla and puncta
Plica semilunaris
Lacrimal carunclein lacrimal lake
Inferior lacrimalpapilla and puncta
Pupil
Cornea
Limbus of cornea
Bulbar conjunctivaover sclera
Inferior fornixof conjunctiva
Inferior palpebral conjunctiva:tarsal glands shining through
FIGURE 3.2 Eye anatomy.
© Springer Publishing Company
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FIGURE 3.3 Trigeminal nerve branches: Sensory distribution.
© Springer Publishing Company
1st Branch:Ophthalmic (eye)
2nd Branch:Maxillary (top jaw)
3rd Branch:Mandibular (lower jaw)
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Internalacoustic meatus
Brachial motor
Visceral motor
Special sensory
General sensory
Motor nucleusof facial nerve
Posteriorauricular branch
Stylomastoid foramen
FIGURE 3.4 Facial nerve motor and sensory components.
© Springer Publishing Company
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FIGURE 3.5 Vagus nerve distribution.
© Springer Publishing Company
Vagus nerve
Superior and inferiorvagal ganglions
Cardiac branch
Pulmonary plexus
Esophageal plexus
Stomach
Liver
Colon
Small intestine
Celiac plexus
Kidney
Spleen
Heart
Lung
Laryngealbranches
Pharyngeal branch
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Evaluation and Management of Hearing and Tinnitus
Quiet
Frequency in Hertz (Hz)
Hea
rin
g L
evel
in D
ecib
els
(dB
)
Loud
Low pitch
Normalhearing
High pitch
–100
102030405060708090
100110120130140
125 250 500 1000 2000 4000 8000
FIGURE 5.1 Audiogram.
© Springer Publishing Company
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FIGURE 5.2 Tympanogram.
© Springer Publishing Company
–400
1400
1200
1000
800
600
400
200
–300 –200 –100
Type C
+100 +2000–400
1400
1200
1000
800
600
400
200
–300 –200 –100
Type B
+100 +2000–400
1400
1200
1000
800
600
400
200
–300 –200 –100
Type A
+100 +2000
–400
1400
1200
1000
800
600
400
200
–300 –200 –100
Type AS
+100 +2000 –400
1400
1200
1000
800
600
400
200
–300 –200 –100
Type AD
+100 +2000
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Frequency in Hertz (Hz)
Hea
rin
g L
evel
in d
ecib
els
(dB
)
–10
0
10
20
30
40
50
60
70
80
90
100
110125 250 500 1000 2000 4000 8000
FIGURE 5.3 Conductive hearing loss (left ear).
© Springer Publishing Company
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FIGURE 5.4 Sensorineural hearing loss (right ear).
© Springer Publishing Company
Frequency in Hertz (Hz)
Sensorineural Hearing Loss AudiogramH
eari
ng
Lev
el in
dec
ibel
s (d
B)
–10
0
10
20
30
40
50
60
70
80
90
100
110125 250 500
Air conduction Bone conduction
1000 2000 4000 8000
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Frequency in Hertz (Hz)
Hea
rin
g L
evel
in d
ecib
els
(dB
)
–10
0
10
20
30
40
50
60
70
80
90
100
110125 250 500
Air conduction:
Left ear
Right ear
Left ear
Right ear
Bone conduction:
1000 2000 4000 8000
FIGURE 5.5 Mixed hearing loss (bilateral ears).
© Springer Publishing Company
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FIGURE 5.6 Otosclerosis Carhart’s notch (right ear).
© Springer Publishing Company
Frequency in Hertz (Hz)
Hea
rin
g L
evel
in d
ecib
els
(dB
)–10
0
10
20
30
40
50
60
70
80
90
100
110125 250 500 1000 2000 4000 8000
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Evaluation and Management of Middle Ear Conditions
FIGURE 7.1 Bulging tympanic membrane as seen with otitis media.
© Springer Publishing Company
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FIGURE 7.2 Bullous myringitis.
© Springer Publishing Company
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FIGURE 7.3 Tympanic membrane perforation (large) with tympanic membrane scarring (left ear).
© Springer Publishing Company
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FIGURE 7.4 Normal tympanostomy tube (Armstrong).
© Springer Publishing Company
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FIGURE 7.5 Large tympanic membrane perforation.
© Springer Publishing Company
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FIGURE 8.1 Components of balance.
© Springer Publishing Company
Evaluation and Management of Inner Ear Conditions
+ =
SensorimotorControl Input
• Vestibular: Inner ear
• Visual: Eyes
• Proprioception:Muscles andjoint receptors
Integration ofInput in CNS
Brainstem(sorts info)
MotorOutput
Bal
ance
• Cerebral cortex:Functions inthinking andmemory andcontains previouslylearned information
• Cerebellum:Functions as thecoordinationcenter andcontains automaticmovementspreviously learned
• Vestibulo-ocular reflex: Eye position
compensatesfor movementsof the head
• Vestibulo-spinal reflex: Controls body posture
• Vestibulo-collic reflex: Keeps head
on a level planewith movement
Components of Balance
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Vestibular System
Angular Acceleration(Head Rotation)
• Anterior/superior canal and posterior canal:
detects rotations of thehead in a sagittal plane(as when nodding) and inthe frontal plane (as whencartwheeling)
• Horizontal or lateral canal:corresponds to rotation of the headaround a verticle axis (i.e., the neck)as when doing a complete spin
Linear Acceleration(One Directional Movement)
• Saccule:senses motion in the sagittalplane (up-down movement)and gravity
Each semicircular canal is a continuous endolymph-filled hoop. Hair cells sit in the small swelling at the base called an ampula. The function of these canals is to stabilize eye movement with head movement.
Both the utricle and saccule use small stones (otoliths) and a viscous fluid to stimulate their hair cells to detect motion and orientation. The major role of the utricle and saccule is to keep the person vertically oriented with respect to gravity.
• Utricle:the three semicircular canalsopen into the utricle. It sensesmotion in the horizontal plane(i.e., forward-backwardmovement, left-rightmovement, or both)
FIGURE 8.2 Vestibular system.
© Springer Publishing Company
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Posteriorcanal
Superiorcanal
Utriculus
Posterior-canalampulla
Particles
Particles
Gravity
Gravity
Vantagepoint
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Superiorcanal
Utriculus
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Posteriorcanal
Gravity
Gravity
A
B
Vantagepoint
Sagittal body
plane
FIGURE 8.3 Dix–Hallpike maneuver.
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3
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4
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FIGURE 8.4 Epley maneuver (for right-sided posterior semicircular canal benign paroxysmal positional vertigo).
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Evaluation and Management of theNose—External Conditions
1 2 3 4 5
Type Anatomical Defi cits
1 Minor supratip or nasal dorsal depression, with a normal projection of lower third of the nose
2 Depressed nasal dorsum (moderate to severe) with relatively prominent lower third
3 Depressed nasal dorsum (moderate to severe) with loss of tip support and structural defi cits in the lower third of the nose
4 Catastrophic (severe) nasal dorsal loss with signifi cant loss of the nasal structures in the lower and upper thirds of the nose
FIGURE 10.1 Saddle nose deformity.
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FIGURE 11.1 Nasal polyp.
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Evaluation and Management ofthe Nasal Cavity and Paranasal Sinuses
Nasal Polyp Nasal Polyp
LEFT MIDDLE TURBINATELEFT MIDDLE TURBINATE
Nasal Polyp
LEFT MIDDLE TURBINATE
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Antrochoanal Polyp Antrochoanal Polyp
BEFORE EXCISIONBEFORE EXCISION
AFTER EXCISIONAFTER EXCISION
MiddleMiddleTurbinate Turbinate
Antrochoanal Polyp
BEFORE EXCISION
AFTER EXCISION
MiddleTurbinate
FIGURE 11.2 Antrochoanal polyp.
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FIGURE 11.3 Mucous retention cyst.
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Left Maxillary MucousLeft Maxillary MucousRetention Cyst Retention Cyst Left Maxillary MucousRetention Cyst
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POSTSURGICAL CHANGESPOSTSURGICAL CHANGES
Bilateral Ethmoidectomies withBilateral Ethmoidectomies withpatency of the frontoethmoid recesses. patency of the frontoethmoid recesses.
Postsurgical changes fromPostsurgical changes frombilateral antral window creation. bilateral antral window creation.
Moderate dependent mucosalModerate dependent mucosalthickening within the rightthickening within the rightmaxillary sinus. maxillary sinus.
POSTSURGICAL CHANGES
Bilateral Ethmoidectomies withpatency of the frontoethmoid recesses.
Postsurgical changes frombilateral antral window creation.
Moderate dependent mucosalthickening within the rightmaxillary sinus.
FIGURE 11.4 Postsurgical changes.
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FIGURE 11.5 Inverted papilloma.
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INVERTED PAPILLOMAINVERTED PAPILLOMA
LEFT MIDDLE TURBINATE LEFT MIDDLE TURBINATE
INVERTED PAPILLOMA
LEFT MIDDLE TURBINATE
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Nasal bone
Perpendicularplate of ethmoid
Septal cartilage
Vomeronasalcartilage
MaxillaVomer
Palatinebone
Pharyngealtonsil
Sphenoidsinus
Cribriform plateof ethmoid boneFrontal sinus
FIGURE 11.6 Nasal septum anatomy.
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FIGURE 11.7 Obstructed osteomeatal complex bilateral. Moderate left and right maxillary and ethmoid sinus mucosal thickening. Osteomeatal complex is
occluded bilaterally.
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FIGURE 11.8 Obstructed osteomeatal complex unilateral. Complete opacifi cation of the right maxillary sinus. Near-complete opacifi cation of the
anterior ethmoid air cells. Right osteomeatal complex is opacifi ed. There is also occlusion of the right frontoethmoid recess.
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FIGURE 11.9 Haller cell.
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Haller Cell Haller Cell Haller Cell
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Concha BullosaConcha BullosaConcha Bullosa
FIGURE 11.10 Concha bullosa.
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FIGURE 11.11 Agger nasi cell.
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Agger Nasi Cell Agger Nasi Cell Agger Nasi Cell
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RIGHT MIDDLE TURBINATE RIGHT MIDDLE TURBINATE
RIGHT MAXILLARYRIGHT MAXILLARYOSTIA OSTIA
RIGHT ETHMOIDRIGHT ETHMOIDOSTIAOSTIA
RIGHT MIDDLE TURBINATE
RIGHT MAXILLARYOSTIA
RIGHT ETHMOIDOSTIA
FIGURE 11.12 Sinus ostia after endoscopic sinus surgery. View of the right ethmoid and maxillary ostia.
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Oroantral Fistula Oroantral Fistula Oroantral Fistula
FIGURE 11.13 Oroantral fi stula.
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FIGURE 11.14 Silent sinus syndrome. Scan shows marked reduction in left maxillary sinus volume. There is inferior bowing of the orbital fl oor with
increased left orbital volume and enophthalmos with an absence of the left maxillary ostium (compared to the right) and complete opacifi cation of the left
maxillary sinus with occlusion of the left osteomeatal complex (OMC). These fi ndings are compatible with silent sinus syndrome. Incidental note: There is a
mucus retention cyst versus a polyp in the right maxillary sinus. The right OMC is patent.
© Springer Publishing Company
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Evaluation and Management ofNasopharynx Conditions
FIGURE 12.1 Adenoid hypertrophy blocking the posterior nasopharynx on nasal endoscopic examination.
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FIGURE 12.2 Postop adenoidectomy scar as seen on nasopharyngoscopy examination.
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Evaluation and Management ofOropharynx Disorders
FIGURE 13.1 Aphthous ulcer.
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TONSIL HYPERTROPHYTONSIL HYPERTROPHYTONSIL HYPERTROPHY
FIGURE 13.2 Tonsil hypertrophy (on fi beroptic laryngoscopy examination).
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FIGURE 13.3 Tonsillitis.
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Infected tonsil
Edematous uvula
Tongue
Infected tonsil
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FIGURE 15.1 Warthin’s tumor. Within left parotid gland there is a peripherally enhancing mass with smooth well-defi ned margins arising within the deep parotid lobe and extending below it, measuring 2.8 x 2.77 cm. It abuts the
sternocleidomastoid. Pathology confi rmed Warthin’s tumor.
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Evaluation and Management ofSalivary Gland Conditions
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FIGURE 16.1 Branchial cleft cyst. Cyst in the right neck anterior to the parotid gland. Excision of the lesion was done and it was determined to be moderately
differentiated cystic squamous cell carcinoma.
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Evaluation and Management ofBenign Neck Conditions
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FIGURE 16.2 Thyroglossal duct cyst: Rounded lesion within midline of the tongue measures 3.3 x 6.1 x 4.5 cm with no evidence of calcifi cation. The lesion is
above the hyoid bone without extension beyond the borders of the tongue.
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Overview ofMalignant Neck Conditions
Dorsum ofDorsum ofTongueTongue
SCC of the tongueSCC of the tongue
Dorsum ofTongue
SCC of the tongue
FIGURE 17.1 Tongue mass.
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FIGURE 17.2 Squamous cell carcinoma at the base of the tongue: Mass has irregular margins, crossing the midline and measuring 3.7 x 3.4 x 5.9 cm.
It was determined to be a moderately to poorly differentiated squamous cell carcinoma predominantly involving the oropharynx with extension into the
posterior tongue.
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Nasopharyngeal MassNasopharyngeal Mass
Nasopharyngeal MassNasopharyngeal Mass
Nasopharyngeal MassNasopharyngeal MassNasopharyngeal MassNasopharyngeal Mass
Nasopharyngeal Mass
Nasopharyngeal Mass
Nasopharyngeal MassNasopharyngeal Mass
FIGURE 17.3 Nasopharyngeal mass.
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FIGURE 17.4 Squamous cell carcinoma of neck: CT with contrast shows a left neck mass interior to the sternocleidomastoid, with increased heterogeneity,
compatible with necrosis. The mass abuts the left carotid artery. There are multiple adjacent lymph nodes as well. Pathology results indicated that the neck
mass was a moderately differentiated squamous cell carcinoma.
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FIGURE 17.5 Lymphoma: Solid right parotid gland mass just inferior to the right ear along the posterior aspect of the inferior-most parotid
gland, 20 x 13 mm. The borders are indistinct with mild surrounding fatty infi ltration. No calcifi cation is observed. Pathology indicated malignant
lymphoma, follicular type.
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Evaluation and Management ofTrachea Disorders and Conditions
Cricothyroidotomy
Percutaneousdilational
tracheostomy site
Standardtracheostomy site
Thyroid cartilage
Cricothyroid membrane
Cricoid cartilage
Subcricoid space
First tracheal cartilage
Second tracheal cartilage
FIGURE 20.1 Tracheostomy tube insertion site.
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Plug
ObturatorInner cannula
Pilot balloon
Cuff inflation line
Outer cannula
Cuff
Fenestration
FIGURE 20.2 Tracheostomy tube.
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Evaluation and Management ofLarynx and Hypopharynx Disorders
FIGURE 22.1 Reinke’s edema.
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FIGURE 22.2 Vocal cord polyp and nodule.
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Right TVCRight TVC
Right TVCRight TVC Left TVCLeft TVC
Left TVCLeft TVC
VC PolypVC Polyp
VC NoduleVC Nodule
Right TVC
Right TVC Left TVC
Left TVC
VC Polyp
VC Nodule
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FIGURE 22.3 Right true vocal cord polyp.
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FIGURE 22.4 Right true vocal cord polyp before and after excision.
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FIGURE 22.5 Vocal cord cysts.
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FIGURE 22.6 Right true vocal cord intracordal cyst.
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FIGURE 22.7 Vocal cord granuloma.
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FIGURE 22.8 Vocal cord papilloma.
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FIGURE 22.9 Squamous cell carcinoma of right true vocal cord. CT shows signifi cant soft tissue density surrounded and nearly occluded
by the glottic portion of the airway. CT fi ndings were worrisome for malignancy. Biopsy results confi rmed moderately differentiated squamous cell carcinoma of
the right true vocal cord.
© Springer Publishing Company
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Quick Reference for Otolaryngology1.Physical Examination Documentation of Normal and Abnormal Findings From the Ear, Nose, and Throat ExaminationFigure 1.1 Normal tympanic membrane.Figure 1.2 Pinna.Figure 1.3 External, middle, and inner ear. Figure 1.4 Tympanic membrane.Figure 1.5 Central tympanic membrane perforation.Figure 1.6 Tympanosclerosis.Figure 1.7 External nose.Figure 1.8 Paranasal sinuses.Figure 1.9 Salivary glands.Figure 1.10 Oral cavity and oropharynx.Figure 1.11 Tonsil size scoring.Figure 1.12 Oropharynx, hypopharynx, trachea, and larynx.Figure 1.13 Larynx landmarks.Figure 1.14 Omega-shaped epiglottis and vallecula.Figure 1.15 Cartilages of larynx.Figure 1.16 Neck: Lymphatic system and node groups.
2. Ear, Nose, and Throat Anatomy and Physiology Normal FindingsFigure 2.1 Skull bone landmarks.Figure 2.2 Trigeminal nerve and facial nerve branches.Figure 2.3 Glossopharyngeal nerve.Figure 2.4 Middle and inner ear.Figure 2.5 Maxillary sinuses.Figure 2.6 Arteries of nasal cavity.Figure 2.7 Olfactory nerve.Figure 2.8 Frontal, ethmoid, and sphenoid sinuses.Figure 2.9 Oral cavity, tongue, and oropharynx.Figure 2.10 Mallampati Classification Score.Figure 2.11 Larynx.Figure 2.12 Anomalous neural and vascular anatomy of the larynx.Figure 2.13 Normal swallowing.
3. Physical Examination of the Cranial Nerves for the Head and NeckFigure 3.1 Cranial nerves.Figure 3.2 Eye anatomy.Figure 3.3 Trigeminal nerve branches: Sensory distribution. Figure 3.4 Facial nerve motor and sensory components.Figure 3.5 Vagus nerve distribution.
5. Evaluation and Management of Hearing and TinnitusFigure 5.1 Audiogram. Figure 5.2 Tympanogram.Figure 5.3 Conductive hearing loss (left ear).Figure 5.4 Sensorineural hearing loss (right ear).Figure 5.5 Mixed hearing loss (bilateral ears).Figure 5.6 Otosclerosis Carhart’s notch (right ear).
7. Evaluation and Management of Middle Ear ConditionsFigure 7.1 Bulging tympanic membrane as seen with otitis media.Figure 7.2 Bullous myringitis.Figure 7.3 Tympanic membrane perforation (large) with tympanic membrane scarring (left ear).Figure 7.4 Normal tympanostomy tube (Armstrong).Figure 7.5 Large tympanic membrane perforation.
8. Evaluation and Management of Inner Ear ConditionsFigure 8.1 Components of balance.Figure 8.2 Vestibular system.Figure 8.3 Dix–Hallpike maneuver. Figure 8.4 Epley maneuver (for right-sided posterior semicircular canal benign paroxysmal positional vertigo).
9. Evaluation and Management of Olfactory DisordersFigure 9.1 Olfaction.
10. Evaluation and Management of the Nose—External ConditionsFigure 10.1 Saddle nose deformity.
11. Evaluation and Management of the Nasal Cavity and Paranasal SinusesFigure 11.1 Nasal polyp.Figure 11.2 Antrochoanal polyp.Figure 11.3 Mucous retention cyst.Figure 11.4 Postsurgical changes.Figure 11.5 Inverted papilloma.Figure 11.6 Nasal septum anatomy. Figure 11.7 Obstructed osteomeatal complex bilateral. Moderate left and right maxillary and ethmoid sinus mucosal thickening. Osteomeatal complex is occluded bilaterally.Figure 11.8 Obstructed osteomeatal complex unilateral. Complete opacification of the right maxillary sinus. Near-complete opacification of the anterior ethmoid air cells. Right osteomeatal complex is opacified. There is also occlusion of the right frontoethmoid recess.Figure 11.9 Haller cell.Figure 11.10 Concha bullosa.Figure 11.11 Agger nasi cell.Figure 11.12 Sinus ostia after endoscopic sinus surgery. View of the right ethmoid and maxillary ostia.Figure 11.13 Oroantral fistula.Figure 11.14 Silent sinus syndrome. Scan shows marked reduction in left maxillary sinus volume. There is inferior bowing of the orbital floor with increased left orbital volume and enophthalmos with an absence of the left maxillary ostium (compared to the right) and complete opacification of the left maxillary sinus with occlusion of the left osteomeatal complex (OMC). These findings are compatible with silent sinus syndrome. Incidental note: There is a mucus retention cyst versus a polyp in the right maxillary sinus. The right OMC is patent.
12. Evaluation and Management of Nasopharynx ConditionsFigure 12.1 Adenoid hypertrophy blocking the posterior nasopharynx on nasal endoscopic examination.Figure 12.2 Postop adenoidectomy scar as seen on nasopharyngoscopy examination.
13. Evaluation and Management of Oropharynx DisordersFigure 13.1 Aphthous ulcer.Figure 13.2 Tonsil hypertrophy (on fiberoptic laryngoscopy examination).Figure 13.3 Tonsillitis.
15. Evaluation and Management of Salivary Gland ConditionsFigure 15.1 Warthin’s tumor. Within left parotid gland there is a peripherally enhancing mass with smooth well-defined margins arising within the deep parotid lobe and extending below it, measuring 2.8 x 2.77 cm. It abuts the sternocleidomastoid. Pathology confirmed Warthin’s tumor.
16. Evaluation and Management of Benign Neck ConditionsFigure 16.1 Branchial cleft cyst. Cyst in the right neck anterior to the parotid gland. Excision of the lesion was done and it was determined to be moderately differentiated cystic squamous cell carcinoma.Figure 16.2 Thyroglossal duct cyst: Rounded lesion within midline of the tongue measures 3.3 x 6.1 x 4.5 cm with no evidence of calcification. The lesion is above the hyoid bone without extension beyond the borders of the tongue.
17. Overview of Malignant Neck ConditionsFigure 17.1 Tongue mass.Figure 17.2 Squamous cell carcinoma at the base of the tongue: Mass has irregular margins, crossing the midline and measuring 3.7 x 3.4 x 5.9 cm. It was determined to be a moderately to poorly differentiated squamous cell carcinoma predominantly involving the oropharynx with extension into the posterior tongue.Figure 17.3 Nasopharyngeal mass.Figure 17.4 Squamous cell carcinoma of neck: CT with contrast shows a left neck mass interior to the sternocleidomastoid, with increased heterogeneity, compatible with necrosis. The mass abuts the left carotid artery. There are multiple adjacent lymph nodes as well. Pathology results indicated that the neck mass was a moderately differentiated squamous cell carcinoma.Figure 17.5 Lymphoma: Solid right parotid gland mass just inferior to the right ear along the posterior aspect of the inferior-most parotid gland, 20 x 13 mm. The borders are indistinct with mild surrounding fatty infiltration. No calcification is observed. Pathology indicated malignant lymphoma, follicular type.
20. Evaluation and Management of Trachea Disorders and ConditionsFigure 20.1 Tracheostomy tube insertion site.Figure 20.2 Tracheostomy tube.
22. Evaluation and Management of Larynx and Hypopharynx DisordersFigure 22.1 Reinke’s edema.Figure 22.2 Vocal cord polyp and nodule.Figure 22.3 Right true vocal cord polyp.Figure 22.4 Right true vocal cord polyp before and after excision.Figure 22.5 Vocal cord cysts.Figure 22.6 Right true vocal cord intracordal cyst.Figure 22.7 Vocal cord granuloma.Figure 22.8 Vocal cord papilloma.Figure 22.9 Squamous cell carcinoma of right true vocal cord. CT shows significant soft tissue density surrounded and nearly occluded by the glottic portion of the airway. CT findings were worrisome for malignancy. Biopsy results confirmed moderately differentiated squamous cell carcinoma of the right true vocal cord.