Ear Nose And Throat Diseases A Pocket Reference Pdf In Html


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The human nose is more than just a flap of flesh and cartilage on the front of the face. Besides being part of the respiratory system that inhales oxygen and exhales carbon dioxide, the nose also contributes to other important functions, such as hearing and tasting. Human noses can have a wide array of shapes and sizes due to genetics and injuries.

Ear infections are some of the most common reasons parents take their children to the doctor.

The Public Health Service-sponsored Clinical Practice Guideline, Treating Tobacco Use and Dependence: Update , on which this Quick Reference Guide for Clinicians is based was developed by a multidisciplinary, non-Federal panel of experts, in collaboration with a consortium of tobacco cessation representatives, consultants, and staff. Panel members, Federal liaisons, and guideline staff were as follows:. Michael C. Fiore, M. Bailey, M.

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A more recent article on ear pain is available. JOHN W. This version of the article includes supplemental content. When the ear is the source of the pain primary otalgia , the ear examination is usually abnormal. When the ear is not the source of the pain secondary otalgia , the ear examination is typically normal.

The cause of primary otalgia is usually apparent on examination; the most common causes are otitis media and otitis externa. The cause of secondary otalgia is often difficult to determine because the innervation of the ear is complex and there are many potential sources of referred pain.

The most common causes are temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis. If the diagnosis is not clear from the history and physical examination, options include a trial of symptomatic treatment without a clear diagnosis; imaging studies; and consultation with an otolaryngologist. Patients who smoke, drink alcohol, are older than 50 years, or have diabetes are at higher risk of a cause of ear pain that needs further evaluation.

Patients whose history or physical examination increases suspicion for a serious occult cause of ear pain or whose symptoms persist after symptomatic treatment should be considered for further evaluation, such as magnetic resonance imaging, fiberoptic nasolaryngoscopy, or an erythrocyte sedimentation rate measurement.

Ear pain otalgia is a common symptom in primary care with many possible causes. When the cause arises from the ear primary otalgia , the ear examination is usually abnormal and the diagnosis is typically apparent. In secondary or referred otalgia, the ear examination is usually normal, and the pain may be referred from a variety of sites.

Magnetic resonance imaging and referral for nasolaryngoscopy should be considered for patients with otalgia who have a normal ear examination and who have signs, symptoms, or risk factors for tumor e. Young i. Referral is appropriate if symptoms persist. Patients older than 50 years with unexplained otalgia and a normal ear examination should have an erythrocyte sedimentation rate measurement to help rule out temporal arteritis.

These nerves have long courses in the head, neck, and chest, which is why so many diseases can cause ear pain. The structures of the inner ear i. Therefore, most pathologic processes of the inner ear do not produce pain. It is often stated that 50 percent of pain in the ear is secondary otalgia, 1 and that 50 percent of secondary otalgia results from dental causes 2 ; however, these estimates are not based on published data.

In a study of patients visiting an ear, nose, and throat clinic, 58 presented with primary otalgia and 28 with secondary otalgia. Key points in the history include the patient's age, the location of pain asking the patient to point with one finger , the radiation of pain, aggravating factors e. Otologic symptoms that favor a primary cause include discharge, tinnitus, hearing loss, and vertigo. The severity of pain is not necessarily correlated with the seriousness of the cause.

For example, the pain from tumors can be mild, whereas the pain from dental caries and otitis media can be severe. Key components of the physical examination include inspection of the auricle and periauricular region and a thorough otoscopic examination, which may require cerumen removal.

Tenderness that occurs with traction on the auricle online Figure A or pressure on the tragus online Figure B indicates a condition of the external auditory canal, usually otitis externa. When the ear examination is normal, the physician should palpate the TMJ for tenderness and crepitus as the patient opens and closes the mouth online Figure C.

In addition, the basic examination should include inspection of the nose and oropharynx, palpation of the head and neck, and examination of the cranial nerves. The gingiva should be inspected and palpated and the teeth inspected and percussed to assess tenderness. Fiberoptic nasolaryngoscopy is not usually necessary. Patients may need this procedure if they have risk factors for tumor or if conservative measures do not resolve symptoms. An assessment of hearing, by audiometry or simple testing i.

An assessment of tympanic membrane mobility with pneumatic otoscopy or tympanometry can be helpful if there is suspicion of middle ear disease. When the physical examination is normal and the goal is to rule out tumor, the patient should have nasolaryngoscopy and magnetic resonance imaging MRI of the head and neck with gadolinium contrast.

For example, temporal bone trauma should be evaluated with CT scanning. Referring to a list of the causes of otalgia Tables 1 through 4 , 1 , 4 , 6 — 39 ; online Table A may be helpful, but in many patients these causes do not seem to fit. When the evaluation is unrevealing, a diagnosis of possible TMJ syndrome or eustachian tube dysfunction is often made. The physician must then decide whether to treat the patient symptomatically or to evaluate further with MRI or fiberoptic nasolaryngoscopy.

Figure 1 provides one approach to this decision. If conservative measures are not helpful, MRI or a more invasive examination should be considered. Recent upper respiratory infection Night restlessness in children.

Most common cause of primary ear pain More common in winter. Pain elicited by traction on auricle or pressure on tragus External auditory canal swollen and red with white debris 1. Findings can be subtle consider empiric therapy More common in summer Consider malignant necrotizing otitis externa in patients with diabetes or immunocompromise.

Insects, small objects Commonly occurs in children. Otoscopic signs of barotrauma are present in 10 percent of adults and 22 percent of children after an airplane flight Information from references 1 and 7 through Dental causes e. Caries Abscess Gingivitis Facial swelling Teeth tender to percussion. Pharyngitis or tonsillitis 4. Pharyngeal or tonsillar erythema Swelling Exudate. Cervical spine arthritis 4 , Decreased neck range of motion Tender spinous processes or paraspinal muscles.

Idiopathic 4 , 6 , In practice, often labeled TMJ syndrome, neuropathic pain, or eustachian tube dysfunction. Information from references 4 , 6 , and 11 through Suspect in refractory otitis externa in patients with diabetes, older patients, and those with immunocompromise Pain disproportionate to examination findings.

Easy to miss, findings can be subtle Obtain technetium bone scan to determine extent of disease and gallium tagged white-cell scan as baseline to follow response to treatment. Ramsay Hunt syndrome herpes zoster oticus 15 , Pain often precedes vesicles and is much worse than in Bell's palsy Patient may have vertigo, hearing loss, or tinnitus. Vesicular rash on auricle and external auditory canal Palsy of cranial nerve VII facial. Can involve other cranial nerves e.

Preceding insect bite, scratch, or piercing Rapid progression Perichondritis characterized by persistent redness, swelling, and pain. Perichondritis must be treated aggressively; sometimes requires parenteral antibiotics. Relapsing polychondritis 17 , Recurrent swelling and redness of auricle Hearing loss frequent. Noninfectious Can involve other cartilage such as trachea and bronchi.

Blunt or sharp trauma Frostbite Burns. Recent or concurrent otitis media Retroauricular pain. May require meticulous examination of external auditory canal May need to remove cerumen. Diagnosis of ear canal tumors is often delayed because of misdiagnosis as chronic inflammation. Viral myringitis 21 , Information from references 14 through Tumors e.

Risk factors include smoking, alcohol use, age older than 50 years, hoarseness, dysphagia, radiation exposure, weight loss. Neuralgias e. Pain usually brief seconds , severe, lancing, jabbing, electric-shock—like, episodic. Bell's palsy 23 , Retroauricular pain, less severe than Ramsay Hunt syndrome; can precede or follow the palsy.

Age older than 50 years Jaw claudication Diplopia. Erythrocyte sedimentation rate usually greater than 50 mm per hour Biopsy and prompt treatment are indicated. Myofascial pain, muscle spasm or inflammation of sternocleidomastoid or muscles of mastication 26 , Can be caused by clenching, bruxism, TMJ syndrome, and dental or oral disorders. Eagle's syndrome elongation of styloid process Deep, unremitting pain exacerbated by swallowing, yawning, or chewing May have pain in neck, foreign body sensation in throat.

Diagnosed with CT Most patients are 3 to 40 years of age and have had a tonsillectomy Styloid process longer than 1 inch 2. More common in women May have abnormal enhancement on MRI. Cricoarytenoid arthritis Ear pain and hoarseness Pain is worse with speaking, coughing, or swallowing. Gastroesophageal reflux 32 , Pain caused by irritation of oropharynx cranial nerves IX [glossopharyngeal] and X or of eustachian tube orifice.

More common in older men May have hypertension and other risk factors for atherosclerosis. Obtain chest CT scan or magnetic resonance angiogram; plain chest radiography is insensitive. Psychogenic e. Other rare causes e. Information from references 1 , 4 , and 23 through

Diagnosis of Ear Pain

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Nose: Facts, Function & Diseases

A more recent article on ear pain is available. JOHN W. This version of the article includes supplemental content.

Knowledge and awareness are vague and perhaps better called illusions. Keeping hands clean is one of the most important steps we can take to avoid gettin This textbook is being read for the last over 25 years generation after generation of medical students and practitioners in the field of Ear, Nose and Throat related diseases. It contains a comprehensive information about the specific ENT problems which are adequately evaluated so that treatment by general surgical methods is considered as the first choice.

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Diagnosis of Ear Pain

Старик умиротворенно вздохнул. - Так гораздо лучше… спасибо. - Pas du tout, - отозвался Беккер. - О! - Старик радостно улыбнулся.  - Так вы говорите на языке цивилизованного мира.

Кассирша сощурилась. - Вашей возлюбленной пятнадцать лет. - Нет! - почти крикнул Беккер.  - Я хотел сказать… - Чертовщина.  - Если бы вы согласились мне помочь.

Проще было его игнорировать. Хейл подошел к буфету, с грохотом открыл решетчатую дверцу, достал из холодильника пластиковую упаковку тофу, соевого творога, и сунул в рот несколько кусочков белой студенистой массы. Затем облокотился о плиту, поправил широкие серые брюки и крахмальную рубашку. - И долго ты собираешься здесь сидеть. - Всю ночь, - безучастно ответила Сьюзан. - Хм-м… - пробурчал Хейл с набитым ртом.  - Милая ночка вдвоем в Детском манеже.

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 - В них постоянно упоминается Цифровая крепость и его планы шантажа АНБ. Сьюзан отнеслась к словам Стратмора скептически. Ее удивило, что он так легко клюнул на эту приманку. - Коммандер, - возразила она, - Танкадо отлично понимал, что АНБ может найти его переписку в Интернете, он никогда не стал бы доверять секреты электронной почте. Это ловушка. Энсей Танкадо всучил вам Северную Дакоту, так как он знал, что вы начнете искать. Что бы ни содержалось в его посланиях, он хотел, чтобы вы их нашли, - это ложный след.

Новая волна паники охватила Сьюзан. Хейл всей тяжестью своего тела придавил ее ноги, холодно следя за каждым ее движением. В сознании Сьюзан промелькнуло все то, что она читала о приемах самозащиты. Она попыталась бороться, но тело ее не слушалось. Она точно окаменела.

И размышлял о том, что должен ей сказать, чтобы убедить остаться. Сьюзан кинулась мимо Стратмора к задней стене и принялась отчаянно нажимать на клавиши. - Пожалуйста, - взмолилась .

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Yvon A.
01.12.2020 at 01:41 - Reply

Strep throat is a sore throat caused by bacteria known as Streptococcus pyogenes, or group A streptococcus.

Cynthia L.
06.12.2020 at 09:20 - Reply

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