Eustachian Tube (ET) Dysfunction Eustachian Tube (ET) Dysfunction Diagnosis of ET dysfunction Diagnosis of ET dysfunction depends upon: depends upon: – Subjective symptoms of aural – Ruling out presence of middle fullness and/or ear “popping” ear effusion (with or without a history of Tympanogram usually will reveal environmental allergies) reduced middle ear pressure – Careful otoscopic examination of the tympanic membrane with pneumatic insufflation to rule out effusion Eustachian Tube (ET) Dysfunction Middle Ear Effusion Treatment Diagnosis of middle ear effusion: – Otalgia with hearing loss – Nasal steroids/saline lavage – Otoscopic examination reveals – Antihistamines/Decongestants middle ear effusion with absent movement – Insufflation of ET – In an adult, a mass in the – Oral corticosteroids nasopharynx must be considered as a possible etiology – GERD treatment – Middle ear ventilation tube placement (only in rare instances) Middle Ear Effusion Middle Ear Effusion Audiogram will demonstrate a Treatment conductive hearing loss with a – Oral antibiotics “flat” tympanogram – Oral corticosteroids – Middle ear pressure equalization tube (PET) placement if persists Hemotympanum Tympanosclerosis (aka Myringosclerosis) Bloody middle ear effusion White plaque-like deposit on usually secondary to trauma tympanic membrane (TM) Workup should include a surface thorough neurologic examination – Usually secondary to frequent and CT scan of temporal bones otitis media and audiogram Blood will usually reabsorb No treatment necessary spontaneously over 4-12 weeks (unless impairment of TM If no resolution, PET is indicated mobility is noted) Tympanic Membrane Perforation Tympanic Membrane Perforation Occurs secondary to pressure Treatment should include: and/or fluid accumulation in – Oral antibiotics the middle ear (can be post – Ear drops head trauma) – Dry ear precautions Conductive hearing loss If perforation is small and/or Potential for otorrhea and post-traumatic, may recurrent middle ear infections spontaneously heal in 3-8 weeks without surgery Otitis Externa Otitis Externa Infection of external auditory Treatment should include: canal (EAC) – Oral antibiotics with anti- – Exquisitely painful Psudomonal coverage – Severe canal edema (conductive hearing loss) – Otowick placement – History of EAC trauma nearly – Otic drops with anti- always elicited Pseudomonal coverage – Multiple bacterial species (including Pseudomonas) are usually present Otitis Externa Exostosis Higher incidence in Hypertrophy of the bony external immunocompromised auditory canal populations Secondary to chronic exposure to cold water (surfing, ocean swimming) If any facial nerve weakness or No treatment needed unless near-total cranial neuropathies are present, EAC occlusion and/or secondary possibility of “malignant otitis conductive hearing loss externa” (skull base Need for meticulous ear cleaning after osteomyelitis) must be considered water exposure Nasal Polyps Nasal Polyps Inflammatory growths associated Diagnosis also depends upon with chronic allergies radiographic appearance of Can cause anatomic obstruction sinuses (limited CT scan) of sinus ostia with secondary acute sinusitis Associated with asthma and aspirin allergy (Sampter’s triad) Nasal Polyps Nasal Septal Hematoma Treatment Usually secondary to trauma – Antibiotics Not always an associated nasal – Oral corticosteroids bone fracture – Antihistamines/Decongestants Needle aspiration and/or incision and drainage – Nasal/sinus lavage – Surgery High incidence of recurrence Nasal Septal Hematoma Mucocele If hematoma is left undrained, Accumulation of mucous in secondary compromise of the submucosal space Most common on labial and vascular supply to nasal dorsal buccal surfaces cartilage can result is so-called Usually secondary to dental saddle nose deformity trauma Occasional superinfection in which case surgical excision may be indicated Oral Leukoplakia Oral Leukoplakia “White plaque” Workup should include thorough Presents most commonly on examination of mucosa of upper lateral aspect of tongue and aerodigestive tract (especially in buccal mucosa tobacco-users) Associated with trauma or Biopsy of areas of erythroplakia chronic inflammation/irritation more important than representative sampling Low (less than 5%) premalignant potential Geographic Tongue Torus Palatini and Torus Mandibularis Asymmetric hypertrophy of Bony overgrowths present in papillae of tongue palate and inner cortex of Unknown etiology mandible Rarely symptomatic Unknown etiology Treatment with antifungal or Unless overlying mucosa becomes antibiotic therapy not indicated inflamed, no treatment indicated for these benign lesions May be exacerbated by GERD Tonsillitis Tonsillar Lymphoma Infection of palatine tonsillar tissue with Lymphoma (usually B-cell type) exudates and trismus comon in the acute that develops within the setting lymphoid tissue of the palatine Chronic infections are associated with tonsils (part of Waldeyer’s ring) hypertrophy and possibly tonsoliths (tonsil stones) Important to keep high index of Treatment simultaneously with oral suspicion if significant corticosteroids and antibiotics for acute infections asymmetry, cervical adenopathy, Surgical excision may be indicated for constitutional symptoms frequent infections, airway obstruction, halitosis, or noticeable asymmetry Peritonsillar Abscess Parotitis Acute, suppurative infection with the Inflammation of the parotid ductal submucosal space around tonsils system with associated swelling, pain, Will always be uvular deviation, bulging erythema, fevers of soft palate, trismus, and muffled- Increased incidence in diabetics but can sounding voice occur secondary to episode of Treatment involves either needle dehydration aspiration and/or incision and drainage Rarely can occur secondary to parotid with oral antibiotics and corticosteroids stone (sialolith) Can re-accumulate following needle Treatment includes antibiotics, aspiration hydration, oral sialogogues, heat and massage directly over the involved gland Submandibular Sialoadenitis/Sialolithiasis Parotid Neoplasm Acute inflammation of submandibular Firm mass within the substance of salivary gland parotid salivary gland Can be secondary to dehydration (as in Approximately 80% benign parotitis) but more commonly due to Presence of ipsilateral facial nerve sialolith (stone) weakness, pain, or adenopathy increase Physical exam can often palpate stone likelihood of malignancy along course of submandibular duct Diagnostic workup should include MRI (within the floor of mouth) of parotid gland followed by fine needle Treatment is same as for parotitis aspiration biopsy except that frequent infections with an Treatment involves surgical excision of associated sialolith mandate surgical gland excision of gland Second Branchial Cleft Cyst Thyroglossal Duct Cyst . painless, fluctuant mass in the most common congenital lateral aspect of the neck that is neck mass (70%) situated deep to the sternomastoid muscle elevates on protrusion of . most common branchial cleft tongue or swallowing anomaly (95%) may develop draining sinus . often becomes apparent after on skin surface recent URI presentation varies depending upon age Thyroglossal Duct Cyst Bell’s Palsy Usually present at or just inferior Paralysis of all branches (upper to the hyoid bone and lower) of facial nerve – may be associated with ectopic Sudden onset thyroid tissue (1-2%) therefore imaging to confirm Viral prodrome (usually) the presence of normal Diagnosis of exclusion thyroid tissue is recommended Must rule out presence of co- Treatment is surgical excision existing mastoiditis, otitis (Sistrunk Procedure) externa, parotid tumor Bell’s Palsy Likely secondary to infection of facial nerve with herpes simplex virus Treatment includes oral corticosteroids and possibly also with an antiviral medication with reassessment after 7-10 days.