Ear nose and throat diseases pdf
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- Ear, Nose and Throat Common Conditions
- Ear, Nose and Throat Problems
- Epidemiology of ENT emergencies
- Endocrinology & Metabolism International Journal
The object of the study was to demonstrate the abilities of optical coherence tomography OCT technique in diagnostics of inflammatory processes in ear, nose, and throat ENT. When used in diagnostics of the nose and pharynx, OCT facilitates differential diagnostics of rhinitis enabling differentiation between the normal state, two stages of allergic rhinitis, vasomotor and atrophic rhinitis and diagnostics of pharyngitis. This paper also demonstrates the ability of OCT to monitor changes in pharynx induced by cryotherapy.
Received: January 01, Published: ,. Citation: DOI:. Download PDF.
Ear, Nose and Throat Common Conditions
The object of the study was to demonstrate the abilities of optical coherence tomography OCT technique in diagnostics of inflammatory processes in ear, nose, and throat ENT. When used in diagnostics of the nose and pharynx, OCT facilitates differential diagnostics of rhinitis enabling differentiation between the normal state, two stages of allergic rhinitis, vasomotor and atrophic rhinitis and diagnostics of pharyngitis.
This paper also demonstrates the ability of OCT to monitor changes in pharynx induced by cryotherapy. In diagnostics of the tympanic cavity the ability of OCT to differentiate between different stages of chronic otitis and retraction of the tympanic membrane is demonstrated. Finally a correlation is discussed between morphologic alterations induced by inflammatory processes and changes in diagnostic OCT images. Inflammatory diseases prevail over other ear, nose, and throat ENT pathologies and have a higher risk of complication development.
Their diagnostics is complicated by a variety of clinical manifestations and morphologic forms, as well as of a prevalence of latent inflammatory processes . The proper selection of treatment should be based on a clear understanding and recognition of the etiological and morphological types of the disease, which if incorrectly assessed, can lead to serious complications [2, 3]. Therefore it is, for example, very important to differentiate between allergic and non-allergic rhinitis, as the treatment strategy for these forms differ dramatically [3, 4].
Currently, simple and inexpensive diagnostic methods are being developed which combine biochemical blood analysis, allergy testing, cytological study of smears from the nasal cavity and even mucosal biopsies. However, further advancement of diagnostic techniques is clearly required. Optical coherence tomography OCT has a high potential for diagnostics and differential diagnostics of inflammatory diseases in ENT. However, the potential of OCT for the study of the internal structure of mucous membrane of nasal cavity and nasopharynx for diagnosis of non-tumor inflammatory pathologies has already been discussed [9, 10].
This potential lies in the morphological heterogeneity of rhinitis and pharyngitis, which is manifested by a variety of types and subtypes of inflammatory processes in the nose and nasopharynx. Information about morphological features can be a key in the clarification of diagnosis and the decisions to be made about treatment strategies. The possibility of in vivo real-time acquisition of such information using OCT is a very attractive possibility for clinicians.
Inflammatory diseases of the middle ear are the most difficult and dangerous pathological processes in otolaryngology.
This is primarily due to the anatomical and physiological connection of the middle ear with the inner ear and topographic proximity to the meninges, which can be instrumental in the development of severe cerebral complications . The most common pathology of the middle ear leading to hearing loss and requiring surgical treatment is chronic suppurative otitis media. The condition of the mucosa of tympanic membrane in patients with chronic otitis media is one of the key factors in selection of treatment strategy.
Otomicroscopy is a traditional technique for evaluation of a mucous membrane. However, results of such diagnostics are subjective and strongly depend on the facilities available, qualification of the clinician and his visual perception. In this context, complementary diagnostic techniques that allow procurement of objective results are very important.
The most common complementary techniques include histological study, evaluation of blood flow in the mucosa, the study of ciliary activity, etc. All these techniques provide important information about the state of the mucous membrane of the middle ear. However, they are invasive histological examination , complex, time-consuming and cannot be used in the everyday practice of an otolaryngologist . Thus novel non-invasive and convenient techniques are required for the diagnosis of inflammatory diseases of the middle ear, and OCT has a high potential for this application [13, 14].
The aim of this study was to demonstrate the principal ability of OCT to distinguish morphological changes of mucosa of the nasal cavity, pharynx and middle ear caused by inflammatory diseases. This study was performed for the first time in a clinical environment, both for differential diagnostics of various forms of inflammatory diseases and for dynamic examination of patients, allowing typical OCT images of mucosa to be obtained at different stages of inflammatory processes throughout the course of the study.
In total, 76 patients with inflammatory diseases of the nose, pharynx and middle ear were registered for the study Table 1. All patients underwent a standard clinical examination in combination with OCT. The set-up was equipped with a forward-looking contact miniprobe. The group of patients with chronic inflammatory diseases of the nose was made up of 50 patients 25 females, 25 males, average age: The group of chronic rhinitis was made up of four subgroups:.
The control group for unaltered nasal cavity mucosa included 35 volunteers with a history of lack of chronic rhinitis, as well as the absence of complaints and evident changes of the mucosa. OCT examination was performed within the course of a standard rhinoscopy procedure.
The miniprobe was brought into contact with the mucosal surface of the lower turbinate under visual control. This study was conducted in an outpatient setting, without anesthesia and additional training of the patients. In 10 patients with chronic pharyngitis 4 females, 6 males, average age: 41 years the OCT examination was performed within the course of the cryotherapy procedure.
The control group for unaltered pharyngeal mucosa included 5 volunteers with a history of lack of chronic pharyngitis, as well as the absence of complaints and evident changes in the mucosa. The group of patients with chronic otitis media included 16 patients 12 females, 4 males, average age: 45 years.
All patients suffered from chronic otitis media with a defect of the stretched eardrum without cholesteatoma. The group of chronic otitis media contained two subgroups:. The control group for unaltered tympanic membrane included 8 volunteers with a history of lack of chronic otitis, as well as the absence of complaints and evident changes of the tympanic cavity.
OCT examination was performed within the course of a standard otoscopy procedure; the miniprobe was brought into contact with the mucosal surface of the tympanic cavity under microscope control. The OCT images of nasal mucosa are consistent with the known morphologic features in both normal and various forms of rhinitis. Figure 1 A shows the OCT image of normal nasal mucosa which corresponds to typical morphology i.
Vasomotor rhinitis is manifested by alterations in the epithelial layer: disorders in ciliary and transport activity of ciliated epithelium and hypersecretion of goblet cells, which promotes the formation of multilayer ciliated epithelium. This leads to a thickening of the upper layer with a moderate signal level in the OCT image Figure 1B. Allergic rhinitis is usually manifested by alterations in the characteristics that relate to discharge from the nasal cavity accompanied by development of eosinophilia of the discharge.
These alterations are accompanied by severe tissue edema, which is manifested by the appearance of areas of irregular shape with low signals in the OCT image Figure 1C. Atrophic rhinitis is manifested by thinning of the mucous membrane mainly due to the epithelial layer and sclerosis of the sub-epithelial tissues. OCT images of mucosa of inferior nasal concha: norm A , chronic vasomotor rhinitis B , allergic rhinitis C and atrophic rhinitis D. Chronic pharyngitis also reveals morphological heterogeneity.
The prevalence of certain morphological alterations determines the form of the disease i. Figure 2 A—C shows the OCT images of healthy mucosa of the pharynx, and hypertrophic pharyngitis before and after cryotherapy. The OCT image of the normal pharynx Figure 2A fully corresponds to the morphological structure of the pharynx.
The upper layer is characterized by a moderate signal level corresponding to stratified squamous epithelium, while the lower layer with a high signal level corresponds to lamina propria with a high content of elastin fibers.
In submucous layer glands and lymphoid, elements are manifested in OCT images by irregular shaped areas of different size and signal level. In the case of the catarrhal form of chronic pharyngitis, a persistent diffuse congestion of the veins accompanied by pronounced edema of tissues is observed leading to disintegration of morphological structures and an increase in the volume of lymphoid tissue Figure 2B.
Since OCT examination of the pharynx was conducted during the course of cryotherapy procedure, OCT images of the same site after cryotherapy were also obtained Figure 2C , which again demonstrates the high sensitivity of OCT to changes in the morphological characteristics of tissues. OCT images obtained from the same site of the same patient before and after cryotherapy differ significantly Figure 2B and C.
Cryotherapy is accompanied by water crystallization manifested in OCT images by disappearance of low-signal areas and a balance of the signal level in the upper layers. No OCT images of the tympanic cavity mucosa are possible in the normal state because the cavity cannot be reached due to access being blocked by an intact tympanic membrane. Different pathologies may induce holes in the tympanic membrane or decrease the inner pressure causing the tympanic membrane to be brought into contact with tympanic cavity mucosa.
In such situations the tympanic cavity mucosa can be reached by an OCT probe and OCT imaging allows morphological changes typical for different stages of an inflammatory process to be obtained Figure 3 A—D. Otomicroscopy and OCT images of tympanic cavity in case of chronic otitis without exacerbation A, C and in the period of exacerbation B, D. The black circles indicate the site of OCT inspection. In the normal state, the epithelial layer of the tympanic cavity mucosa is located on the basal membrane, behind which lamina propria is situated.
In this case the mucosa is tight against the bone wall. The OCT image of chronic otitis without exacerbation demonstrates a typical structure allowing not only the epithelial layer be distinguished but also a clear boundary between the mucosa and promontorium bone Figure 3C. Exacerbation induces a distinguished edema accompanied by cellular infiltration of all layers of the mucosa which causes blurring of the boundaries between layers and structural elements in the OCT image Figure 3D.
OCT imaging of the tympanic membrane also allows it to be distinguished in its various pathologies. Figure 4 A—D demonstrates OCT images of tympanic membrane in its normal and in three pathologic states. In normal state the tympanic membrane appears in an OCT image as a separate object with a high signal level.
Layered structures can be distinguished, revealing the epithelial, fibrous and mucosal layers Figure 4A. Analysis of diagnostic OCT images obtained in patients with chronic otitis without exacerbation allowed us to conclude that OCT enables retractions of tympanic membrane to be seen.
In the case of retraction the tympanic membrane is sucked into the middle ear space due to lower inner pressure and may come in contact with tympanic cavity mucosa which can be clearly detected by OCT Figure 4B. Acute exudative otitis is usually manifested by inflammation resulting in bulging of tympanic membrane resulting in a loss of the OCT signal level and a thickening of the layer that corresponds to the tympanic membrane in the OCT image Figure 4C.
Behind the layer, a weakly scattering media can be observed which is associated with exudate. Chronic mesotympanitis is manifested by significant thickening of the epithelial layer of tympanic membrane which can be clearly seen in the OCT image Figure 4D , and its perforation appears as low signal areas right part of the image.
OCT images of tympanic membrane in norm A , in case of retraction with the background of chronic otitis media without exacerbation B , acute exudative otitis C and chronic mesotympanitis during exacerbation stage D.
For diagnostics of the nose and pharynx, OCT images manifested changes that correlate with morphologic alterations. This would allow differential diagnostics of rhinitis enabling differentiation between the normal state, two stages of allergic rhinitis, vasomotor and chronic rhinitis and diagnostics of pharyngitis.
Also the ability of OCT to monitor changes in the pharynx induced by cryotherapy was demonstrated. The usefulness of OCT for diagnostics of the tympanic cavity was illustrated in its ability to differentiate between different stages of chronic otitis media and reveal tympanic membrane retraction. Unfortunately comparative analysis and interpretation of OCT in comparison with histologic date was not possibly as biopsy was contraindicated.
Information was taken therefore from the literature about the features of nose, pharynx and tympanic cavity morphology and its alterations in cases of various forms of inflammation, and was used instead for the interpretation of the obtained images.
This complicates the interpretation of diagnostic OCT images and requires the development of algorithms for the numerical processing of OCT images to increase diagnostic accuracy of the technique. Such algorithms are usually based on the extraction of numerical parameters of the OCT images, such as individual optical properties of tissue layers , parameters of the histograms of entire OCT image  or preselected region of interest . Numerous studies have consistently proved that the pathological processes in biological tissues significantly change their optical properties, which can be sensed by OCT see, for example, [15—17].
In the case of rhinitis and rhinopharyngitis, OCT provides information about the morphological features of the nose and pharynx tissues which can be further employed for diagnosis of various forms of inflammation and can contribute to a better choice of treatment. In diagnosis of otitis media, OCT is a promising method for accurate determination of inflammation stages, to reveal indications for surgery tympanoplasty , and in selecting the optimal timing for surgery.
Non-invasive and real-time imaging increases the attractiveness of OCT for clinicians, especially in diagnosing inflammatory diseases of ENT organs when biopsies are contraindicated. In our opinion, OCT has a high potential for noninvasive differential diagnostics of different forms of ENT chronic inflammatory diseases and real-time monitoring during the course of treatment. However, further studies with an increased number of patients with a variety of ENT pathologies are required to qualitatively evaluate diagnostic efficacy of OCT in diagnosing ENT pathologies for translation of the technique into clinical practice.
This work was financially supported by the basic financing of the Institute of Applied Physics within the framework of the Theme Differences between allergic and nonallergic rhinitis in a large sample of adolescents and adults.
Allergy ;62 9 —7.
Ear, Nose and Throat Problems
Galveston, Tex. This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. When this reviewer undertook to evaluate this small volume, he experienced a disconcerting inability to categorize it. It is not a reference work, a teaching text, a practitioner's handbook, or a student's synopsis.
Epidemiology of ENT emergencies
Ear, nose and throat problems range from common problems such as strep throat and ear infections to complex conditions such as tinnitus ringing in the ears , taste and smell disorders, and head and neck cancer. Most people experience an ear, nose or throat problem from time to time. Interested in becoming a Sutter patient? Noises in the ear, whether it be thumping, ringing, buzzing, roaring or any other unusual sound not explained by outside sounds, are called tinnitus. Tinnitus can be constant, intermittent, high or low pitched,
Diseases of the Ear, Nose, and Throat, Second Edition covers more updated topics on the diseases of the ear, nose, and throat, including the methods of examination and treatment of these diseases, compared to those presented in the previous edition. This book first discusses the clinical examination of the regions of the ear, nose, and throat. Each of the subsequent chapters discusses a particular organ and its diseases.
Although many ear nose and throat conditions require supervision from an Otorhinolaryngologist long term, wherever possible, the objective of an ear, nose and throat outpatient appointment is to provide an assessment of the patient, an opinion regarding the key clinical issues and advice to the patient and the referring practitioner over one to two visits followed by formal discharge from the clinic. If the condition is life-threatening, the patient should be sent to the nearest Emergency Department.
Endocrinology & Metabolism International Journal
Ear, nose and throat problems range from common problems such as strep throat and ear infections to complex conditions such as tinnitus ringing in the ears , taste and smell disorders, and head and neck cancer. Most people experience an ear, nose or throat problem from time to time. Interested in becoming a Sutter patient? Headaches after climax have been described over the years and are felt related to changes in the size of blood vessels after sex. Vertigo is more unusual and might suggest a problem with the inner ear system; a
Charlottesville, Va. This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. In both these new editions, the authors are well-known experienced clinicians and academicians, who have the ability to present their accumulated knowledge in a most acceptable manner.
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This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. This book was written primarily for the student and the general practitioner. The matter is admirably presented, concisely, and yet every important phase of otorhinolaryngology is covered. The work is divided into three parts. The first part deals with the anatomy and the physiology of the ears, the nose and the throat. The second part is devoted to a detailed description of various methods of examining the ears, the nose, the throat and the larynx, and this description is graphically supplemented by many photographs and a careful detailed report of the normal findings.