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Otorhinolaryngology is a surgical subspeciality within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face and neck.
A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate contains an opening into the nose. The term orofacial cleft refers to either condition or to both occurring together. These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders.
A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blood pressure occurs. Blood may also come up the nasolacrimal duct and out from the eye.
Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu disease and Osler–Weber–Rendu syndrome, is a rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain.
Aspirin-exacerbated respiratory disease (AERD), also called NSAID-exacerbated respiratory disease (NERD/N-ERD) or historically aspirin-induced asthma and Samter's Triad, refers to the triad of asthma, chronic rhinosinusitis with nasal polyps, and intolerance of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). AERD most commonly begins in early- to mid-adulthood and is a chronic disease that has no known cure. The cause of the disease is a dysregulation of the arachidonic acid metabolic pathway and of various innate immune cells, though the initial cause of this dysregulation is not currently know. While NSAID intolerance is a defining feature of AERD, simple avoidance does not prevent the onset, development or perennial nature of the disease.
The nasal cannula (NC) is a device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help. This device consists of a lightweight tube which on one end splits into two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows. The other end of the tube is connected to an oxygen supply such as a portable oxygen generator, or a wall connection in a hospital via a flowmeter. The cannula is generally attached to the patient by way of the tube hooking around the patient's ears or by an elastic headband. The earliest, and most widely used form of adult nasal cannula carries 1–3 litres of oxygen per minute.
Empty nose syndrome (ENS) is a potential complication of surgery to the nasal turbinates. ENS is a clinical syndrome that is often referred to as one form of secondary atrophic rhinitis in the medical literature. People with ENS have usually undergone a turbinectomy or other surgical procedures that reduce or injure the nasal turbinates. The overall incidence of ENS is unknown due to the lack of a reliable epidemiological study or International Classification of Diseases (ICD-10) code. According to this article, Dr. Talmadge noted that "many cases likely go unrecognized or underdiagnosed, and therefore unreported."
Augmentation pharyngoplasty is a kind of plastic surgery for the pharynx when the tissue at the back of the mouth is not able to close properly. It is typically used to correct speech problems in children with cleft palate. It may also be used to correct problems from a tonsillectomy or because of degenerative diseases. After the surgery, patients have an easier time pronouncing certain sounds, such as 'p' and 't', and the voice may have a less nasal sound.
Velopharyngeal inadequacy is a malfunction of a velopharyngeal mechanism which is responsible for directing the transmission of sound energy and air pressure in both the oral cavity and the nasal cavity. When this mechanism is impaired in some way, the valve does not fully close, and a condition known as 'velopharyngeal inadequacy' can develop. VPI can either be congenital or acquired later in life.
A palatal obturator is a prosthesis that totally occludes an opening such as an oronasal fistula. They are similar to dental retainers, but without the front wire. Palatal obturators are typically short-term prosthetics used to close defects of the hard/soft palate that may affect speech production or cause nasal regurgitation during feeding. Following surgery, there may remain a residual orinasal opening on the palate, alveolar ridge, or vestibule of the larynx. A palatal obturator may be used to compensate for hypernasality and to aid in speech therapy targeting correction of compensatory articulation caused by the cleft palate. In simpler terms, a palatal obturator covers any fistulas in the roof of the mouth that lead to the nasal cavity, providing the wearer with a plastic/acrylic, removable roof of the mouth, which aids in speech, eating, and proper air flow.
Pharyngeal flap surgery is a procedure to correct the airflow during speech. The procedure is common among people with cleft palate and some types of dysarthria.
Functional endoscopic sinus surgery (FESS), or functional endoscopic sinus surgery, is a procedure that is used to treat sinusitis and other conditions that affect the sinuses. Sinusitis is an inflammation of the sinuses that can cause symptoms such as congestion, headaches, and difficulty breathing through the nose.
Velopharyngeal insufficiency is a disorder of structure that causes a failure of the velum to close against the posterior pharyngeal wall during speech in order to close off the nose during oral speech production. This is important because speech requires sound and airflow to be directed into the oral cavity (mouth) for the production of all speech sound with the exception of nasal sounds. If complete closure does not occur during speech, this can cause hypernasality and/or audible nasal emission during speech. In addition, there may be inadequate airflow to produce most consonants, making them sound weak or omitted.
A tracheo-esophageal puncture is a surgically created hole between the trachea (windpipe) and the esophagus in a person who has had a total laryngectomy, a surgery where the larynx is removed. The purpose of the puncture is to restore a person’s ability to speak after the vocal cords have been removed. This involves creation of a fistula between trachea and oesophagus, puncturing the short segment of tissue or “common wall” that typically separates these two structures. A voice prosthesis is inserted into this puncture. The prosthesis keeps food out of the trachea but lets air into the esophagus for oesophageal speech.
Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.
Nasal emission is the abnormal passing of oral air through a cleft palate, or from some other type of velopharyngeal inadequacy (VPI), during the production of a consonant that requires a buildup of oral air pressure for proper pronunciation, such as /p/ or /s/. The escaping air tends to reduce the oral air pressure and impede the proper production of the consonant. Secondary effects sometimes noted with nasal emission are the development of improper compensatory pronunciation habits, including using a very soft voice that uses less breath pressure. Nasal emission can be detected by a number of simple techniques, such as looking for the fogging of a mirror held under the nares or measured more definitively by means of a nasal pneumotachograph
Orofacial Myofunctional Disorders (OMD) are muscle disorders of the face, mouth, lips, or jaw due to chronic mouth breathing.
Voice therapy consists of techniques and procedures that target vocal parameters, such as vocal fold closure, pitch, volume, and quality. This therapy is provided by speech-language pathologists and is primarily used to aid in the management of voice disorders, or for altering the overall quality of voice, as in the case of transgender voice therapy. Vocal pedagogy is a related field to alter voice for the purpose of singing. Voice therapy may also serve to teach preventive measures such as vocal hygiene and other safe speaking or singing practices.
Hypernasal speech is a disorder that causes abnormal resonance in a human's voice due to increased airflow through the nose during speech. It is caused by an open nasal cavity resulting from an incomplete closure of the soft palate and/or velopharyngeal sphincter. In normal speech, nasality is referred to as nasalization and is a linguistic category that can apply to vowels or consonants in a specific language. The primary underlying physical variable determining the degree of nasality in normal speech is the opening and closing of a velopharyngeal passage way between the oral vocal tract and the nasal vocal tract. In the normal vocal tract anatomy, this opening is controlled by lowering and raising the velum or soft palate, to open or close, respectively, the velopharyngeal passageway.
Oroantral fistula (OAF) is an epithelialised oroantral communication (OAC). OAC refers to an abnormal connection between the oral cavity and antrum. The creation of an OAC is most commonly due to the extraction of a maxillary (upper) tooth closely related to the antral floor. A small OAC may heal spontaneously but a larger OAC would require surgical closure to prevent the development of persistent OAF and chronic sinusitis.
References
- ↑ Pegoraro-Krook M. I., Dutka-Souza J. C., Marino V. C. (2008.) "Nasoendoscopy of velopharynx before and during diagnostic therapy", J App Oral Sci, 16(3):181-8.
- ↑ Seikel J. A., King D. W., Drumright D. G. (2010.) Anatomy & Physiology for Speech, Language, and Hearing, Cengage Learning, p. 290.
- ↑ Makarawo T. P., Howe D., Chan S. K. (2011.) "Is routine nasoendoscopy warranted in epistaxis patients after removal of nasal packing?", Allergy Rhinol, 2(1):12-5.
- ↑ Nasoendoscopy Procedure - White Memorial Medical Center
- ↑ Tabaee A., Hsu A. K., Kacker A. (2011.) "Indications, technique, safety, and accuracy of office-based nasal endoscopy with biopsy for sinonasal neoplasm", Int Forum Allergy Rhinol, 1(3):225-8.