--- module: 056-01 language: en chapter: 56 title: "Ear, Nose, Throat, Hearing, Balance, Voice, and Swallowing" module_title: "Foundations" source_sha256: 4e0a1546281d515378caffabfa86fdba4093cdcb682d3f85317bb98968a9591e --- # Ear, nose, throat, hearing, balance, voice, and swallowing ## Orientation and red flags ### Many functions concentrated in a small region #### Minor swelling obstructs airflow #### Infection spreads to orbit, skull base, neck, brain ### Recognise stridor, drooling, respiratory effort ### Expanding neck swelling, severe haemorrhage ### Sudden sensorineural loss, central vertigo ## Hearing physiology and assessment ### Ossicles transmit and amplify to cochlear fluid ### Basilar membrane bends hair-cell stereocilia #### Mechanical energy becomes auditory nerve signals ### High frequencies at base, low at apex ### Bilateral brainstem input supports localisation ### Conductive: external or middle-ear transmission ### Sensorineural: cochlea, nerve, central pathways ### Sudden sensorineural loss is an emergency #### Time-sensitive corticosteroid treatment ### Audiometry quantifies air, bone, speech #### Tuning forks do not replace it ## External and middle-ear disease ### Otitis externa after moisture or trauma #### Tragal tenderness, itch, discharge #### Clean canal, topical antimicrobial ### Invasive skull-base infection in diabetes #### Urgent imaging, systemic antipseudomonal therapy ### Acute otitis media follows Eustachian dysfunction #### Bulging inflamed membrane with effusion #### Analgesia central, antibiotics selective ### Persistent effusion affects speech development ### Cholesteatoma: expanding keratinising epithelium #### Bone erosion, facial palsy, intracranial infection #### Definitive management usually surgical ### Perforation: avoid water and ototoxic drops ## Tinnitus and hearing rehabilitation ### Sound without an external source ### Unilateral, asymmetric, pulsatile need investigation #### Pulsatile: vascular flow or raised pressure ### Non-pulsatile usually accompanies hearing loss #### Hearing aids, sound strategies, CBT #### Do not promise a universal cure ### Age and noise loss hit high frequencies ### Cochlear implant stimulates nerve in severe loss ## Vestibular physiology and vertigo ### Canals detect angular acceleration ### Utricle and saccule: linear acceleration, gravity ### Vertigo is an illusion of movement #### Dizziness may mean presyncope or disequilibrium ### BPPV from displaced otoconia #### Delayed fatigable positional nystagmus #### Canalith repositioning treats ### Neuritis spares hearing, labyrinthitis does not ### Meniere: episodic vertigo, fluctuating hearing ### Stroke can mimic peripheral disease #### Expert head impulse, nystagmus, skew #### Severe headache, cannot stand, vertical nystagmus ### Suppressants brief, early mobilisation ## Nose and sinuses ### Nose warms, humidifies, filters air ### Allergy: itch, sneeze, watery discharge #### Saline, intranasal corticosteroids ### Topical decongestants cause rebound congestion ### Acute rhinosinusitis usually viral #### Orbital or intracranial spread is an emergency ### Anterior epistaxis: sit forward, pinch soft nose #### Posterior bleeding needs specialist control ### Unilateral symptoms may signal malignancy ## Throat, tonsils, and deep-neck infection ### Pharyngitis mostly viral, test selectively ### Mononucleosis: protect the vulnerable spleen #### Aminopenicillin rash without true allergy ### Peritonsillar abscess: trismus, uvular deviation ### Retropharyngeal infection threatens airway ### Ludwig angina elevates the tongue #### Early airway, antibiotics, drainage ## Voice, larynx, and airway ### Hoarseness from laryngitis to cancer #### Persistent or red flags need laryngoscopy ### Stridor is an emergency sign #### Inspiratory: extrathoracic obstruction #### Biphasic: glottic or subglottic narrowing ### Calm, oxygen, airway expertise ### Adrenaline, foreign-body removal, surgical airway ## Swallowing ### Oral, pharyngeal, sphincter, oesophageal phases ### Dysfunction: cough, wet voice, pneumonia ### Bedside screen only estimates risk #### Silent aspiration needs instrumental study ### Posture, texture, rehabilitation, mouth care ### Thickened fluid may impair hydration