Textbook of Clinical Otolaryngology

Preface
Preface
Preface
Contents
Part I: Audiology
	1: General Audiology
		1.1	 Introduction
		1.2	 Definitions
		1.3	 Assessment of Hearing
			1.3.1	 Clinical Tests
				1.3.1.1	 Tuning Fork Tests
			1.3.2	 Audiometric Tests
				1.3.2.1	 Pure Tone Audiometry
					Note
					Masking
				1.3.2.2	 Speech Audiometry
				1.3.2.3	 Immittance/Impedance Test
					Tympanometry
					Acoustic Reflex
		1.4	 Special Tests of Hearing
			1.4.1	 Otoacoustic Emissions (OAE)
			1.4.2	 Auditory Brainstem Response (ABR)
				1.4.2.1	 Parameters Used in ABR
				1.4.2.2	 ABR Interpretation
				1.4.2.3	 ABR Interpretation According to the Type of Hearing Loss
				1.4.2.4	 Factors Affecting ABR
				1.4.2.5	 Application of ABR
			1.4.3	 Electrocochleography (ECoG)
			1.4.4	 Other Tests Like
		References
Part II: Otology/Neurology
	2: Temporal Bone Imaging
		2.1	 Introduction
		2.2	 Temporal Bone Imaging Techniques
			2.2.1	 MDCT (Multidetector-CT)
				2.2.1.1 CT Acquisition and Processing
			2.2.2	 CBCT (Cone-Beam CT)
				2.2.2.1 Advantages
				2.2.2.2 Inconvenients
			2.2.3	 MR Imaging
				2.2.3.1 General MR Imaging Characteristics
				2.2.3.2 Dedicated Sequences for Temporal Bone Imaging
					High-Resolution 3D T2-Weighted Sequence (3D Drive/CISS/FIESTA/etc.)
					Diffusion-Weighted Imaging (DWI)
					3D Flair Imaging 4 h Delayed After Gadolinium Injection for 3 T MRI
				2.2.3.3 Contraindications
		2.3	 Cross-Sectional Anatomy of the Temporal Bone
			2.3.1	 Cross-Sectional CT-Anatomy
			2.3.2	 Cross-Sectional MR-Anatomy
		2.4	 Systematic Reading of Temporal Bone Structures Imaging and Most Frequent Pathologies
			2.4.1	 External Auditory Canal (EAC)
				2.4.1.1 EAC Stenosis or Atresia
			2.4.2	 Tympanic Membrane (TM)
			2.4.3	 Tympanic Cavity
				2.4.3.1 Cholesteatoma
			2.4.4	 Ossicular Chain
			2.4.5	 Oval Window
			2.4.6	 Round Window
			2.4.7	 Facial Nerve
				2.4.7.1 Facial Nerve Paralysis
			2.4.8	 Mastoid and Sigmoid Sinus
			2.4.9	 Petrous Apex
			2.4.10	 Cochlea
				2.4.10.1 Cochlear Anomalies
				2.4.10.2 Labyrinthitis
				2.4.10.3 Imaging Workup for Cochlear Implant
			2.4.11	 Cochlear Aqueduct
			2.4.12	 Vestibule
			2.4.13	 Vestibular Aqueduct
			2.4.14	 Semicircular Canals
			2.4.15	 Inner Auditory Canal (IAC)
		2.5	 Temporal Bone Surfaces: Topographic Pathologies
			2.5.1	 Lateral Surface
				2.5.1.1 Anomalies of the Auricle
				2.5.1.2 External Necrotizing Otitis
					Pathways of Infection Spread
				2.5.1.3 Subperiosteal Abscess
			2.5.2	 Posterior Surface
				2.5.2.1 Extratemporal Intracranial Complications of CSOM
				2.5.2.2 Endolymphatic Sac
				2.5.2.3 IAC Meatus and the Cerebellopontine Angle
			2.5.3	 Superior Surface
				2.5.3.1 Tegmen Tympani
				2.5.3.2 Geniculate Ganglion and Greater Superficial Petrosal Nerve
			2.5.4	 Inferior Surface
				2.5.4.1 Glomus Tumor
		2.6	 Input of Postoperative Imaging/Follow-Up
			2.6.1	 Ossicular Reconstruction (Incus Interposition, PORP/TORP)
			2.6.2	 Stapes Prosthesis
			2.6.3	 Recurrent/Residual Cholesteatoma
			2.6.4	 Vestibular Schwannoma
		2.7	 Conclusion
		References
	3: The External Ear
		3.1	 Introduction
			3.1.1	 Embryology
			3.1.2	 Anatomy
			3.1.3	 Physiology
		3.2	 Auricle
			3.2.1	 Congenital Anomalies of the Auricle
				3.2.1.1	 Prominent Ear (Bat Ear)
				3.2.1.2	 Periauricular Pits, Sinuses, and Cysts
				3.2.1.3	 Skin Tags
				3.2.1.4	 Microtia
			3.2.2	 Acquired and Inflammatory Conditions of the Auricle
				3.2.2.1	 Keloids and Hypertrophic Scars
				3.2.2.2	 Chondritis/Perichondritis
				3.2.2.3	 Bacterial Infections
					Impetigo and Erysipelas
					Furunculosis and Carbunculosis
					Auricular Abscess
				3.2.2.4	 Ramsey Hunt Syndrome (Herpes Zoster Oticus)
				3.2.2.5	 Traumatic Injuries
					Hematoma
					Auricular Pseudocysts
					Laceration and Avulsion
				3.2.2.6	 Other
		3.3	 External Auditory Canal (EAC)
			3.3.1	 Congenital Anomalies of the External Auditory Canal
				3.3.1.1	 Aural Atresia
			3.3.2	 Acquired and Inflammatory Conditions of the External Auditory Canal
				3.3.2.1	 Cerumen Impaction
				3.3.2.2	 Foreign Bodies (FB)
				3.3.2.3	 External Ear Canal Infections
					Otitis Externa
					Otomycosis
					Malignant Otitis Externa (MOE)
					Myringitis
				3.3.2.4	 Keratosis Obturans and External Auditory Canal Cholesteatoma
					Keratosis Obturans
					External Canal Cholesteatoma
				3.3.2.5	 Benign Neoplasms
					Exostosis
					Osteoma
					Aural Polyp
				3.3.2.6	 Malignant Neoplasms
		References
	4: Otitis Media with Effusion (OME)
		4.1	 Introduction
		4.2	 Epidemiology
		4.3	 Pathogenesis
		4.4	 Risk Factors (Look at Table 4.1)
		4.5	 Clinical Features
			4.5.1	 Symptoms
			4.5.2	 Otoscopic Findings
			4.5.3	 Pneumatic Otoscopy
			4.5.4	 Tympanometry
			4.5.5	 Hearing Assessment
		4.6	 The Clinical Course of OME
		4.7	 Treatment
			4.7.1	 Indication of TT Insertion
			4.7.2	 TT Types
			4.7.3	 Role of Adenoidectomy
			4.7.4	 The Complications of TT (See Table 4.2)
		References
	5: Chronic Suppurative Otitis Media (CSOM)
		5.1	 Introduction
		5.2	 Epidemiology
		5.3	 Etiology
		5.4	 Molecular Biology of CSOM
		5.5	 Microbiology of CSOM
		5.6	 Histopathology of CSOM
		5.7	 Ossicular Chain Erosion in CSOM (Fig. 5.5)
		5.8	 Tympanosclerosis in CSOM
		5.9	 Cholesterol Granuloma
		5.10	 Clinical Features
			5.10.1	 Otoscopy
			5.10.2	 Audiology
		5.11	 Imaging Studies
		5.12	 Complications and Sequelae
		5.13	 Treatment of CSOM
			5.13.1	 Medical Treatment
			5.13.2	 Surgery for CSOM
				5.13.2.1	 Surgical Techniques in Tympanoplasty (Middle Ear Reconstruction)
					Tympanic Membrane Repair (Myringoplasty)
						TM Repair Outcome
					Ossicular Chain Reconstruction (Ossiculoplasty)
						Biomechanics of Ossiculoplasty
						Strategies and Techniques in Ossiculoplasty
						The Outcome of Ossiculoplasty
						Complications of Middle Ear Reconstruction
						Complications of Mastoidectomy or Tympano-Mastoidectomy
		5.14	 Some Unusual Clinical Presentations of CSOM
		References
	6: Cholesteatoma
		6.1	 Introduction
		6.2	 Epidemiology
		6.3	 Types of Cholesteatoma
			6.3.1	 Congenital Cholesteatoma
			6.3.2	 Acquired Cholesteatoma
		6.4	 Histopathology of Cholesteatoma
		6.5	 Pathogenesis of Cholesteatoma
			6.5.1	 Theories for Congenital Cholesteatoma
			6.5.2	 Theories for Acquired Cholesteatoma
		6.6	 Molecular Biology of Cholesteatoma
		6.7	 Cholesteatoma Origin and Growth Pathways [6]
		6.8	 Clinical Manifestations
			6.8.1	 Symptoms
			6.8.2	 Otomicroscopy
			6.8.3	 Audiological Testing
		6.9	 CT Imaging in Cholesteatoma
		6.10	 MRI in Cholesteatoma
		6.11	 Management of Cholesteatoma
			6.11.1	 Surgical Procedures
			6.11.2	 Endoscopy in Cholesteatoma
			6.11.3	 Hearing Rehabilitation in Cholesteatoma Surgery
			6.11.4	 Follow-Up
		6.12	 Complications of Chronic Otitis Media with Cholesteatoma [6]
		References
	7: Complications of Otitis Media
		7.1	 Introduction
		7.2	 Complications of Acute Otitis Media
			7.2.1	 Extracranial Complications
			7.2.2	 Intracranial Complications
		7.3	 Complications of Chronic Otitis Media
			7.3.1	 Extracranial Complications
			7.3.2	 Intracranial Complications
		References
	8: Otosclerosis
		8.1	 Introduction
		8.2	 Epidemiology
		8.3	 Pathogenesis
		8.4	 Histology
		8.5	 Sites of Predilection
		8.6	 Clinical Manifestations
		8.7	 Clinical Evaluation
		8.8	 Imaging: High-Resolution CT Scan
		8.9	 Stapes Surgery
			8.9.1	 Indications
			8.9.2	 Contraindications
			8.9.3	 Surgical Steps (Video 8.1)
				8.9.3.1	 Stapedectomy vs. Stapedotomy
				8.9.3.2	 Laser in Stapes Surgery
				8.9.3.3	 Prosthesis Selection
				8.9.3.4	 Intraoperative Challenges in Stapes Surgery [7]
			8.9.4	 Outcome of Stapes Surgery
			8.9.5	 Complications of Stapes Surgery
				8.9.5.1	 Failure in Stapes Surgery
		8.10	 Conservative Treatment of Hearing Loss in Otosclerosis
		References
	9: Congenital Hearing Loss
		9.1	 Introduction
		9.2	 Neonatal Hearing Screening
		9.3	 Evaluation of a Child with Congenital Hearing Loss
		9.4	 Categories of Congenital Hearing Loss
		References
	10: Sensorineural Hearing Loss (SNHL)
		10.1	 Introduction
		10.2	 Etiology of Sensorineural Hearing Loss
			10.2.1	 Congenital
			10.2.2	 Acquired
				10.2.2.1	 Presbycusis
					Management
				10.2.2.2	 Ototoxicity
				10.2.2.3	 Noise-Induced Hearing Loss
					Management
				10.2.2.4	 Sudden Sensorineural Hearing Loss
					Management
				10.2.2.5	 Auditory Neuropathy/Dys-Synchrony
				10.2.2.6	 Autoimmune Inner Ear Disease (AIED)
					Management
		10.3	 Hearing Aids and Auditory Rehabilitation
		References
	11: Tinnitus and Hyperacusis
		11.1	 Introduction
		11.2	 Tinnitus
			11.2.1	 Subjective Non-pulsatile Tinnitus
				11.2.1.1	 Hearing Loss Subtype
				11.2.1.2	 Somatic Tinnitus Subtype
				11.2.1.3	 Typewriter Tinnitus
			11.2.2	 Objective Tinnitus
			11.2.3	 Non-pulsatile Objective Tinnitus
			11.2.4	 Pulsatile Tinnitus
				11.2.4.1	 Synchronous Pulsatile Tinnitus
				11.2.4.2	 Non-synchronous Pulsatile Tinnitus
		11.3	 Hyperacusis
		References
	12: Physiology and Diagnostic Tests of the Vestibular System
		12.1	 Introduction
		12.2	 Anatomy of the Vestibular System
		12.3	 Vestibular Reflexes
		12.4	 Nystagmus: Involuntary Repetitive Rhythmic Eye Movement
		12.5	 Vestibular Diagnostic Studies
			12.5.1	 Videonystagmography (VNG)/Electronystagmography (ENG)
			12.5.2	 Oculomotor Testing
			12.5.3	 Positional and Positioning (Dix–Hallpike) Testing
			12.5.4	 Caloric Test
			12.5.5	 Kinetic Rotatory Chair
			12.5.6	 Vestibular Evoked Myogenic potential
			12.5.7	 Video Head Impulse Test (vHIT)
			12.5.8	 Computerized Dynamic Posturography
		References
	13: Dizziness and Vestibular Disorders
		13.1	 Introduction
		13.2	 Evaluation of a Dizzy Patient
			13.2.1	 History
			13.2.2	 Examination
		13.3	 Vertigo
			13.3.1	 Peripheral Vertigo
			13.3.2	 Central Vertigo
		13.4	 Vestibular Disorders
			13.4.1	 Vestibular Neuritis
			13.4.2	 Meniere’s Disease
				13.4.2.1	 Epidemiology
				13.4.2.2	 Physiopathology
				13.4.2.3	 Diagnosis
				13.4.2.4	 Electrophysiologic Studies
				13.4.2.5	 Management
			13.4.3	 Benign Paroxysmal Positional Vertigo
				13.4.3.1	 Epidemiology
				13.4.3.2	 Pathophysiology of BPPV
				13.4.3.3	 Diagnosis and Treatment of PSC-BPPV
				13.4.3.4	 Diagnosis and Treatment of LSC-BPPV
				13.4.3.5	 Surgical Treatment of BPPV
			13.4.4	 Migraine-Associated Vertigo
				13.4.4.1	 Prevalence
				13.4.4.2	 Clinical Manifestations
				13.4.4.3	 Diagnosis
				13.4.4.4	 Treatment
			13.4.5	 Superior Canal Dehiscence Syndrome
			13.4.6	 Perilymph Fistula
		13.5	 Central Causes of Vertigo
			13.5.1	 Chiari Malformation
			13.5.2	 Vertebrobasilar Insufficiency
			13.5.3	 Vertebral Artery Dissection
		13.6	 Disequilibrium
		References
	14: Perilymphatic Fistula
		14.1	 Introduction
		14.2	 Clinical Manifestations
		14.3	 Workup
		14.4	 Management
		14.5	 Etiologic Causes
			14.5.1	 Barotrauma (Fig. 14.1)
			14.5.2	 Acoustic Trauma
			14.5.3	 Trauma
			14.5.4	 Stapedectomy
			14.5.5	 Superior Semicircular Canal Dehiscence
			14.5.6	 Mondini Malformation [2] (Fig. 14.4)
			14.5.7	 Congenital Perilymphatic Fistula
			14.5.8	 Perilymphatic Fistula in Children
		References
	15: Temporal Bone Trauma
		15.1	 Temporal Bone Fractures
			15.1.1	 Introduction
			15.1.2	 Types
				15.1.2.1	 Longitudinal Fractures
				15.1.2.2	 Transverse Fractures
				15.1.2.3	 Oblique or Mixed Fractures
			15.1.3	 Clinical Presentation
				15.1.3.1	 Bleeding
				15.1.3.2	 Hearing Loss
				15.1.3.3	 Facial Nerve Paralysis
				15.1.3.4	 Vertigo and Nystagmus
				15.1.3.5	 CSF Otorhinorrhea
			15.1.4	 Physical Examination
			15.1.5	 Investigations
			15.1.6	 Treatment
				15.1.6.1	 Medical
				15.1.6.2	 Surgical
		15.2	 Middle Ear Trauma
			15.2.1	 Introduction
			15.2.2	 Clinical Presentation
			15.2.3	 Physical Examination
			15.2.4	 Investigations
			15.2.5	 Treatment
				15.2.5.1	 Medical
				15.2.5.2	 Surgical
		15.3	 Barotrauma
			15.3.1	 Introduction
			15.3.2	 Etiology
			15.3.3	 Clinical Presentation
			15.3.4	 Diagnosis
			15.3.5	 Treatment
				15.3.5.1	 Medical
				15.3.5.2	 Surgical Treatment
			15.3.6	 Prevention
		References
	16: Cerebellopontine Angle Pathologies
		16.1	 Introduction
		16.2	 Anatomy of the Cerebellopontine Angle
			16.2.1	 Vascular Structures of CPA
			16.2.2	 Cranial Nerves in the CPA (Fig. 16.3)
			16.2.3	 Internal Auditory Canal
			16.2.4	 Surgical Endoscopical Anatomy of the CPA (Fig. 16.4)
		16.3	 Cerebellopontine Angle (CPA) Tumors
			16.3.1	 Vestibular Schwannoma (VS)
				16.3.1.1	 Clinical Presentation
				16.3.1.2	 Diagnosis
				16.3.1.3	 Management
					Observation
					Stereotactic Radiation Therapy
					Surgery
			16.3.2	 Other Cerebellopontine Angle Tumors
				16.3.2.1	 Meningiomas
				16.3.2.2	 Epidermoid Cysts
				16.3.2.3	 Facial and Lower Cranial Nerve Schwannomas
					Management Plan
				16.3.2.4	 Arachnoid Cysts (1%)
				16.3.2.5	 Others
		16.4	 Neurovascular Conflicts of CPA
			16.4.1	 Pathogenesis
			16.4.2	 Hemifacial Spasm (HFS)
			16.4.3	 Trigeminal Neuralgia (TN)
			16.4.4	 Vascular Compression of the Vestibulocochlear Nerve
			16.4.5	 Glossopharyngeal Neuralgia (GN)
		Further Reading
	17: Lateral Skull Base Pathologies
		17.1	 Introduction
		17.2	 Jugular Foramen Tumors
			17.2.1	 Paraganglioma
				17.2.1.1	 Clinical Presentation
				17.2.1.2	 Diagnostic Tests
				17.2.1.3	 Staging
				17.2.1.4	 Treatment
					Surgery
			17.2.2	 Other Jugular Foramen Tumors
		17.3	 Petrous Apex Lesions
			17.3.1	 Cholesterol Granuloma
			17.3.2	 Asymmetric Marrow
			17.3.3	 Effusion/Trapped Fluid
			17.3.4	 Cholesteatoma/Epidermoid Cyst
			17.3.5	 Petrous Apicitis
			17.3.6	 Chordoma
			17.3.7	 Chondrosarcoma
			17.3.8	 Metastasis
		17.4	 Diffuse Temporal Bone/Other Skull Base Lesions
			17.4.1	 Fibrous Dysplasia
			17.4.2	 Eosinophilic Granuloma
			17.4.3	 Rhabdomyosarcoma
			17.4.4	 Endolymphatic Sac Tumor
			17.4.5	 Osteopetrosis
		References
	18: The Facial Nerve
		18.1	 Introduction
		18.2	 Facial Nerve Anatomy
		18.3	 House–Brackmann Scale
		18.4	 Facial Nerve Injury and Regeneration
			18.4.1	 Facial Nerve Injury Classification (Fig. 18.2)
		18.5	 Facial Nerve Function Tests
			18.5.1	 Electroneuronography (ENoG: Evoked EMG)
			18.5.2	 Electromyography (EMG)
			18.5.3	 Nerve Excitability Test (NET)
			18.5.4	 Maximum Stimulation Test (MST)
		18.6	 Unilateral Facial Nerve Weakness (Fig. 18.3)
			18.6.1	 Congenital Facial Palsy
			18.6.2	 Bell’s Palsy
				18.6.2.1	 Clinical
				18.6.2.2	 Treatment
				18.6.2.3 Prognosis
			18.6.3	 Traumatic Facial Palsy
				18.6.3.1	 Blunt Trauma
				18.6.3.2	 Penetrating Trauma
			18.6.4	 Herpes Zoster Oticus/Ramsay Hunt Syndrome
				18.6.4.1	 Clinical
				18.6.4.2	 Diagnosis
				18.6.4.3	 Treatment
			18.6.5	 Acute Otitis Media and Mastoiditis
			18.6.6	 Chronic Otitis Media
				18.6.6.1	 Treatment
			18.6.7	 Malignant Otitis Externa
				18.6.7.1	 Diagnosis
				18.6.7.2	 Treatment
			18.6.8	 Facial Nerve Neoplasms
				18.6.8.1	 Management Plan
				18.6.8.2	 Surgery
			18.6.9	 Iatrogenic Facial Paralysis
				18.6.9.1 Parotid Surgery
				18.6.9.2	 Ear Surgery
		18.7	 Bilateral Facial Nerve Paralysis (Fig. 18.7)
			18.7.1	 Melkersson–Rosenthal Syndrome
		18.8	 Facial Nerve Reanimation Strategies
			18.8.1	 Static Procedures
			18.8.2	 Dynamic Procedures
		18.9	 Hemifacial Spasm
			18.9.1	 Diagnosis
			18.9.2	 Treatment
		References
	19: External Ear Malignancies
		19.1	 Introduction
		19.2	 Malignancy of Auricle
			19.2.1	 Actinic Keratosis
			19.2.2	 Lentigo Maligna
			19.2.3	 Keratoacanthoma
			19.2.4	 Basal Cell Carcinoma (BCC)
			19.2.5	 Squamous Cell Carcinoma
			19.2.6	 Melanoma
			19.2.7	 Rhabdomyosarcoma
			19.2.8	 Merkel Cell Carcinoma
		19.3	 Malignancy of EAC
			19.3.1	 Spread
			19.3.2	 Basal Cell Carcinoma
			19.3.3	 Squamous Cell Carcinoma
			19.3.4	 Rhabdomyosarcoma
			19.3.5	 Melanoma
			19.3.6	 Langerhans Cell Histiocytosis
			19.3.7	 Malignant Ceruminous Tumors
				19.3.7.1	 Ceruminous Adenoid Cystic Carcinoma
				19.3.7.2	 Ceruminous Adenocarcinoma
				19.3.7.3	 Ceruminous Mucoepidermoid Carcinoma
		References
	20: Cochlear Implant and Other Implantable Hearing Devices
		20.1	 Introduction
		20.2	 History of the Procedure
		20.3	 Etiology
		20.4	 Pathophysiology
		20.5	 Diagnosis and Selection
		20.6	 Indications
		20.7	 Contraindication
		20.8	 Evaluation
			20.8.1	 History
			20.8.2	 Physical Examination
		20.9	 Investigations
			20.9.1	 Laboratory Studies
		20.10	 Imaging Studies
		20.11	 Treatment
			20.11.1 Medical Therapy
			20.11.2 Surgical Therapy
		20.12	 Procedure
			20.12.1 Step 1: Flap Marking and Incision Design
			20.12.2 Step 2: Mastoidectomy and Posterior Tympanotomy
			20.12.3 Step 3: Cochlear Implant Receiver Well Drill Out with Tie-Down Holes
			20.12.4 Step 4: Cochleostomy
			20.12.5 Step 5: Implant Tie Down and Electrode Insertion
			20.12.6 Step 6: Telemetry, Closure, and Radiograph
			20.12.7 Postoperative Details
			20.12.8 Follow-Up
		20.13	 Complications
		20.14	 Outcome and Prognosis
		20.15	 Future and Controversies
		20.16	 Conclusion
		20.17	 Implantable Hearing Aids
			20.17.1 Middle Ear Implantable Hearing Aids
			20.17.2 Bone-Anchored Hearing Devices
		References
Part III: Rhinology/Allergy
	21: Radiology of Paranasal Sinuses
		21.1	 Introduction
		21.2	 Technique of CT Scan for FESS
			21.2.1	 Anatomy and Its Variation
		21.3	 Ostiomeatal Unit
			21.3.1	 Ethmoidal Cells [3–5]
			21.3.2	 Agger Nasi Cells Fig. 21.2
			21.3.3	 Onodi Cells Fig. 21.3
			21.3.4	 Haller Cells Fig. 21.4
		21.4	 The Frontalethmoidal (Kuhn) Cells [15]
			21.4.1	 Inverted Papilloma
			21.4.2	 Osteitis Sign (Fig. 21.11)
		21.5	 Allergic Fungal Sinusitis (Fig. 21.13) [20–24]
			21.5.1	 Neoplasms (Fig. 21.15a, b) [23, 24]
		21.6	 Vessels in Paranasal Sinuses
		21.7	 Anterior Ethmoidal Artery (Fig. 21.17)
		21.8	 Posterior Ethmoidal Artery (Fig. 21.18)
		21.9	 Sphenopalatine Artery (Fig. 21.19)
		References
	22: Allergic and Non-allergic Rhinitis
		22.1	 Allergic Rhinitis
			22.1.1	 Introduction
			22.1.2	 Definition
			22.1.3	 Pathophysiology
			22.1.4	 Diagnosis
			22.1.5	 Diagnostic Scenarios When Standard Testing Is Not Enough
			22.1.6	 Clinical Approach to Improve Diagnosis
				22.1.6.1	 Component-Resolved Diagnosis
				22.1.6.2	 Basophil Activation Test
			22.1.7	 Treatment
		22.2	 Non-allergic Rhinitis
			22.2.1	 Idiopathic (Vasomotor) Rhinitis
			22.2.2	 Drug-Induced Rhinitis
			22.2.3	 Occupational
			22.2.4	 Hormonal
			22.2.5	 Non-allergic Rhinitis with Eosinophilia Syndrome (NARES)
			22.2.6	 Senile Rhinitis
			22.2.7	 Gustatory Rhinitis
			22.2.8	 Atrophic Rhinitis
		References
	23: Acute Sinusitis and Its Complications
		23.1	 Introduction
			23.1.1	 Classification
			23.1.2	 Epidemiology
			23.1.3	 Pathophysiology
			23.1.4	 Clinical Presentation
			23.1.5	 Diagnostic Evaluation
			23.1.6	 Treatment
			23.1.7	 Complications
			23.1.8	 Recurrent Acute Rhinosinusitis
		Further Reading
	24: Fungal Sinusitis
		24.1	 Introduction
		24.2	 Fungus Ball (Mycetoma)
		24.3	 Allergic Fungal Sinusitis (AFS)
		24.4	 Acute Invasive Fungal Sinusitis (AIFS)
		24.5	 Chronic Invasive Fungal Sinusitis (CIFS)
		24.6	 Granulomatous Invasive Fungal Sinusitis (GIFS)
		References
	25: Chronic Rhinosinusitis in Adults
		25.1	 Introduction
		25.2	 Definition
		25.3	 Duration of Disease
			25.3.1	 Acute
			25.3.2	 Chronic
		25.4	 Classification
		25.5	 Pathophysiology
		25.6	 Diseases Associated with Chronic Rhinosinusitis
			25.6.1	 Ciliary Impairment
			25.6.2	 Allergy
			25.6.3	 Asthma
			25.6.4	 Aspirin Sensitivity
			25.6.5	 Immunocompromised State
			25.6.6	 Immune Deficiencies
			25.6.7	 Gastroesophageal Reflux Disease
			25.6.8	 Allergic Fungal Rhinosinusitis (Figs. 25.1 and 25.2)
			25.6.9	 Pregnancy and Endocrine State
			25.6.10 Biofilms
			25.6.11 Environmental Factors
			25.6.12 Nasal Anatomic Variants
			25.6.13 Diagnosis
				25.6.13.1	 Anterior Rhinoscopy
				25.6.13.2	 Nasal Endoscopy
			25.6.14 Imaging [25] (Fig. 25.3)
			25.6.15 Grading of Nasal Polyp [1, 2, 4]
			25.6.16 Nasomucociliary Clearance [26, 27]
			25.6.17 Rhinomanometry (Active Anterior and Posterior)
			25.6.18 Treatment (Figs. 25.4 and 25.5)
			25.6.19 Intranasal Corticosteroids
			25.6.20 Long-Term Antibiotics
			25.6.21 Antibiotics Versus Placebo
			25.6.22 Topical Antibiotics in CRS [30, 31]
			25.6.23 Level of Evidence Ib
				25.6.23.1	 Nasal Irrigation with Saline [32]
			25.6.24 Level of Evidence 1a
				25.6.24.1	 A New Treatment with Monoclonal Antibodies [1, 23]
			25.6.25 Functional Endoscopic Sinus Surgery [33] (Figs. 25.6, 25.7, and 25.8)
			25.6.26 Resistant/ Refractory CRS [34]
		References
	26: Functional Endoscopic Sinus Surgery
		26.1	 Introduction
		26.2	 Uncinectomy
			26.2.1 The Anterior Posterior Approach
			26.2.2 The Posterior Anterior Approach
		26.3	 Complications of Uncinectomy
		26.4	 Middle Meatal Antrostomy
		26.5	 Mega-Antrostomy
		26.6	 Anterior Ethmoid
		26.7	 Posterior Ethmoid
		26.8	 Sphenoethmoidal Cell (Onodi Cell)
		26.9	 The Anterior Ethmoid Artery
		26.10	 The Middle Turbinate
		26.11	 Concha Bullosa (Middle Turbinate Pneumatization)
		26.12	 Sphenoidectomy
			26.12.1 Anatomical Landmarks
		References
	27: Complications of Functional Endoscopic Sinus Surgery
		27.1	 Introduction
		27.2	 Increased Risk of Complications
		27.3	 Prevention of Complications
		27.4	 Intraoperative Complications
			27.4.1	 Intranasal Complications
			27.4.2	 Arterial Injury
			27.4.3	 Intraorbital Complications
			27.4.4	 Orbital Emphysema
			27.4.5	 Orbital Fat Exposure
			27.4.6	 Intraorbital Hematoma
			27.4.7	 Extraocular Muscle Injury
			27.4.8	 Optic Nerve Injury
			27.4.9	 Intracranial Complications
			27.4.10 Cerebrospinal Fluid Leak
			27.4.11 Internal Carotid Artery Injury
		27.5	 Postoperative Complications
			27.5.1	 Intranasal Complications
				27.5.1.1	 Epistaxis
				27.5.1.2	 Sinusitis
				27.5.1.3	 Synechiae
				27.5.1.4	 Anosmia
				27.5.1.5	 Hyposmia
				27.5.1.6	 Secondary Atrophic Rhinitis
			27.5.2	 Orbital Complications
				27.5.2.1	 Corneal Abrasion
				27.5.2.2	 Nasolacrimal Duct System Injury
			27.5.3	 Intracranial Complications
				27.5.3.1	 Cerebrospinal Fluid Leak
				27.5.3.2	 Meningitis
		27.6	 Revision Surgery
		References
	28: Neoplasms of the Sinonasal Cavity
		28.1	 Introduction
		28.2	 Sinonasal Cavity Tumor Epidemiology
		28.3	 History and Presentation
		28.4	 Imaging
		28.5	 Differential Diagnosis of Neoplasms
		28.6	 Factors Associated with Survival
		28.7	 Treatment
		28.8	 Complications from Tumor Treatment
		Recommended Readings
	29: Cerebrospinal Fluid Rhinorrhea
		29.1	 Introduction
		29.2	 Aetiology
		29.3	 Diagnosis
			29.3.1	 High-Resolution Computed Tomography (HRCT)
			29.3.2	 Computed Tomography Cisternography [10]
			29.3.3	 Magnetic Resonance Cisternogram
			29.3.4	 Radionuclide Cisternography
		29.4	 Spontaneous CSF Leaks
		29.5	 Traumatic CSF Rhinorrhea
		29.6	 Management of CSF Leaks
			29.6.1	 Conservative Management
			29.6.2	 Prophylactic Antibiotics
			29.6.3	 Cerebrospinal Fluid Diversion
			29.6.4	 Surgical Management
			29.6.5	 Transcranial Approach
			29.6.6	 Endoscopic Repair
		References
	30: Anterior and Midline Central Skull Base Tumors
		30.1	 Introduction
		30.2	 Anatomy
		30.3	 Tumors of the Anterior Skull Base
			30.3.1	 Sinonasal Neoplasms
				30.3.1.1	 Squamous Cell Carcinoma
				30.3.1.2	 Adenocarcinoma
				30.3.1.3	 Olfactory Neuroblastoma
				30.3.1.4	 Others
			30.3.2	 Orbital Tumors
		30.4	 Tumors Arising from Above the Anterior Skull Base
			30.4.1	 Olfactory Groove Meningioma
			30.4.2	 Subfrontal Schwannomas
		30.5	 Pseudotumors
		30.6	 Tumors of the Midline Central Skull Base
			30.6.1	 Pituitary Adenomas
			30.6.2	 Chordomas and Chondrosarcomas
			30.6.3	 Craniopharyngomas
			30.6.4	 Others
		30.7	 Tumors of Posterior Skull Base
		References
	31: Epistaxis
		31.1	 Introduction
		31.2	 Woodruffs Plexus
		31.3	 Classification of Epistaxis [3–5]
			31.3.1 Causes of Nasal Bleeding
			31.3.2 Management
				31.3.2.1	 General Management
					ABC: Airway Breathing and Circulation Assessment
			31.3.3 Specific Management
		31.4	 Nasal Packing
			31.4.1 Anterior Nasal Packs
				31.4.1.1	 Absorbable [8]
				31.4.1.2	 Non-absorbable Packs
					Carboxymethylcellulose Sponge (Merocel)
			31.4.2 Surgical Management of Epistaxis [9–13]
		31.5	 Anterior Ethmoid Artery Ligation
		31.6	 Endoscopic Sphenopalatine Artery Ligation
			31.6.1 Anatomy of Sphenopalatine Artery
			31.6.2 Embolization
		References
	32: The Nasal Septum and Turbinates
		32.1	 Introduction
		32.2	 The Nasal Septum
		32.3	 Embryology
		32.4	 Blood Supply
		32.5	 Venous Drainage
		32.6	 Nasal Valves (Table 32.1)
		32.7	 Nasal Septal Deviation
		32.8	 Nasal Septal Surgeries (Table 32.3)
		32.9	 Indications for Septoplasty
		32.10	 Complications of Septoplasty
		32.11	 Nasal Septal Perforation
		32.12	 Indications for Surgery Include
		32.13	 Contraindications to Surgery Include
		32.14	 The Turbinates
		32.15	 Management of the Hypertrophy of the Inferior Turbinates (Table 32.4)
		References
	33: Pitfalls and Pearls in Endoscopic Sinus Surgery
		33.1	 Introduction
		33.2	 Position of the Patient and the Surgeon
		33.3	 Nasal Preparation and Vasoconstriction
		33.4	 Surgical Steps
			33.4.1	 Uncinectomy
			33.4.2	 Middle Meatal Antrostomy
			33.4.3	 Anterior Ethmoidectomy
			33.4.4	 Posterior Ethmoidectomy
			33.4.5	 Sphenoidotomy
			33.4.6	 Frontal Sinus (Figs. 33.11 and 33.12)
		References
Part IV: Head and Neck
	34: Thyroid and Parathyroid Glands
		34.1	 Introduction
		34.2	 Thyroid Gland
			34.2.1	 Embryology
			34.2.2	 Anatomy of the Thyroid Gland
				34.2.2.1	 Lymphatic Drainage of the Thyroid Gland
					Anatomy of the Recurrent Laryngeal Nerve
					Anatomy of the Superior Laryngeal Nerve
			34.2.3	 Benign Thyroid Disease
				34.2.3.1	 Graves’ Disease
				34.2.3.2	 Toxic Nodular Goiter
				34.2.3.3	 Hashimoto’s Thyroiditis
				34.2.3.4	 Subacute Granulomatous (De Quervain’s) Thyroiditis
				34.2.3.5	 Riedel’s Thyroiditis
			34.2.4	 Thyroid Nodules
				34.2.4.1	 Ultrasonography
				34.2.4.2	 Radioisotope Imaging
				34.2.4.3	 Fine Needle Aspiration Cytology
			34.2.5	 Malignant Thyroid Disease
				34.2.5.1	 Papillary Thyroid Carcinoma
				34.2.5.2	 Follicular Carcinoma
				34.2.5.3	 Hurthle Cell Carcinoma
				34.2.5.4	 Medullary Thyroid Carcinoma
				34.2.5.5	 Surgery
				34.2.5.6	 Protein Kinase Inhibitors
				34.2.5.7	 Prognosis
				34.2.5.8	 Anaplastic Thyroid Carcinoma
			34.2.6	 Thyroidectomy and Its Complications
				34.2.6.1	 Thyroidectomy Types
				34.2.6.2	 Complications
		34.3	 Parathyroid Glands
			34.3.1	 Embryology and Anatomy of the Parathyroid Glands
			34.3.2	 Primary Hyperparathyroidism
				34.3.2.1	 Indications for Treatment
				34.3.2.2	 Parathyroidectomy
				34.3.2.3	 Medical Treatment
			34.3.3	 Secondary Hyperparathyroidism
			34.3.4	 Tertiary Hyperparathyroidism
			34.3.5	 Parathyroid Carcinoma
		References
	35: Diseases of the Salivary Glands
		35.1	 Introduction
			35.1.1	 Saliva
			35.1.2	 Saliva Secretion
		35.2	 Anatomy
			35.2.1	 Parotid Gland
			35.2.2	 Submandibular Gland
			35.2.3	 Sublingual Gland
		35.3	 Salivary Gland Inflammatory Process
			35.3.1	 Acute Sialadenitis
				35.3.1.1	 Viral
				35.3.1.2	 Bacterial
			35.3.2	 Sialolithiasis (Figs. 35.1 and 35.2)
			35.3.3	 Uveoparotid Fever (Heerfordt’s Disease)
			35.3.4	 Kuttner’s Tumor (Chronic Sclerosing Sialadenitis)
			35.3.5	 Sjogren’s Syndrome
			35.3.6	 Recurrent Parotitis
			35.3.7	 Benign Lymphoepithelial Cysts
			35.3.8	 Necrotizing Sialometaplasia
		35.4	 Salivary Gland Neoplasms
			35.4.1	 Benign Masses
				35.4.1.1	 Common Salivary Gland Tumors in Children
				35.4.1.2	 Pleomorphic Adenoma
				35.4.1.3	 Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)
				35.4.1.4	 Oncocytoma
				35.4.1.5	 Monomorphic Adenoma
				35.4.1.6	 Hemangioma
			35.4.2	 Salivary Gland Malignancies (Fig. 35.6)
				35.4.2.1	 Mucoepidermoid Carcinoma
				35.4.2.2	 Adenoid Cystic Carcinoma
				35.4.2.3	 Acinic Cell Carcinoma
				35.4.2.4	 Adenocarcinoma
				35.4.2.5	 Polymorphous Low-Grade Adenocarcinoma
				35.4.2.6	 Malignant Mixed Tumors
				35.4.2.7	 Other Salivary Gland Malignancy Types
		35.5	 Miscellaneous
			35.5.1	 Frey’s Syndrome
			35.5.2	 Mucous Retention Cysts, Mucoceles, and Ranulas
		Further Reading
	36: An Approach to Neck Masses
		36.1	 Introduction
		36.2	 An Approach to the Neck Mass
			36.2.1 Prominent Landmarks
			36.2.2 Triangles of the Neck
			36.2.3 Lymph Node Levels of the Neck
		36.3	 Differential Diagnosis
		36.4	 The Patient Presented with Neck Lump, Swelling, or Mass, What Is Your Workup?
			36.4.1 Duration
			36.4.2 Others
		36.5	 Examination
		36.6	 Some of the Features Raise Suspicion of Malignancy
		36.7	 Diagnostic Tools
		36.8	 Treatment Differs According to the Diagnosis
			36.8.1 Cystic Hygroma (Lymphangiomas)
			36.8.2 Hemangiomas
			36.8.3 Branchial Cleft Cysts
			36.8.4 Thyroglossal Duct Cyst
			36.8.5 Sebaceous Cysts
			36.8.6 Cervical Lymphadenopathy
				36.8.6.1 TB Cervical Lymphadenitis
			36.8.7 Carotid Body Tumor
			36.8.8 Pharyngeal Pouch
			36.8.9 Thyroid Masses
			36.8.10 Ludwig’s Angina
			36.8.11 Salivary Gland Neoplasm
				36.8.11.1 The Most Common Benign Tumor of the Parotid
				36.8.11.2 The Most Common Malignant Neoplasm of the Parotid Gland
			36.8.12 Metastatic Lymph Nodes
				36.8.12.1 Characteristics of Malignant Neck Lumps
		Further Reading
	37: Principles of Management of Head and Neck Cancers
		37.1	 Introduction
		37.2	 Natural History of the Disease
		37.3	 Diagnostic Workup
		37.4	 Pathology
		37.5	 Current American Joint Committee on Cancer (AJCC) Staging Eighth Edition Highlighting Major Stages
		37.6	 Treatment Philosophy (Fig. 37.1)
		37.7	 Stage I and II
		37.8	 Stage III and IVA
		37.9	 Stage IVB
		37.10	 Stage IVC
		37.11	 Principles of Treatment
			37.11.1 Surgery
			37.11.2 Reconstruction
			37.11.3 Principles of Treatment of Neck
			37.11.4 Principles of Radiotherapy
				37.11.4.1	 Definitive Radiotherapy
				37.11.4.2	 Adjuvant Therapy
			37.11.5 Principles of Chemotherapy
		37.12	 Treatment of Recurrent and Metastatic Cancers
		37.13	 Follow-Up
		References
	38: Neoplasms of the Oral Cavity and Oropharynx
		38.1	 Introduction
		38.2	 Oral Cancers
			38.2.1 Presentation
			38.2.2 Workup
				38.2.2.1	 Clinical Assessment
				38.2.2.2	 Biopsy
				38.2.2.3	 Imaging
			38.2.3 Staging of Oral Cancers
			38.2.4 Principles of Management of Oral Cancers
				38.2.4.1	 Early-Stage Disease (Stage I, II)
				38.2.4.2	 Locally Advanced Operable Lesions (Stage III, IVA and Select IVB)
			38.2.5 Principles of Surgery
				38.2.5.1	 Margins
				38.2.5.2	 Establishing Operability
				38.2.5.3	 Addressing the Mandible
				38.2.5.4	 Approaches
				38.2.5.5	 Management of the Neck
			38.2.6 Adjuvant Treatment
			38.2.7 Role of Neoadjuvant Chemotherapy
			38.2.8 Management of Recurrent and Metastatic Disease
		38.3	 Oropharyngeal Cancers
			38.3.1 Introduction
			38.3.2 HPV Positive OPC
				38.3.2.1	 Epidemiology
				38.3.2.2	 Etiopathogenesis
				38.3.2.3	 Improved Outcomes
				38.3.2.4	 Biological Explanation for Improved Survival
			38.3.3 Staging of Oropharyngeal Cancers
			38.3.4 Diagnostic Assessment of Oropharyngeal Cancers
			38.3.5 Principles of Management
			38.3.6 Management of the Neck in OPC
			38.3.7 Transoral Robotic Surgery: An Evolving Paradigm
			38.3.8 Deintensification Approaches for HPV-Related Oropharyngeal Cancers
			38.3.9 Management of Recurrent/Metastatic Oropharyngeal Cancers
			38.3.10 Follow-Up of Patients with Oral and Oropharyngeal Cancer
		References
	39: Neoplasms of the Larynx and Laryngopharynx
		39.1	 Introduction
		39.2	 Benign Neoplasms
		39.3	 Malignant Neoplasms
			39.3.1	 Incidence and Pathogenesis
			39.3.2	 Surgical Anatomy
			39.3.3	 Pathology
			39.3.4	 Evaluation
		39.4	 Treatment of Early Cancer Larynx
			39.4.1	 Treatment of Early Glottic Cancer
			39.4.2	 Treatment of Early Supraglottic Cancer
		39.5	 Treatment of Subglottic Carcinoma
		39.6	 Treatment of Advanced Cancer Larynx
		39.7	 Treatment of Laryngopharyngeal Carcinoma
		References
	40: Cancer of the Nasal Cavity and Paranasal Sinuses
		40.1	 Introduction
		40.2	 Pathology and Biology
		40.3	 Evaluation
			40.3.1	 Presentation
			40.3.2	 Diagnostic Imaging
			40.3.3	 Biopsy
			40.3.4	 Staging
		40.4	 Treatment
			40.4.1	 Surgical Treatment
				40.4.1.1	 Nasoethmoidal Tumors
					Endoscopic Resection of Nasoethmoidal Malignancies
				40.4.1.2	 Maxillary Tumors
			40.4.2	 Non-surgical Treatment
				40.4.2.1	 Radiation Therapy
				40.4.2.2	 Chemotherapy
			40.4.3	 Management of Orbital Invasion
		References
	41: Nasopharyngeal Cancer
		41.1	 Introduction
		41.2	 Anatomy
		41.3	 Etiologies
		41.4	 Pathology
		41.5	 Clinical Manifestations
			41.5.1	 Diagnosis
				41.5.1.1	 EBV Antibodies Serology
			41.5.2	 Imaging Studies
				41.5.2.1	 CT Scan
				41.5.2.2	 MRI
				41.5.2.3	 Positron Emission Tomography (PET)
		41.6	 Staging and TNM Classification [16]
		41.7	 Treatment
			41.7.1	 Chemotherapy
			41.7.2	 Surgery
			41.7.3	 Follow-up
		41.8	 Prognosis
		References
	42: Difficult Airway Management for ENT Surgery for Non-anesthesiologists
		42.1	 Introduction and Facts
		42.2	 Definition of the Difficult Airway
			42.2.1	 Difficult Face Mask Ventilation (DMV)
				42.2.1.1	 Incidence of Difficult Mask Ventilation
				42.2.1.2	 Causes and Risk Factors of Difficult Mask Ventilation
				42.2.1.3	 Techniques of Mask Ventilation (MV)
		42.3	 Difficult Supraglottic Airway Device (SAD) Insertion
			42.3.1	 SAD/LMA Generations [6] (Figs. 42.1 and 42.2)
		42.4	 Management of Difficult Intubation
			42.4.1	 Difficult Intubation
				42.4.1.1	 Management of Anticipated Difficult Airway
				42.4.1.2	 Strategy for Intubation of the Difficult Airway
				42.4.1.3	 Common Equipment for Intubation
			42.4.2	 Causes of Difficult Intubation
				42.4.2.1	 Congenital Disorders Associated with Difficult Airway (Table 42.2)
					Down’s Syndrome (Trisomy 21)
					Beckwith-Wiedemann Syndrome
					Pierre Robin Syndrome
				42.4.2.2	 Acquired Disorders Associated with Difficult Airway Management
					Diabetes Mellitus
					Rheumatoid Arthritis
					Obesity
					Obstructive Sleep Apnea
				42.4.2.3	 Masses of the Head and Neck
				42.4.2.4	 Deep Neck Infections
				42.4.2.5	 Burns
			42.4.3	 Extubating Difficult Airway
				42.4.3.1	 The Difficult Airway Society (DAS) Issued Guidelines for Management of Tracheal Extubation
		42.5	 Prediction of Difficult Airway
			42.5.1	 Traditional Airway Assessment
				42.5.1.1	 Clinical History
				42.5.1.2	 Physical Examination
				42.5.1.3	 Specific Tests and Scores for Airway Assessment
					Anatomical Criteria
						Mouth Opening and Inter-Incisor Gap (IIG)
						Mallampati Score
						Upper Lip Bite Test (ULBT)/Mandible Protrusion Test
						Mandibular Space (Fig. 42.5)
						The LEMON Score for Airway Assessment Table 42.7
					Direct Laryngoscopy View and Fiber-Optic Bronchoscopy
				42.5.1.4	 Investigations
				42.5.1.5	 Nontraditional Airway Assessment
					Virtual Endoscopy (VE)
					3D Reconstruction and Decision-Making
						The Benefits of VE and 3D Reconstructions in Airway Management
					Preoperative Endoscopic Airway Examination (PEAE)
		42.6	 Future Plane in Airway Management
			42.6.1	 Airway Ventilation Through “Straw”
				42.6.1.1	 Evone and Tritube in Stenotic Airway
				42.6.1.2	 Ventrain
			42.6.2	 Alternative Oxygenation Techniques (THRIVE/HFNO)
				42.6.2.1	 Introduction
				42.6.2.2	 Final Outcome After HFNC Application [55]
				42.6.2.3	 General Indications of HFNC
			42.6.3	 Tubeless Anesthesia or Tube Free of Upper Airway Surgery
		References
Part V: Laryngology and Esophagology
	43: Physiology of the Voice and Clinical Voice Assessment
		43.1	 Introduction
		43.2	 Voice Physiology
			43.2.1	 The Respiratory System and Airflow
			43.2.2	 Vocal Folds (Also Called Vocal Cords)
				43.2.2.1	 Vocal Tract—Resonators and Articulators
			43.2.3	 The Nervous System
		43.3	 Voice Assessment in Outpatient Department
			43.3.1	 Voice Case History
			43.3.2	 Observation (Posture, Breathing, Palpation)
			43.3.3	 Patient Questionnaire?
			43.3.4	 Endoscopic Evaluation with a Nasopharyngoscopy and Video Stroboscope
				43.3.4.1	 Flexible Endoscopies
				43.3.4.2	 Rigid Scope
			43.3.5	 Video Stroboscope
				43.3.5.1	 Simple Aerodynamic Assessment
				43.3.5.2	 Complex Aerodynamic Assessment
			43.3.6	 Electro Laryngography or Electroglottography
			43.3.7	 Electromyography (EMG)
	44: Inflammatory, Infectious, and Acquired Conditions of the Larynx
		44.1	 Introduction
		44.2	 Embryology
		44.3	 Anatomy
		44.4	 Infectious and Inflammatory Conditions of the Larynx
			44.4.1	 Infectious
			44.4.2	 Inflammatory/Autoimmune
			44.4.3	 Iatrogenic/Trauma
			44.4.4	 Idiopathic/Infiltrative
			44.4.5	 Allergic
		44.5	 Acute Laryngo-Tracheo-Bronchitis (Croup)
			44.5.1	 Clinical Presentation
			44.5.2	 Work Up and Management
				44.5.2.1	 “Steeple Sign” (Steeple or Funnel-Shaped Subglottic Narrowing on X-Ray Films)
				44.5.2.2	 Acute Epiglottitis (Supraglottic Laryngitis)
				44.5.2.3	 Clinical Features
			44.5.3	 Work Up and Management
			44.5.4	 Laryngeal Diphtheria
			44.5.5	 Tubercular Laryngitis
			44.5.6	 Work Up and Management
			44.5.7	 Lupus of the Larynx
			44.5.8	 Syphilis of the Larynx
			44.5.9	 Leprosy
			44.5.10 Histoplasmosis
			44.5.11 Blastomycosis
			44.5.12 Laryngitis Sicca
			44.5.13 Clinical Features
			44.5.14 Treatment
		44.6	 Noninfectious Laryngitis in Adults
			44.6.1	 Chronic Laryngitis
			44.6.2	 Traumatic Laryngitis
			44.6.3	 Angioedema
			44.6.4	 Treatment
			44.6.5	 Amyloidosis
			44.6.6	 Sarcoidosis
			44.6.7	 Wegener Granulomatosis
			44.6.8	 Radiation Laryngitis
			44.6.9	 Subglottic Stenosis
				44.6.9.1	 Etiologies
			44.6.10 Factors Affect Subglottic Stenosis
				44.6.10.1	 Systemic
				44.6.10.2	 Local Factors
				44.6.10.3	 Endotracheal Tube Factors
				44.6.10.4	 Infection and Chronic Inflammatory Diseases
				44.6.10.5	 Laryngopharyngeal Reflux/Reflux Laryngitis
				44.6.10.6	 Idiopathic
		44.7	 Clinical Presentation
			44.7.1	 Grading System of Subglottic Stenosis
			44.7.2	 Work Up
			44.7.3	 Management
		References
	45: Benign Lesions of the Vocal Folds
		45.1	 Introduction
		45.2	 Types of Office-Based Procedures
		45.3	 Types of Laryngeal Lesions
		45.4	 Vocal Cord Nodules
		45.5	 Vocal Cord Cysts
		45.6	 Vocal Process Granulomas
			45.6.1	 Treatment
		45.7	 Sulcus Vocals
		45.8	 Recurrent Respiratory Papilloma (RRP)
		45.9	 Leukoplakia
		45.10	 Ectasias
		45.11	 Polypoid Cordites (Reinke’s Edema)
		45.12	 Rheumatoid Nodules
		45.13	 Vocal Cord Scar
		45.14	 Vocal Hygiene
		Bibliography
	46: Vocal Cord Paralysis
		46.1	 Introduction
		46.2	 Pathophysiology
		46.3	 Unilateral Vocal Cord Paralysis
			46.3.1	 Etiology
			46.3.2	 History
				46.3.2.1	 Voice Quality
			46.3.3	 Clinical Examination
				46.3.3.1	 Neck
				46.3.3.2	 Larynx
				46.3.3.3	 Investigation
				46.3.3.4	 Treatment
			46.3.4	 Surgical Treatment
				46.3.4.1	 Temporary—Injection Augmentation
				46.3.4.2	 Permanent-Framework Surgery
				46.3.4.3	 Arytenoid Adduction
					Laryngeal Reinnervation
		46.4	 Bilateral Vocal Cord Paralysis
			46.4.1	 Etiology
			46.4.2	 Clinical Presentation
			46.4.3	 Clinical Examination
			46.4.4	 Investigations
			46.4.5	 Laryngoscopy
			46.4.6	 Management
				46.4.6.1	 Immediate Airway Management
			46.4.7	 Reversible Treatments
				46.4.7.1	 Tracheostomy
				46.4.7.2	 Extralaryngeal Suture Lateralization [7]
				46.4.7.3	 Laryngeal Botox Injection
			46.4.8	 Permanent Surgical Methods
				46.4.8.1	 Laser Cordotomy
				46.4.8.2	 Laryngeal Pacing [9]
		References
	47: Dysphagia Disorders Evaluation and Management
		47.1	 Introduction
		47.2	 The Structure of a Swallowing Clinic?
		47.3	 Neural Control of Swallowing
		47.4	 Stages of Swallowing in Both Adults and Pediatrics
		47.5	 Signs and Symptoms of Swallowing Disorders
		47.6	 Causes of Swallowing Disorders
		47.7	 Diagnostic Procedures for the Swallowing Disorders
		47.8	 Transnasal Flexible Laryngoscopy (TFL)
		47.9	 Flexible Endoscopic Evaluation of Swallowing Safely (FEESS)
		47.10	 Fibreoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)
		47.11	 Swallowing Treatment, or Swallowing Therapy, Is Divided into Four Broad Categories
		47.12	 Tube Feeding
		47.13	 Effect of Tracheostomy on Swallowing
		47.14	 Management of Swallowing in Patients on Tracheostomy
		47.15	 Benefit of Using the Speaking Valve
		Further Reading
	48: Esophageal Diseases
		48.1	 Introduction
		48.2	 Motility Disorder
		48.3	 Anatomical Causes
		48.4	 Esophagitis
			48.4.1	 Infectious Esophagitis
		48.5	 Neoplasia
		References
Part VI: General Otolaryngology
	49: Pharyngitis
		49.1	 Introduction
		49.2	 Infectious Pharyngitis
			49.2.1	 Bacterial Infection
				49.2.1.1	 Streptococcal Infection
				49.2.1.2	 Corynebacterium Diphtheriae
				49.2.1.3	 Other Bacterial Pharyngitis
			49.2.2	 Viral Infection
				49.2.2.1	 Infectious Mononucleosis (Glandular Fever)
				49.2.2.2	 Coxsackie virus infections (Herpangina)
				49.2.2.3	 Cytomegalovirus
				49.2.2.4	 Others
			49.2.3	 Fungal Infection
				49.2.3.1	 Oropharyngeal Candidiasis (Thrush)
		49.3	 Noninfectious Pharyngitis
		References
	50: Deep Neck Space Infections
		50.1	 Introduction
		50.2	 Anatomy
		50.3	 Lymphatic Drainage of Head and Neck
		50.4	 Microbiology for the Deep Neck Space Infections
		50.5	 Clinical Presentation
		50.6	 Imaging
			50.6.1	 CT Scan
			50.6.2	 MRI
		50.7	 Treatment of Deep Neck Space Infections
		50.8	 Peritonsillar Abscess (Quinsy)
		50.9	 Parapharyngeal Space Infections
		50.10	 Retropharyngeal Space Infections
		50.11	 Submandibular Space Infection (Ludwig’s Angina)
		50.12	 Other Space Infections
		References
	51: Obstructive Sleep Apnea
		51.1	 Introduction
		51.2	 Definition
		51.3	 Pathophysiology of OSAS
		51.4	 Diagnosis
			51.4.1	 History
			51.4.2	 ENT Examination
			51.4.3	 Polysomnography (PSG)
			51.4.4	 Sleep Endoscopy (DISE)
		51.5	 Management
			51.5.1	 Standard Treatment for Obstructive Sleep Apnea
				51.5.1.1	 Nonsurgical
				51.5.1.2	 Surgical Treatment
					Pharyngoplasty
					Maxillo-mandibular Advancement (MMA)
					Trans Oral Robotic Surgery (TORS)
					Hypoglossal Nerve Stimulation (HNS)
		References
	52: ENT Pharmacotherapy
		52.1	 Antibiotics in ENT
			52.1.1	 Introduction
			52.1.2	 Common Organisms in ENT Infections
			52.1.3	 Classification of Antibiotics
				52.1.3.1 Beta-Lactams
					Penicillins
					Natural Penicillin G and V
					Anti-staphylococcal Penicillin
					Aminopenicillin
					Augmented Amino Penicillin
					Antipseudomonal Penicillin
					Cephalosporins
				52.1.3.2 Other B-Lactams
					Carbapenem
					Monobactam
				52.1.3.3 Macrolides
				52.1.3.4 Quinolones
				52.1.3.5 Clindamycin
				52.1.3.6 Vancomycin
				52.1.3.7 Metronidazole
			52.1.4	 Surgical Antimicrobial Prophylaxis
		52.2	 Steroids in ENT
			52.2.1	 Pharmacology
			52.2.2	 Indications
			52.2.3	 Complications
		52.3	 Decongestant and Anti-histamines in ENT
			52.3.1	 Pharmacology
		52.4	 Drugs for Vertigo and Motion Sickness
			52.4.1	 Betahistine
			52.4.2	 Diuretics
			52.4.3	 Antihistamines and Anticholinergics
		References
	53: Neck Trauma
		53.1	 Introduction
		53.2	 Zones of the Neck and Anatomical Structures [5, 6]
			53.2.1	 Vital Structures in the Neck
			53.2.2	 Skeletal Anatomy
			53.2.3	 Muscular Landmarks
		53.3	 Etiology [3, 7]
			53.3.1	 Blunt Trauma Include
			53.3.2	 Penetrating Trauma [5, 2]
		53.4	 History and Physical
			53.4.1	 Signs and Symptoms [9]
		53.5	 Evaluation
			53.5.1	 Neck Trauma Diagnostic Measures [6, 7]
			53.5.2	 Other Diagnostic Procedures [10]
		53.6	 Definitive Management
			53.6.1	 General Approach [11]
			53.6.2	 Specific Injuries [6]
		53.7	 Neck Injuries in Children [7]
		53.8	 Complications [13]
		53.9	 Outcomes [1, 4]
		53.10	 Summary and Recommendation [3, 11]
		References
	54: ENT Manifestations in Systemic and Inflammatory Diseases
		54.1	 Introduction
		54.2	 Hereditary Hemorrhagic Telangiectasia HHT (Formerly Osler Weber Rendu)
		54.3	 Kawasaki Disease
		54.4	 Giant Cell Arteritis GCA Also Known as (Temporal Arteritis)
		54.5	 Cogan’s Syndrome
		54.6	 Granulomatosis with Polyangiitis (Wegener Granulomatosis)
		54.7	 Sarcoidosis
		54.8	 Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)
		54.9	 Amyloidosis
		54.10	 Relapsing Polychondritis
		54.11	 Systemic Lupus Erythematosis
		54.12	 Medications Used to Treat SLE Manifestations Include the Following in Table 54.3
		54.13	 Rheumatoid Arthritis (RA)
		54.14	 Behcet’s Syndrome
			54.14.1 Treatment
		54.15	 Sjogren’s Syndrome
			54.15.1 Classification
			54.15.2 ENT Manifestations
			54.15.3 Diagnosis
			54.15.4 Treatment:
		54.16	 Myasthenia Gravis MG
			54.16.1 Diagnosis
		54.17	 Pemphigus Vulgaris
			54.17.1 ENT Symptoms
			54.17.2 Diagnosis
			54.17.3 Treatment
			54.17.4 Scleroderma
		References
Part VII: Pediatrics
	55: Anesthetic Considerations for Pediatric ENT Surgeries for Non-anesthesiologists
		55.1	 Introduction
		55.2	 Preoperative Assessment
			55.2.1	 Airway Assessment
			55.2.2	 Assessment for Comorbidities
			55.2.3	 Preoperative Fasting
			55.2.4	 Preoperative Investigations
		55.3	 Airway Management
			55.3.1	 Difference Between the Pediatric and the Adult Airway
			55.3.2	 Pediatric Bag-Mask Ventilation
			55.3.3	 Direct Laryngoscopy (DL)
			55.3.4	 Video-Laryngoscopy (VL)
			55.3.5	 Fiber-Optic Bronchoscopic Intubation (FOB)
			55.3.6	 Complications of Airway Management
			55.3.7	 Goals of Anesthetists in-Hospital Course
				55.3.7.1	 Preoperative Sedation
				55.3.7.2	 Preoxygenation
				55.3.7.3	 Induction
					Choice of Equipment Sizes
				55.3.7.4	 Airway Equipment Sizes
				55.3.7.5	 Temperature Management
		55.4	 Common Challenges in Pediatric Anesthesia for ENT Procedures
			55.4.1	 Perioperative Management of Children with Obstructive Sleep Apnea
				55.4.1.1 Introduction
				55.4.1.2 Diagnosis
				55.4.1.3 Polysomnography
				55.4.1.4 Preoperative Assessment
				55.4.1.5 History
				55.4.1.6 Physical Exam
				55.4.1.7 Investigations
				55.4.1.8 Intraoperative Considerations
				55.4.1.9 Postoperative Care
			55.4.2	 Anesthesia for Children with Upper Respiratory Tract Infection
				55.4.2.1 Introduction
				55.4.2.2 Pathophysiology
				55.4.2.3 Perioperative Respiratory Adverse Events (PRAE)
				55.4.2.4 Risk Factors for Perioperative Adverse Risk Events (PRAE)
				55.4.2.5 Perioperative Management of Children with URI
					Preoperative Management
					Reasons to Consider Postponing an Elective Case in the Presence of a URI (Fig. 55.5)
					Reasons to Proceed with Surgery (Fig. 55.5)
					Intraoperative Management of Children with URTI
			55.4.3	 Anesthetic Management for a Child with Post-tonsillectomy Bleeding
				55.4.3.1 Introduction
				55.4.3.2 Risk Factors
				55.4.3.3 Anesthetic Management
				55.4.3.4 Preoperative Preparation
				55.4.3.5 Anesthesia Set Up
				55.4.3.6 Anesthesia Conduct
					Induction
						Inhalation Induction
						Intravenous “Rapid Sequence” Induction with Cricoid Pressure
					Intraoperative Management
					Postoperative Management
			55.4.4	 Postoperative Nausea and Vomiting in Children (PONV)
				55.4.4.1 Drugs Used for Prophylaxis and Treatment [34]
			55.4.5	 Postoperative Pain Management in Children
				55.4.5.1 Pain Assessment
				55.4.5.2 Postoperative Analgesia
		References
	56: Adenoid and Tonsils
		56.1	 Introduction
		56.2	 Waldeyer’s Ring of Lymphoid Tissues (Fig. 56.1)
		56.3	 Adenoids (Nasopharyngeal Tonsils)
			56.3.1 Clinical Features and Types
				56.3.1.1 Acute Adenoiditis (Table 56.1)
				56.3.1.2 Recurrent Acute Adenoiditis (Table 56.2)
				56.3.1.3 Chronic Adenoiditis (Table 56.3)
			56.3.2 Adenoidal Facies
			56.3.3 Diagnosis
			56.3.4 Treatment of Adenoiditis (Table 56.4)
			56.3.5 Guidelines and Recommendation for Treatment
		56.4	 Tonsils
			56.4.1 Brodsky Grading Tonsil Size (Fig. 56.3)
			56.4.2 Definitions
			56.4.3 Aetiology of Tonsillitis
				56.4.3.1 Infectious
				56.4.3.2 Non-infectious
			56.4.4 Prognosis
			56.4.5 Complications of Tonsillitis Are Either
			56.4.6 Recurrent Acute Tonsillitis Is Defined as
				56.4.6.1 Clinical Episode of Tonsillitis
			56.4.7 Chronic Tonsillitis
			56.4.8 Investigations
				56.4.8.1 Full Blood Count
			56.4.9 Viral vs Bacterial
			56.4.10 Differential Diagnosis of Sore Throat
			56.4.11 Treatment of Acute Tonsillitis
				56.4.11.1 Centor Scoring System
				56.4.11.2 Choice of Antibiotic
		56.5	 Key Recommendations of the Guideline
		Further Reading
	57: Branchial Arch: Anatomy and Anomalies
		57.1	 Introduction
		57.2	 Presentation
		57.3	 Investigations
		57.4	 Differential Diagnosis
		57.5	 Classification
		57.6	 Developmental Anatomy
		57.7	 The Branchial Arches and Their Derivatives
		57.8	 Derivatives of the Pouches
		57.9	 Classification
			57.9.1 First Branchial Cleft Anomalies
			57.9.2 Second Branchial Cleft Anomalies
			57.9.3 Third Branchial Cleft Anomalies
		57.10	 Thymic Cysts/Ectopic Thymic Tissue
			57.10.1 Treatment
		57.11	 Thyroglossal Duct Cyst
			57.11.1 Presentation
			57.11.2 Investigations
			57.11.3 Treatment
			57.11.4 Complications
		57.12	 Lingual Thyroid
			57.12.1 Presentation
			57.12.2 Investigations
			57.12.3 Management
		Further Readings
	58: Evaluation of Pediatric Head and Neck Masses
		58.1	 Introduction
		58.2	 Clinical History
		58.3	 Physical Examination
		58.4	 Examination of Swelling
		58.5	 Investigation
		58.6	 Differential Diagnosis
		58.7	 Anatomy and Differential Diagnosis of Neck Triangles
		58.8	 Head and Neck Infections in Pediatrics
			58.8.1	 Bacterial Lymphadenitis
				58.8.1.1 Treatment
			58.8.2	 Mycobacterial Infections
				58.8.2.1 Diagnosis
				58.8.2.2 Treatment
			58.8.3	 Deep Neck Space Infections [11, 12]
			58.8.4	 Viral Lymphadenitis
			58.8.5	 Infectious Mononucleosis (Glandular Fever)
				58.8.5.1 Clinical Features
				58.8.5.2 Diagnosis
				58.8.5.3 Treatment
			58.8.6	 Lemierre’s Syndrome
				58.8.6.1 Diagnosis
				58.8.6.2 Treatment
			58.8.7	 Cat Scratch Disease
				58.8.7.1 Clinical Features
				58.8.7.2 Treatment
			58.8.8	 Actinomycosis
				58.8.8.1 Diagnosis
				58.8.8.2 Treatment
		58.9	 Non-infectious Inflammatory Lymphadenopathy
			58.9.1	 Kawasaki Disease
				58.9.1.1 Clinical Features
				58.9.1.2 Treatment
			58.9.2	 Sinus Histiocytosis (Rosai–Dorfman Disease)
				58.9.2.1 Clinical Features
				58.9.2.2 Diagnosis
				58.9.2.3 Treatment
			58.9.3	 Kikuchi–Fujimoto Disease
				58.9.3.1 Clinical Features
				58.9.3.2 Diagnosis
		References
	59: Pediatric Head and Neck Vascular Anomalies and Tumors
		59.1	 Introduction
		59.2	 Vascular Anomalies-Tumors
			59.2.1	 Infantile Hemangioma
				59.2.1.1 Clinical Features
				59.2.1.2 Treatment
		59.3	 Vascular Anomalies- Malformations
			59.3.1	 Capillary Malformation
				59.3.1.1 Clinical Features
				59.3.1.2 Treatment
			59.3.2	 Venous Malformations (VM)
				59.3.2.1 Diagnosis
				59.3.2.2 Treatment
			59.3.3	 Lymphatic Malformations (LM)
				59.3.3.1 Clinical Features
				59.3.3.2 Treatment
			59.3.4	 Arteriovenous Malformation (AVM)
				59.3.4.1 Clinical Features
				59.3.4.2 Diagnosis
				59.3.4.3 Treatment
		59.4	 Benign Tumors
			59.4.1	 Teratoma
				59.4.1.1 Clinical Features
				59.4.1.2 Treatment
			59.4.2	 Juvenile Nasopharyngeal Angiofibroma
		59.5	 Malignant Tumors
			59.5.1	 Hodgkin’s Lymphoma
				59.5.1.1 Clinical Features
				59.5.1.2 Diagnosis
				59.5.1.3 Treatment
			59.5.2	 Non-Hodgkin’s Lymphoma
				59.5.2.1 Clinical Features
				59.5.2.2 Diagnosis
				59.5.2.3 Treatment
			59.5.3	 Rhabdomyosarcoma
				59.5.3.1 Clinical Features
				59.5.3.2 Diagnosis
				59.5.3.3 Treatment
			59.5.4	 Thyroid Malignancy
				59.5.4.1 Clinical Features
				59.5.4.2 Diagnosis
				59.5.4.3 Treatment
			59.5.5	 Neuroblastoma
				59.5.5.1 Clinical Features
				59.5.5.2 Treatment
			59.5.6	 Nasopharyngeal Carcinoma (NPS)
				59.5.6.1 Clinical Features
				59.5.6.2 Diagnosis
				59.5.6.3 Treatment
		References
	60: Evaluation of Stridor and Wheezy Children
		60.1	 Introduction
		60.2	 Types of Sounds
			60.2.1	 Stertor
			60.2.2	 Stridor
			60.2.3	 Wheezing
		60.3	 Airway in Children
			60.3.1	 Anatomy
			60.3.2	 Physiology
			60.3.3	 Pathology
		60.4	 Stridor Causes
			60.4.1	 Etiology and Site (Table 60.1)
			60.4.2	 Stridor (Site and Timing) (Fig. 60.4)
				60.4.2.1 Sites
		60.5	 Evaluation
			60.5.1	 History
			60.5.2	 Examination
				60.5.2.1 Check the Heart Rate, Respiratory Rate, and Look for Presence of Retraction (Table 60.6)
				60.5.2.2 Position of Comfort of the Child
				60.5.2.3 Flexible Fiberoptic Laryngoscopy and/or Direct Laryngoscopy and Bronchoscopy
					Normal Larynx (Fig. 60.8)
		60.6	 Respiratory Distress
			60.6.1	 Impending Respiratory Failure
				60.6.1.1 Warning Signs
				60.6.1.2 Ominous Signs
			60.6.2	 Diagnostic Studies and Monitoring
		Further Reading
	61: Managing the Stridulous Child
		61.1	 Introduction
		61.2	 Anatomy and Pathophysiology of Stridor
			61.2.1	 Physics of Stridor
			61.2.2	 Evaluation of the Stridulous Patient
			61.2.3	 Physical Examination
				61.2.3.1	 Indication for Endoscopy Under General Anesthesia
			61.2.4	 Radiological Evaluation
			61.2.5	 Assessment of the Patient’s General Condition
			61.2.6	 Resuscitation and ­ Pre-operating Room Management
			61.2.7	 Operative Endoscopy
		References
	62: Congenital and Acquired Disorders of the Larynx
		62.1	 Introduction
		62.2	 Difference Between Pediatric and Adult Larynx
		62.3	 Congenital Anomalies
			62.3.1	 Supraglottic Anomalies
				62.3.1.1 Laryngomalacia
				62.3.1.2 Saccular Cysts and Laryngoceles
			62.3.2	 Glottic Anomalies
				62.3.2.1 Vocal Cord Paralysis
				62.3.2.2 Laryngeal Atresia
				62.3.2.3 Laryngeal Web
			62.3.3	 Subglottic Anomalies
				62.3.3.1 Subglottic Hemangioma
				62.3.3.2 Congenital Subglottic Stenosis
				62.3.3.3 Laryngeal Cleft
				62.3.3.4 Tracheoesophageal Fistula (TEF)
		62.4	 Acquired
			62.4.1	 Infections
				62.4.1.1 Laryngotracheobronchitis (Croup)
				62.4.1.2 Acute supraglottitis (Epiglottitis)
			62.4.2	 Gastroesophageal Reflux Disease (GERD)
			62.4.3	 Laryngeal Trauma
			62.4.4	 Corrosive Ingestion
			62.4.5	 Intubation Injury
			62.4.6	 Vocal Abuse
			62.4.7	 Recurrent Respiratory Papillomatosis (RRP)
			62.4.8	 Foreign Bodies
		References
	63: ENT-Related Syndromes
		63.1	 Introduction
		63.2	 General Approach for Evaluation to the Child with Suspected Syndrome
		63.3	 Syndromes of Particular Relevance to the ENT Surgeon
			63.3.1	 Pierre Robin Sequence
			63.3.2	 Down Syndrome
		63.4	 Autosomal Dominant Syndromes
			63.4.1	 Treacher Collins Syndrome
			63.4.2	 Goldenhar Syndrome (Oculo-Auriculovertebral Spectrum)
			63.4.3	 CHARGE Syndrome
			63.4.4	 Branchio-Oto-Renal Syndrome (Melnick–Fraser Syndrome)
			63.4.5	 22q11.2 Deletion Syndrome
			63.4.6	 Waardenburg Syndrome
			63.4.7	 Alport Syndrome
		63.5	 Autosomal Recessive Syndromes
			63.5.1	 Pendred Syndrome
			63.5.2	 Usher Syndrome
		63.6	 Syndromic Craniosynostosis
			63.6.1	 Crouzon Syndrome
			63.6.2	 Apert Syndrome
			63.6.3	 Pfeiffer Syndrome
		63.7	 Other Syndromes That Might Have ENT Involvement
			63.7.1	 Achondroplasia
			63.7.2	 Beckwith–Wiedemann Syndrome
			63.7.3	 Neurofibromatosis Type 2
			63.7.4	 Noonan Syndrome
			63.7.5	 Prader–Willi Syndrome
			63.7.6	 Mucopolysaccharidoses
		References
			Further Reading
	64: Congenital Anomalies of the Nose
		64.1	 Introduction
		64.2	 Other Malformations
		64.3	 Rare Nasal Anomalies
		Further Readings
	65: Cleft Lip and Palate
		65.1	 Introduction
		65.2	 Embryology
		65.3	 Epidemiology (Fig. 65.3)
		65.4	 Etiology and Genetics
		65.5	 Classification of Cleft Lip and Palate
			65.5.1	 Veau Classification
			65.5.2	 International Confederation of Plastic and Reconstructive Surgery Classification
				65.5.2.1	 Submucous Cleft Palate: A Minor Form of Secondary Cleft Palate Defect
		65.6	 Evaluation
		65.7	 Management of Cleft Lip and Palate
		65.8	 Surgical Repair of Cleft Lip and Palate
			65.8.1	 Unilateral Cleft Lip
			65.8.2	 Bilateral Cleft Lip
			65.8.3	 Cleft Palate Repair
		Further Reading
	66: Pediatric Audiology
		66.1	 Introduction
		66.2	 Pediatric Hearing Assessment
			66.2.1	 Newborn Hearing Screening Program
			66.2.2	 Pediatric Audiological Test Battery
				66.2.2.1 Immittance Audiometry
				66.2.2.2 Audiometry
				66.2.2.3 Otoacoustic Emissions (OAE)
				66.2.2.4 Auditory Brainstem Response (ABR)
				66.2.2.5 The Cochlear Microphonic (CM)
		66.3	 Management of Hearing Loss
		66.4	 Strategies for Prevention of Hearing Loss
		References
Part VIII: Facial Plastics
	67: Facial Aesthetic Analysis
		67.1	 Introduction
		67.2	 Skin Classification [1]
		67.3	 Facial Wrinkles [3]
		67.4	 Poor Candidates for Cosmetic Facial Plastic Surgeries
		67.5	 Proportions [4]
			67.5.1	 The Frankfurt Horizontal Plane (FHP)
			67.5.2	 Vertical Fifths (Fig. 67.2)
			67.5.3	 Horizontal Facial Thirds (Fig. 67.3)
			67.5.4	 Lateral View (Fig. 67.4)
		67.6	 Soft Tissue Anatomic Reference Points (Fig. 67.5) [5]
		67.7	 On Cephalometric Reference Point [6]
		67.8	 Facial Angles [5]
			67.8.1	 According to Powell and Humphrey (Fig. 67.7)
			67.8.2	 According to Peck and Peck (Fig. 67.8)
		67.9	 Forehead [5, 7]
		67.10	 The Eyes
		67.11	 The Nose [5, 7, 8]
		67.12	 The Ears [7]
		67.13	 The Mouth
		67.14	 Chin
		67.15	 The Neck
		References
	68: Rhinoplasty
		68.1	 Introduction
		68.2	 Surgical Anatomy of Rhinoplasty (Figs. 68.1 and 68.2)
		68.3	 Rhinofacial Analysis
			68.3.1	 Functional Analysis
			68.3.2	 Aesthetic Analysis (Figs. 68.4, 68.5, and 68.6)
		68.4	 Surgical Techniques
			68.4.1	 Incisions
			68.4.2	 Surgical Approach (Closed or Open)
				68.4.2.1	 Closed
				68.4.2.2	 Open
			68.4.3	 Tip Modifications
				68.4.3.1	 Tip Narrowing/Refinement
					Volume Reduction
					Tip Augmentation
					Soft Tissue Debulking
			68.4.4	 Techniques to Increase Projection
			68.4.5	 Techniques to Increase Rotation
			68.4.6	 Techniques to Decrease Projection
			68.4.7	 Techniques to Decrease Rotation
			68.4.8	 Dorsal Augmentation
			68.4.9	 Dorsal Hump Reduction
			68.4.10 Osteotomies
			68.4.11 Twisted Nose
			68.4.12 Functional Considerations
		68.5	 Complications of Rhinoplasty
		Further Readings
	69: Otoplasty
		69.1	 Introduction
		69.2	 Development of the Auricle
		69.3	 Ear Aesthetics
		69.4	 Epidemiology
		69.5	 Nonsurgical Treatment
		69.6	 Surgical Treatment
			69.6.1	 Indications
			69.6.2	 Preoperative Evaluation
			69.6.3	 Goals of Surgical Treatment
			69.6.4	 Surgical Techniques
		69.7	 Complications [10]
		References
	70: Blepharoplasty
		70.1	 Introduction
		70.2	 Eyelid Anatomy
			70.2.1	 The Anterior Lamella
			70.2.2	 The Eyelid Retractors
			70.2.3	 The Layers Found at the Upper Eyelid Crease
		70.3	 Indication
		70.4	 Preoperative Evaluation [6]
			70.4.1	 History
			70.4.2	 Physical Examination
		70.5	 Surgical Technique [8, 9]
			70.5.1	 Upper Eyelid Blepharoplasty
			70.5.2	 Lower Eyelid Blepharoplasty
		70.6	 Complications
		References
	71: Facelifting
		71.1	 Introduction
		71.2	 Facelift Anatomy (Fig. 71.1) [1]
			71.2.1	 Malar Fat Compartment (Fig. 71.2)
		71.3	 Indications for Facelift Surgery
		71.4	 Facelift Techniques
			71.4.1	 Subcutaneous Facelift
			71.4.2	 SMAS Plication Facelift
			71.4.3	 Lateral SMAS-ectomy
			71.4.4	 Deep Plane Facelift (DPFL)
			71.4.5	 Extended SMAS Lift
			71.4.6	 Complications of the Facelift Procedure [3–6]
		References
	72: Fillers and Neurotoxins
		72.1	 Neurotoxins
			72.1.1	 Introduction
			72.1.2	 Neurotoxin Serotypes
			72.1.3	 Mechanism of Action
			72.1.4	 Indication (Fig. 72.1)
				72.1.4.1	 In Upper Face
				72.1.4.2	 In Mid Face
				72.1.4.3	 In Lower Face
				72.1.4.4	 In the Neck
			72.1.5	 Contraindication
				72.1.5.1	 Absolute Contraindications
				72.1.5.2	 Relative Contraindications
				72.1.5.3	 Pregnancy and Lactation
			72.1.6	 Side Effects
			72.1.7	 Complications
				72.1.7.1	 In the Upper Face
				72.1.7.2	 In the Lower Face
				72.1.7.3	 In the Neck
		72.2	 Fillers
			72.2.1	 Introduction
			72.2.2	 Types of Injectable Filler
			72.2.3	 Indications (Fig. 72.2)
				72.2.3.1	 Cosmetic Indications
				72.2.3.2	 Therapeutic Indications
			72.2.4	 Complications
				72.2.4.1	 Early Injection Site Reactions
				72.2.4.2	 Inappropriate Placement
				72.2.4.3	 Delayed Nodules
				72.2.4.4	 Vascular Occlusion and Necrosis
		References