Chapter 21: Common Ear, Nose, and Throat Complaints

Ear-related complaints include otalgia, which is classified as primary when originating from structures within the ear such as otitis externa, otitis media, or mastoiditis, and secondary when pain is referred from distant sites including dental pathology, sinusitis, temporomandibular joint dysfunction, or malignancy. Visual examination of the tympanic membrane for edema, erythema, fluid, or perforation guides diagnostic reasoning. Hearing impairment presents as either conductive loss involving mechanical dysfunction of middle ear structures or sensorineural loss reflecting inner ear or auditory nerve pathology, with cerumen impaction representing the most commonly reversible etiology. Tinnitus, the subjective or objective perception of sound without external stimulus, warrants investigation when pulsatile in nature to exclude vascular abnormalities. Oral and pharyngeal complaints encompass mouth ulcerations stemming from immunologic, inflammatory, traumatic, or neoplastic causes, with aphthous ulcers being most prevalent. Dysphonia indicates laryngeal dysfunction and carries particular significance when present in at-risk populations or as a potential harbinger of laryngeal malignancy. Acute pharyngitis results predominantly from viral pathogens, though Streptococcus pyogenes remains the most significant bacterial agent, while chronic presentation warrants evaluation for reflux disease, allergic rhinitis, tonsillopharyngitis, and malignancy. Nasal complaints include epistaxis, occurring in approximately sixty percent of the population with anterior bleeding at Little's area comprising the majority of cases and posterior hemorrhage from Woodruff's plexus presenting greater management challenges. The paranasal sinuses, comprising paired frontal, ethmoid, sphenoid, and maxillary cavities, serve physiologic functions including cranial lightening, air conditioning, and mucus production while remaining vulnerable to infectious and inflammatory processes. Neck masses require systematic evaluation to differentiate between benign lymphadenopathy, salivary pathology, thyroid abnormalities, and cystic lesions, with malignancy consideration paramount in adult populations.