ENT I Goiter, Hoarseness, Neck Mass, Oral Cancer, Parotid

SUGGESTED READINGS

ENT I 1. Hermus AR, Huysmans DA. Treatment of benign nodular thyroid disease. N Engl J Med. 338(20):1438-1447,1998.
2. Neville BW, Day TA. Oral cancer and precancerous lesions. CA Cancer J Clin. 52(4):195-215, Jul-Aug 2002.
3. McGuirt WF. The neck mass. Med Clin North Am. 83(1):219-234,1999.
4. Garrett CG, Ossoff RH. Hoarseness. Med Clin North Am. 83(1):115-123,1999.
5. Hoffman H, Funk G, Endres D. Chapter 54: Evaluation and surgical treatment of tumors of the salivary glands, in Comprehensive Management of Head and Neck Tumors, Thawley S, et al. eds., 2nd edition. W.B. Saunders Company, Philadelphia, 1999.

OBJECTIVES ENT I

1. Discuss the differential diagnosis and work-up of a patient with a thyroid nodule.

2. Discuss the role of surgery, medical treatment and I131 in treating patients with hyperthyroidism and with carcinoma of the thyroid.

3. Discuss the multiple endocrine adenoma syndromes, which involve the thyroid gland; discuss their clinical significance.

4. Describe the usual surgical treatment for papillary, follicular and medullary cancer of the thyroid.

5. Describe the anatomical boundaries of the oral cavity, nasopharynx, oropharynx, hypopharynx and larynx.

6. Describe the anatomic representation of the cervical lymph node zones.

7. List the risk factors for cancer of the upper aerodigestive tract.

8. Discuss the differential diagnosis, evaluation and management of a neck mass in an adult.

9. Understand the usefulness and indications of fine needle aspiration biopsy, open biopsy and excisional biopsy.

10. Describe the clinical presentation, signs and symptoms of cancer involving the upper aerodigestive tract.

11. Discuss the evaluation and management for cancer of the oral cavity and pharynx.

12. Describe the clinical presentation of larynx cancer and discuss the various treatment modalities.

13. Describe the more common benign and malignant neoplasms involving the salivary glands.

14. Outline the evaluation of a patient with a salivary gland mass.

15. Understand the anatomy and physiology of the larynx.

16. Discuss the differential diagnosis of hoarseness for adult and pediatric patients.

17. Describe the evaluation of the patient with hoarseness.

18. Understand the patients who have hoarseness that should be referred to an otolaryngologist for evaluation. 19. Describe the patients who are at risk for having malignancies of the upper aerodigestive tract that can present as hoarseness.

CASE HISTORIES ENT I

1. A 56 year-old man presents with a 6 week history of progressive hoarseness, sore throat and weight loss. There is no prior history of voice problems, neck surgery or trauma. He works as a bricklayer. He smokes 1 pack of cigarettes/day and consumes “3-4 beers” each evening.

2. A 50 year-old woman presents with a 3 month history of a mass in her right cheek in front of her ear. It has slowly increased in size but is otherwise asymptomatic. She has no other medical problems. She owns her own business. She used to smoke 1 pack of cigarettes/day but quit 15 years ago. She drinks alcohol on social occasions.

3. A 38 year-old woman presents with a 6 month history of difficulty swallowing. Her dysphagia is greater for solids than for liquids. She denies any odynophagia and has no significant weight loss or weight gain. She also describes some shortness of breath at night when lying supine. She does not report any previous medical problems. She is a stay-at-home mother. She denies tobacco or alcohol use.

4. A 45 year-old man incidentally noted a lump in the upper part of his neck while shaving 3 months ago. He was initially evaluated in the emergency department at a local hospital and given a 10 day course of antibiotics without any improvement. Other than some fatigue, he does not report any symptoms related to the mass. He states that he is “healthy” and does not seek routine medical care. He works long hours as an investment banker. He does not smoke but usually has “several” drinks each week.

5. A 77 year-old woman presents with a complaint of a sore on her tongue. It has bothered her for about 1 month. She believes it is irritated by a sharp area on her lower teeth that continues to rub against the tongue. The area occasionally bleeds, and she has some difficulty swallowing because of the pain. Her past medical history is most notable for severe rheumatoid arthritis for which she takes Immuran. She is a retired school teacher. She used to smoke 1 ½ packs of cigarettes / day for 20 years but quit 8 years ago. She denies alcohol use.

Back to Objectives main page