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R1 Otolaryngology Resident Preparation Rotation with Dr. Hoffman

last modified on: Wed, 01/24/2024 - 07:00

See also: Iowa Otolaryngology Resident Handbook and R3-5 Otolaryngology Resident Preparation VA Rotation with Dean Lyons

Goals

General Considerations

         Laryngology  

Salivary Disorders

Become proficient in taking a history

Become proficient in exam

Become proficient in exam

First establish rapport! Confirm the patient name, age, occupation, and home situation and identify his/her reason for visit (it helps to assert -when true: 'I studied your chart yesterday in preparation for your visit today and identified you are listed as seeing us today for ..."

1. The ABC's of rapport building: Active listening, Body language, Candor (Kern 2017) 

2. Renee Bacher "Boost Your Emotional Intelligence" in ENTtoday (enttoday.org) November 11 2010 https://www.enttoday.org/article/the-important-role-emotional-intelligen... reporting on lecture by Ellen Friedman MD "IQ Got You Here. EQ Can Get You There" presented at the Women in otolaryngology luncheon as part of hte AAO-HNS 2019 meeting Sept 15-18 in New Orleans.

Full head and neck exam include cranial nerves

Indirect mirror exam of the larynx

Oral exam (bimanual palpation/assess salivary flow)

Example: Mrs. X is an 84 year old retired former secretary living in Sioux City, IA (4 1/2 hour trip to Iowa City) accompanied by her supportive husband of 50 years here for evaluation of hoarseness beginning after thyroid surgery two months ago

Trans-nasal flexible laryngoscopy

Diagnostic ultrasound

see: descriptive images

History of present illness 

Office procedures including 

Salivary gland interventions

Characterize concern in detail: (PPQRSTA = Provoking, Palliative, Quality, Radiation, Severity, Timing, Associated factors)

When there are multiple confusing possibly interacting complaints, it is often useful to list them numerically by writing them on dry erase board in a hierarchy of most important to the patient to least important

1. Voice Clinic

A. Interpretation of voice analysis

B. Performance of rigid transoral video laryngoscopy in Voice Clinic

2. Botox injection to head and neck

1. Duct canulation and dilation

Physical exam - always employ concept of "fulcrum"(word for the day=fulcrum)

3. Anesthesia for laryngeal procedures (topical, SLN, glossopharyngeal  blocks)

2. Ultrasound guided botox injection/needle biopsy

Otoscopy: nasal exam (anterior rhinoscopy): oral cavity exam (bimanual palpation, massage of salivary glands): indirect mirror exam of oropharynx and larynx: palpation of neck (levels I-VI) ; consider ultrasound an extension of physical exam

4. Assist with laryngeal injections/biopsies/laser

3. Sialography

In many cases it is useful for the resident to write out the primary concerns of the patient in front of the patient to include the patient in organizing the history as in the photos below

(as initiated  by Z Robinett):

Reading to prepare for rotation

A. Laryngology - clinical exam

Examination of the subglottis with transnasal laryngoscopy

Narrow band imaging of vocal cord leukoplakia flexible transnasal videolaryngoscopy

​B. Laryngology - disease processes

i. Unilateral Laryngeal Paralysis or Vocal Cord Paralysis

ii. Laryngeal Movement Disorders Clinic (Neurolaryngology)

C. Salivary disorders - clinical exam

Salivary Ultrasound

Sialograms and Sialography

Hoffman HT, Pagedar NA.Ultrasound-Guided Salivary Gland Techniques and Interpretations.Atlas Oral Maxillofac Surg Clin North Am. 2018 Sep;26(2):119-132. doi: 10.1016/j.cxom.2018.04.001. Review. .

D. Salivary Disorders - disease processes

Salivary Swelling

References

Kern, Eugene B: The Birkett lecture: Avoiding the Unhappy Patient: The ABC's of Rapport Building  Laryngoscope 127:2517-2521 November 2017

Renee Bacher "Boost Your Emotional Intelligence" in ENTtoday (enttoday.org) November 11 2010 https://www.enttoday.org/article/the-important-role-emotional-intelligen...

          reporting on lecture by Ellen Friedman MD "IQ Got You Here. EQ Can Get You There" presented at the Women in otolaryngology luncheon as part of hte AAO-HNS 2019 meeting Sept 15-18 in New Orleans.

Hoffman HT, Pagedar NA.Ultrasound-Guided Salivary Gland Techniques and Interpretations.Atlas Oral Maxillofac Surg Clin North Am. 2018 Sep;26(2):119-132. doi: 10.1016/j.cxom.2018.04.001. Review. .