Kim Scott, FNP, MSN, AE-C, is a Nurse Practitioner with a six-physician partnership at Eastern Virginia Ear, Nose & Throat Specialists, Chesapeake, VA.Richard F. Debo, MD, FACS is Associate Otolaryngologist, Eastern Virginia Ear, Nose & Throat Specialist, Chesapeake, VA, is Assistant Professor of Clinical Otolaryngology - head and neck surgery, Eastern Virginia Medical School, Department of Otolaryngology (since 2004) and is Instructor of Surgery, Uniformed Services University of the Health Sciences (since 1989).Alan Keyes, MD, FACS, is Associate Otolaryngologist, Eastern Virginia Ear, Nose & Throat Specialist, Chesapeake, VA, and Associate Professor, Eastern Virginia Medical School.David Leonard, MD, FACS, FAAOHNS, served at the Naval Hospital Jacksonville, Florida as the Otolaryngology Department Head, Chairman of the Credentials Subcommittee, Vice-Chairman Executive Committee of the Medical Staff, and Director Surgical Services. He retired as a US Navy Captain with over 26 years of service, and joined Eastern Virginia Ear, Nose, and Throat Specialists in 2010.

• Preface ix1. Physical Examination Documentation of Normal and AbnormalFindings From the Ear, Nose, and Throat Examination 1Procedure Protocol: Pneumatic Otoscopy 5Procedure Protocol: Rinne and Weber Tuning Fork Tests 7Procedure Protocol: Nasal Endoscopy 11Procedure Protocol: Evaluating the Nasopharynx With IndirectMirror Examination 12Video 1.1: Nasal endoscopyVideo 1.2: Flexible fi beroptic laryngoscopyProcedure Protocol: Flexible Fiberoptic Laryngoscopy 22Procedure Protocol: Evaluating the Larynx With IndirectMirror Examination 232. Ear, Nose, and Throat Anatomy and Physiology Normal Findings 333. Physical Examination of the Cranial Nerves for the Head and Neck 614. Evaluation and Management of Facial Nerve Conditions 895. Evaluation and Management of Hearing and Tinnitus 1016. Evaluation and Management of External Ear Conditions 129Procedure Protocol: Ear Cleaning 134Procedure Protocol: Otowick Insertion 1347. Evaluation and Management of Middle Ear Conditions 149Procedure Protocol: Myringotomy With and Without Tympanostomyor Pressure Equalizer Tube Insertion 160Procedure Protocol: Paper Patch Myringoplasty 1668. Evaluation and Management of Inner Ear Conditions 179Procedure Protocol: Epley Maneuver 1909. Evaluation and Management of Olfactory Disorders 20110. Evaluation and Management of the Nose—External Conditions 209Scott_96064_PTR_00_i-x_03-11-14.indd vii 3/12/2014 5:10:56 PM11. Evaluation and Management of the Nasal Cavity and Paranasal Sinuses 215Procedure Protocol: Silver Nitrate Cauterization for Epistaxis 229Procedure Protocol: Nasal Packing for Epistaxis 230Staging Criteria: How to Read and/or Determine Cancer Staging 242Staging Criteria: TNM Staging System for the Nasal Cavity andParanasal Sinuses 24312. Evaluation and Management of Nasopharynx Conditions 249Staging Criteria: TNM Staging System for the Nasopharynx 25313. Evaluation and Management of Oropharynx Disorders 255Procedure Protocol: Needle Drainage and Incision and Drainageof a Peritonsillar Abscess 272Procedure Protocol: Lingual Frenulectomy 280Staging Criteria: TNM Staging Criteria: Lip and Oral Cavity Cancer 284Staging Criteria: TNM Staging Criteria: Oropharyngealand Hypopharyngeal Cancer 28514. Evaluation and Management of Sleep Apnea 29115. Evaluation and Management of Salivary Gland Conditions 301Staging Criteria: TNM Staging Criteria for Salivary GlandCancerous Tumors 31516. Evaluation and Management of Benign Neck Conditions 32317. Overview of Malignant Neck Conditions 34518. Evaluation and Management of Thyroid Disorders 355Staging Criteria: TNM Staging Criteria for Thyroid Cancer 36819. Evaluation and Management of Parathyroid Disorders 37320. Evaluation and Management of Trachea Disorders and Conditions 38321. Evaluation and Management of Esophageal Disorders 40122. Evaluation and Management of Larynx and Hypopharynx Disorders 413Video 22.1: Stroboscopy: False vocal cord useVideo 22.2: Left vocal cord paralysis patient 1Video 22.3: Left vocal cord paralysis patient 2Video 22.4: Stroboscopy: Normal vocal cord functionVideo 22.5: Stroboscopy: Bilateral ball-valving vocal cord polypsStaging Criteria: TNM Staging Criteria for Larynx 43323. Overview of Lesions of the Skin: Head and Neck 437Procedure Protocol: Biopsy of Skin Lesion 439Staging Criteria: TNM Staging Criteria for Mucosal Melanoma of theHead and Neck 44224. Evaluation and Management of Allergic and Nonallergic Disorders 44525. Overview of Commonly Ordered Tests in ENT 473Index 479

Kim Scott, FNP, MSN, AE-C, is a Nurse Practitioner with a six-physician partnership at Eastern Virginia Ear, Nose & Throat Specialists, Chesapeake, VA.Richard F. Debo, MD, FACS is Associate Otolaryngologist, Eastern Virginia Ear, Nose & Throat Specialist, Chesapeake, VA, is Assistant Professor of Clinical Otolaryngology - head and neck surgery, Eastern Virginia Medical School, Department of Otolaryngology (since 2004) and is Instructor of Surgery, Uniformed Services University of the Health Sciences (since 1989).Alan Keyes, MD, FACS, is Associate Otolaryngologist, Eastern Virginia Ear, Nose & Throat Specialist, Chesapeake, VA, and Associate Professor, Eastern Virginia Medical School.David Leonard, MD, FACS, FAAOHNS, served at the Naval Hospital Jacksonville, Florida as the Otolaryngology Department Head, Chairman of the Credentials Subcommittee, Vice-Chairman Executive Committee of the Medical Staff, and Director Surgical Services. He retired as a US Navy Captain with over 26 years of service, and joined Eastern Virginia Ear, Nose, and Throat Specialists in 2010.

• Preface ix1. Physical Examination Documentation of Normal and AbnormalFindings From the Ear, Nose, and Throat Examination 1Procedure Protocol: Pneumatic Otoscopy 5Procedure Protocol: Rinne and Weber Tuning Fork Tests 7Procedure Protocol: Nasal Endoscopy 11Procedure Protocol: Evaluating the Nasopharynx With IndirectMirror Examination 12Video 1.1: Nasal endoscopyVideo 1.2: Flexible fi beroptic laryngoscopyProcedure Protocol: Flexible Fiberoptic Laryngoscopy 22Procedure Protocol: Evaluating the Larynx With IndirectMirror Examination 232. Ear, Nose, and Throat Anatomy and Physiology Normal Findings 333. Physical Examination of the Cranial Nerves for the Head and Neck 614. Evaluation and Management of Facial Nerve Conditions 895. Evaluation and Management of Hearing and Tinnitus 1016. Evaluation and Management of External Ear Conditions 129Procedure Protocol: Ear Cleaning 134Procedure Protocol: Otowick Insertion 1347. Evaluation and Management of Middle Ear Conditions 149Procedure Protocol: Myringotomy With and Without Tympanostomyor Pressure Equalizer Tube Insertion 160Procedure Protocol: Paper Patch Myringoplasty 1668. Evaluation and Management of Inner Ear Conditions 179Procedure Protocol: Epley Maneuver 1909. Evaluation and Management of Olfactory Disorders 20110. Evaluation and Management of the Nose—External Conditions 209Scott_96064_PTR_00_i-x_03-11-14.indd vii 3/12/2014 5:10:56 PM11. Evaluation and Management of the Nasal Cavity and Paranasal Sinuses 215Procedure Protocol: Silver Nitrate Cauterization for Epistaxis 229Procedure Protocol: Nasal Packing for Epistaxis 230Staging Criteria: How to Read and/or Determine Cancer Staging 242Staging Criteria: TNM Staging System for the Nasal Cavity andParanasal Sinuses 24312. Evaluation and Management of Nasopharynx Conditions 249Staging Criteria: TNM Staging System for the Nasopharynx 25313. Evaluation and Management of Oropharynx Disorders 255Procedure Protocol: Needle Drainage and Incision and Drainageof a Peritonsillar Abscess 272Procedure Protocol: Lingual Frenulectomy 280Staging Criteria: TNM Staging Criteria: Lip and Oral Cavity Cancer 284Staging Criteria: TNM Staging Criteria: Oropharyngealand Hypopharyngeal Cancer 28514. Evaluation and Management of Sleep Apnea 29115. Evaluation and Management of Salivary Gland Conditions 301Staging Criteria: TNM Staging Criteria for Salivary GlandCancerous Tumors 31516. Evaluation and Management of Benign Neck Conditions 32317. Overview of Malignant Neck Conditions 34518. Evaluation and Management of Thyroid Disorders 355Staging Criteria: TNM Staging Criteria for Thyroid Cancer 36819. Evaluation and Management of Parathyroid Disorders 37320. Evaluation and Management of Trachea Disorders and Conditions 38321. Evaluation and Management of Esophageal Disorders 40122. Evaluation and Management of Larynx and Hypopharynx Disorders 413Video 22.1: Stroboscopy: False vocal cord useVideo 22.2: Left vocal cord paralysis patient 1Video 22.3: Left vocal cord paralysis patient 2Video 22.4: Stroboscopy: Normal vocal cord functionVideo 22.5: Stroboscopy: Bilateral ball-valving vocal cord polypsStaging Criteria: TNM Staging Criteria for Larynx 43323. Overview of Lesions of the Skin: Head and Neck 437Procedure Protocol: Biopsy of Skin Lesion 439Staging Criteria: TNM Staging Criteria for Mucosal Melanoma of theHead and Neck 44224. Evaluation and Management of Allergic and Nonallergic Disorders 44525. Overview of Commonly Ordered Tests in ENT 473Index 479

Kim Scott, FNP, MSN, AE-C, is a Nurse Practitioner with a six-physician partnership at Eastern Virginia Ear, Nose & Throat Specialists, Chesapeake, VA.Richard F. Debo, MD, FACS is Associate Otolaryngologist, Eastern Virginia Ear, Nose & Throat Specialist, Chesapeake, VA, is Assistant Professor of Clinical Otolaryngology - head and neck surgery, Eastern Virginia Medical School, Department of Otolaryngology (since 2004) and is Instructor of Surgery, Uniformed Services University of the Health Sciences (since 1989).Alan Keyes, MD, FACS, is Associate Otolaryngologist, Eastern Virginia Ear, Nose & Throat Specialist, Chesapeake, VA, and Associate Professor, Eastern Virginia Medical School.David Leonard, MD, FACS, FAAOHNS, served at the Naval Hospital Jacksonville, Florida as the Otolaryngology Department Head, Chairman of the Credentials Subcommittee, Vice-Chairman Executive Committee of the Medical Staff, and Director Surgical Services. He retired as a US Navy Captain with over 26 years of service, and joined Eastern Virginia Ear, Nose, and Throat Specialists in 2010.

• Preface ix1. Physical Examination Documentation of Normal and AbnormalFindings From the Ear, Nose, and Throat Examination 1Procedure Protocol: Pneumatic Otoscopy 5Procedure Protocol: Rinne and Weber Tuning Fork Tests 7Procedure Protocol: Nasal Endoscopy 11Procedure Protocol: Evaluating the Nasopharynx With IndirectMirror Examination 12Video 1.1: Nasal endoscopyVideo 1.2: Flexible fi beroptic laryngoscopyProcedure Protocol: Flexible Fiberoptic Laryngoscopy 22Procedure Protocol: Evaluating the Larynx With IndirectMirror Examination 232. Ear, Nose, and Throat Anatomy and Physiology Normal Findings 333. Physical Examination of the Cranial Nerves for the Head and Neck 614. Evaluation and Management of Facial Nerve Conditions 895. Evaluation and Management of Hearing and Tinnitus 1016. Evaluation and Management of External Ear Conditions 129Procedure Protocol: Ear Cleaning 134Procedure Protocol: Otowick Insertion 1347. Evaluation and Management of Middle Ear Conditions 149Procedure Protocol: Myringotomy With and Without Tympanostomyor Pressure Equalizer Tube Insertion 160Procedure Protocol: Paper Patch Myringoplasty 1668. Evaluation and Management of Inner Ear Conditions 179Procedure Protocol: Epley Maneuver 1909. Evaluation and Management of Olfactory Disorders 20110. Evaluation and Management of the Nose—External Conditions 209Scott_96064_PTR_00_i-x_03-11-14.indd vii 3/12/2014 5:10:56 PM11. Evaluation and Management of the Nasal Cavity and Paranasal Sinuses 215Procedure Protocol: Silver Nitrate Cauterization for Epistaxis 229Procedure Protocol: Nasal Packing for Epistaxis 230Staging Criteria: How to Read and/or Determine Cancer Staging 242Staging Criteria: TNM Staging System for the Nasal Cavity andParanasal Sinuses 24312. Evaluation and Management of Nasopharynx Conditions 249Staging Criteria: TNM Staging System for the Nasopharynx 25313. Evaluation and Management of Oropharynx Disorders 255Procedure Protocol: Needle Drainage and Incision and Drainageof a Peritonsillar Abscess 272Procedure Protocol: Lingual Frenulectomy 280Staging Criteria: TNM Staging Criteria: Lip and Oral Cavity Cancer 284Staging Criteria: TNM Staging Criteria: Oropharyngealand Hypopharyngeal Cancer 28514. Evaluation and Management of Sleep Apnea 29115. Evaluation and Management of Salivary Gland Conditions 301Staging Criteria: TNM Staging Criteria for Salivary GlandCancerous Tumors 31516. Evaluation and Management of Benign Neck Conditions 32317. Overview of Malignant Neck Conditions 34518. Evaluation and Management of Thyroid Disorders 355Staging Criteria: TNM Staging Criteria for Thyroid Cancer 36819. Evaluation and Management of Parathyroid Disorders 37320. Evaluation and Management of Trachea Disorders and Conditions 38321. Evaluation and Management of Esophageal Disorders 40122. Evaluation and Management of Larynx and Hypopharynx Disorders 413Video 22.1: Stroboscopy: False vocal cord useVideo 22.2: Left vocal cord paralysis patient 1Video 22.3: Left vocal cord paralysis patient 2Video 22.4: Stroboscopy: Normal vocal cord functionVideo 22.5: Stroboscopy: Bilateral ball-valving vocal cord polypsStaging Criteria: TNM Staging Criteria for Larynx 43323. Overview of Lesions of the Skin: Head and Neck 437Procedure Protocol: Biopsy of Skin Lesion 439Staging Criteria: TNM Staging Criteria for Mucosal Melanoma of theHead and Neck 44224. Evaluation and Management of Allergic and Nonallergic Disorders 44525. Overview of Commonly Ordered Tests in ENT 473Index 479