WIXLIB

Acknowledgments to the first editionThis reference guide required the guidance and contributions of manyindividuals to whom I must express my appreciation. Some are formalcontributors, others have provided support in more subtle ways unknownto them.To my mentors, Dr. James Paul Dworkin and Dr. Robert J. Meleca,who encouraged the conception of this project and who have graciouslyprovided editorial comments: Without your expert advice this projectcould not have been possible.To Dr. Robert H. Mathog and the faculty of Wayne State UniversityDepartment of Otolaryngology—Head and Neck Surgery who providedthe foundation of my education: I am forever grateful for their scholarlyguidance and their contribution to this material.To Candice Janco, Kristin Banach, Sandy Doyle, indexer Pam Rider,and the staff of Singular who had the faith and patience with thisfirst-time author and who helped in many decisions along the path topublication.To Loralee McAuliffe, who created splendid illustrations fromsketchy line drawings and illegible handwriting.To Dr. Harry Kim for his expertise in editing our review of radiationoncology and to Dr. Margie Crawford for her expertise in reviewingaudiology and vestibular testing.To my graduating colleagues of 2001: Syed, Sam, and Greg, whoencouraged my endeavor from the onset and on whom I have relied forso many things over the past years.To my closest friends of Detroit: Doug and Kristin, Faye, Olmina(Maria), Joe and Rielly, Jimmy, Dave, Ramin, Steve, Teresa and Norm,Joe and Paula, all of whom have provided a family away from home.Finally, to my loving family to whom I dedicate this book: EverythingI have ever accomplished and ever will accomplish goes to their credit.Thank you all. —Raza Pashaxii

PREFACE To the SECOND editionThis time in office, the messages were different . . . a physician fromTurkey? A residency director in California? My “Contact Us” hyperlinkregistered a number of hits from systems outside of the Greater Houstoncircle requesting additional copies of the “Pocket Pasha.” After beingdropped by my original publishing company, having 2 years’ worth ofupdates stolen from my car, starting my private practice, and officiallyresigning from checking the status box, “Single,” to the one of “Married,”I pretty much had sequestered any remnants of the first edition to ashadow box in my office waiting room. Graciously, I did not haveto wait as long to realize the full potential of the first edition, nor itspostresidency boom in interest; albeit, this occurred the day after it wasout of press and no longer available.As a result of the positive response to the first edition, and gratefullyby request, I present the second edition. The augmented pages containupdated information specifically in regards to General Otolaryngology,Rhinology, and Endocrinology. In addition, the Head and Neck Cancer, Neurotology/Ototlogy, Trauma, and Facial Plastic/Reconstructivechapters have undergone academic facelifts. I have retained the sameformat of its predecessor, excising only the pharmacology section, whichwas not user friendly. A more functional index further augments thesecond edition for another generation of residents, medical students,and clinicians.Please send your comments, errors, or suggestions for upcoming editions to rpasha@PashaMD.comxiii

Acknowledgments to the SECOND editionI am indebted to many people — the list has as much depth and is asvivid as the circumstances, mentors, friends, and family in my life havebeen thus far.I graciously thank my wonderful staff. Angie Cano, Angel Rodriquez,Tracey Kaderka, Claudia Ramirez, and Monica Lerma who provide asmooth running ship, encouraging and enabling me to complete thislatest project.The patient people of Plural Publishing, especially Sandy Doyle whohas been present since the inception of the first edition.The Boys of Houston, Zahid, Taseer, Poorang, Soroush, Umair,Kraig, Rodney, Ed, and Zephyr. You have all been unwavering in yourfriendship, confidence, and support of all projects I heap on to my plate.Finally, to my wonderful wife, Mamta, and family who provide thebaseline of my happiness and who are the best “springboard from whichto launch beyond myself.” It is your intrepid courage, your omnipresentlove, your sage thoughts, your reckless abandon, and your belief in whoI am, that sustains me. I look to you all for inspiration, the true mentorsof my life. Thank you.Thank you all once again.—Raza Pashaxiv

PREFACE To the Third editionYou would have thought that I’m the chump responsible for an offshore oil spill by the number of hate E-mails I have received. Almostdaily, my inbox was torpedoed with charming one-liners in the form ofmultilingual expletives and lots of exclamation marks. You guys did acommendable job on slamming the index of the last edition. Hopefullywe have recalibrated all the elements in this edition, so please no morecyber grumbles.Hear Ye, Hear YeLoyal subjects of the great ENT fiefdom, heed my word: we need tobe more integrated into sleep medicine. Sleep is as controversial as itcomes and as surgeons, we are getting clobbered. Our data are stale andnot convincing to the many critics who wave the wand of the almightyCPAP wizard for every snorer, mouth breather, and overworked truckdriver. As with allergy in sinus surgery or audiology in otology, we needto speak the language and be part of the great debate. As vanguardsurgeons, we cannot consider the sleep apneic without recognizing thenarcoleptic. At the same time, a sleep study is more than an AHI and aCPAP level.I’m offering Chapter 5, Sleep Medicine and Sleep Apnea Surgery, asa crusade to my readers. Admittedly, some parts may be over the top.Read the chapter. Absorb the concepts. Then highlight the OSAS andsleep test section for your exam. I purposely want to be cutting edge andcover the basics of sleep medicine and not just OSAS surgery. You maythank me later.Moving AheadIt has been an incredible experience creating this pocket book. I especiallyhave enjoyed working with Dr. Golub, the resident on the ground per se.As I become more and more removed from residency, I invite all of youto be part of the fourth edition. If you have corrections, additions, illustrations, charts, appendix notes, or any other essentials, collect them, verifythem, and then provide your source and visit my Web site, PashaMD.com.You may upload your information for consideration for the next editionunder the tab, “Residents and Practitioners.”xv

xviOtolaryngology-Head and Neck SurgeryWe want to continue to produce a book that is less self-indulgentand more about you, the student, the practitioner, the resident who ispounding the dirt and is too overwhelmed to read through 50 pagesof historical references on odontogenic cysts before getting to the onesentence summary point. Our aim is to deliver just the facts, so that you getthrough preoperative interrogations, morning round grilling, and examsbased in minutia. We have done our job well if we are able to get youhome in time to enjoy the more important things in life; family, friends,and cable programming.

Acknowledgments to the THIRD editionAs always I have to thank God, family, and friends for guiding methrough this venture with both encouragement and forgiveness. ButI would be remiss if I did not acknowledge a few essential ingredientsthat lent their flavor and dimension to making this text more robust.By far, I would like to recognize our fresh infusion of scholarly bloodin the form of our newest contributor and cyber collegue, Justin Golub.Pending a face-to-face encounter with Dr. Golub, I have formulatedmy own version of him: A young academician ensconced in a makeshiftlaboratory-cave buried high within the formidable Washington mountains. Cloaked in all the mystery of Charlie to his Angels, Dr. Golub isrecognized by his voice alone and a series of communiques via Outlook.Although we have yet to meet in person, our minds have already takenthe liberty to do so. Justin and I share the same intuition, drive, andimpetuous flow of thought in creating this book. My “hands on” experience garnered by my years in the trenches coupled with Justin’s full-timeimmersion in academia, we have succeeded in stocking this book withthe most current and relevant information. I look forward to both working with and meeting Justin for the fourth edition.I also need to shoutout to a handful of new coauthors who helpedoverhaul a few chapters, Neil Tanna, Joseph Goodman, and DouglasSidell. In keeping with the same dose of incognito as Justin, these writersand revisers were diligent in their efforts to take an already phenomenaltext and make it better.Another key reviewer was Vishad Nabili, a microvascular and reconstructive fellow from UCLA, who uploaded the latest and greatestin H&N Cancer.I’d also like to recognize those individuals comprising the AccuracyPolice, who were kind (read: obsessed) enough to point out blunders,bloopers, fiction, and outright lies that occasionally appeared in thesecond edition. The sheriff of this fact-finding force, Talal Al-Khatibfrom McGill University, not only ferreted out significant errors but alsocaught wind of the less notable grammatical goofs, extra letters, gratuitousspaces, widgets, and dingbats.I’ll even give John Ramsay a plug. He educated me on the grammatical analysis and root form of “stridorous,” which gets flagged onevery medical spell-checker I’ve used. FYI . . . “stridulous” is the Latinadjective, “stridor” is the noun.xvii

xviiiOtolaryngology-Head and Neck SurgeryThank you also to Plural Publishing for supporting this project andletting me have my way with the cover and agreeing on the color change.Black is so bad.So, with that, I hope you enjoy, maybe even rally around this piece ofliterary canon for a Pulitzer. In any case, we worked hard and we workedsmart to bring you the ins and outs of all the latest, greatest, and oftenexam-tested ENT facts.Peace.—Raza Pasha

PREFACE To the fOURTH editionThis fourth edition evens out my staggered, shadow-boxed display in myoffice waiting room. It also satisfies an essential update and provides anintroduction to our more than welcomed Little People chapter for thoseof you entrenched in transmittable conjunctivitis and the everlastingcold/influenza rotation.As for me, I’ve spent the last few years as a target for academics andskeptics alike lecturing cross-country on “hot button” topics such asindications of in-office balloon sinuplasty and the surgical managementof sleep apnea. Should you ever find yourself with a desire to nettle tothe brink of combat, walk into a rhinology conference and brag abouthow balloon sinuplasty is the greatest thing since electrocautery. Betteryet, whisper to your pulmonologist colleague that you operated on his23-year-old bachelor referral last week by jerking his 4 tonsils withoutoffering him a CPAP machine. “What?!!! You didn’t even have thedecency to offer him a dental appliance so he can experience referredotalgia and teeth shifting first?!?”No worries though. You’d be pressed to find any controversial pointsin this handbook. No need for naked disclosures. We’re once again, nononsense. We’ve kept to the highlights so you can pass your boards andpossibly prevent an occasional cauliflower ear now and then.No specific acknowledgments section this year since a well-deservedJustin Golub is now blazed in the front of the book and authors arecredited within.Deeply entrenched in midlife, with three sprouting legacies, my timeis apportioned between soccer matches, Super Mario marathons, andpiano recitals. I dream about Mary’s Little Lamb as an adjuvant remedyfor psycho-physiological insomnia. The fourth edition is a product ofmy free time and I was tempted to include illustrations of the cochlearlabyrinth crafted by my 5-year-old. Wanting to minimize distractionsand leaving something for inclusion in the fifth edition, I opted to leavethose out.Thanks for your support.—Raza Pashaxix

Help us make this book even better!We welcome any tips, suggestions, or corrections. Please emailPashaGolubGuide@gmail.com.We regret if we cannot respond to all emails, but we will consider every comment.

contributorsItalic lines indicate areas of author’s contributionsSyed F. Ahsan, MD, FACSNeurotologistHenry Ford Medical CenterClinical Assistant ProfessorInterim Residency ProgramDirectorWayne State UniversityDepartment of OtolaryngologyDetroit, MIChapter 8Valley ENTScottsdale, AZChapter 8Anthongy J. Cornetta, MD,FACSAttendingOtolaryngology-Head and NeckSurgeryHuntington HospitalNorth Shore–Long Island JewishHealth SystemHuntington, NYChapter 2Richard L. ArdenWilliam Beaumont HospitalTroy, MichiganChapter 9Valerie Cote, MD, FRCS (C)Pediatric OtolaryngologistDivision of OtolaryngologyHead and Neck SurgeryConnecticut Children’s MedicalCenterHartford, CTAssistant ProfessorUniversity of ConnecticutFarmington, CTChapter 10Dennis I. Bojrab, MDCEO and Director of ResearchMichigan Ear InstituteProfessor of OtolaryngologyOakland University WilliamBeaumont School of MedicineRochester Hills, MIClinical Professor ofOtolaryngology andNeurosurgeryWayne State UniversityDetroit, MIFounding PresidentAmerican CISEPO (CanadaInternational ScientificExchange Program)Toronto, CanadaChapter 8Timothy D. Doerr, MD,FACSAssociate ProfessorResidency Program DirectorHead of Facial Plastic SurgeryDepartment of OtolaryngologyHead and Neck SurgeryUniversity of Rochester MedicalCenterRochester, NYChapter 11Don L. Burgio, MD, FACSChiefOtology/Neurotologyxxi

xxiiOtolaryngology-Head and Neck SurgeryJames P. DworkinProfessorDepartment of OtolaryngologyDetroit Medical CenterDetroit, MICollege of Osteopathic MedicineMichigan State UniversityEast Lansing, MIChapter 3Justin S. Golub, MDOtology/Neurotology/Skull BaseSurgery FellowClinical InstructorDepartment of OtolaryngologyHead and Neck SurgeryUniversity of CincinnatiCincinnati Children’s HospitalMedical CenterCincinnati, OHChapters 1, 3, 5, 6, 7, 8, 9, and 10Joseph F. Goodman, MDDivision of OtolaryngologyHead and Neck SurgeryGeorge Washington UniversityWashington, DCChapter 9Amanda Hu, MD, FRCSCAssistant ProfessorLaryngologistDepartment of OtolaryngologyHead and Neck SurgeryDrexel University College ofMedicinePhiladelphia Ear, Nose andThroat AssociatesPhiladelphia, PAChapter 3Peggy E. Kelley, MD, FACS,FAAPAssociate ProfessorDirectorVoice, Vascular Malformation,and Microtia ClinicsDivision of PediatricOtolaryngologyChildren’s Hospital ColoradoDepartment of OtolaryngologyUniversity of Colorado, DenverAurora, COChapter 10Cody A. Koch, MD, PhDClinical InstructorDepartment of OtolaryngologyHead and Neck SurgeryUniversity of WashingtonSeattle, WAKoch Facial Plastic SurgeryDes Moines, IAChapter 11Steven C. Marks, MDPrivate PracticeHavre de Grace, MarylandChapter 1Robert H. Mathog, PhD, MDProfessor and ChairmanDepartment ofOtolaryngology-Head andNeck SurgeryWayne State UniversityKarmanos HospitalHarper HospitalDetroit, MIOakwood HospitalDearborn, MICrittenton HospitalRochester Hills, MIChapter 11Robert J. Meleca, MD, FACSGrand Rapids ENT, PCGrand Rapids, MIChapter 3Vishad Nabili, MD, FACSDiplomate, ABFPRSAssociate Professor

ContributorsClinical Head and Neck SurgeryResidency Program DirectorDepartment of Head and NeckSurgeryUniversity of California, LosAngelesLos Angeles, CAChapter 7Henry C. Ou, MDAssociate ProfessorPediatric Otolaryngology-Headand Neck SurgerySeattle Children’s HospitalUniversity of WashingtonVirginia Merrill Bloedel HearingResearch CenterSeattle, WAChapter 10Richard Chan Woo Park, MDAssistant ProfessorDepartment of OtolaryngologyHead and Neck SurgeryRutgers New Jersey MedicalSchoolNewark, New JerseyChapter 7Raza Pasha, MDMedical DirectorPasha Snoring and Sinus CenterAltus Healthcare ManagementServicesHouston, TXOprex Surgery CenterBeaumont, TXChapters 1, 2, 3, 4, 5, 6, 7, 8, 9,10, and 11Jeremy Prager, MDAssistant Professor PediatricOtolaryngologyUniversity of ColoradoDenver, COStaff Otolaryngologist xxiiiCo-Director, AerodigestiveProgramChildren’s Hospital ColoradoAurora, ColoradoChapter 10Robert T. Sataloff, MD, DMA,FACSProfessor and ChairmanDepartment of OtolaryngologyHead and Neck SurgerySenior Associate Dean forClinical Academic SpecialtiesDrexel University College ofMedicineChairmanThe Voice FoundationChairmanAmerican Institute for Voice andEar ResearchPhiladelphia, PAChapter 2Terry Y. Shibuya, MD, FACSCo-Director SCPMG Head andNeck Tumor BoardCo-Director SCPMG Skull BaseSurgery Center of ExcellenceFull-Time PartnerDepartment of Head and NeckSurgerySouthern California PermanenteMedical GroupOrange County, CAAssistant Clinical ProfessorDepartment of OtolaryngologyHead and Neck SurgeryUniversity of California IrvineSchool of MedicineIrvine, CAChapter 6Douglas R. Sidell, MDCincinnati Children’s HospitalCincinnati, OhioChapter 8

xxivOtolaryngology-Head and Neck SurgeryRobert J. StachlerSenior StaffOtolaryngology-Head and NeckSurgeryHenry Ford Medical GroupDivision ChiefLakeside Medical CenterClinical Associate ProfessorWayne State UniversityDepartment of OtolaryngologyHead and Neck SurgeryDetroit, MIChapters 3 and 6Mas Takashima, MD, FACSDirectorOtolaryngology SectionSleep Medicine FellowshipBaylor College of MedicineHouston, TXChapter 5Neil Tanna, MD, MBAAssociate ProfessorPlastic Surgery andOtolaryngologyHofstra North Shore–LIJ Schoolof MedicineHuntington, NYDivision of Plastic andReconstructive SurgeryNew York Head and NeckInstituteNew York, NYChapters 8 and 9George H. Yoo, MD, FACSChief Medical OfficerKarmanos Cancer CenterProfessorDepartments of OtolaryngologyHead and Neck Surgery andOncologyWayne State University Schoolof MedicineDetroit, MIChapter 7Richard Zoumalan, MDPrivate PracticeBeverly Hills, CACedars-Sinai Medical CenterWest Hollywood, CAClinical InstructorUCLA and USC Schools ofMedicineLos Angeles, CAChapter 9

Common Abbreviations inOtolaryngology-Head and Neck AAOMAPAPASAASSRAVMBAEPBAERBAHA3 dimensional5-fluorouracilaryepiglotticarytenoid abductionarterial blood gas,air bone gapauditory brainstemresponseair conductionangiotensinconverting enzymeapnea-hypopneaindexapnea indexacquiredimmunodeficiencysyndromeAmerican JointCommission onCancerassisted listeningdeviceamyotrophic lateralsclerosisantinuclear antibodyacute otitis mediaautotitrating positiveairway pressureaspirinauditory stem auditoryevoked potentialbrainstem auditoryevoked HLCICCMVCNCNSCOMCOMMANDOxxvbone-anchoredhearing aidbone conductionbasal cellcarcinomatwice a daybilevel positiveairway pressurebilateralmyringotomy andtubesbehavioralobservationaudiometrybenign paroxysmalpositional vertigobehind the earblood urea nitrogenConsensusAuditory-PerceptualEvaluation of Voicecomplete bloodcountcentigrayconductive hearinglosscompletely in canalcytomegaloviruscranial nervecentral nervoussystemchronic otitismediacombinedmandibulectomyand neck dissectionoperation

xxviOtolaryngology-Head and Neck SurgeryCPACPAPCROSCRPCSACSFCTCTACVAcVEMPCXRdBdB HLdB SLdB ineangle, conditionedplay audiometrycontinuous positiveairway pressurecontralateral routingof soundC-reactive proteincentral sleep apneacerebrospinal fluidcomputed cularaccidentcervical vestibularevoked myogenicpotentialchest x-

Chapter 10 Pediatric Otolaryngology 519 Valerie Cote, Jeremy D. Prager, Henry Ou, Peggy E. Kelley, Raza Pasha, and Justin S. Golub The Pediatric Encounter 521 General Pediatric Otola