Prefaces to Otolaryngology—Head and Neck Surgery

Most students and practitioners of medicine may be overwhelmed in their initial endeavors to understand the field of Otolaryngology—Head and Neck Surgery. The sheer quantity of information, from the anatomy of the temporal bone to head and neck reconstruction strategies, may be difficult to comprehend and organize.

This reference book provides a state-of-the-art, comprehensive overview that captures the essential facts relative to various Otolaryngology topics. All chapters are co-authored by nationally recognized subspecialty experts. Each chapter follows a uniform outline to facilitate systematic development of in-depth knowledge of head and neck pathologies and to afford quick reviews at a glance. Its comprehensive content provides the depth required for written and oral standardized tests.

In addition, the material presented provides practitioners with current step-by-step management protocols for patients with common clinical problems such as dysphonia, dysphagia, head and neck trauma, upper airway obstruction, and head and neck cancer. Each work-up includes differential diagnoses, symptomatology, pathophysiology, complications, and alternative treatment plans that are consistent with accepted standards of care.

Chapter 1 offers a complete review of rhinology, paranasal sinuses, and immunology, including clinical protocols regarding nasal obstruction.

Chapter 2 addresses salivary gland pathology and management strategies.

Chapter 3 discusses the anatomy, physiology, and pathological conditions associated with Laryngology, including complete clinical work-ups of dysphonia and upper airway obstruction.

Chapter 4 provides a comprehensive review of general otolaryngological disorders such as pharyngitis, thyroid disease, and sleep apnea.

Chapter 5 discusses management of the head and neck cancer patient by anatomical site.

Chapter 6 reviews diseases of the ear and temporal bone, including management protocols for hearing loss, dizziness, and facial nerve injuries.

Chapter 7 offers the fundamental principles for aesthetic and reconstruction surgery of the head and neck.

Finally, Chapter 8 introduces the essential concepts of managing the head and neck trauma patient.

—Raza Pasha

This time in office, the messages were different…a physician from Turkey? A residency director in California? My “Contact Us” hyperlink registered a number of hits from systems outside of the Greater Houston circle requesting additional copies of the “Pocket Pasha.”

After being dropped by my original publishing company, having 2 years’ worth of updates stolen from my car, starting my private practice, and officially resigning from checking the status box “Single” to the one of “Married,” I pretty much had sequestered any remnants of the first edition to a shadow box in my office waiting room.

Graciously, I did not have to wait as long to realize the full potential of the first edition, nor its post-residency boom in interest, albeit this occurred the day after it was out of press and no longer available.

As a result of the positive response to the first edition, and gratefully by request, I present the second edition. The augmented pages contain updated information specifically in regards to General Otolaryngology, Rhinology, and Endocrinology. In addition, the Head and Neck Cancer, Neurotology/Otology, Trauma, and Facial Plastic/Reconstructive chapters have undergone academic facelifts. I have retained the same format of its predecessor, excising only the pharmacology section, which was not user-friendly. A more functional index further augments the second edition for another generation of residents, medical students, and clinicians.

Please send your comments, errors, or suggestions for upcoming editions to rpasha@PashaMD.com.

—Raza Pasha

You would have thought that I’m the chump responsible for an offshore oil spill by the number of hate E-mails I have received. Almost daily, my inbox was torpedoed with charming one-liners in the form of multilingual expletives and lots of exclamation marks. You guys did a commendable job on slamming the index of the last edition. Hopefully, we have recalibrated all the elements in this edition, so please no more cyber grumbles.

Hear Ye, Hear Ye

Loyal subjects of the great ENT fiefdom, heed my word: we need to be more integrated into sleep medicine. Sleep is as controversial as it comes, and as surgeons, we are getting clobbered. Our data are stale and not convincing to the many critics who wave the wand of the almighty CPAP wizard for every snorer, mouth breather, and overworked truck driver. As with allergy in sinus surgery or audiology in otology, we need to speak the language and be part of the great debate. As vanguard surgeons, we cannot consider the sleep apneic without recognizing the narcoleptic. At the same time, a sleep study is more than an AHI and a CPAP level.

I’m offering Chapter 5, Sleep Medicine and Sleep Apnea Surgery, as a crusade to my readers. Admittedly, some parts may be over the top. Read the chapter. Absorb the concepts. Then highlight the OSAS and sleep test section for your exam. I purposely want to be cutting-edge and cover the basics of sleep medicine and not just OSAS surgery. You may thank me later.

Moving Ahead

It has been an incredible experience creating this pocketbook. I especially have 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 you to be part of the fourth edition. If you have corrections, additions, illustrations, charts, appendix notes, or any other essentials, collect them, verify them, and then provide your source and visit my website, PashaMD.com.

You may upload your information for consideration for the next edition under the tab “Residents and Practitioners.” We want to continue to produce a book that is less self-indulgent and more about you, the student, the practitioner, the resident who is pounding the dirt and is too overwhelmed to read through 50 pages of historical references on odontogenic cysts before getting to the one-sentence summary point. Our aim is to deliver just the facts, so that you get through preoperative interrogations, morning round grilling, and exams based in minutia. We have done our job well if we are able to get you home in time to enjoy the more important things in life: family, friends, and cable programming.

—Raza Pasha

This fourth edition evens out my staggered, shadow-boxed display in my office waiting room. It also satisfies an essential update and provides an introduction to our more-than-welcome Little People chapter for those of you entrenched in transmittable conjunctivitis and the everlasting cold/influenza rotation.

As for me, I’ve spent the last few years as a target for academics and skeptics alike, lecturing cross-country on “hot button” topics such as indications of in-office balloon sinuplasty and the surgical management of sleep apnea. Should you ever find yourself with a desire to nettle to the brink of combat, walk into a rhinology conference and brag about how balloon sinuplasty is the greatest thing since electrocautery. Better yet, whisper to your pulmonologist colleague that you operated on his 23-year-old bachelor referral last week by jerking his 4+ tonsils without offering him a CPAP machine. “What?!!! You didn’t even have the decency to offer him a dental appliance so he can experience referred otalgia and teeth shifting first?!?”

No worries, though. You’d be pressed to find any controversial points in this handbook. No need for naked disclosures. We’re, once again, no nonsense. We’ve kept to the highlights so you can pass your boards and possibly prevent an occasional cauliflower ear now and then. No specific acknowledgments section this year, since a well-deserved Justin Golub is now blazed in the front of the book, and authors are credited within.

Deeply entrenched in midlife, with three sprouting legacies, my time is apportioned between soccer matches, Super Mario marathons, and piano recitals. I dream about Mary’s Little Lamb as an adjuvant remedy for psycho-physiological insomnia. The fourth edition is a product of my free time. I was tempted to include illustrations of the cochlear labyrinth crafted by my 5-year-old. Wanting to minimize distractions and leaving something for inclusion in the fifth edition, I opted to leave those out. Thanks for your support.

—Raza Pasha

The fourth begets a fifth and, like a cauldron of cooling magma, these editions are becoming more and more challenging to churn. This initial pet project, when I was jet-black-haired, has now become that insatiable Waponian volcano god that demands and demands episodic updates.

So here you go, the public, for your consumption. I’ve asked for a reprieve for at least a few years or so until the beast requires another sacrifice of an epoch of time and effort.

But I kid!! True, it’s not always the best of times revisiting Alport versus Apert on my holiday, yet I’m happy to serve. This edition bookmarks the era of Trump…a divided nation of ballooners and anti-ballooners. I only ask one thing…stop taking out uvulas. That little punching bag has God’s/Darwinian purposes beyond all of us. Oh, and also never ever use the term uvulopharyngopalatoplasty. That term belongs in a song from Mary Poppins. Quite frankly, it sounds dumb, no one knows what it means anymore, and I’m tired of hearing they were told that “it” doesn’t work. “Palatal reconstruction,” please; it’s sexier. OK, off the sermon, enjoy the book, study hard, and all the best. See you at conference.

—Raza Pasha

P.S. Need to give a shout out to Abdullah Al-Bader, who humbled the authors and editors by providing 5 pages of errata from the fourth edition. Dr. Al-Bader would later provide 23 alternative pathways to our academy’s position paper on cerumen impaction (total joke…we appreciate Abdullah).

I’m 50 years in the running, churning out edition 6 of 20 billion, got the team back together to update to the latest and greatest so I can revisit the best approach to the pterygoid fossa—wherever that is. I’m getting a tad senile, as I data replace Pemphigus and Pemphigoid with my kids’ birthday and anniversaries. I’ve got probably a gigabyte or two of room left in my skull, and something had to go…and that’s fine by me.

I’ve gotten laser-focused in my practice, doubt I’d ever ligate the internal jugular again or even remember how to use an ear microscope. I’ve become risk-averse and now limit my exposure to what I do best, with sleep and noses being quick to pass if not centered in my wheelhouse. Not dead though, last year I studied wellness and nutrition, started a physical therapy company, and spend my off-time modeling…planes, not runway.

I filmed a TikTok video with my youngest the other day after her 4th day quarantining because her classmate Livvie forgot to wash her hands, or something like that. The Mayans were off by a decade or so, but 2020 has been summarized by so many memes that I couldn’t do
another metaphor for “sucky” any more justice that’s been done a million times. Everyone is an expert now on virology and advanced epidemiological statistics, too many head explosions, and we’re hovering at stress level 11.

And so, we beget our sixth edition to save the world! If this version doesn’t bring peace, unity, and harmony to our community, then I have failed. Although I’d be satisfied with a good review on Amazon.

Ok, this version is a complete revamp letter to letter. New are more pics and flow charts for those who chose comics over prose as a kid. We recruited fresh authors and added online questions so you can feel good/bad about yourself. Justin still is in the mix as a co-author and we added resident bad ass, Alex Chern, as an editor and the artistry of Rahul Sharma as an illustrator. Bottom line . . . this version rawks.

Per usual, if we messed up on a major global concept or even forgot a period, don’t riot or invade our nation’s capital, just tell us. We aim to serve and want this legacy book to be just that—a legacy. And believe me, I’d never imagined when I started this saga, 20-plus years ago, I’d still be reviewing the boundaries of the facial recess, albeit much more rested. So, enjoy and absorb, hoping that this book remains your staple in your pocket or Kindle Fire. Peace.

—Raza Pasha