Download Chapter 12: Ears, Nose, and Throat

Chapter 12 Notes
6/18/2012 4:49:00 AM
Chapter 12: Ears, Nose, and Throat
Ear anatomy
Cerumen –acidic- prevents micorganisms made in the distal esteral ear canal
TM-Annulus- fiburous ring surrounding the TM- pars tens- bottom of TMpars flaccida- top of the TM
Middle ear- Eustachian tube drains into posterior aspect of inf. Turbinate
(nasopharynx) equilzes pressure so the TM can vibrate freely
Inner ear curved cavityvestibule and semicircular canals= end organs for vestibular/ equilibrium
fnx., to cerebellum
cochlea (organ of Corti) to CNXIII vestibulochlear
Nose Anatomy
CN 1 olfactory
Anterior septum should be thicker than posterior
Bridge bones: frontal , maxillary
Nasal floor: hard and soft palate
Roof: frontal and shenoid
Receptors for smell in olfactory epithelium
Kiesselbach plexus
Mouth Anatomy
Stensens ducts-parotid gland opening near 2nd upper molar
Wharton ducts- submandibular glands opening near frenulum
Sublingual gland openings lateral to the wharton ducts in the sublingual fold
Vermillion border: btw lips and skin
buccal mucosa :is the lining of the cheeks and the back of the lips, inside
the mouth where they touch the teeth
Extra techniques
Sinus transillumination – if infection is suspected
Maxillary- place light near nose and look for glow in mouth
Frontal – place light on supraorbital and look for glow above
Should glow if opaque not good, or asymmetry
Smiling with teeth clenched test for occlusion and facial nerve CN 7
Sticking out tongue test CN XII hypoglossal
Gag response: Depressing tongue and saying “ah” also test CN IX
glossopharyngeal and vagus X ( deviation of the uvula may indicate vagus
paralysis)
Describe the following findings and problems for which they may be
indicative:
ear pits,
Preauricular pits are relatively common and are usually detected at birth. Some are
complicated by infection as the child grows, and may need surgical attention at a later
stage.While usually benign (and often familial), they may be associated with other
ear and face anomalies and may be present in branchio-otorenal dysplasia (with
external ear anomalies, branchial fistulae, hearing impairment, and renal anomalies). Ho
indicated unless there are other risk factors for deafness.
ear tags,
These are most often benign, isolated minor anomalies, occurring mostly unilaterally
but occasionally bilaterally. It is important however to examine the anatomic landmark
s carefully. If the tags are associated with distortion of the pinna as noted in the photo
graph of the left ear then it should trigger suspicion of associated pathology such as
the possibility of hemifacial microsomia.Tags may also be seen as part of multiple
dysmorphic features of infants with chromosomal anomalies. However, if isolated,
no investigations are required and audiology referral is not necessary unless there are oth
history of hearing loss.
Pedunculated tags can be removed by tying them at the base should the parents
wish but the parents need to be informed that tying the knot causes pain for a little
while and will result in the tag changing colour, shrivelling up, and eventually falling
of over the next week or so. Even if a tag is tied off, there may be a residual lump of
soft tissue which may need subsequent cosmetic attention
hearing loss, Some causes of hearing loss include damage to the inner
ear, a buildup of earwax, infections and a ruptured eardrum
instant= vascular disruption/autoimmune
hours/days= viral
adults= syphills, Genetic Meniere disease, presbycusis
Children=hyperbilirubinemia, craniofcaical abnormalits, low birth weight
nasal flaring, respiratory distress
nasal discharge,
Allergy- watery blue gray turbinities
Cerebrospinal fluid- unilateral water dixcharge from head trauma
Epixtaxis/ trauma- bloody
Rhinitis URI- bilateral mucoid / purulent
Foreign body- unilateral purulent thick greenish malodors
color of nasal mucosa,
deep pink shiny
purulent = URI for foreign body
redness= infection
localized redness= furuncle(boil)
Blusish gray, plale, swollen, boggy= allerfies
cheilosis, dry cracked lips, wind hydration normal things
Cheilosis, deep fissures at the corner of the mouth indicates riboflavin
(B2)deficiency
Tropi- crystals on external associated with gout
Angioedema- swelling of the lips
Parotitis(mumps)- red spot on the oping of the Stensen duct
malocclusion, -under/ over bites, crooked teeth
class 1molars good but front teeth twisted
class 2 under bite
class 3 lower molars medial to upper molars
aphthous ulcers, on buccal mucosa white, round, oval lesions with a red
halo also know as a canker sore aren't contagious. They can be painful,
however, and can make eating and talking difficult.
geographic tongue, is an EXPECTED /normal variant.
hairy tongue, elongated black/ yellow papillae can appear after antibiotic
therapy. Hairy tongue is a harmless condition in which the tongue looks
hairy or furry. The disorder usually goes away with antibiotics.
smooth tongue,=Glossitis red with slick appears = vit b12
streptococcal pharyngitis : tonsillar enlargement and exudates and engorged
cervical nodes pharyngeal erythema
cleft palate, most common craniofacial congenital malformation lip failing
to fuse during embryonic development prior to 13th week of gestation make
cause under weight babies because they cannot suck well
bifid uvula. Is a benign condition that is a normal variant in some Native
American s, but may be a sign of submucous cleft palate
Atresia is a condition in which a body orifice or passage in the body is
abnormally closed or absent
Edentulous= without teeth
Koplik spots white speck with red base on buccula mucosa opposite 1st and
2nd molar= rubeola( meases)
Presbycusis- sensory neural hearing loss with age
Xerostomia- dry oral tissues
Use table 12-1 as a resource.
Describe findings that may be associated with the following conditions:
B12 deficiency (look at the tongue), smooth slick red tongue
tonsillar infection, Acute tonsillitis is an infection of the tonsils caused by
one of several possible types of bacteria or viruses.
Chronic tonsillitis is a persistent infection of the tonsils and can cause tonsil
stone formation.
.Symptoms of tonsil or adenoid infection include sore throat, fever, bad
breath, difficulty swallowing, and swollen glands in the front of the neck.
Peritonsillar abscess is a collection of pus behind the tonsils.
acute otitis media, Inflammation in middle ear associated w/ middle ear
effusion that becomes infected with bacteria
otitis media with effusion, itis of middle ear resulting in collection of serous
muciod w/ TM still intact; Eustachian tube doesn’t work is is blocked by
lymph tissue in nasopharnx
perforated TM, TM with not move with bulb pressure. When the eardrum can
no longer stretch, it bursts or tears. Frequently, the pain gets better, because the pressure is now relieved,
however, sometimes the pain can get worse
Pain is the most common symptom of a perforated eardrum. It can range
from general discomfort to immediate or intense pain, or the patient may
just feel as if there is something not right with the ear.
Other common symptoms of perforated eardrum include:
Vertigo (spinning sensation) ;Hearing change or loss; Often with ringing,
buzzing, or clicking
; Fluid or blood draining from the ear
cerumen impaction.=earwax remove with instrument or irrigation may
present as conductive hearing loss
otitis externa
acute otitis media
itching in ear
Abrupt onset; fever ;feeling
sticking/cracking
blockage;anorexia;irritablity whenswallowing/yawing;
dizziness;
vomiting;feelling full
Intes w/ chewing
Deep ear ach prevents
sleep
discomfort
Watery then
purulent discharge
Discharge only if TM
ruptures
uncommon
Conductive hearing
loss
Conductive hearing loss ear
fills w pus
Conductive hearing loss
ear fills w fluid
Canal is red
TM w/ erythema ; bulging;
limited to no movement
TM is retracted(
sometimes bulging);
with bulb pressure
yellowish.’ Air-filled fluid
behind TM. movement
w/ negative press with
bulb pressure
Webber
otitis media w effusion
Normal
Conductive
Sensorineural
No lateralization;
lateralizes to
To affected ear
To opposite of
affected ear
Air< bone in
affected ear
Air>bone
covered ear
Rinne
Air> bone
6/18/2012 4:49:00 AM
6/18/2012 4:49:00 AM