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Ears, Nose, Throat
| Question | Answer |
|---|---|
| 3 functions of ear | 1) Identification, localization, and interpretation of sound 2) Mainenance of equilibrium 3) Housing CN VIII |
| external ear structure | auricle and external auditory canal: S shaped (2.5 cm), cartilage (distal 1/3), bone (proximal 2/3), cerumen (protective) |
| tympanic membrane | connects outer and middle ear. Concave, pulled in at center umbo/malleus. Oblique position, light reflex-conical shape, short processes and handle of malleus may be visible, pars tensa>pars flaccida |
| middle ear | air filled cavity that contains incus, stapes, and malleus |
| 3 functions of middle ear | 1) transmits sound vibrations to inner ear 2) protects inner ear by reducing amplitude of loud sounds 3) equalizes air pressure on each side of tympanic membrane |
| eustachian tubes | connect middle ear to nasopharynx, allows for equalization of air pressue on each of tympanic membrane so tympanic membrane doesnt rupture |
| mastoid | air filled cavity in temporal bone that is continuous with middle ear |
| inner ear | contains bony labyrinth, which holds sensory organs for equilibrium (semicircular canals) and hearing (cochlea) |
| cochlea | central hearing apparatus that transmits sound to CN VIII |
| vertigo | abnormal sensation of movement, spinning, whirling, staggering gait. Have pt describe symptoms without using the word dizzy |
| causes of vertigo (nonmedical) | seasickness, prolonged/unusual head or neck positions, spinning |
| medical causes of vertigo | benign positional vertigo (<1 min), meniere's disease (30 min-hours, also with tinnitus and hearing loss), constant vertigo (vestibular neuronitis, labrynthitis/inner ear infection), migraine headaches, stroke, tumor |
| Peripheral Hearing | ear transmits sound and converts its vibrations into electrical impulses, which can be analyzed by the brain. Amplitude= how loud sound is. Frequency== pitch/number of cycles |
| brainstem hearing | binaural interaction; permits locating direction of a sound as well as identifying the sound |
| cortex hearing | interprets meaning of sound and begin appropriate response |
| Otoscope Exam | hold like a pen, straighten canal up and back (>3 yrs), or down and out (<3 yrs). Insert <1/2", examine canal, check unaffected ear first |
| tympanic Membrane- exam | landmarks- cone of light at 0500 on rt. TM, and at 0700 on lt TM. Malleus- umbo, handle, short process. Incus and stapes junction |
| Acute Otitis Media | middle ear is infected; redness, bulging or lowered mobility, hard to see landmarks, increased vascularity, deep throbbing pain, earache, fever |
| serous otitis Media | amber-yellow drum. Serum in middle ear transudates to relieve negative pressure from blocked eustachian tube. TM may be retracted, may see air/fluid level, air bubbles. s/s: fullness, transient hearing loss, popping when swallow |
| otitis externa | pain with movement of tragus, secondary to trauma or moisture. Red, swollen, painful canal |
| risks for otitis externa | water in ear, narrowing of external auditory canal, impacted cerumen, dermatologic conditions, diabetes, immunocompromised state, insertion of devices into ear canal |
| perforated tympanic membrane | drum can rupture from increased pressure. Occurs if acute otitis media is not treated OR from trauma |
| tympanostomy tubes | polyethylene tubes inserted surgically into eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections |
| mastoiditis | otitis media causes infection of mastoid air cells and bine. Erythema, edema, pain on auricle and mastoid. Ear displaced forward, toxic appearance |
| cranial nerve VIII tests | gross hearing- whisper test and watch test high frequency- tuning fork tests (weber and rinne) |
| whisper test | one finger twists and person repeats whispered words |
| Conductive hearing loss | mechanical dysfunction in conduction of sound waves of the external ear, tympanic membrane, middle ear, or ossicles |
| sensorineural loss | pathology of the inner ear, cranial nerve VIII or auditory areas of cerebral cortex |
| mixed loss | combo of conductive and sensorineural loss |
| Functions of the nose | identify odors, humidify, warm and filter air, provide resonation of vocal sound |
| external nose | upper 1/3 bone, lower 2/3 cartilage |
| septum | in midline, holds a vascular network called kiesselbach plexus (site of epistaxis) |
| adenoids | located in nasopharynx |
| turbinates | 3 parallel bony projections (superior, middle inferior) in lateral walls of each nasal cavity. Increase surface area so more blood vessel adn mucous membranes are available to warm, humidify and filter air |
| meatus | opening named for the turbinate above it |
| nasolacrimal ducts | drain into inferior meatus |
| sinuses | drain into inferior meatus |
| external nose exam | shape, size, symmetry, flaring/narrowing of nares, columella is < size of one naris, palpate bridge and soft tissues, check patency |
| nasal drainage | unilateral or bilateral. note color, amount, odor. |
| rhinorrhea | mucous drainage (runny nose). Allergy- thin and clear. URI-thick. Purulent- sinusitis (bilateral), FB (unilateral). Epistaxis- bloody |
| Internal Nose Exam | gently insert speculum 1/2". dont touch septum. Check for symmetry, lesions, visible turbinates (get swollen, pale, boggy with allergies) |
| paranasal sinuses | air filled pockets within cranium that communicate with the nasal cavity and are lined with ciliated mucous membranes. they lighten weight of skull bones, serve as resonators for sound production, provide mucous that drains into nasal cavity |
| 4 sinuses | frontal (accessible for PE), maxillary (accessible for PE), ethmoid, sphenoid |
| examining the sinuses | inspect for swelling and erythema, palpation for tenderness, percussion for tenderness, transillumination |
| Mouth and oropharynx functions | vocalization, passageway for air and food, initiation of digestion. |
| taste | At least 75% of what we eprceive as taste is smell. Anterior 2/3 tongue= CN VII, sweet and salty. Posterior 1/3 tongue: CN IX, sour, bitter, umami |
| papillae | rough, bumpy elevations on dorsal surface of tongue. Taste buds are located in papillae at back and along side of tongue and on soft palate |
| supertasters | increased number of papillae, more common in women, Asians and African Americana |
| salivary glands | 3 pairs: parotidd glands, submandibular glands, sublingual glands |
| parotid glands | largest salivary glands, lie within cheeks. Stenson's duct runs forward to open on the buccal mucosa opposite second molar |
| submandibular glands | wharton's duct runs up and forward to floor of the mouth and opens at either side of frenulum |
| sublingual glands | lies within floor of the mouth under tongue |
| chelitis | dry, cracked lips |
| angioedema | allergic swelling |
| herpes labialis | cold sores |
| lip exam | symmetry, color, lesions, vermillion border lesion free. Should be pink, clear, moist |
| buccal mucosa exam | inspect for hydration, color, lesions, stenson's ducts, fordyce spots WNL (small, isolated white or yellow papules on mucosa), sebaceous cysts are painless, frenulum sensitive |
| leukoplakia | white raised patches that wont scrape away; precancerous |
| deeply pigmented mouth | endocrine disease |
| scars in mouth | malocclusion |
| parotitis | inflammation of stenson's duct |
| aphthousulcer | canker sore |
| gums | normally pink or coral with stippler surface, check for swelling, retraction of gingival margins, spongy, bleeding, discolored gums. |
| blue-black line 1 mm from margin of gums | lead poisoning |
| gingivitis | bleeding, tenderness, pockets of debris |
| teeth | 1 tooth at 7 mos, permanent teeth 6+, 20 teeth by 2.5 yrs, four 6 yr molars, 4 12 yr molars, 4 wisdom. 32 all together. |
| teeth exam | inspect for caries, make sure anchored, color range and shape, bruxism (clenching or grinding), malocclusion, TMJ |
| Tongue- dorsal exam | Should have dull white coating. check CN XII (hypoglossal), extend tongue, check for fasiculations, deviation, ROM, check tongue strength. |
| Geographic Tongue | pattenr of normal coating interspersed with bright, red, shiny, circular bald areas. Not significant, no known cause |
| hairy tongue | elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection. Occurs after use of antibiotics (inhibit beneficial bacteria and allow proliferaion of fungus) |
| smooth, red, slick, tongue | mucosa thins and looks red from decreased papillae. Dryness and burning. occurs with niacin deficiency, B12 deficiency (pernicious anemia), folic acid deficiency, and iron deficiency anemia |
| strawberry tongue | strep infection |
| tongue- dorsal exam | check if swelling of Wharton's duct, frenulum, varicosities, mucosa darker, check sides of tongue, cancer risk if smoker |
| bifid uvula | uvula looks partly severed |
| torus palatinus | bony midline projection of hard palate |
| CN IX (glossopharyngeal) and CN X (vagus) | tested together; motor portion of CN X tested only. With phonation, uvula rises and pharynx curtains. Gag reflex test. Taste is posterior 1/3 of tongue (IX) |
| tonsil exam | use bright light and moistened tongue blade. Note size, color, exudate, crypts. Check pharyngeal wall. |
| tonsilitis | strep, viral, mon, gonorrhea |
| peritonsilar abscess | dysphagia, increased temp, pain, red bulge at tonsil, may displace uvula |
| retropharyngeal abscess | dysphagia, inc temp, pain, inc post pharyngeal wall |
| diptheria | caused by Corynebacterium diptheriae, produces toxins and affects other organs. thick grayish black membrane may be present on tonsils, pharynx, uvula, etc and can block airway. |
Created by:
alexadianna
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