Breathing Voice and Hearing Flashcards
Upper respiratory tract includes
nose, nasal cavities, paranasal sinuses, pharynx and larynx.
The 2 nasal cavities: contains, shape, held open by
Contains olfactory receptors
Wedge shaped
Open by cartilage and bone
The anterior apertures of the nasal cavities are…and open onto
the nares
inferior surface of the external nose
The posterior apertures are the… and open into
Choanae
the nasopharynx
The nasal cavities are separated:
• From each other by
• From the oral cavity below by
• From the cranial cavity above by
midline nasal septum
hard palate
parts of the frontal, ethmoid and sphenoid bones
The lateral wall of the nasal cavity is characterized by
conchae - 3 curved shelves of bone, dividing the nasal cavity into 4 air chambers
Where are the paranasal sinuses’ openings
on the lateral wall and roof
Bones that contribute to the skeletal framework of the nasal cavities include:
Ethmoid – complex bones that lies between the two orbits –> the roof, lateral wall and medial
wall of both nasal cavities. Contains the ethmoidal sinuses. – forms the superior and middle conchae.
• Other unpaired bones = sphenoid, frontal bone, vomer
• Paired nasal, maxillary, palatine and lacrimal bones, and inferior conchae
4 paranasal sinuses
ethmoidal air cells
frontal sinus
maxillary sinus
sphenoidal sinus
paranasal sinuses are lined by
ciliated and mucous secreting respiratory mucosa
paranasal sinuses open into
the nasal cavities
paranasal sinuses are innervated by
branches of the trigeminal nerve
function of paranasal sinuses
reduce weight of skull
act as resonators for the voice
paranasal sinuses are connected to the pharynx by
small holes (route of infection)
build of mucus in the sinuses > pain + possible infection
Frontal sinuses drains via the
Innervated by
frontonasal duct
Branches of the supraorbital nerve from the ophthalmic branch of trigeminal (V1)
Ethmoidal cells Innervated by
branches of nasociliary nerve from the ophthalmic branch of trigeminal (V1)
AND maxillary branch of trigeminal (V2)
Maxillary sinuses - can often be infected by
tooth infections
Maxillary sinuses Innervated by
infra-orbital and alveolar branches of the ophthalmic branch of trigeminal (V1)
Sphenoidal sinus located
just posterior to the ethmoidal air cells in the sphenoid bone
Sphenoidal sinus Innervated by
posterior ethmoidal branch of the ophthalmic branch (V1)
AND the maxillary branch of the trigeminal nerve (V2)
Drainage of the sinuses:
Frontal, sphenoid, anterior middle and posterior ethmoidal, maxillary (nasolacrimal)
Sphenoid - Sphenoehtmoidal recess
Posterior ethmoidal air cells - superior meatus
Anterior & middle ethmoidal air cells; frontal; maxillary - middle meatus
Nasolacrimal - inferior meatus
Larynx is composed of the following bones:
Unpaired:
Paired:
Unpaired: Epiglottis, thyroid, cricoid
Paired: Arytenoid, corniculate, cuneiform
Movement of the larynx in the neck facilitates
closing of the laryngeal inlet and opening of the oesophagus during swallowing
Motor and sensory innervation of the larynx is provided by
vagus nerve
The thyroid cartilage is formed by
right and left lamina which are widely separated posteriorly but converge and join anteriorly (superior anterior prominence = Adam’s apple)
The angle between the two lamina is …. in men and ….in women
90 men
120 women
The posterior margin of each lamina is elongated to form
a superior + inferior horn (which are associated with the cricoid cartilage and hyoid bone respectively)
The epiglottis is a leaf-shaped cartilage attached
by its stem to the posterior aspect of the thyroid cartilage
epiglottis function
acts as a flap which closes off the trachea during swallowing to direct food into the oesophagus
If food enters the trachea and contacts the vocal folds, it causes a cough reflex to expel the matter in order to prevent choking
The two arytenoid cartilages: function
associated with the vocal folds + phonation
Vocal folds are located….
attachments
located within the larynx at the top of the trachea
They are attached posteriorly to the arytenoid cartillages, and anteriorly to the thyroid cartilage
Their outer edges are attached to muscle within the larynx
False vocal folds are the
Vestibular folds above both sides of the vocal folds
False vocal folds role
minimal role in normal phonation, but rather in screaming or deep growling.
When phonating, the arytenoid cartilages and vocal folds are
adducted
air is forced through between them
What produces sounds
the vocal folds vibrating against each other
Tension in the vocal folds can be adjusted by
laryngeal muscles
Pitch depends on the relative position and tension in the vocal folds by the movement of
arytenoid cartilages and cricothyroid joint
Intensity of sound depends on
the force with which air is pushed through the glottis
During quiet respiration
arytenoid cartilages and vocal folds position
arytenoid cartilages abducted
Vocal folds open
During forced inspiration
arytenoid cartilages position
the arytenoid cartilages are rotated laterally, and the rims glottides (opening between true vocal folds) widens into a rhomboid shape, which increases the diameter of the laryngeal airway
During swallowing
position of the vocal folds, laryngeal inlet, larynx
This causes…
Vocal folds closed
laryngeal inlet narrowed
larynx moves up and forward (opens the oesophagus)
This action causes the epiglottis to close the laryngeal inlet
Anatomy of outer ear
Pinna
External acoustic meatus (canal bit)
Anatomy of middle ear
3 Auditory ossicles
o Malleus
o Incus
o Stapes
Tympanic membrane
Anatomy of inner ear
Oval and round windows Utricle and saccule Cochlea Semicircular canals Auditory nerve (VIII) Phanygotympanic/ Eustachian tube
3 functional components of the facial nerve
Motor – to the muscles of facial expression
Sensory – branches to the cauda tympani where it joins the lingunal nerve (branch of V3) just after the acoustic meatus to supply the anterior 2/3rds of tongue
Parasympathetic secretor motor – to the salivary (not parotid-CN9) and lacrimal glands
4 mechanisms that protect the airways from aspiration
Swallowing
Gag reflex
Sneeze
Cough
2 main function mechanisms in swallowing
Levator veli palatine - muscle elevates the soft palate during swallowing, pushing the soft palate against the wall of the pharynx, thereby preventing the passage of the food into the nasal cavity
When swallowing, a peristaltic wave of constrictor muscles of the pharynx raises the larynx which becomes closed off by the epiglottis
What is the soft palate
mucous membrane that tapers to
form uvula
Explain the pathway for the sneeze reflex
- Inspiration
- Intrathoracic pressure raised
(glottis closed, abdominal muscles contracted) - Soft palate depressed against tongue (palatopharyngeus/palatoglossus)
- Sudden abduction of vocal folds to release intrathoracic pressure through nose
Explain the pathway for the cough reflex
- Inspiration
- Intrathoracic pressure raised
(glottis closed, abdominal muscles contracted) - Soft palate raised and tensed against posterior wall of pharynx. (Levator veli palatini, tensor veli palatini, superior constrictor)
- Sudden abduction of vocal folds to release intrathoracic pressure through mouth
Cough Reflex - Irritation of receptors in the larynx and trachea is sensed by
This causes…. nerves to initiate …
This results in
During exhalation, the …. is …. so that the air escapes through the mouth
Laryngeal branches of the vagus nerve (X)
the phrenic nerve (C3-C5) + thoracic nerves (T1-T12) to initiate a deep inhalation
a build up of pressure in the thorax against the closed glottis, followed by forced exhalation
The oropharyngeal isthmus. Open
Sneeze reflex - …sense irritation of receptors in the nasal mucosa
This causes …nerves to initiate..
This results in
During exhalation, the …. is….so that the air escapes through the nose
The ophthalmic + maxillary branches of the trigeminal (V1 and V2)
the phrenic nerve (C3-C5) + thoracic nerves (T1-T12) to initiate a deep inhalation
a build up of pressure in the thorax against the closed glottis, followed by forced exhalation
Oropharyngeal isthmus. Closed.
possible route of infection from the pharynx to the middle ear
The pharyngotympanic (auditory) tube
The pharyngotympanic (auditory) tube connects what and what
the tympanic cavity of the middle ear to the nasopharynx
The pharyngotympanic (auditory) tube is tonically….. but during swallowing and yawning it….so that…
closed by a sphincter
opens so that air can leave or enter the middle ear and equalize pressure with the nasopharynx and hence the atmosphere
If the…. is visible through an auroscope, the ear is considered normal. Infection of the…..will result in a loss of…..
cone of light
middle ear ….the cone of light
List the actions that may be taken to restore patency of the airway in an emergency
Chin lift/jaw thrust – this straightens + opens up the airway, making it easier for patient to breathe on their own
• Use of oropharyngeal or nasopharyngeal airway
• Endotracheal intubation – passing a tube into trachea through mouth
• Cricothyroidotomy
• Tracheotomy
Cricothyroidotomy involves
piercing the cricothyroid membrane in the midline, between the thyroid and cricoid cartilage
Tracheostomy involves
retracting the infrahyoid muscles, dividing the isthmus of the thyroid and piercing the trachea between the 1st and 2nd cartilaginous ring
A tracheostomy tube is then inserted, and secured with neck straps
