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Head and neck > Ear and larynx > Flashcards

Ear and larynx Flashcards

1
Q

What are the internal features of the larynx?

A

Laryngeal skeleton includes:
Single cartilages: Thyroid, cricoid, and epiglottis.
Paired cartilages: Arytenoid, corniculate, and cuneiform.
Spaces: Rima vestibuli (between vestibular folds) and rima glottidis (between vocal folds).
Lining: Respiratory epithelium, except for vocal folds (non-keratinized squamous epithelium).

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2
Q

What are the major movements in the larynx and their muscles?

A

Movements: Abduction of vocal folds: Posterior cricoarytenoid muscle. Adduction: Lateral cricoarytenoid, transverse, and oblique arytenoid muscles. Tension adjustment: Cricothyroid muscle (raises pitch). Innervation: External laryngeal nerve (motor to cricothyroid). Recurrent laryngeal nerve (all other intrinsic muscles).

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3
Q

What are the effects of laryngeal nerve injury?

A

External laryngeal nerve: Weak voice or inability to adjust pitch. Recurrent laryngeal nerve: Hoarseness or loss of voice; bilateral injury may cause airway obstruction.

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4
Q

What are the major relations of the walls of the middle ear?

A

Roof: Petrous temporal bone. Floor: Jugular vein. Medial wall: Promontory, oval and round windows. Anterior wall: Eustachian tube, internal carotid artery. Posterior wall: Facial nerve, mastoid air cells.

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5
Q

What spaces communicate with the middle ear?

A

Eustachian tube connects to the nasopharynx: Equalizes pressure. Aditus to mastoid antrum connects to mastoid air cells: Potential pathway for infection.

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6
Q

What is the clinical significance of middle ear infections?

A

Can spread to: Brain (via petrous temporal bone). Mastoid air cells (mastoiditis). Nasopharynx (via Eustachian tube).

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7
Q

What is the morphology and innervation of the external acoustic meatus?

A

Morphology: Lateral 2/3 elastic cartilage, medial 1/3 bony. Sensory innervation: Auriculotemporal nerve (V3). Auricular branch of vagus nerve (X).

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8
Q

What are the features of the tympanic membrane as seen through an otoscope?

A

Shape: Concave with a central umbo. Visible landmarks: Handle of malleus, light reflex, and pars flaccida.

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9
Q

How does the ear convert sound vibrations to nerve impulses?

A

External ear collects sound. Middle ear amplifies sound via ossicles (malleus, incus, stapes). Inner ear (cochlea): Hair cells in the organ of Corti convert mechanical vibrations into nerve signals.

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10
Q

How does epithelium change across the pharynx and larynx?

A

Nasopharynx: Respiratory epithelium. Oropharynx and laryngopharynx: Non-keratinized squamous epithelium. Larynx: Respiratory epithelium, except vocal folds (non-keratinized squamous epithelium).

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11
Q

What are the movements of the vocal cords during phonation?

A

Adducted by lateral cricoarytenoid and arytenoid muscles. Controlled tension via cricothyroid muscle.

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12
Q

What features can be observed in the larynx during endoscopy?

A

Epiglottis, vestibular folds, vocal folds, valleculae, pyriform fossae.

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13
Q

What internal features of the nasopharynx can be observed during endoscopy?

A

Torus tubarius (surrounds the opening of the Eustachian tube). Pharyngeal tonsils (adenoids). Pharyngeal recess.

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14
Q

What are the important relations and lymphatic drainage of the nasopharynx?

A

Relations: Superior: Base of skull. Posterior: Cervical vertebrae. Lateral: Eustachian tube and surrounding structures. Lymphatic drainage: Retropharyngeal lymph nodes, deep cervical lymph nodes.

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15
Q

What are the boundaries and innervation of the palatine tonsils?

A

Boundaries: Superior: Soft palate. Inferior: Tongue. Lateral: Tonsillar fossa bounded by palatoglossal and palatopharyngeal arches. Innervation: Glossopharyngeal nerve (CN IX).

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16
Q

What are the three phases of deglutition?

A

Oral phase: Voluntary; bolus formation and propulsion by the tongue. Muscles: Intrinsic/extrinsic tongue muscles. Nerve: Hypoglossal (CN XII). Pharyngeal phase: Involuntary; bolus moves through pharynx. Muscles: Pharyngeal constrictors. Nerves: Vagus (CN X) and glossopharyngeal (CN IX). Esophageal phase: Involuntary; bolus passes into the esophagus. Muscles: Esophageal smooth muscles. Nerve: Vagus (CN X).

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17
Q

What is the clinical importance of the recurrent laryngeal nerve?

A

Supplies motor innervation to all intrinsic laryngeal muscles (except cricothyroid). Damage leads to: Unilateral: Hoarseness and weak voice. Bilateral: Respiratory obstruction due to vocal cord paralysis.

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18
Q

What is the significance of the superior laryngeal nerve?

A

External branch: Motor to cricothyroid (affects pitch). Internal branch: Sensory to laryngeal mucosa above the vocal cords. Injury during thyroid surgery may cause voice weakness.

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19
Q

What structures of the inner ear are involved in hearing?

A

Cochlea (spiral organ of Corti): Converts sound vibrations to nerve impulses. Nerve: Cochlear division of the vestibulocochlear nerve (CN VIII).

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20
Q

What is the clinical relevance of the tympanic membrane?

A

Boundary between external and middle ear. Damage (e.g., perforation) can impair hearing and expose the middle ear to infection.

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21
Q

How is the innervation of the pharynx and larynx derived embryologically?

A

Derived from pharyngeal arches: 1st arch: Mandibular nerve (V3). 2nd arch: Facial nerve (CN VII). 3rd arch: Glossopharyngeal nerve (CN IX). 4th and 6th arches: Vagus nerve (CN X).

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22
Q

How does epithelium adapt according to functional requirements?

A

Nasopharynx: Respiratory epithelium for air filtration. Oropharynx and laryngopharynx: Non-keratinized squamous epithelium for resistance to abrasion during swallowing. Larynx: Combination, with vocal cords having non-keratinized squamous epithelium for wear resistance.

23
Q

What are the boundaries and major features of the laryngeal inlet?

A

Boundaries: Anterior: Epiglottis. Posterior: Interarytenoid fold. Lateral: Aryepiglottic folds. Features: Vestibule, vestibular folds, vocal folds, rima vestibuli, and rima glottidis.

24
Q

What are the valleculae and pyriform fossae?

A

Valleculae: Depressions between the base of the tongue and epiglottis, serving as ‘spit traps.’ Pyriform fossae: Recesses in the laryngopharynx lateral to the laryngeal inlet, common sites for foreign body lodging.

25
Q

What are the functions of the vocal folds?

A

Phonation (sound production). Regulating airflow through the glottis. Preventing food aspiration by closing during swallowing.

26
Q

How does the recurrent laryngeal nerve relate to surgical anatomy?

A

Left RLN: Loops under the aortic arch. Right RLN: Loops under the right subclavian artery. Vulnerable to damage during thyroid, cardiac, or neck surgeries.

27
Q

What are the dual roles of the internal laryngeal nerve?

A

Provides sensory innervation above the vocal folds. Facilitates reflex closure of the glottis to protect the airway.

28
Q

What is the functional role of the Eustachian tube?

A

Equalizes pressure between the middle ear and nasopharynx. Drains mucus from the middle ear into the nasopharynx. Opened by the tensor veli palatini and levator veli palatini muscles during swallowing or yawning.

29
Q

What are the clinical implications of the mastoid antrum?

A

Communicates with the mastoid air cells posteriorly and the middle ear anteriorly. Infections can spread to the mastoid cells (mastoiditis) or the brain (via temporal bone erosion).

30
Q

What can be observed during endoscopic examination of the larynx?

A

Structures: Epiglottis, vestibular folds, vocal folds, aryepiglottic folds, and interarytenoid notch. Movements: Abduction and adduction of vocal folds, epiglottic closure during swallowing.

31
Q

What are the changes in vocal cord movement during phonation and breathing?

A

Phonation: Vocal cords adduct and vibrate. Breathing: Quiet breathing: Vocal cords are partially abducted. Forced inspiration: Vocal cords fully abduct via posterior cricoarytenoid muscles.

32
Q

What are the features of the external acoustic meatus?

A

Lateral 2/3: Elastic cartilage. Medial 1/3: Bony canal in the temporal bone. S-shaped curvature requiring auricle retraction for examination.

33
Q

What precautions should be taken during tympanic membrane examination?

A

Pull the auricle backward and upward to straighten the canal. Identify the umbo, handle of malleus, and cone of light for landmarks.

34
Q

What are the key muscles involved in swallowing?

A

Oral phase: Intrinsic/extrinsic tongue muscles (hypoglossal nerve). Pharyngeal phase: Pharyngeal constrictors (vagus and glossopharyngeal nerves). Esophageal phase: Esophageal muscles (vagus nerve).

35
Q

What is the embryological basis of ear and larynx innervation?

A

Derived from pharyngeal arches: 1st arch: Mandibular nerve (V3). 2nd arch: Facial nerve (VII). 3rd arch: Glossopharyngeal nerve (IX). 4th and 6th arches: Vagus nerve (X).

36
Q

What is keratinized squamous epithelium?

A

Thick for mechanical resistance to abrasion during swallowing or vocal fold movement.

37
Q

What structures can be identified during endoscopic examination of the nasal cavity?

A

Nasal septum, turbinates, and choanae.

38
Q

What structures can be identified during endoscopic examination of the pharynx?

A

Nasopharynx, oropharynx, and laryngopharynx, with key landmarks like the epiglottis and aryepiglottic folds.

39
Q

What should be appreciated during endoscopic examination of the larynx?

A

Movements of vocal cords during phonation and respiration, and borders of the laryngeal inlet.

40
Q

What features should be identified in the larynx during examination?

A

Cartilages: Thyroid, cricoid, arytenoid, corniculate, and cuneiform.

Spaces: Rima vestibuli and rima glottidis. Muscles: Cricothyroid, posterior and lateral cricoarytenoids, interarytenoids.

41
Q

What is the role of the cricothyroid muscle?

A

Adjusts tension of the vocal cords by tilting the thyroid cartilage downward and forward, raising pitch during phonation.

42
Q

What is the clinical importance of the cricothyroid membrane?

A

Site for emergency cricothyrotomy to establish an airway in upper airway obstruction.

43
Q

What is the role of the epiglottis during swallowing?

A

The epiglottis folds backward to close the laryngeal inlet, preventing food and liquids from entering the airway.

44
Q

What are the clinical implications of vocal cord paralysis?

A

Unilateral paralysis: Hoarseness, weak voice, aspiration risk.
Bilateral paralysis: Airway obstruction due to inability to abduct the vocal cords.

45
Q

How does the ear convert sound vibrations into nerve impulses?

A

External ear: Collects sound waves.
Middle ear: Amplifies vibrations via ossicles (malleus, incus, stapes).
Inner ear: Cochlear hair cells in the organ of Corti transform vibrations into electrical signals transmitted by the cochlear nerve.

46
Q

What are the components of the vestibular system, and their roles?

A

Utricle and saccule: Detect linear acceleration.

Semicircular canals: Detect rotational movements.

Vestibular nerve: Transmits signals for balance and posture.

47
Q

What are the communications of the middle ear cavity?

A

Anteriorly: Eustachian tube (connects to nasopharynx).
Posteriorly: Aditus to mastoid antrum (leads to mastoid air cells).

48
Q

Why is the middle ear clinically significant in otitis media?

A

Infections can spread to the:
Nasopharynx via the Eustachian tube.
Mastoid air cells (mastoiditis).
Cranial cavity causing meningitis or brain abscess.

49
Q

What are the main features of the tympanic membrane as seen through an otoscope?

A

Appearance: Pearly gray, translucent.
Landmarks: Handle of malleus, umbo, cone of light (anteroinferior quadrant).

50
Q

What is the significance of tympanic membrane perforation?

A

May impair hearing.
Creates a pathway for infections to enter the middle ear.

51
Q

How does epithelium change across the larynx and pharynx?

A

Nasopharynx: Respiratory epithelium for air passage.
Oropharynx and laryngopharynx: Non-keratinized squamous epithelium for abrasion resistance.
Larynx:
Respiratory epithelium, except for vocal folds, which have non-keratinized squamous epithelium for wear resistance.

52
Q

How is the epithelium adapted to functional requirements?

A

Respiratory epithelium: Thin and ciliated for mucus clearance.
Non-keratinized squamous epithelium: Thick for mechanical resistance to abrasion during swallowing or vocal fold movement.

53
Q

What structures can be identified during endoscopic examination of the nasal cavity and pharynx?

A

Nasal cavity: Nasal septum, turbinates, and choanae.
Pharynx: Nasopharynx, oropharynx, and laryngopharynx, with key landmarks like the epiglottis and aryepiglottic folds.

Head and neck (24 decks)

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