Ear, Nose, & Throat Flashcards
What are the parts of the external ear
Helix Antihelix Tragus Lobule (lobe) External auditory meatus
Which cranial nerve sends the auditory info from the ear to the brain & is responsible for proprioception
CN #8
What is the umbo
The center of the TM, represents the handle of the maleus
Lack of TM mobility (against pressure) suggests…
Fluid build up behind the TM
Tenderness when pushing on the tragus is a sign of…
Otitis externa
The most common cause of ear damage is…
Q-tips
Signs of an ear infection include…
Ejection, inflammation, discharge, loss of light reflex, loss of landmarks (such as umbo), signs of fluid build up behind the ear
What does a normal TM look like
Pearly gray, non-injected, non-erythematous, intact, light reflex in tact
Overgrowths of the ear canal that can obscure the TM; caused by repeated exposures to cold water, as in surfers or divers
Bony exostoses
The most common cause of conductive hearing loss is…
Cerumen impaction
Cerumen impaction is a normal variant. It is abnormal if it causes…
Pain, tinnitus, or conductive hearing loss
Treatments for cerumen impaction are….
warm water in the ear, mineral oils
Hardening of the TM that is essentially scar tissue and common in pts with frequent OM is…
Tympano-sclerosis
Signs of acute otitis media include…
Bulging, erythema, loss of landmarks and red cone of light, injection, non-mobile TM with bulging
Serous otitis media is most often caused by
Viral URI, pressure changes, or seasonal allergies
The main problem in serous otitis media is…
ET tube not working properly causing serous fluid to accumulate
What is a Myringotomy tube (AKA tympanotomy tube or T-tube)
It is a tube placed in the TM that may be a solution for ET dysfunction which has SxS of tinnitus, hearing loss, vertigo
Indications for T-tube include…
chronic middle ear effusion with hearing loss; reccurent OM with cumulative duration > 6 months; suppurative complications of OM (meningitis, mastoiditis, brain abscess, facial nerve palsy)
Common causes of perforated TMs are
very load noise, extreme pressure
Pt complains of immediate pain (intense, 10/10) with d/c that slowly subsides is most likely due to…
Perforated TM
Infection of the external auditory canal, occurs when the epithelium is breached and becomes infected is called…
Otitis externa
Most common cause of otitis externa is…
Pseudomonas auriginosa
Otitis externa is also called…
Swimmer’s ear
Fungal infections of the ear are common in…
Pts with DM or that are immunocompromised
Discharge seen in OE or AOM with perforation and often seen with perforated TM or with infection is called…
Otorrhea
One of the most common forms of skin cancer, very benign & hardly has Mets
Basal cell carcinoma
Appearance of telangectasias and necrosis/ulceration is indicative of…
Basal cell carcinoma
Hypertrophic scar tissue; more common in blacks; can grow in any area where there has been trauma to the skin, not painful
Keloids
Chronic inflammatory lesion on helix or antihelix
Chondrodermatitis helicis
What do you need to do with chondrodermatitis helicis
Biopsy to rule out carcinoma
Pain in the ear canal, not due to direct infection, more common in people who live in poor socioeconomic conditions
Bug in the ear canal that can erode through the TM
Air conduction phase characterized by…
sound waves conducted through the ear, TM, ossicles, to choclea
Bone conduction phase characterized by…
sound waves travel through the bone, bypass the external/middle ear structures, and reach the choclea, muffled sound
Which conduction phase should normally be louder
Air conduction
This test measures bone conduction vs air conduction
Rhinne test
A normal rhinne test result is…
Louder noise with air conduction
Most common causes of conductive hearing loss
cerumen impaction then AOM
Sensorineural hearing loss is caused by…
Disorder of the Inner Ear, Brain, or CN VIII
Normal SN hearing loss due to aging
Presbycusis
This test checks for sensoroneural hearing loss by checking for lateralization of sound
Webber test
Webber test with sensoroneural loss result is…
Laterilzes to the good ear because the sound won’t be transmitted through the bad side
Webber test with obstruction/conduction loss result is…
Lateralizes to the blocked ear because it will travel through the obstruction
Functions of the nasal mucosa
Cleanse, Humidify, Control temperature of inspired air
Nasolacrimal duct drains into
The inferior meatus
This drains the maxillary sinuses into the middle meatus; drainage from this common in sinus infections
Sinus ostia
Deviated septum may be due to
congenital defect, trauma, drug use
Pts with deviated septum may have
anosmia (difficulty smelling), more prone to infections, breathing problems, more common to have nosebleeds
Septal perforations are commonly caused by…
snorting crack/cocaine or crystal meth
Broken nose w/o significant displacement, nasal bleeding, or breathing trouble. Is it treated or not?
No need to treat, likely will heal on its own
Network of vessels in the anterior of the nasal cavity; most common source of nose bleeds
Kiesselbach’s plexus
Potential causes of bleed from Kiesselbach’s plexus include…
If plexus mucosa is dry, experienced trauma, or has platelet problems may be more prone to bleeds
Posterior nasal network of vessels
Woodruffs plexus
Bleed from Woodruffs plexus
Are uncommon and represent a true emergency, may lead to compromised airway
Bleeding coming out of the nose is due to…
Bleeding draining from nose into the back of the throat is due to…
Kiesselbach’s plexus
Woodruffs plexus
Why is it important to thoroughly examine nasal trauma?
Because trauma to the nose, in the correct place and angle, may lead to brain trauma through the cribiform plate
Normal/healthy turbinates should be…
mucosa pink, no d/c, no deformities, no swelling
Allergic rhinitis may present as…
Paleness of mucosa and string like d/c
The allergic triad
eczema, seasonal allergies, asthma
People with the allergic triad are more likely to form these
Nasal polyps
Causes of perforated septum
trauma, surgery, cocaine of amphetamine use
Large bulbous ruddy nose d/t granulomatous inflammation often secondary to severe, untreated Rosacea
Rhinophyma
Growth on nose with telangectasia, pearly appearance
Basal cell carcinoma
Outer layer of the tooth
enamel, gives tooth strength/protection
Mid layer of the tooth contains
Dentin
Inner layer of the tooth
pulp, has blood & nerve supply
Cements the tooth into the gum & periodontal membrane
Cementum
System used for staging dental fractures
Ellis classification
Ducts that open on the papila on each side of frenulum
Wharton’s ducts (opening for submandibular gland)
Ducts that open near upper second molar
Stenson’s duct (opening for parotid gland)
Where teeth meet from sucking and chewing irritation
Wavey white patch
Black line across the gums is seen in…
Lead poisoning
Red line across the gums is seen in…
Gingivitis
Movement of the tongue is controlled by CN #…
CN #9
Softening of the corners of the mouth followed by fissuring, common with nutritional deficiency or denture wearers, leads to candiada
Angular cheilitis
Results from excessive exposure to sunlight, primarily affects the lower lip; lips become scaly, somewhat thickened, and slightly everted
Actinic cheilitis
Recurrent and painful vesicular eruptions of the lips and surrounding skin; first develops as cluster of vesicles which then break and form a yellow-brown crust; heal in 10-14 days
Herpes simplex virus (AKA Cold sores or fever blisters)
Localized subcutaneous or submucosal swelling of the lips caused by leakage of the intravascular fluid into the interstitial tissue; commonly caused by mast cells in allergic & NSAID reactions or with ACE-I users; usually benign and resolves in 24-48hrs
Angiodema
Multiple small red spots on the lips strongly suggest hereditary hemorrhagic telangiectasia, also visible on the oral mucosa & fingertips; commonly also have nosebleeds, GI bleeding, & iron deficiency
Osler-Weber-Rendu Syndrome
Osler-Weber-Rendu Syndrome is a ___________ genetic disorder
Autosomal dominant
Prominent small brown pigmented spots in the dermal layer of the lips, buccal mucosa, and perioral areas; also accoompanied by intestinal polyps
Peutz-Jeghers Syndrome
Peutz-Jeghers Syndrome is a ____________ genetic disease
Autosomal dominant
Ulcerated papule with an indurated edge, usually appears after 3-6 weeks of incubation, caused by spirochete infection, resemble carcinoma or crusted cold sores; appear on tongue, lips, and genitals
Chancre of Primary Syphilis
Where the lips meet the frenulum; very important in suturing
Vermillium border
Benign midline lump, may be mandibular or maxillary, normal variant
Torus palatinus
Soft palate rise controlled by CN #
Controlled by CN #12
Hypertrophied tonsils common in those with…
Recurrent bacterial pharyngitis
Normal variance of the uvula include…
Pointed uvula, biphid uvula, no uvula
Ulcerative lesions on the tongue are suspicious for…
Malignancy (squamous cell carcinoma); remember over 50 smokers, men, drinkers; lesion should be biopsied especially if not tender
Normal or abnormal? Fissured tongue Geographic tongue Thrush tongue Hairy tongue
Fissured tongue = normal
Geographic tongue = normal
Thrush tongue = normal
Hairy tongue = may be normal or abnormal
What can you do with thrush
Scrape it off
What is hairy tongue associated with
Antibiotics, poor hygeine, smoking/chewing tobacco use, thrush, sometimes coffee
Incompetent valves of the veins, common as people age
Sublingual varices
Pink, not ulcerative or necrotic, shouldn’t be tender, bony, normal variant, can be unilaterl or bilateral
Mandibular tori
Most commonly caused by HSV 1 but can also be caused by genital herpes; Vessicles on an erythematous base (dew drops on a rose petal description) with crusting; very painful
Herpes simplex virus
During herpes infection, crusting indicates…
Healing phase
What are the 3 phases of herpes infection
Vessicles -> lesions/ulcerative (infective phase) -> crusting (healing phase)
Painless white patches on the tongue or buccal mucosa; precursor to SCC
Leukoplakia
Can you scrape off leukoplakia?
No, it won’t scrape off b/c it is fixed
Type of leukoplakia that is found in HIV Pts
Hariy leukoplakia
Very painful, scrapes off to yeild red inflammed bleeding tissue; seen in immunocompromised, babies/infants, denture wearers, & some Pts on inhaled corticosteroids
Thrush Oral Candidiasis
Inflamation of tongue
Glossitis
Smooth tongue, shrinkage/inflammation
Atrophic glossitis
Infection of the apex of the tooth, seen on the gingival margin (odontogenic infection), often caused by bacteria entering through a cracked tooth
Periapical abscess
Gingival hyperplasia is commonly seen in…
Chronic use of Dilantin can cause it (CLASSIC long term side effect)
Pregnancy (reversible)
Overgrowth of the gums or access gum tissue
Gingival hyperplasia
Looks very gross/bad but it is not cancerous and is a “normal” side effect in pregnancy but still should be biopsied
Pyogenic Granuloma
Very rare disease in the U.S.; grey-white pseudomembrane on the back of the throat; undiagnosed leads to airway obstruction; bacterial infection
Diphtheria
Low grade purple vascular lesion/tumor d/t HHV 8 in AIDS patient mostly men
Kaposi’s sarcoma
Erosions in the teeth
Dental carries
Pts with balemia often are found to have what oral sign?
Poor dentition due to continuous exposure to gastric acids
Fever, malaise, LAD, foul breath, bleeding, pain, spread of grayish pseudomembrane across gum margins; common in AIDs Pts
ANUG = Acute necrotizing ulcerative gingivitis
Can get very bad if tonsils impeed on the airway or progresses to peritonsial abcess or rheumatic feve
Exudative Pharyngitis
When do you surgically repair the tongue
Full thickness tongue lacerations or those at risk of retaining foreign bodies
