Ear, Nose, Throat Flashcards
what is the normal first part of the hearing pathway from the external ear through the middle ear?
air conduction (AC)
how does sound waves travel in AC
through the air and transmitted from external and middle ear to the cochlea
what is the phase of hearing that is an alternative pathway that bypasses the external and middle ear?
used for testing purpose
Bone conduction
how does sound travel for bone conduction?
vibrating fork sis placed on the head, and the bone of sull is vibrated
stimulates the cohclea directing
what is the senosrineural phase of hearing?
second part of hearing pathway that involves the cochlea and cochlear branch of CN VIII
what type of conduction is more sensitve in hearing loss?
AC>BC
what type of condution is more sensitive in conductive hearing loss?
BC>AC
what questions should be asked for history of the ears?
- hearing loss
- earache/ear discharge
- tinnitus
- vertigo
what are you inspecting the auricle for?
deformities, lumps, pits, skin lesions
what test evaluates for ear pain or dischage?
Tug Test
- moves the auricle up and down and presses on tragus
- press firmly over the mastoid process behind the ear
when would you see a positive tug test?
acute otitis externa
when would you see a negative tug test
Otitis media
what diseases do you see tenderness over the mastoid process druring the tug test?
Otitis media and mastoiditis
where is the inflammation in otitis externa
the ear canal is inflamemd
see wax, pus coming from the ear
where in the ear is inflammed with Otitis Media
inflammation of the fluid accumulation in the middle ear
Don’t forget to do what during the otoscope ear exam
straighten the ear canal by grasping the auricle
what angle do you insert the speculum at into the ear?
downward angle
what three things do you inspect for during an otoscope?
- ear canal for d/c, foreign body, redness or swelling
- inspect Tm for color, cone of light, perforations
- Mobility of TM can be evaluated with pneumatic otoscope
what conditions do you see decreaswed mobility of the TM
- serous effusion
- thickened tympanic membrane
- purulent otitis media
what does perforation of the TM cause upon pneumatic otoscopy
no mobility of pneumatic otoscopy
what color is a normal TM
pinkish/gray color
what does the malleus lie behind?
the upper part of the ear drum
What lies above the malleus
pars flaccida
what are the 3 components of the TM
- lateral process of the malleus
- par flaccida
- pars tensa
where does the cone of light fan down to?
fans downward and anteriorly
what is normal in the handle of the malleus
small blood vessels
whispered voice test result
if the pt repeats the intial sequence correctly
normal hearing in ear
whisphered test results
pt responds incorrecttly or not at all, what do you do
repeat that ear with a new combo of letters/ numbers
whispered test results
pt gets 3/6 of the letters/numbers correct
passed hearing screening test
whispered voice test results
less than 3/6 correct
c
conduct further testing using audiometry
what should you do to the other earing during a whispered voice test
occlude it
what test evaluates lateralizatoin
Weber test
what does a normal weber test indicate
sound heard equally in both ears
for the weber test, the sound is heard best/lateralizes to impaired ear by bone indicates
unilateral conductive hearing loss
BC>AC
for the weber test, sound is heard best/lateralizes to the good ear indicates
unilateral sensorineural hearing loss
when do you conduct a Rinne test?
for pts failing the whispered voice test in order to compare air conduction and bone conduction
what is a normal Rinne test?
AC > BC
sound heard longer through the air than the bone
what are the Rinne results indicating conductive hearing loss
BC > AC
sound heard longer through bone than air
what Rinne results indicate sensorineural hearing loss?
AC > BC
air heard longer than bone
(—-) environment may help hearing in what hearing loss
noisy environment
conductive hearing loss
cerumen impaction, otitis externa, SCC, Trauma, Exostasis are problems with (—–)
external ear causing conductive hearing loss
conductive hearing loss
otitis media, oteosclerosis, Tympanosclerosis, cholesteatoma, perforation of TM, Tumor are problems with (—–)
the middle ear causing conductive hearing loss
what type of hearing loss causes trouble to understand speech/hearing & noisy envrionments make it worse?
sensorineural hearing
what are some disorderes of the inner ear?
- congenital/hereditary conditions
- presbycuris
- rubella or CMV
- Meniere disease
- noise exposure
- ototoxic drug exposure
history to ask about the nose
- rhinorrhea
- nasal congestion
- epistaxis
- sinus trouble
step of the nose examination
- inspect the anterior and inferior surface of the nose
- test for nasal obstruction on each nasi (if indicated)
- inspect the nasal mucosa, septum, inferior and middle turbinates & meatus with a otosscope
- palpate the frontal sinuses
- palpate the maxillary sinuses
what do you inspect the anterior & inferior surfaces of the nose for?
- asymmetry
- deformity
- deviation
- lower septum
how to test for nasal obstruction
press on each ala nasi and ask the pt to breathe in
what do you inspect the interior of the nose for
- inspect mucosa for color, swelling, bleeding, exudate
- inspect the septum for deviation, inflammation, perforation, bleeding
- any abnormalities (polyps or ulcers)
what sinuses do you transilluminate
frontal and maxillary
stenson duct
opening of the parotid duct
what health history should be asked about the throat?
- sore throat
- sore tongue
- bleeding or swollen gums
- Hoarseness
- malodorous breath
acute hoarseness is
from voice overuse, acute viral laryngitis, possible neck trauma
<2weeks
chronic Hoarseness
> 2 weeks
refer for laryngoscopy
what should you consider for chronic hoarseness
- hypothyroisdism
- acid reflex
- vocal cord nodules
- head & neck cancers
- neurologic disorders (parkinsons, als, myasthenia gravis)
what do you inspect the mouth for
- lips
- oral mucosa
- gums & teeth
- roof of mouth (hard palate)
- Tongue (side & under surface)
- floor of mouth
what do you palpate the mouth for
any suspicious lesions for thickening or infiltration of the tx that might suggest malignancy
what do you exam of the pharynx
- soft palate
- anterior & posterior pillars
- uvula
- tonsils
- pharynx
what is the grading of the tonsils range
0-4
Grade 0 tonsils
e
entirely within the tonsillar pillar or previously removed by surgery
Grade 1+ tonsils
tonsils occupy 0-25% of the mouth
grade 2+ tonsils
tonsils occupy 26-50% of the oropharynx
grade 3+ tonsils
tonsils occupy 51-75% of the oropharynx
grade 4+ tonsils
tonsils occupy more than 75% of the oropharynx
how to test the hypogloxxal nerve CN XII
ask the pt to stick out their tongue and assess for symmerty and deviation
lesion of the hypoglossal nerve
suggested by asymmetric protrusion/deviation of the tongue to one side
tongue points TOWARD the side of lesion
tongue =
toward
CN XII sdamage
how to test vagus nerve CNX
- ask pt to open mouth and say “ahhhh”
- if pharynx is not visible use a tongue depresser
- note the rise of the soft palate and medial position of the uvula
vagus nerve paralysis CN x
soft palate fails to rise on one side and uvula deviates to the OPPOSITE side
uvula points
away
firm nodular hypertrophic mass of scar tissue extending beyond the area of injury; common in people with darker skin
keloid
deposit of uric acid crystals characteristic in chronic tophaceous gout
hard nodule on the helix or antihelix
tophi
what discharge does tophi have
white, chalky crystals through the skin
small lumps on the helix or antihelix associate with (——); can also be found on hands, surface of ulna, elbow, knees & heels
Rheumatoid arthritis
Rheumatoid nodules
chronic inflammatory condition that begins as a painful, tender papule on the helix or antihelix; reddening may occur
chondrodermatitis helicis
biopsy is Needed
Hole in the ear drum from purulent infections of middle ear
perforation of TM
what may come out of the ear with perforated TM
discharge from infected middle ear may drain out through perforated opening
scarring process in the middle ear from the otitis media & if severe can entrap ossicles and cause conductive hearing loss
Typmanosclerosis
what is amber fluid behind the eardrum w/ or w/o bubbles
serous effusion
what can cause serous effusion
viral URI, sudden changes in atmospheric pressure
what organism causes acute otitis media w/ purulent effusion
s. pneumonia or H. influenzae
eardrum is reddened, loses its landmarks, and bulges towards the examiners eyes
acute otitis media w/ purulent effusion
painful hemorrhagic vesicles appear on the TM, ear canal, or both
bullous myringitis
what organism causes bullous myringitis
mycoplasma, viruses and bacteria OM
what hearing loss is more common in children/young people
conductive
what hearing loss is associated with external or middle ear disorders
conductive period
is the abnormality visible in conductive hearing loss
yes except otosclerosis
where does sound lateralize in conductive hearing loss for weber test
toward impaired ear
what hearing loss is more common in middle or later years
sensorineural hearing loss
is abnormality visible in sensorineural hearing loss
no
what part of the ear is associated with sensorineural hearing loss
inner ear
where does sound lateralize in senosorineural hearing loss
weber’s test
to the good ear
vestibular neuronitis
- sudden onset
- hours to weeks
- hearing not affected
- no tinnitus
acute labryinthitis
- sudden onset
- hourrs to weeks
- sensorineural hearing loss unilaterally
- tinnitus +/-
softening of the skin on the angles to the mouth leading to fissuring
angular chelitis
when is angular chelitis seen
- candida
- overclosure of the mouth
- ill fittin gdentures
- b vitamins or iron deficiency
