Ear/Nose/Throat Case Based Learning Flashcards
General facts about OMT in ENT conditions
Treatment is based on musculoskeletal systems impact on circulatory flow to and from all tissues of the body
Promoting lymphatic circulation plays an important role in reducing swelling and inflammation as well as stimulating the immune system
Physiologic function of various organs can be affected by noxious somatic afferent stimulation
Treatment improves recovery time and recurrence/complications
Goals in treating somatic dysfunctions in head and neck
Restore proper biomechanics
Assist in Venousd and lymphatic circulation
Promote arterial flow
Renormlize spinal reflexes affecting function
Relieve pain and discomfort
How to treat multiple dysfunctions in ENT with OMT
Evaluate and treat somatic dysfunctions from central -> periphery
- allows better venous drainage
Treat somatic dysfunction in upper thoracic and cervical spine 1st
- decreases somatic stimulation in sympathetic outflow and ganglia supplying the head and neck
Improve enough lymphatic flow in the cervical and thoracic inlet areas
- decreases myofascial tension in areas through where the lymphatic and venous vessels pass from head to entrance into circulation
Facial effleurage is used when?
Treating tissue congestion in the anterior sinuses
Mandibular drainage (galbreath) Is used when?
Lymphatic drainage directed at he ear, Eustachian tube and throat
Sub-occipital inhibition is used when?
Sinus and inner ear conditions in general
Why do we address chapman points?
To normalize the visceral-somatic and somatic-visceral reflexes
Lung sympathetics = T2-T7
Lung and trachea parasympathetics = vagus
Head and neck sympathetics = T1-4
Bacterial sinusitis typical symptoms
Big 4 are PODS
Pain: facial, pressure or fullness present
- can be unilateral or bilateral
- often above or below eyes when leaning forward
Obstruction: nasal (stuffiness/congestion)
Discharge: Purulent or discolored
Smell: cant smell properly
can also include fever, cough, fatigue, ear pain, maxillary toothache
When to suspect serious acute bacterial sinusitis over viral or non-acute bacterial sinusitis
1) signs/symptoms of sinusitis last > 10 days without clinical improvement
2) worsening signs/symptoms following inital improvement
3) severe symptoms are present
- fever > 39C
- discharge lasts 3-4 consecutive days
4) unilateral cheek or maxillary tooth pain is present
- accompanies Purulent nasal discharge
How to treat viral sinusitis vs bacterial
Viral and mild non-acute bacterial sinusitis
- analgesics and antipyretic as needed and let it run its course
- can also use decongestants if want
- NO antihistamines unless has allergic component
- NO antibiotics
- can use intra nasal saline
Severe acute bacterial sinusitis
- antibiotics + all the above as needed
Contraindication for select OMT procedures
Lymphatic pumps
- avoid when fever > 102
Splenic pump
- avoid in cases of mono (wait unless 1 month after infection has resolved)
Treatment of streptococcal pharyngitis
Must use antibiotics
- penicillin G 1x or penicillin/amoxicillin for 10 days
- if penicillin allergy, use azithromycin 5x or clindamycin/clarithromycin/1st gen cephalosporin 10x *
Also use pain management as needed and OMT as needed
Treatment of otitis media
Pain management
- oral analgesics
- acetaminophen or ibuprofen (dont use ibuprofen if child < 6 months)
- DONT USE ASPIRIN
Antibiotics
- indicated for all children, but should be wary in kids under 6 months (unless worried of increased risk of complications
Signs/symptoms for antibiotic use
- moderate-severe otalgia
- otalgia > 48 hrs
- temp > 39C
Chapman reflex points for upper respiratory (ENT)
Middle ear:
- anterior = supraclavicular at crossing of 1st rib
- posterior = lateral pillar of C1 (inferior to mastoid)
Nasal sinuses
- anterior = infraclavicular at crossing of 1st rib
- posterior = C1 articular pillar
Facial sinuses
- anterior = superior edge of 2nd rib
- posterior = C2 articular pillar
Tonsils
- anterior = 1st intercostal space
- posterior = N/A
Tongue
- anterior = costosternal junction of rib 2
- posterior = transverse processes of C2
Pharynx
- anterior = costosternal junction of anterior rib 1
- posterior = transverse process of C2
Retina/conjunctiva
- anterior = lateral humerus on surgical neck
- posterior = occipital-bone directly posterior to mastoid processes
Neck
- anterior = medial aspect of surgical numeral neck
- posterior = C3-7 articular pillars
note all of these are treated posterior -> anterior with gentle rotary movement
Sympathetic OMT techniques include what?
Rib raising
MFR thoracolumbar
Paraspinal ST
Lymphatic techniques
