Ear, Nose & Throat (ENT) Flashcards
Kiesselbach plexus
vascular watershed area contained in the anterior nasal sputum of the nostrils; very common source of bleeding during epistaxis
malignant otitis externa (MOE)
most commonly caused by Pseudomonas aeruginosa; non lactose-fermenting, oxidase (+) motile gram (-) rod; MOE is a serious infection of the ear seen in early diabetic pts; presents with exquisite ear pain and drainage and granulation tissue is often seen within the ear canal
Thyroglossal duct cyst
presents as midline neck mass and moves superiorly w tongue protrusion or swallowing; caused by failed atrophy of the thyroglossal duct in utero and can be located anywhere along the path of thyroid descent (tongue to thyroid isthmus)
Decongestant overuse
decongestants act by vasoconstriction via alpha-adrenergic agonist; overuse causes negative feedback, resulting in decreased NE synthesis and release from nerve endings which diminishes their effect (tachyphylaxis)
tachyphylaxis
rapidly diminishing response to successive doses of a drug, rendering it less effective; seen in decongestant overuse
pathogenesis of allergic rhinitis
type I hypersensitivity; sensitization to aeroallergens occurs when inhaled antigens induce Th cells to Th2 cells and then promote B-cell maturation and isotope switching to IgE
Field cancerization
occurs when a large area of cells is exposed to carcinogens that induce mutations, leading to a higher risk of forming cancers
Cleft lip
occurs due to failed fusion of the left or right maxillary prominence w the inter maxillary segment in early gestation; can occur with cleft palate
Cleft palate
occurs primarily when the palatine shelves fail to fuse in early gestation; can occur w cleft lip
lateral pterygoid functions
the only muscles of mastication that aid in depressing the mandible (opening the jaw); spasm of these prevents spontaneous reduction of an anterior dislocation of the TMJ
Oral thrush tx
Nystatin; a polyene antifungal is the 1st choice; acts by binding to ergosterol in the fungal cell membrane, causing the formation of pores and leakage of fungal cell contents; it is not absorbed by the GI and is admin as an oral “swish and swallow” agent
Cutaneous innervation of the ear
CN X cutaneous sensation of ear
provides cutaneous sensation to the posterior external auditory canal via auricular branch; vasovagal syncope can occur after stimulation (increases parasympathetic outflow to HR and BP)
Cholesteatomas
collections of squamous cell debris that form a round, pearly mass behind the tympanic membrane in the middle ear; can be congenital or may occur as an acquired primary lesions; can cause hearing loss due to erosion into auditory ossicles
cleft lip and palate
at increased risk for chronic or recurrent acute otitis media due to Eustachian tube dysfxn via tensor veli palatini that contracts against the soft palate to open the Eustachian tube
muscles of the Eustachian tube
recurrent laryngeal nerve
travels in close proximity to the inferior thyroid artery and can be injured during thyroid surgery resulting in vocal cord paralysis (hoarseness)
Risk factors for brain abscess
appears as ring-enhancing lesion on imaging and typically causes HA w/ or w/o fever and neurologic symptoms (seizures); often involves direct spread from the head and neck space infections, such as otitis media
Croup
viral infection in which edema and narrowing of the proximal trachea (sub glottis) *not the epiglottis
results in a barking cough and inspiratory stridor; can see “steeple sign” on imaging
clinical features of peritonsillar abscess
infections are typically polymicrobial with group A streptococcus being the most commonly isolated pathogen
Peritonsillar abscess
an acute bacterial infection of the region between the tonsil and pharyngeal muscles that turns into a pus collecting abscess; visible bulge above the tonsils that pushes the uvula to the c/l side; classic presentations of muffled voice (“hot potato voice”); infections are typically polymicrobial with group A streptococcus being the most common
Epiglottis
severe infection that can lead to stridor and respiratory distress; pts appear very ill, anxious and have a high fever, difficulty swallowing, drooling and tripping position; contrast w croup where pts are generally comfortable even in a supine position, there is no barking cough and if visualized they would have normal appearing epiglottis
recurrent respiratory papillomatosis
occurs via vertical transmission of HPV subtypes 6 and 11; results in wart-like growths most commonly on the true vocal cords
Acute otitis media
usually occurs after a viral URI causes obstruction of the Eustachian tube; this obstruction leads to accumulation of secretions which encourages bacterial growth including: Strep pneumoniae (most common), Haemophilus influenzae and Moraxella catarrhalis
TMJ syndrome
associated w dysfxn of the TMJ and hypersensitivity of the mandibular nerve (CN V3); can result in pathological contraction in the muscles of mastication including the master and pterygoids
Speed of head and neck SCC
typically spread first to the anterior cervical (ex; jugular) lymph nodes via lymphatics; distant spread occurs after regional lymph node involvement
Chronic rhinosinusitis w nasal polyposis in children should prompt what?
a CF evaluation; especially when signs of pancreatic insufficiency (ex: loose stools, failure to thrive, weight loss) are present
Referred otalgia
common in head and neck pathology because many cranial nerves innervate the ear; in particular tumors in the hypoopharynx, larynx or base of the tongue cause referred otalgia due to sensory contributions from the CN IX and CN X
Orbital blowout fractures
commonly due to blunt trauma; commonly involve the medial or inferior walls due to the thin bone bordering the ethmoid and maxillary sinuses
Complication of acute otitis media
can be complicated by inflammation or infection of nearby structures (ex: facial nerve) which travels through the middle ear and can result in facial neuritis w unilateral facial paralysis
Cricothyrotomy placement layers
- Skin
- Superficial cervical fascia (platysma)
- Deep cervical fascia
- Cricothyroid membrane
Cricothyrotomy
indicated when an emergency airway is required and orotracheal or nasotracheal intubation is either unsuccessful or contraindicated; the cricothyrotomy incision passes through the superficial cervical fascia, pre tracheal fascia and the cricothyroid membrane
nontypeable strains of Haemophilus influenza
part of the normal UR tract flora and are a common cause of acute otitis media, sinusitis and bronchitis; because they do not form a polysaccharide capsule, immunity is not conferred by vaccination w the H influenza type b vaccine
middle ear effusion due to nasopharyngeal carcinoma
cancer located in the nasopharynx can lead to obstruction of the Eustachian tube causing a middle ear effusion
impairment of cough reflex
internal laryngeal nerve mediates the afferent limb of the cough reflex above the vocal cords; foreign bodies (ex: fish bones) can become lodges in the piriformis recess and may cause damage to the nerve imparting the cough reflex
prolonged exposure of loud noises
can lead to hearing loss due to damage to the sterociliated hair cells of the organ of Corti
menière disease
episodic vertigo, sensorineural hearing loss, and tinnitus w aural fullness; pathogenesis is related to an increased volume and pressure of endolymph in the vestibular apparatus
Brachial cleft cyst
are most often located anterior to the SCM and result from incomplete obliteration of a pharyngeal cleft (or groove); pts typically have tender fluctuant mass w/ or w/o purulent drainage
Pierre Robin sequence
characterized as a sequence because the primary defect (hypoplasia of the mandibular prominence) leads to a cascade of further malformations (micrognathia, posteriorly displaced tongue, U-shaped cleft palate)
