HEENT Flashcards
What is the only muscle that will abduct the larynx?
The posterior portion of the cricoarytenoid muscle
What is the treatment of vocal cord nodules?
Caused from vocal abuse so can be best treated with rest and vocal therapy.
What is the concern with white plaques located in the larynx?
White nodules are usually associated with lekuoplakia (an ulceration of the muscosal membrane) and can be a sign of pre-malignancy.
What does the superior laryngeal nerve innervate?
The external branch of the superior laryngeal nerve innervates the only muscle on the outer surface of the larynx: the cricothyroid (which tightens the vocal cords).
The internal branch of the superior laryngeal nerve innervates the sensory portions of the larynx and is responsible for the cough reflex.
What is the concern with aminoglycosides (-mycin) antibiotics? (Neomycin, gentamcyin, tobramycin)
What drugs will you use instead?
They are Ototoxins and should not be used with perforated eardrums.
Use fluroquinilone (floxin, cipro, ciprodex)
What is different about cellulitis of the auricle presentation than that of frostbite and neomycin allergy?
No weeping or vesicular eruption
Auricular hematoma will progress to what if not treated properly?
Cauliflower ear
Difference between Osteoma and Exostosis?
Osteomas are deep in the ear canal related to cold-water
Exostosis are lateral in the ear canal and are congenital
What bacteria are common causes of otitis externa “swimmer’s ear”?
Gram negative or pseudomonas
Patient comes in with an otitis externa that is not improving. Patient has known diabetes and has severe pain. Patient is starting to show signs of facial dropping and hoarseness. The attending says the initial infection has progressed to a bad state. What is the Dx?
Malignant (necrotizing) Otitis Externa
A non-improving otitis externa
Pt w/ severe pain, diabetes, immune infection, granulations, bony sequestra and cranial nerve deficits, what is the Dx and Tx?
Malignant (Necrotizing) Otitis Externa
antibiotics, debridement, control of diabetes
How would you treat a Fungal otitis externa?
must suck out
Why does Chondrodermatitis Nodularis Helicis need long term treatment?
Invasion of the cartilage takes a long time for lysis of bacteria. At least a month of antibiotics.
How to diff exostosis, tympanosclerosis and cysts?
pillow test = anesthetic drops then “touch” the membrane for hardness
Exostosis
Tympanosclerosis = hard
Cysts
Most common bacteria that cause acute otitis media?
S. Pneumoniae, H. influenza, and M. catarrhalis
Otoscopy shows a white plaque covering the tympanic membrane, what is the Dx and the histological makeup?
Tympanosclerosis
hyaline cartilage
What is the most common ear infection and usually due to what type of infection?
acute otitis media
upper respiratory infection
What type of bacteria cause Neonatal AOM?
Gram negative bacilli (pseudonmonas)
Stage of AOM
- Mringitis (Inflammation of TM)
- Bullous Myringitis (blistering of TM)
- Rupture of TM
- Intracranial complications (abscesses)
Coalescent Mastoiditis
Intracranial complication of AOM that causes abscess of the mastoid sinus
How are the Mastoid cells related to the middle ear?
Create lubrication
Role of the Eustachian Tubes?
Ventilation and drainage of the middle ear
Symptoms of Eustachain Tube Dysfunction?
Hearing loss (conductive), sense of fullness in ear, dizziness (if unilateral)
A patient with hearing loss and recurrent infections from having their significant other kiss them in the ear could be suffering from what?
tympanic membrane perforation
What type of infections are seen in chronic ear infections?
Pseudomonas and Gram negatives
Cholesteotomas develop how?
- congenital (grows behind eardrum, epithelial cells will pinch off and grow)
- perforation of the tympanic membrane (that grows inwards causing dead skin in the middle ear)
- retraction pocket
Pt. Presents with loss of hearing in the left ear and left side facial drooping. Evaluation of the ear reveals cheesy debris and a white hue visible behind the TM. Pt says a couple of weeks ago he had a perforated tympanic membrane but they were gonna wait an see. What is the cause of the symptoms?
Cholesteatoma. Most likely will have to be surgically removed
Pt presents with episodic: vertigo, hearing loss, nystagmus, tinnitus and fullness, what could be the cause?
Meniere’s Disease (Endolymphatic hydrops)
*altered fluid dynamics causing rupture of inner ear membranes, electrolyte imbalance (a short circuiting inner ear)
What is one of the SNHL that can be surgically repaired?
perilymphatic fistula
other treatable SNHL are syphilitic and Autoimmune
Remember the sun does not set on the…
…perilymphatic fistula!
When will a congenital cholesteatoma present itself?
What test will you perform to check?
Not untill 2-5 years because it will slowly progress.
Soft pillow test
Pt. presents with dizziness and facial paralysis but no pain. Otoscopic exam reveals polyp and inflammation. White hue is visible behind TM.
Aural polyps with cholesteatoma
Pain is absent or minimal
How do you treat a Meniere’s disease?
Low salt diet and diuretics
What are the important auditory structures in the mid temporal bone space?
tympanic membrane, periossicles, facial nerve, Eustachian tube
Others included in just temporal bone: Jugular vein Carotid artery Cochlea Vestibular labyrinth
What are the two effects and their associated auditory amplification of the middle ear transformer?
the ossicular lever = 1.3:1
Hydraulic ratio = 17:1
Total 22 fold
How often does SNHL occur in infants and by age 19 and what does it affect?
1:1000 infants
2:1000 by 19yo
affects speech, language and psychosocial development
What is the graphic representation of the sensitivity for pure tones as a function of frequency?
audiogram
What does peak hearing loss at 4000 Hz indicate?
noise-induced hearing loss
What can be used to test an infant(neonatal) for hearing loss?
ABR (auditory brainstem response)
What are simple assisted listening devices?
Telephone with a light, same with doorbells, telephone amplifiers.
What are the two parts of the Tympanic Membrane?
Pars tensa (lower portion) and Pars flaccida (smaller supper portion; weaker fibrous middle layer)
TORCHES
acronym for Toxoplasmosis, Other, Rubella virus, Cytomegalovirus, and Herpes simplex viruses, a group of agents that can infect the fetus or the newborn, causing a constellation of morbid effects called the TORCH syndrome
Differentiate Intensity and Frequency
Intensity = strength in sound measured in decibels Frequency = pitch of a sound in cycles per second (Hz)
What is the Pure Tone average?
Average of thresholds at 500, 1000 and 2000 Hz
What is a normal Audiogram look like
Hearing sensitivity with 0-20 dB
What condition has an upsloaping SNHL (meaning deficits at pure tone low frequencies but normal hearing at the highest frequencies)
Meniere’s disease
What does the Presbycusis patient’s pure tone hearing average look like?
Normal at lower Hz but impaired at higher Hz
What is Tympanometry?
Acoustic impedance related to middle ear function (TM and ossicles), eustachian tube function and acoustic reflex.
Normal Tympanometry versus a fluid filled versus a flaccid tympanic membrane
Normal = peak
Fluid filled = flat
Flaccid = notched
By finishing this what do you deserve?
A. Break
B. Sandwhich
C. Time in the sun
You just went through 49 slides. Why not all three?
