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Medicine Year 2 > HNN Topic 18 - Pharynx, Larynx, Tonsils, Nose and Ear > Flashcards

HNN Topic 18 - Pharynx, Larynx, Tonsils, Nose and Ear Flashcards

1
Q

List the intrinsic muscles of the larynx and describe their functions

A
  1. Cricothyroid muscle - stretches and tenses vocal ligaments (forceful speech)
  2. Thyroarytenoid muscle - relaxes vocal ligament (soft speech)
  3. Posterior cricoarytenoid muscle - abducts vocal ligament
  4. Lateral cricoarytenoid muscle - adducts vocal ligament
  5. Transverse and oblique arytenoid muscles - adducts vocal ligament
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2
Q

What is the function of the larynx?

A

Phonation, cough reflex, protection of lower respiratory tract

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3
Q

Describe the areas of the nasal cavity

A
  • Vestibule - surrounds anterior external opening to nasal cavity
  • Respiratory region - lined by ciliated pseudostratified epithelium (respiratory), mucous secreting goblet cells
  • Olfactory region - at apex of nasal cavity, lined by olfactory cells
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4
Q

What is the function of the intrinsic muscles of the larynx?

A

Control shape of rima glottidis and length/tension of vocal folds for phonation

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5
Q

How can the vestibuloocular reflex be tested?

A

Barany chair or caloric stimulation

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6
Q

Describe how the inner ear functions in balance

A
  • Vestibular apparatus = semi-circular canals and otolith organs (utricle and saccule)
  • Semi-circular canals detect angular acceleration in 3 planes due to orientation in 3 different planes - superior, horizontal + posterior
  • Otolith organs detect linear acceleration (horizontal and vertical) and orientation in a gravitational field
  • Vestibular receptors - hair cells, affected by movement of endolymph
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7
Q

Describe the lining and location of the oropharynx

A
  • Lined by stratified squamous non-keratinised epithelium
  • From edge of soft palate to tip of epiglottis
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8
Q

List the treatment/management options in otitis media with effusion

A
  • Active observation (6-12 weeks)
  • Hearing aids
  • Autoinflation/Valsalva manoeuvre
  • Surgical - myringotomy and ventilation tube (Grommet) insertion
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9
Q

If things become stuck in the throat (e.g. fish bones), where are they likely to be lodged?

A

In the vallecula/piriform fossa

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10
Q

What is the function of the fenestra vestibuli and the fenestra cochlea?

A
  • Fenestra vestibuli - stapes moves in and out of in response to vibration
  • Fenestra cochlea - fluid pushed by footplate of stapes bulges here (2nd tympanic membrane)
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11
Q

List the risk factors for otitis media with effusion

A
  • Bottle-fed
  • Parental smoking
  • Group nursery
  • Atopy e.g. eczema, asthma
  • Genetic disorders
    • Mucociliary e.g. cystic fibrosis, primary ciliary dyskinesia
    • Craniofacial e.g. Down’s syndrome, cleft palate
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12
Q

Describe the structure of the palatine tonsils

A
  • Covered by stratified squamous epithelium
  • Penetrated by 15-20 crypts - contains lymphocytes, bacteria and desquamated epithelial cells
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13
Q

What is the function of the vestibuloocular reflex?

A

Stabilise images on the retina during movements - eyes move against direction of rotation of head

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14
Q

Describe the boundaries of the nasal cavity

A

Vestibule to nasopharynx

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15
Q

What is the function of the sphenopalatine foramen?

A

At the level of the superior meatus, allows communication between the nasal cavity and the pterygopalatine fossa, sphenopalatine artery, nasopalatine and posterior superior lateral nasal nerve pass through

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16
Q

What is the function of the inner ear?

A

Hearing and balance

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17
Q

Describe the contents of the mastoid antrum

A

Mastoid air cells - can become infected ( =mastoiditis)

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18
Q

What causes sensorineural deafness?

A
  • Nerve deafness- damage to nerve or inner ear (hair cells)
  • Aging, ototoxicity, loud noise, tumours
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19
Q

What is the function of the nose?

A

Olfactory and respiratory

  • Warms/humidifies air
  • Removes and traps pathogens/particulate matter from inspired air
  • Sense of smell
  • Drains paranasal sinuses and lacrimal ducts
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20
Q

Describe the parts of the middle ear

A
  • Tympanic cavity - contains ossicles
  • Epitympanic recess - superior to tympanic cavity, next to mastoid antrum
  • Auditory tube - connects middle ear to nasopharynx
  • Fenestra vestibuli
  • Fenestra cochlea
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21
Q

Where is the incisive canal and what is its function?

A

Between nasal cavity and incisive fossa of the oral cavity, transmits nasopalatine nerve and greater palatine artery

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22
Q

Where are the corniculate cartilages found?

A

Articulate with the apex of the arytenoid cartilage

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23
Q

How is autoinflation/Valsalva manoeuvre used in treatment of otitis media with effusion?

A
  • Valsalva manoeuvre = blow out air against pressure (with nose pinched/mouth shut)
    • Equalises pressure in middle ear, allows ventilation and drainage of fluid
    • Done if child is old enough
  • Young children - autoinflation
    • Blow up balloon via nostril to equalise pressure
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24
Q

Describe the aetiology/pathogenesis of otitis media with effusion in children

A
  • Combination of inflammatory changes and auditory tube dysfunction
  • Upper respiratory infection - inflammation of tonsils, tubal tonsil inflammation causes occlusion of auditory tube
  • Negative pressure due to occlusion of the auditory tube - fluid accummulation
  • Children’s auditory tubes are shorter + more horizontal, more susceptible to infection/occlusion
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25
Q

What is the Weber test used for?

A
  • Detect unilateral conductive/sensorineural hearing loss
  • Tuning fork placed in the middle of the forehead - compare volume in each ear
  • Normal - symmetrical
  • Abnormal
    • Conductive - louder in defective ear
    • Sensorineural - louder in normal ear
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26
Q

Describe how the inner ear functions in hearing

A
  • Cochlea detects magnitude/frequency of sound waves
  • Inner hair cells of organ of Corti activate ion channels in response to vibration of the basilar membrane
  • Action potential from spiral ganglia (cell bodies of cochlear nerve)
  • Higher magnitude of sound waves = more action potentials
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27
Q

Describe the blood supply of the lingual tonsils

A

Lingual artery, tonsillar branch of external carotid artery

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28
Q

Describe the location of the tonsils

A

Waldeyer’s ring of tonsil tissue - around oropharynx

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29
Q

Describe the location and structure of the pharyngeal tonsils

A
  • Adenoids, in superior nasopharynx
  • Covered by pseudostratified columnar epithelium (respiratory)
  • No crypts
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30
Q

Describe the venous drainage of the palatine tonsil

A

Internal jugular vein via peritonsillar plexus of the lingual/pharyngeal veins

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31
Q

Describe the clinical signs which would be seen in conductive deafness

A
  • Rinne test negative - bone conduction > air conduction
  • Absolute bone conduction normal
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32
Q

Describe the blood supply of the nasal cavity

A
  • Branches of internal and external carotid arteries
    • Internal - anterior and posterior ethmoidal arteries, branches of ophthalmic artery, come through cribiform plate
    • External - sphenopalatine, greater palatine, superior labial and lateral nasal arteries
  • Veins follow arteries, drain into pterygoid plexus, facial vein or cavernous sinus
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33
Q

Where are the tubal tonsils found?

A

On tubal elevation, surrounds the opening to the auditory tube

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34
Q

What is the clinical significance of the relationship between the paranasal sinuses and the nasal cavity?

A
  • Upper respiratory tract infection can spread to sinuses, causes inflammation (swelling and pain) of mucosa - sinusitis
  • More than one sinus affected = pansinusitis
  • Maxillary nerve supplies maxillary sinus and maxillary teeth - inflammation of maxillary sinus can present with toothache
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35
Q

List the types of deafness

A
  1. Conductive deafness
  2. Sensorineural deafness
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36
Q

Describe the surgical treatment of otitis media with effusion

A
  • Myringotomy - small incision in tympanic membrane, relieves pressure and allows for Grommet insertion
  • Grommet - small tube inserted in tympanic membrane to ventilate middle ear and allow drainage of fluid
    • Side effects - ear discharge (otorrhoea), tympanic membrane perforation
    • Remain in membrane for 6 months - 2 years, spontaneously fall out
    • Tympanic membrane usually closes without residual hole
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37
Q

Why is observation often the first line of management of otitis media with effusion? When is observation not appropriate?

A
  • Spontaneous resolution is common
  • Referral to ENT if:
    • Severe hearing loss
    • Delay in reaching developmental milestones
    • Symptoms persist for longer than observation period
    • Underlying craniofacial abnormality e.g. Down’s syndrome/cleft palate
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38
Q

Where does the ethmoid sinus drain to?

A
  • Anterior, middle and posterior
  • Anterior drains to hiatus semilunaris
  • Middle into ethmoid bulla
  • Posterior into superior meatus
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39
Q

Describe the structure of the interior of the nasal cavity

A
  • 3 nasal conchae - inferior, middle + superior
    • ‘Turbinates’ - curved shelves of bone
  • Create 4 pathways for air
    • Inferior, middle and superior meatuses
    • Spheno-ethmoidal recess
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40
Q

Define otitis media with effusion

A
  • Also called serous otitis media/secretory otitis media/glue ear
  • Fluid accummulation in the middle ear and mastoid air cells due to negative pressure produced by dysfunction of the auditory tube
  • Can be associated with a viral or bacterial upper respiratory infection e.g. otitis media
  • Causes conductive hearing loss
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41
Q

What is the function of the auditory tube?

A

Equalises pressure between the external environment and the middle ear

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42
Q

Describe the innervation of the muscles of the middle ear

A
  • Tensor tympani - innervated by tensor tympani nerve (branch of mandibular nerve)
  • Stapedius - innervated by nerve to stapedius (branch of facial nerve)
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43
Q

Describe the structure of the vocal folds

A
  • Superor vestibular folds - false vocal folds
  • Inferior vocal folds - true vocal folds
  • Rima glottidis between the true vocal folds, size altered by muscles of phonation
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44
Q

What would be see during an otoscopy in otitis media with effusion?

A
  • Dull tympanic membrane
  • Loss of ‘cone of light’
  • Fluid level behind tympanic membrane
  • Reduced tympanic membrane mobility
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45
Q

Where do the lacrimal ducts drain to?

A

Nasolacrimal duct drains to the inferior meatus

46
Q

What is the clinical significance of the annular ligament?

A

Can calcify with age - common cause of deafness

47
Q

List the parts of the external ear

A
  1. Auricle/pinna
  2. External acoustic meatus
  3. Tympanic membrane
48
Q

Why does motion sickness occur?

A

Sustained movement at constant velocity - endolymph keeps moving after movement stops

49
Q

List causes of vestibular dysfunction and their symptoms/signs

A
  • Due to labrythitis, vestibular neuritis, Meniere’s disease etc.
  • Symptoms/signs - vertigo, nausea, vomiting, loss of balance, nystagmus
50
Q

What is the function of the tonsils?

A
  • 1st line defence against ingested or inhaled foreign particles
  • Engore with blood to assist in immune responses to common illnesses
  • Have M cells (antigen presenting) on their surface, alert underlying B and T cells in the tonsil
  • Hold B memory cells, allow for production of secretory antibodies (IgA)
  • Produce T cells similarly to the thymus
51
Q

Describe screening for deafness in children

A
  • Newborns/first few weeks after birth - automated otoacoustic emission test (clicking noises, measure response)
  • 8-12 months
  • 4/5 years
  • Further testing if hearing loss suspected
52
Q

Why does cleaning the ear sometimes illicit an involuntary cough reflex?

A

Deep part of external acoustic meatus innervated by branches of the facial/vagus nerve - cleaning ears results in stimulation of the auricular branch of the vagus nerve which is responsible for controlling the cough reflex

53
Q

Describe the appearance of a healthy tympanic membrane in an otoscopy

A
  • Transluscent - can see middle ear structures through it
  • ‘Cone of light’ - reflection of light during otoscopy
  • Pearly grey colour
  • Malleus and umbo visible
54
Q

What is the clinical significance of the sphenoid sinus

A

Can reach the pituitary surgically through the sphenoid sinus and bone

55
Q

What is the function of the auricle of the external ear?

A

Capture and direct sound towards the external acoustic meatus

56
Q

Describe the impact of deafness on children

A
  • Delayed speech and language development, communication, cognitive skills (learning)
  • Linked to - isolation, low self-esteem, learning difficulties, behavioural problems
  • Poor academic performance - often misidentified as ADD/ADHD, leads to frustration/confusion
  • Early intervention is important
57
Q

Where does the maxillary sinus drain to?

A

Drains into nasal cavity at hiatus semilunaris, under frontal sinus opening (potential spread of infection from frontal to maxillary sinus)

58
Q

Where are the lingual tonsils located?

A

On posterior part of tongue base

59
Q

Describe the clinical signs which would be seen in sensorineural deafness

A
  • Rinne test positive - air conduction > bone conduction
  • Absolute bone conduction reduced
60
Q

Describe the innervation of the intrinsic muscles of the larynx

A
  • Inferior laryngeal nerve - terminal branch of the recurrent laryngeal nerve (branch of vagus nerve) except cricothyroid muscle
    • Cricothyroid innervated by superior laryngeal nerve
61
Q

Describe the lining and location of the nasopharynx

A
  • Respiratory epithelium
  • Ends at palatoglossal fold
62
Q

How does the cribiform plate contribute to the nasal cavity?

A

Forms part of the roof of the nasal cavity, allows fibres of the olfactory nerve to enter/exit

63
Q

List the gateways to the nasal cavity

A
  1. Cribiform plate
  2. Sphenopalatine foramen
  3. Incisive canal
64
Q

Why is caloric stimulation clinically relevant?

A
  • Used to test brainstem integrity in unconscious patient (as well as pupil/gag reflex)
  • Removal of ear wac by syringing may elicit reflex and cause dizziness
65
Q

List the parts of the pharynx

A
  1. Nasopharynx
  2. Oropharynx
  3. Laryngopharynx
66
Q

Describe the signs/symptoms of otitis media with effusion

A
  • Difficulty hearing - conductive hearing loss
    • In young children often noticed as difficulty with attention at school or poor speech/language development
  • Feeling of pressure inside ear
67
Q

Describe the parts of the internal larynx

A
  • Supraglottis - superior border of epiglottis to the vestibular folds
  • Glottis - vocal folds and 1cm away
  • Subglottis - inferior border of epiglottis to inferior cricoid cartilage
68
Q

What kind of epithelium lines the paranasal sinuses?

A

Psuedostratified columnar ciliated epithelium (respiratory epithelium)

69
Q

Describe the structure of the tonsils

A
  • Mass of lymphoid follicles supported on a connective tissue framework
  • Germinal centre - middle of nodules densely packed with lymphocytes
  • Tonsillar crypts - penetrate from the surface, almost down to the centre of the tonsil follicle (except in pharyngeal tonsils)
  • Luminal surface - non-keratinised stratified squamous epithelium (same as surrounding oropharynx)
  • M cells on surface
70
Q

Describe the location and function of the middle ear

A

Within the temporal bone, transmits vibration from the tympanic membrane to the inner ear

71
Q

List the muscles of the middle ear and describe their function

A
  • Protective function - contract in response to loud noises
  • Tensor tympani - attaches to handle of malleus, pulls it off of tympanic membrane
  • Stapedius - attaches to stapes
72
Q

Describe the location of the pharyngeal recess

A

Also called fossa of Rosenmuller, deep pocket moving laterally from nasopharynx

73
Q

What is the function of the conchae?

A

Increase the surface area of the nasal cavity to increase the amount of air in contact with the walls of the nasal cavity, make the airflow slow and turbulent

74
Q

What is the clinical importance of the cricoid cartilage?

A

Pressure applied to occlude the oesophagus - prevents regurgitation of gastric contents.

= Cricoid pressure/Sellick’s maneouvre

75
Q

Where does the sphenoid sinus drain to?

A

Drains onto roof of nasal cavity

76
Q

Describe the process of the vestibuloocular reflex

A

Rotation of the head, endolymph in semi-circular canals moves in opposite direction, causes activation of hair cells and eventual excitation of the extraocular muscles on one side with inhibition on the othe side

77
Q

What is the tubal elevation?

A
  • Elevation around opening of auditory tube
  • Made of cartilage, lined by mucous membrane
  • Rich in lymphoid tissue - tubal tonsil
  • Projects 4/5mm into auditory tube
78
Q

Define otitis media

A

Infection of the middle ear which causes inflammation and a build-up of fluid behind the tympanic membrane

79
Q

Describe the location of the larynx and its anatomical relations

A
  • C3-6, continuous with laryngopharynx superiorly and trachea inferiorly
  • Covered anteriorly by infrahyoid muscles, laterally by lobes of thyroid
  • Oesophagus is posterior
80
Q

Describe the lining and location of the laryngopharynx

A
  • Stratified squamous non-keratinised epithelium
  • From tip of epiglottis to end of pharynx - where it narrows to become oesophagus (at level of C6)
81
Q

Where are the cuneiform cartilages found?

A

In the aryepiglottic folds, strengthen the folds

82
Q

Describe the general structure of the larynx

A
  • Cartilaginous skeleton held together by ligaments and membranes
  • Lined by pseudostratified ciliated columnar epithelium, except true vocal folds (stratified squamous epithelium)
83
Q

Describe the aetiology of otitis media with effusion in adults

A
  • Less common in adults than children
  • Due to blockage of auditory tube - infection/occlusive mass
84
Q

What is the clinical significance of the auditory tube?

A
  • Path for upper respiratory infection to spread to middle ear
  • Shorter and narrower in children, infection more common
85
Q

Where does the auditory tube drain to?

A

Drains into the nasopharynx at the level of the inferior meatus, allows middle ear to equalise with atmospheric air pressure

86
Q

What are tonsils?

A
  • Collections of lymphoid tissue - sites of high immune activity
  • Face into the aerodigestive tract, part of mucosa associated lymphoid tissue (MALT)
87
Q

Describe the structure of the tympanic membrane

A
  • 3 layers - outer cutaneous, middle fibrous and inner mucous membrane
  • Cone shaped
  • Handle of the malleus articulates with the tympanic membrane at the umbo
  • Anterior and posterior malleolar folds move away from the lateral process of the malleus
  • Thin, susceptible to perforation (trauma or infection)
88
Q

Describe the structure of the arytenoid cartilage

A
  • Pyramidal cartilages on top of the cricoid cartilage
  • Attached to vocal cords - tighted/relax to change pitch of voice
  • Attachment for posterior and lateral cricoarytenoid muscles
89
Q

Compare the severity and treatment of conductive and sensorineural deafness

A
  • Conductive - usually mild, treatable
  • Sensorineural - usually persistance/long-lived, not treatable, can be mild, moderate, severe or profound
90
Q

What is the clinical significance of the pharyngeal recess?

A
  • Site of potential tumour growth
  • Difficult to visualise - may have to take blind biopsy
  • Passes close to internal carotid artery
91
Q

List the tonsils which make up Waldeyer’s ring of tonsil tissue

A
  1. Pharyngeal tonsil
  2. Tubal tonsil
  3. Palatine tonsil
  4. Lingual tonsil
92
Q

Describe the structure of the external acoustic meatus

A
  • Sigmoid shaped tube
  • Extends from deep concha to the tympanic membrane
  • Walls - external 1/3 = cartilage, internal 2/3 = tympanic part of temporal bone
93
Q

Describe the structure and function of the ossicles of the middle ear

A
  • Malleus, incus and stapes
  • Held in place by ligaments - annular ligament of stapes
  • Synovial joints between
  • Amplify sound, transmit vibrations to inner ear
94
Q

What causes conductive deafness?

A
  • Blockage in outer or middle ear preventing conduction of sound into the inner ear
  • Infection, impacted wax, perforated tympanic membrane, foreign objects
95
Q

List the cartilages of the larynx

A
  • Unpaired
    • Thyroid
    • Cricoid
    • Epiglottis
  • Paired
    • Arytenoid
    • Corniculate
    • Cuneiform
96
Q

What is the function of a Barany chair?

A
  • Spins, used to test vestibuloocular reflex
  • Observe nystagmus when spinning stops
  • Head up - horizontal nystagmus/semi-circular canal
  • Head down - rotational nystagmus, superior semi-circular canal
  • Head down and turned 90 degrees - vertical nystagmus, posterior semi-circular canal
97
Q

What is the Rinne test used for?

A
  • Compares perception of sounds transmitter by air to those transmitted by bone conduction through the mastoid process
  • Tuning fork against mastoid process then 1-2cm from auditory canal
  • Normal or sensorineural deafness - air > bone
  • Abnormal (conductive deafness) - bone > air
98
Q

How is caloric stimulation used to test the vestibuloocular reflex?

A
  • Injection of water into external acoustic meatus - higher or lower than body temperature
  • Leads to heat transfer, convection current in horizontal semi-circular canal
  • Fluid movement stimulates hair cells, activates vestibuloocular reflex
  • Causes dizziness and horizontal nystagmus
99
Q

Describe the structure of the epiglottis

A

Triangular flap of elastic cartilage at entrance of larynx, blocks entrance to larynx during swallowing - food bolus moves into oesophagus by passing through the piriform fossa on either side of the larynx

100
Q

Where are the palatine tonsils found?

A

Between the palatoglossal arch anteriorly and palatopharyngeal arch posteriorly, in the isthmus of the fauces, laterally attached to wall by fibrous capsule

101
Q

Describe the structure of the cricoid cartilage

A
  • Complete ring of hyaline cartilage, inferior border of larynx (C6)
  • United with trachea by cricotracheal ligament
102
Q

Describe the structure of the thyroid cartilage

A
  • Two laminae joined in the midline anteriorly to form the laryngeal prominence
  • Posterior border project in superior and inferior horns
    • Superior connects to hyoid bone via thyrohyoid ligament
    • Inferior articulates with cricoid cartilage
103
Q

How is the ear protected by structures in the external acoustic meatus?

A
  • Hairs
  • Secretion of the ceruminous glands
  • Helps with lubrication and cleaning of the external acoustic meatus, protects from foreign objects and bacterial/fungal infections
104
Q

Describe the innervation of the nasal cavity

A
  • Special and general
    • Special = olfactory nerve
    • General
      • Septal and lateral walls = nasopalatine nerve (branch of maxillary) and nasociliary nerve (branch of ophthalmic)
      • External skin = trigeminal nerve
105
Q

Where does the frontal sinus drain to?

A

Drains into nasal cavity via frontonasal duct, opens at hiatus semilunaris on lateral wall

106
Q

Other than tonsils, what other structures are classified as MALT?

A

Peyer’s patches in the gut

107
Q

Describe the innervation of the lingual tonsil

A

Tonsillar branch of glossopharyngeal nerve

108
Q

Describe the innervation of the palatine tonsil

A

Maxillary branch of trigeminal nerve, tonsillar branch of glossopharyngeal nerve

109
Q

Describe the arterial supply of the palatine tonsils

A
  • Ascending palatine branch of facial artery
  • Tonsillar branch of facial artery
  • Ascending pharyngeal branch of external carotid artery
  • Dorsal lingual branch of lingual artery
  • Lesser palatine branch of descending palatine artery
110
Q

Which treatments are not usually recommended in the treatment of otitis media with effusion?

A
  • Antibiotics
  • Decongestants
  • Corticosteroids
111
Q

Describe the structure of the lingual tonsils

A

Covered by stratified squamous epithelium, single crypt

Medicine Year 2 (41 decks)

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