Otitis Media and Sinus Drainage

Question 1

Sympathetic innervation to Sinus/OM

Answer 1

T1-4, passes through the cervical ganglia

Question 2

PSNS innervation to Sinus/OM

Answer 2

CN VII (sphenopalatine
ganglion)

Question 3

Bc of PSNS innervation through the sphenopalantine ganglion, treat SD in what four bones and treat the ganglia with what stretch?

Answer 3

*treat dysfunctional temporals, sphenoid, maxillary, and palatine bones.
Also can treat ganglia with the pterygoid fascial stretch

Question 4

Goals of Treatment in these areas.

Answer 4

relieve obstruction and pain, improve venous and lymphatic flow from the
area, affect reflex changes, and improve mucociliary clearance

Question 5

Three contraindications of treatment for sinus/OM

Answer 5

• Fever>102
• Not on abx if bacterial infection
• Inflamed lymph nodes at the site

Question 6

Indication for Pre and post auricular drainage technique

Answer 6

Any dysfunction or lymphatic congestion in the ear region (i.e. otitis media or externa) with
goal of improving lymphatic drainage of the anterior and posterior lymph nodes.
30sec-2min

Question 7

Indication for Galbreath’s Technique (Mandibular Drainage) technique

Answer 7

Ear pain or symptoms due to any dysfunction or lymphatic congestion in the ENT or submandibular region (specific aim of opening eustachian tubes), such as otitis media or increased barometric pressure (altitude changes).

Question 8

Caution using Galbreath’s Technique in patients with active __ dysfunction.

Answer 8

active TMJ dysfunction

-30sec-2min; ant/medial/caudal traction

Question 9

Steps of Counterstrain Technique (Maxillary Sinus TP and Supraorbital TP)

Answer 9

Steps of CNST:

• Diagnose somatic dysfunction
• Find a significant tender point
• Establish pain scale
• Wrap around the TP while monitoring
• Reduce pain at least 70% (patient in position of comfort)
• Maintain position for 90 seconds (120 sec for rib TPs)
• Slowly and passively return patient to neutral
• Reassess somatic dysfunction (tender point)

Question 10

Steps for Pre and post auricular drainage

Answer 10

 Patient supine with head turned slightly toward physician seated at their side
 Physician stabilizes patients head with cephalad hand and caudad hand is placed flat against side of head with finger pads over nodes with ear between third and fourth fingers
 Caudad hand makes clockwise and counterclockwise circular motions, moving the skin and fascia over surface of skull.
 Procedure applied for 30 seconds to 2 minutes

Question 11

Steps for Galbreath’s Technique

Mandibular Drainage

Answer 11

 Patient supine with head turned slightly toward doc standing or seated opposite side of dysfunction
 Physician’s cephalad hand stabilizes the patient’s head, while caudad hand grasps the
posterior ramus of the mandible with third, fourth and fifth fingertips and hypothenar
eminence resting along the body of the mandible.
 Patient opens mouth slightly and doc applies an anterior (forward), medial and caudal
traction and is then released.
 Procedure applied and released in a slow rhythmic fashion for 30 seconds to 2
minutes.

Question 12

Submandibular

“Walking” Technique

Answer 12

 Fingertips under angle of jaw and walk fingers toward chin and back

Question 13

Anterior
Tracheal/Deep
Cervical Technique

Answer 13

 Physician places fingers along lateral borders
of trachea and gently induces movement from side to side
 May also pull superior to

Question 14

Direct Pressure and Sinus Milking

Answer 14

Patient supine, eyes closed and relaxed while doc is seated at head
1. Frontal Sinus
o With thumbs, apply direct pressure over the frontal sinuses. Increase pressure gradually and release in a
gentle, rhythmic motion.
o Cycle is repeated several times
2. Supraorbital notch
o Gentle pressure applied over the supraorbital notch. Slide thumbs laterally along the eyebrow ridge bilaterally
3. Maxillary Sinus
o Apply pressure over sinuses with thumbs
o “Milk” nasal passages by applying downward pressure on either side of nose while sweeping laterally across the maxilla

Question 15

Crossed thumb technique

Answer 15

 Patient is supine with the student seated at the head of the table.
 The student crosses the thumbs so that the left thumb contacts the right nasal region and the right thumb contacts the left nasal region.
 The student applies a force with the left thumb towards the midline and then releases
followed by the same force with the right thumb. This is continued by alternating the
forces in a rhythmical manner
 This can be followed by a milking motion laterally across the maxillary sinuses bilaterally.

Question 16

Condylar Decompression technique

Answer 16

Physician cradles occiput with fingers and translates occiput superiorly, spreading the condyles apart

Question 17

CV4 technique

Answer 17

 Pt is supine with physician seated at the head of the table
 Physician places thenar eminences on occiput
medial to OM suture (volleyball bump position)
 Follow extension (motion of the occiput is anterior) and resist cranial flexion until you
reach a Still point, then let CRI come back

Question 18

Location of the Maxillary Sinus Tender Point

Answer 18

 Located just inferior to the infraorbital notch

 Contact at lateral curve of zygoma and compress and lift

Question 19

Location of the Supraorbital Tender Point

Answer 19

 Located over the supraorbital notch
 Physician places one hand on forehead, pulling superiorly
 Physician places other hand pinching the nose and pulling caudad

Question 20

Ear Pull Technique

Answer 20

 Pull posteriorly and laterally along axis of the external auditory canal. Wait for tissue
release