(Test #1) OCMM Lecture Flashcards
Ear
A) Otitis media
- Result of impaired drainage of the eustachian tube
- Cause may be bacterial
- Or… Infection may be the result
B) Higher frequency in infants because the TUBE IS SHORTER and more A/P
C) Especially during teething, more fluids
*** Eustachian tube is WITHIN the Temporal Bone and EXITS the Auditory Canal!!!!
Ear Anatomy
- “pharyngotympanic tube (aka Eustachian)…lies in the temporal bone and opens on the external base of the skull BETWEEN the FORAMEN SPINOSUM and the CAROTID CANAL” Hollingshead 5th edition Atlas
- The tube lies in the “GROOVE between the PETROUS temporal bone and the GREATER wing of the sphenoid”
Ear Anatomy Cont
- The narrowest caliber of the tube is as it leaves the cranium before entering the nasopharyngeal tissue. (from Grey’s 37th)
- ** The area most likely to cause a CONSTRICTION or BLOCKAGE of the Eustachian Tube is at the CRANIAL BASE where the SPHENOID and TEMPORAL bones MEET!!!
- This is the NARROWEST AREA of the tube where it exits the Cranial Base
Ear Treatment
1) Osteopathic Manipulative treatment as adjuvant therapy in children with recurrent acute otitis media:
- Significant improvement in middle ear tympanic membrane motion and
reduction in middle ear effusion. - Benefit may also prevent the development of middle ear damage leading to hear problems
Recurrent Otitis Media
- “Given the position of the auditory tube BETWEEN the Temporal and Sphenoid bones and its relationship to the muscles of the soft palate, the tensor veli palatini, levator veli palatini and salpingopharyngeus, it is apparent that the tube is VULNERABLE to EXTRSINCI COMPRESSION, presumably during birth.”
Pain in the Cranium
Arteries
- Distention, Traction or Dilation of intracranial or extracranial arteries
- Two primary examples: MIDDLE MENINGEAL and SUPERFICIAL TEMPORAL Arteries
- Parts of the dura at the base of the brain
- Arteries within the dura:
i) Especially the PROXIMAL parts of the ANTERIOR and MIDDLE Cerebral Arteries and the INTRACRANIAL portion of the INTERNAL CAROTID (Pain Sensitive portions of Internal Carotid)
Pain In Cranium
Veins
- Veins, if impaired, will cause Headaches
- Traction of Displacement of the Large Intracranial Veins or their Dural Envelope
** EXITS out of the JUGULAR FORAMEN!!!!
Cranial Veins with a Dural Envelope
- Superior and Inferior SAGGITAL SINUS
- STRAIGHT sinus
- TRANSVERSE sinuses
Cervical Nerves
1) Relationship of SUPERIOR CERVICAL GANGLION to SECOND Cervical Vertebra!!!
2) Relation of C1 to INFERIOR GANGLION of VAGUS!!!
Compression of CN VII
*** Correction of marked EXTERNAL ROTATION of the Temporal with Sphenobasilar Flexion and Sidebending Rotation
- Paralysis resolved QUICKLY!!!
Bell’s Palsy
- Change in TASTE (Ant 2/3 of Tongue)
- Chorda Tympani
- Unable to CONTROL affected Side of Facial Muscles
*** HAVE TO RULE OUT STROKE
Other Clinical Considerations
1) SUPRATENTORIAL:
- Referred ANTERIORLY via the TRIGEMINAL NERVE!!!!
2) INFRATENTORIAL:
- Referred to the VERTEX and POSTERIOR HEAD and NECK by the 3 CERVICAL NERVES (C1-3)
3) CN 7, 9, and 10 refer pain to the NASO-ORBITAL area, the EAR, and THROAT
Trigeminal Neuralgia
- Incapacitating pain lasting a few seconds
- Stimulus is chewing or brushing teeth
- Distribution to MAXILLARY DISTRIBUTION of Trigeminal (V2)
Clinical Correlate with Trigeminal Nerve
- Sensory impulses from the Forehead, Orbit, Anterior and Middle fossae of the skull, and the Upper Surface of the tentorium are all transmitted by the TRIGEMINAL NERVE, NOTABLY V1 & V2
Trigeminal
- The foramen OVALE and foramen ROTUNDUM are located in the SPHENOID BONE!!!!!
- The TRIGEMINAL GANGLION lies in the TEMPORAL BONE
