The Ear and nose Flashcards
What are the signs and symptoms of ear disorders?
otalgia (ear pain)
tinnitus (ringing)
Vertigo (dizziness, feels like everythings spinning)
hearing loss
facial nerve palsy
facial tingling discharge
Name the areas of the pinna shown in the diagram
What is the pinnar of the ear made of?
Elastic cartilage, skin and fatty tissue (esp in lobule)
How does cauliflower ear develop?
Trauma= bleeding between the cartilage and perichondrium (pinna haematoma).
This deprives the cartilage of its blood supply. This, plus the pressure causes necrosis of the cartilage. if left untreated this will lead to fibrosis and new asymetrical cartilage development leading to cauliflower ear
How can cauliflower ear be treated?
prompt drainage of the haematoma and reapposition of the two layers
A pt presents with ear pain and hyperacusis. On examination vesciles found in the pinna, mouth and tongue and there is facial paralysis on the ipsilateral side. What is the most likely diagnosis? Describe this condition
Ramsey- hunt syndrome
This is reactivation of varicella zosta virus from the genitculate ganglion of the facial nerve
What shape is the ear canal? How does it need to be pulled for viewing the tympanic membrane with an otoscope
S shaped- about 2.5 cm long
In adults up and back, in children down and back
What forms the wax?
The cartilagenous part of the ear canal (outer 1/3) has hair cells and produces cerumen- this and dead skin cells make up the wax
This 7 y/o presents which acute onset otalgia.
What is the most likley diagnosis? Why is this disease common in swimmers
Otitis externa
Common in swimmers due to water being trapped in the external auditory canal, which is a promotes growth of organisms such as pseundomona
What is shown in the image? How should it be managed?
Perforated tympanic membrane
It should resolve itself within 6-8 weeks. Surgery can be considered if it doesnt
Fill in the blanks, is this a left or right ear?
Red= malleus
Green= incus
blue= cone of light
Corda tympani nerve can sometimes be seen above the incus
Right eardrum- malleus points inwards
What are the proper names for the hammer, anvil and stirrup bones of the middle ear (the ossicles)?
Malleus= hammer
incus= anvil
Stapes= stirrup
What is the role of the ossicles?
To transmit vibrations form the tympanic membrane to the oval window of the cochlear
What is the acoustic reflex?
Tensor tympani and stapedius contract to dampen movement of the ossicles when loud noises are detected. This is coordinated by the facial nerve.
What is otosclerosis?
Ossicles becoming fused at articulations- imparticular between stapedius and oval window. It causes progressive conductive hearingloss and deafness
What is the function of the eustachian tube?
Opens to allow pressure to equilibriate- there is negative pressure in the middle ear due to the mucous membrane absorbing air.
It also allows drainage and ventilation of the middle ear.
What is glue ear?
otitis media with effusion- eustachian tube dysfunction leading to negative pressure build up, which draws fluid into the middle ear cavity across the mucous membrane.
What is otitis media with effusion?
Eustachian tube dysfunction, leading to negative pressure build up in the ear. This leads to reduced movement of ossicles and so conductive hearing loss
How is otis media with effusion treated?
Initially conservativley as it should go away on its own but if it persists longer than 3 months, or development/ school performance is affected, grommet (tube through the tympanic membrane) is required to ventilate the middle ear
Why is acute otitis media more common in children?
their eustachian tube is shorter and more horizontal so infection can travel up it easier and block more easily
Give 3 complications of otitis media?
- perforation
- facial nerve involvement
- mastoiditis (middle ear communicates w/ mastoid air cells)
- meningitis
- sigmoid sinus thrombus
- brain abcesses
How can you spot mastoiditis and what is its significance?
Redness and swelling behind the ear
Can lead to meningitis and brain abcesses if it spreads further
This pt comes in complaining of hearingloss and a smelly dicharge. He has no otalgia and has a history of recurrent ear infections. What is the most likely diagnosis?
Cholesteatoma- a non cancercous growth of skin cells in the middle ear, it is not malignant but slowly expands and erodes structures
How does the cochlear work?
The stapes vibrates against the oval window, which vauses movement of the fluid within the cochlear, this causes movement of the stereocilia (special sensory cells) within the cochlear duct, which generates action potentials in the vestibulocochlear nerve.
How does the vesitble work?
There are lots of fluid filled channels (semcicircular canals) in different orientations. When we move the fluid moves, this helps us detect position and keep balance.
What is meniere’s disease and what is thought to be the cause?
Dizziness, hearing loss and tinnitus attacks which can develop to become permenant. It is thought to be due to fluid buildup within the labrynth. Repeated bouts of swelling affects the hearing cells themselves which can mean the hearingloss is permenant.
What is thought to be the cause of benign paroxysmal positional vertigo?
Crystals forming within the semicircular canals of the trochlear, small movements of the head dislodge them and cause the fluid within the move. The fluid is moving but you are not so you get vertigo
What is labrynthitis and what does it lead to?
Infection of the inner ear, it causes vertigo, headahces, hearing loss and tinnitus. It usually gets better in a couple of weeks
Describe how rinnes and webers tests are done? What are the normal results?
Rinnes test= tuning folk held close to ear and then put on mastoid bone and it should be louder when held in air around ear than when put on bone
Webers test= Place the tuning folk on the top of their head and if should be equally lound in both ears
What rinnes and webers test results would you get for conducitve hearing loss problems?
Vibrations through bone are heared louder than though air on the affected ear on a rinnes test.
Vibrations are heared louder on the affected ear on a webers test. This is because there is less ambient noise from the environement in the affected ear masking the noise of the tuning folk
What rinnes and webers test results would you get for sensorineural hearing loss?
Rinnes test is normal, with air being louder than bone.
However in the webers test the vibrations are heared louder in the normal ear, this is because there is a problem with processing the vibrations in the affected ear so less noise is heared.
Where is the pathology is conductive hearing loss? give 4 examples
external or middle ear
EG. excess wax, otitis media, glue ear or otosclerosis
Where is the pathology in sensorineural hearing loss? give 4 examples
inner ear or vestibulocochlear nerve
eg. menieres disease, labyrnthitis, presbyacusis, acoustic neuroma or ototoxic mediations
What is prescbuacusis? describe the pathogenesis
Loss of hearing in the elderly. It is thought be be due to nerve cells degenerating with age due to exposure to loud noises, smoking, mediactions, arterioslerosis ect.
Both ears are usually affected and it is usually high pitches which are lost first
What are the 5 functions of the nose and nasal cavity?
- sense of smell
- route for inspired air
- filters particles and microbes out of the inspired air
- Moistens and warms inspired air
- resonating chamber for speach
What froms the ridge of the nose?
In the cartilagenous part- nasal cartilage
In the boney part- nasal bone and frontal process of maxilla
What lines the nasal cavity?
Skin (stratifed squamous epithelium)- so has hair and sebaceous glands
Why are suspected nasal fractures often asked to come back a few weeks later? Do thye get an xray?
Swelling masks any midline deviation, so get them to come back when its gone down so you can asses deviation and realign.
No xray tends to be done as you cant see it
What is a septal haematoma? what causes it and how do you spot one?
Where facial trauma has caused the septum to buckle and shears the blood vessels in the perichondrium supplying the cartilage.
Can spot one by looking up nostril.
What happens if you do not drain and reappose a septal haematoma?
Necrosis of the cartilagenous septum leading to saddle nose deformity.
This is why septal haematomas require urgent ENT refferal
What two CNS structures can be accessed via the nose due to close proximity?
Frontal lobe and pituitary gland
What type of mucosa is found in the nasal cavity?
In roof= olefactory mucus membrane
In ref= respiratory mucosa
What are the 3 bone projections into the nasal cavity called?
Superior, middle and inferior conchae or turbinate
What are the grooves of the nasal cavity called? What drains into them?
Meatuses- this is where paranasal sinuses, eustachian tube and nasolacrimal duct drain into
What is the role of the conchae and meatuses?
Creates turbulent airflow, which slows down air. They also increases surface area (which also slows down the air). High SA and slower air means maximal warming and humdifying of the air
What makes up the boundaries of the nasal cavity?
Medial wall= septal cartilage
Lateral wall= conchae and meatuses
Floor= hard palate
Roof= crista galli and part of sphenoid bone
Describe the general sensory innervation of the nose?
External= opthalmic branch of the trigeminal nerve
Internal= maxillary branch of the trigeminal nerve
What are nasal poylps, how do they appear and what symptoms may they cause?
Benign growths in the nasal cavity, usually bilateral and relatively common in >40 y/o. They are pale yellow or red and fleshy in appearance.
They cause blocked noses, watery rhinorrhea, post nasal drip and reduced smell and taste.
What 2 features suggest a nasal polyp is cancerous?
blood tinged secretions from the nose
unilateral
What is rhinits? what can cause it?
Inflammation of the mucous lining of the nose.
Usually caused by infections (acute infective rhinitis)- usually viral (rhinovirus).
May also be caused by allergens- hayfever.
What are the symptoms of rhinitis?
Nasal congestion, rhinorrhoea (runny nose), sneezing, nasal irritation, post nasal drip
How may a forgein body and rhinitis be distinguished in a child presenting with nasal congestion, sneezing, rhinorrhoea ect?
Forgein body- uni lateral, discharge is smelly and blood stained.
What is the name for nasal bleeding?
Epitaxis
Where is the most common area/ origin for nasal bleeding?
Kesselbach’s area- an area of opthalmic and maxillary artery anastomosis in the cartilagenous part of the nose
Why are nose bleeds originating from the sphenopalatine artery more severe?
- larger artery so more blood
- further back so hard to stop the bleeding and also higher risk of aspiration/ swallowing
Why may epitaxis arise?
Spontaneously or minor trauma- the arteries are very friable in very old and very young.
How should epitaxis be managed?
- compress area and lean forwards
if this doesnt stop it:
- cauterise using silver nitrate
- pack usuing nasal tampons
if still bleeding:
- surgery to ligate the blood vessels
and check for coagulopathies
What is the point of the paranasal sinuses?
Warm and humifify inspired air and reduce the weight of the skull
What is the name of the channels which drain the paranasal sinuses?
Ostia
Describe the pathophysiology of sinusitis?
Primary infection of nasal cavity causes reduced cilary function, odema and increased nasal secretions. this impeded sinus drainage, the stagnantion is a breeding ground for baceteria to grow in the sinuses and thus cause an infection
Describe the presentation of someone with sinusitis
Non resolving cold or flu like illness, with pyrexia, blocked nose, rhinorrhea +/- yellow/ green discharge, headache/ facial pain in region of sinuses made worse by sitting forward.
How is sinusitis managed?
self limiting so dont give antibiotics
How can sinusitis lead to pre septal orbital cellulitis?
Infection of ethmoid air cells breaks through medial wall or orbit
