Unit 5 - ENT Flashcards
What are the external structures of the ear
Auricle and external auditory canal
What are the external functions of the ear
Protective and helps gather/channel sound
What are the middle ear structures
Ossicles (malleolus, incus, stapes) and the tympanic membrane
What are the functions of the middle ear
Ossicles transmit sound from tympanic membrane to inner ear and the tympanic membrane separates middle from external ear
What are the structures of the inner ear
Vestibule, semicircular canals, and chochlea
What are the functions of the inner ear
Cochlea transmits sound to CN VIII and semicircular canals involved in vestibular function
Sound is also transmitted by ____ directly to the inner ear
By bone
What has the function of odor identifying, passage for inspire/expire air, humidifying and warmth, resonance of laryngeal sounds
Nose, nasopharynx and sinuses
What is the structure of the external nose
Bone/cartilage and nares
What is the kiesselbach plexus
Convergence of small fragile arteries and veins within the nose, nasopharynx, and sinus
What are the only sinuses accessible for physical examination
Only the maxillary and frontal sinuses
What is the nasal floor is formed by what
The hard and soft palate
What is the nasal roof formed by
The frontal and sphenoid bone
Where are do the adenoids lie
On the posterior wall of the nasopharynx
What has the function of emission of air for vocalization and expiration, passage for material, initiation of digestion, and identify taste
Mouth and oropharynx
The oral cavity is divided into the ____ and the _____
Mouth and the vestibule
The ____ houses the tongue teeth, gums and anterior opening of the oropharynx
The mouth
The _________ of the hard palate and the fibrous soft palate form the roof of the mouth
The bony arch
Loose mobile tissue covering the mandibular bone forms the ______
Floor of the mouth
The tongue is anchored to the floor of the mouth by what
The frenulum
The roots of the teeth are anchored to the ________ of the maxilla and mandible
Alveolar ridges
The oropharynx is continuous but inferior to what
The nasopharynx
What separates the oropharynx from the mouth
Separated from the mouth by bilateral anterior and posterior tonsillar pillars
The tonsils lie in the cavity between waht
The anterior and posterior tonsilar pillars
When does the inner ear develop
In first trimester
When is salivation increases in infants
By 3 months
What is different about the eustachian tube in infants than adults
Its wider shorter and more horizontal
When do the frontal and sphenoid sinuses begin to develop
About 3 years of age completing development in late adolescents
Permanent teeth begin forming in the jaw by what age
6 months
When doe eruption of permanent teeth begin and when is it completed
Begins at 6 and completed around 14/15 years
In what cases can tooth eruption being delayed
In cases of poor nutritional status and chronic conditions
What does the elevated levels of estrogen cause in a womens respiratory tract
Causes increased vascularity of upper rspiratory tract
What does the increased vascularity in the upper respiratory tract of pregnant women cause
Capilllaries in nose, pharynx, and ears engorge as well as laryngeal changes
Nearly a third of older adults over age ____ have hearing loss
65 years
What can be associated with age related hearing loss
Degeneration of hair cells in organ of corti, loss of cortical and organ of corti auditory neurons, degeneration of cochlear conductive membrane, decreased vascularization of cochlear
What does sensorineural hearing loss first occur with
High frequency sounds and progresses to low ones
Excess deposition of bone cells along the ossicle chain causes what
Fixation of stapes in the oval window resulting in conductive hearing loss
What can produce conductive hearing loss
Excess deposition of bone cells, cerumen impaction, sclerotic tympanic membrane
Deterioration of sense of smell results is from what
Loss of olfactory sensory neurons beginning at age 60 years
When does the sense of taste begin to deteriorate
By about 50 years
Why does taste sense deteriorate
As the number of papillae on the tongue and salivary gland secretion disease
Why do ears and nose get larger as we age
Continuing cartilage formation in ear and nose
What mouth soft tissues change in older adults
Cheeks more prominent
What happens to gingival tissues as we age
Less elastic and more vulnerable to trauma
What happens to the tongue in older adults that cause difficulty swallowing
Altered motor function of tongue
What can ear pain often be concurrent with
Upper respiratory infection, frequent swimming, and trauma to the head
What is a false sense of motion
Vertigo
What can be an indicator in infants and children regarding serum bilirubin
Serum bilirubin greater than 20 mg/100 mL
When doing an external exam on the external auditory canal what are you looking for
Discharge/odor
What should the consistency of the auricle be like for the external exam
Consistency should be firm and mobile and without nodules
What are the middle ear structures
Ossicles (malleus, incus, stapes) tympanic membrane
How do we compare air to bone conduction
Weber test and rinne test
What are 3 evaluations of auditory function
Response to questions directions, whispered voice test, finger rustle test
What do response to questions/directions, whispered voice test, and finger rustle test all have in common
They all are GROSS assessments with limited diagnostic accuracy
What are the two types of hearing loss
Sensorineural and conductive
What is the tool used in the weber test
512 hz tuning fork
During the weber test if patient hears well in both ears what is it labeled as
Normal = weber midline
During the weber test if a patient hears it better in the left or right ear what does it indicate and what is it labeled as
Abnormal = weber left or weber right respectively
Weber test interpretation that has sound lateralizing to one ear is what (2 options)
Ipsilateral conductive hearing loss or contralateral sensorineural hearing loss
What does the weber test interpretation assume
That the patient only has one form of hearing losse
What is the most common cause of hearing loss
Conductive hearing loss
When does conductive hearing loss usually take place
Usually under age of 40
During rinne test if air conduction (part 2) is ____ as long as the ____ (part 1)
2 times as long; bone conductive
What is a normal rinne test be labeled
Positive rinne ( air conduction 2x as long as bone conduction)
If bone conduction is better in a rinne test what is it labeled
Negative rinne = suggests conductive hearing loss
When does sensorineuronal hearing loss take place
Usually over age 40
What is the otoscopic exam used for
Used to inspect external auditory canal and middle ear
What findings are you looking for on the tympanic membrane during otoscopic exam
Landmarks, color, contour, perforation
What determines the mobility and compliance of tympanic membrane during otoscopic membrane
Using pneumatic attachment and evaluation
When should auditory canals be first examined
First few weeks of life
When does the TM become conical
After 1st months
How do you evaluate hearing of infant
Using sound stimuli
When do you perform an otoscopic/oral exam for children
At end of PE (maybe physical exam)
When do you do weber and rinne test in children
After age of 3
What should be performed on all newborns
Audiometry
What kinds of things should we examine in the ears and hearing of older adults
Irritation (if hearing aid), course hair on auricle, tm for sclerotic changes, presence of presbycusis/conductive loss, cerumen impaction
What are the external nose parts
Bone, cartilage, nares
What are the 4 sinuses
Maxillary, frontal, ethmoid, sphenoid
When should you perform palpation of the nose
With injury history
How do you evaluate the patency of the nares
Occlude one nostril while breathing in through the other
What sinuses should we palpate
Frontal and maxillary
What are fordyce spots
Small yellowish white bodies on mouth/oropharynx that represent ectopic sebacceous glands
What is the wharton duct
Duct of submandibular salivary gland opening near frenulum in mouth/oropharynx
What should saying “ahh” do in the mouth/oropharrynx
Raises soft palate symmetrically, uvula in midline, and pharynx should constrict like a curtain
How far should a tongue blade go
No more than 1/2 way bac
What is the tongue blade used to assess
Tonsillar pillars and retropharyngeal wall
What is menieres disease
Combo of vertigo and tinnitus
What causes menieres disease
Dilation of fluid, chambers of the middle ear
What evaluates equilibrium
Romberg test
What test is performed if imabalance is detected
Nylen barany test (dix-hallpike test)
Who has a higher incidence of rhinophyma
Rosacea and alcoholics
What does the otoscope provide illumination for while examining the ear
Auditory canal and tympanic membrane
What does a tympanometer or tympanometry examine
Assesses the functions of the ossicular chain, eustachian tube, tympanic membrane, and interrelation of these parts
The amount of energy transmitted from tympanometer is directly related to what
The compliance of the system
What is compliance of tympanometer measured in
Mm or cubic cm of equivalent volume
What does compliance indicate
Mobility in the middle ear
Low compliance measurement indicates what
More energy returned to probe with less transmitted to middle ear
High compliance reading indicates what from tympanometer
Flaccid or highly mobile system
What is a graphic representation of the change in compliance of the middle ear system as air pressure is varied
Tympanogram
What can be visualized by a nasal speculum
The lower and middle turbinates of the nose
What instrument is used in a Screening tests for auditory function for vibratory sensations as part of the neurological exam
A tuning fork
What does a tuning fork vibrate at
512 Hz (512 cycles per second) (can use 500-1000)
Tuning forks with a frequency lower than 500 cause what
To overestimate bone condution and can be felt as vibration as well as hearsd
For vibratory sensation what frequency fork will i use
Lower frequency
The greatest sensitivity to vibration occurs when the fork is vibrating between what
100-400 hz
What is a sensory organ that identifies, localizes, and interprets sound and helps maintain balance
The ear
The middle ear mucosa produces a small amount of mucus that is rapidly cleared by ciliary action of the ______
Eustachian tube (passageway between nasopharynx and middle ear)
The eustachian tube drains into what
Posterior aspect of the inferior turbinate of the nose
The cochlea is a coiled structure containing the _______ and transmits sound impulses to the ______
Organ of corti; CN 8
Equilibrium receptors of semicircular canals and vestibule of inner ear send signals to where
The cerebellum to maintain balance
How are vibrations passed through the ear
Tm to malleus, incus, stapes, to oval window of inner ear, causing cochlear endolymph motion to round window where it is dissipated
Impulses of CN 8. Are sent to what lobe for interpretation of sound
Temporal lobe
What bones form the nasal bridge
Frontal and maxillary bones
Mucus collects and carries debris and bacteria from the inspired air in the nose to the ____ for _____
Nasopharynx; swallow/exportation
What does the mucus of the nose contain to fight infection
Immunoglobulins and enzymes
Receptors for smell are located where
In the olfactory epithelium
The internal nose is divided by the septum into what
Two anterior cavities = the vestibules
What houses the sensory endings of the olfactory nerve
The cribriform plate
What is a small convergence of small fragile arties and veins in the nose and where specifically is it located
Kiesselbach plexus located on anterior/superior portion of the septum
What are parallel curved bony structures covered by vascular mucous membranes in the nose
Turbinates
What do turbinates of the nose form
Lateral walls of the nose protruding into nasal cavity
A ___ below each turbinate is named for the turbinate above it
Meatus
What is the purpose of the turbinates
Increase nasal surface area to warm, humidify, filter inspired air
Where does the inferior meatus drain to
The nasolacrimal duct
Where does the medial meatus drain into
The paranasal sinuses
Where does the superior meatus drain into
The ethmoid sinuses
What are air filled paired extensions of the nasal cavities within the bones of the skull
Paranasal sinuses
Where do the ethmoid sinuses lie
Behind frontal sinuses near the superior portion of nasal cavity
Where do the sphenoid sinuses lie
Deep in skull behind the ethmoid sinuses
What are the taste receptors scattered throughout the filiform papillae of the tongue
Fungiform papillae
How many teeth do adults have
32 permanent
The oropharynx is separated from the mouth by what
Bilateral anterior and posterior tonsillar pillars
What part of the tonsils collect cell debris and food
Crypts
How does an infants eustachian tube differ to an adults and why is it different
Wider, shorter, and more horizontal = easier reflux of nasopharyngeal secretions
As a child grows what happens to the estachian tube
Lengthens and its pharyngeal orifice moves inferiorly
What can occlude the eustachian tube and interfere with aeration of the middle ear causing ear effusion
Growth of lymphatic tissue specifically adenoids
When are the sphenoid sinuses present on a child
By 5 yrs old
When do frontal sinuses begin to develop
7-8 years
20 decidious teeth erupt between what age of infant
6-24 months
Permanent teeth begin forming in the jaw by how old
6 months of age
Eruption of permanent teeth begins when
About 6 years of age completing around 14-15 years
Conductive hearing loss may result from what
Excess deposition of bone cells along the ossicle chain
What could an instant onset of hearing loss inn one or both ears indicate
Vascular or autoimmune process
What could the onset of hearing loss over a few hours or days indicate
Viral infection
Is meniere disease genetic
Yes
What is a false sense of motion
Vertigo
What age is most at risk for oral cancer and oropharyngeal cancer
Older than age 55
What nutritional impact can affect ENT
Excessive sugar intake
When should a child start babbling
Before 6 months of age
When should there be concern of hearing loss in regards to communicative speech and reliance on gestures
After 15 months of age
What can cause a cauliflower ear
Blunt trauma or necrosis of underlying cartilage
What can indicate gout along the peripheral margins of the auricles
Tophi crystals
The auricle must be almost vertical with no more than a ____ degree lateral posterior angle
10
When performing external auditory canal inspection a purulent fould smelling discharge can indicate what
Otitis externa, perforated acute otitis media, or foreign body
What can a low set postition of the auricle or unusual angle indicate
Chromosomal aberrations or renal disorders
The triad of hearing loss, tinnitus and vertigo constitutes as what
Meniere syndrome
What is meniere disease
Usual symptoms plus another cause undetermined
In the nose what is indicated by bilateral watery dishcharge and associated sneezing/nasal congestion
Allergy
In the nose what is indicated by bloody discharge
Epistaxis or trauma
In the nose what is indicated by bilateral mucoid or purulent discharge
Rhitiis or upper respiratory infection
In the nose what is indicated by unilateral purulent, thick, greenish, malodorous discharge
Foreign body
In the nose what is indicated by unilateral watery discharge occurring after head trauma
Cerbrospinal fluid leakage
Placing a light against the medial aspect of each supraorbital rim illuminates what
Frontal sinus
Deep fissures at the corneers of the mouth (chielosis) can indicate what
Riboflavin deficiency or overclosure of mouth
Lip pallor is associated with ____ and circumoral pallor is associated with ____
Anemia; scarlet fever
What are round oval or irregular bluish gray macules on the lips and buccal mucosa are associated with what
Peutz jhegers syndrome
Which malocclusion has the lower molars distally positioned
Class II
What malocclusion has the lower molars mediallly positioned
Class III
A red spot on the buccal mucosa at the opening of the stensens duct is associated with what
Parotitis
What is a localized gingival enlargement or granuloma that is usually inflammatory rather than neoplastic change
Epulis
The hard palate may have a bony protuberance at the midline called what
Torus palatinus
Saying “ah” tests what
CN 9/10
Deviation of the uvula to one side may indicate what
Vagus nerve paralysis or peritonsillar abcess
A bifid uvula is associated with what
Loeys dietz syndrome
A yellowish mucoid film in the pharynx is typical of what
Postnasal drip
The tm does not become conical for several months in newborn and the light reflex may appear what
Diffuse
A saddle shaped nose with a low bridge and broad base or a short small nose or large nose can suggest a what
Chromosomal disorger or congenital anomooly
Macroglossia is associate with congenital anomalies such as what
Congenital hypothyroidism
What are small whitish yellow masses at the juncture between the hard/soft palate and dissappear within a few weeks after birth
Epstein pearls
How young can weber and rinne be performed
3/4 years
When do maxillary sinuses form and are ready to palpate
At 4 years of age
When are frontal sinuses developed and ready to be palpated
7 to 8 years
Chalky white lines or speckles on the cutting edges of permanent incisors may result from what
Excessive flouride intake
Multiple brown areas or caries on the upper/lower incisors can be result of what
Bedtime bottle of juice or milk
Teeth with black or gray color may indicate what
Pulp decay or oral iron therapy
Mottled or pitted teeth result from what
Tetracycline treatment during tooth development or enamel dysplasia
Whit specks with a red base on the buccal mucosa opposit the first and second molars occuring in the prodromal phase of rubela are what
Koplik spots
When do childs tonils reach peak size
6 years of age
What is inflammation of middle ear resulting in collection of serous mucoid or purulent fluid (effusion) when tm is intact
Otitis media with effusion or acute otitis media
What is inflammation of auditory canal and external surface of tympanic membrane
Otitis externa
What is trapped epithelial tissue behind the tm that often is result of untreated or chronic recurrent otitis media
Cholesteatoma
What is a reduced transmission of sound to middle ear
Conductive hearing loss
What is a reduced transmission of sound in the inner ear
Sensorineural hearing loss
What is a disorder of progressive hearing loss that in some cases is hereditary
Meniere disease (endolymphatic hydrops)
What is the illusion of rotational movement by patient often due to disorder of the inner ear
Vertigo
What is a bacterial infection of one or more of the paranasal sinuses
Sinusitis
What is an iinfection of tonsils or posterior pharynx by microorganisms
Acute pharyngitis
What is a deep infection in the space between the soft palate and tonisl
Peritonsilar abcess
What is a life threatening infection in the lateral pharyngeal space that has the potential to occlude the airway and mostly occurs in children
Retropharyngeal abcess
What is a cancer involving the oral cavity or related structures
Oral cancer
What is a chronic infection of the gums, bones, and other tissues that surround and support teeth
Peridontal disease
What is a craniofacial congenital malformation that is result of lip or palate failing to fuse during embryonic development prior to 12th week of gestation
Cleft lip/palate
