Week 1 ENT 2 of 4

Question 1

Risk related to undiagnosed Ear disorders?

Answer 1

• Poor language development
• Delayed learning
• Social isolation
• Hearing loss
• Risk for falls
• Missed diagnoses of respiratory and oral infections

Question 2

Types of and causes of hearing loss:

Answer 2

•Conductive

–Poor transmission of sound waves through the external and/or middle ear

•Sensorineural

–Diseases of the cochlea and/or poor conduction of sound-generated impulses along the eighth cranial nerve to the brain stem

•Mixed

–Combination of both conductive and sensorineural hearing loss in the same ear

Question 3

Types of hearing scuity test?

Answer 3

•Tuning Fork Tests

–Test the ability of the patients to hear pure tones

–Weber Test

–Tests for adequacy of bone conduction

–Rinne Test

–Tests for comparison of air conduction to bone conduction in each ear separately

•Whisper Test

–Gross screening test for hearing acuity

Question 4

•More than 75% of all children experience at least one episode of ______ before the age of 3 years

Answer 4

•More than 75% of all children experience at least one episode of otitis media before the age of 3 years

Question 5

•Allow young children to_________.

Answer 5

•Allow young children to sit in their parent’s lap

Question 6

Consideration for Ped patient:

Answer 6

• Allow young children to sit in their parent’s lap
• Make a “game” of the examination to gain cooperation
• Get acquainted with both the child and the parent prior to the examination
• Explain the examination
• Allow the child to become acquainted with the equipment

Question 7

Consideration for Adult patient:

Answer 7

• 30% to 40% of adults over age 65 years experience some degree of presbycusis
• There is an increasing incidence of tinnitus until about 70 years of age
• Vertigo increases with age
• A common cause of hearing loss is cerumen impaction
• Hearing loss may be associated with paranoia and agitation
• Men have poorer hearing after age 40 than women

Question 8

Paranasal sinuses and their locations:

Answer 8

•Maxillary sinuses

–Below the orbit of the eye in the maxillary bone

•Frontal sinuses

–Frontal bone just above the eyebrows

•Ethmoidal sinuses

–Ethmoid bone lying behind the eyes and nose

•Sphenoidal sinuses

–Sphenoid bone behind the eyes and the nose

Question 9

Types of bleeding and possible causes:

Answer 9

•Copious and short-term bleeding

–Associated with trauma

–Usually an isolated incident

•Chronic bleeding

–Drug therapies

–Chemotherapies

–Very dry environment and fragile nasal mucosa

Question 10

What instrument do you use for examination of the interior nasal cavity?

Answer 10

• Use an otoscope with cover to examine the interior nasal cavity
• Individuals are sensitive to the examination of the nose

Question 11

How do you palapte and percuss the nose?

Answer 11

• Palpate the bridge and soft tissues of the nose
• Palpate the sinuses
• Percuss the sinuses
• If tenderness is noted, transilluminate the sinuses to gather additional information

Question 12

Focus of past medical hx?

Answer 12

• Allergies
• Influenza and colds
• Chronic respiratory problems

–Polyps

–Sinusitis

–Septal deviation or surgeries

Question 13

Common disorders of the nasal system?

Answer 13

• Congestion
• Epistaxis
• Trauma
• Rhinitis
• Sinusitis
• Smell and Taste Disorders
• Tumors and polyps of the nose

Question 14

Congestion is?

Answer 14

•Vascular changes in the nasal mucosa caused by neural, hormonal, or local mediators

Question 15

Subjective findings of congestion?

Answer 15

• Subjective findings:
• Rhinorrhea, coughing, sneezing, purulent discharge, fever, eye symptoms

Question 16

Objective findings of congestion

Answer 16

• Objective findings:
• Erythema of the mucosa, pallor, edema, atrophy, crusting and discharge

Question 17

Management of congestion?

Answer 17

• Management:
• Topical decongestants or inhaled corticosteriods such as nasocort, nasonex, etc work better than over-the-counter oral agents. Nasal lavage and saline nasal sprays can be beneficial

Question 18

Health promotion of congestion?

Answer 18

• Health Promotion:
• Over-the-counter medications containing pseudoephedrine and phenyleprhine should be used with caution.

Question 19

What is epistaxis?

Answer 19

•Bleeding from the nose from irritation, trauma, infection, or tumors.

Question 20

Subjective an objective findings in epistaxis?

Answer 20

• Subjective findings:
• May be acute or chronic
• Objective findings:
• Scant to copious amounts of bleeding from nares

Question 21

Management of epistaxis?

Answer 21

• Management:
• Leaning forward while applying direct pressure to the anterior portion x 15 minutes, topical decongestants such as phenylephrine (vasoconstrictors) are helpful, cauterization may be necessary for persistent bleeding, nasal tampon with bactroban lubrication x 48 -72 hours.

Question 22

Health promotion of epistaxis?

Answer 22

• Health Promotion:
• No picking in nares, avoid anti-coagulants several days, avoidance of spicy foods and tobacco (vasodilators)

Question 23

What is a trauma to the nose?

Answer 23

Follows direct blow to the face from trauma such as MVA, sports injuries, or altercations.

Question 24

Subjective and Objective findings in trauma to nose?

Answer 24

• Subjective findings:
• Ask for mechanism of injury, facial numbness, diplopia, visual changes and bleeding
• Objective findings:
• Periorbital ecchymosis, edema, abrasions, lacerations, epistaxis, trauma to other facial structures

Question 25

Management and health promotion of trauma to nose?

Answer 25

• Management:
• Cool, local pressure to the area, facial x-rays and CT scans to determine precise injury
• Health Promotion:
• Encourage patients to wear protective gear.