23.2 Omm & Ent Diseases

Front 1

What are common ENT-related problems seen in primary care?

Back 1

Cold
Headache
-Otitis Media
-Sinusitis
-Tonsillitis/Pharyngitis
-Vertigo/Dizziness

Front 2

What are the unique osteopathic diagnostic features observed in ENT-related problems?

Back 2

-Referred Pain and Viscero-Somatic Reflexes.
-Chapman’s Reflexes
-Manual Thermal Diagnosis
-Travell Trigger Points

Front 3

What innervates the majority of the facial organs?

Back 3

Trigeminal nerve (CN V)

Front 4

What are structures are innervated by the trigeminal nerve

Back 4

-Nasal Structures
-Paranasal Sinuses
-Tongue
-Teeth
-Most of Palate

Front 5

How far does the sensory nucleus of the trigeminal extend to?

Back 5

The sensory nucleus of Trigeminal nerve extends well down into the cervical spinal cord.

Front 6

Where can pain in any division of the trigeminal nerve refer to?

Back 6

Pain in any division of Trigeminal nerve can refer to the upper and mid neck and generate secondary somatic dysfunction from the Occiput to as low as C5.

Front 7

What is the innervation (or sensory) of the ear?

Back 7

Trigeminal via Mandibular nn.
C2, C3 Nerve Roots via Cervical Plexus
Vagus via auricular branch supplies external acoustic meatus and a small area on the posteromedial surface of the auricle

or

Vagus
Reflexly connected to C1 & C2 nerve Roots
C2 & C3
Direct Pain Referral to Dermatome and Myotome
Trigeminal
Can affect OA to C5

Front 8

Chapman's Reflexes again...

Back 8

Chapman reported many different points for different diseases of the head and neck region. A summary follows, but again, all the points end up in the Cervical and are in the T1 & T2 levels anteriorly, and the C1 & C2 levels posteriorly.
Anterior points are predominantly on the surface of the ribs or clavicle, not in the intercostal spaces like the heart and lungs.

Front 9

What are the Chapman's reflexes for laryngitis?

Back 9

Anterior: Upper Surface of the Second Rib, two to three inches from the sternum
Posterior: Over the transverse process of C2, midway between the tip of the spinous process and the tip of the transverse process.

Front 10

What are the nasal Chapman's reflexes?

Back 10

Anterior: On the first rib at the junction of the rib with the costal cartilage
Posterior: Anterior surface of the transverse process of C2

Front 11

What chapman's reflexes are used for otitis media?

Back 11

Anterior: On the upper edge of the clavicle where it crosses the first rib
Posterior: Upper edge of the tip of the C-1 transverse process

Front 12

What chapman's are used for pharyngitis?

Back 12

Anterior: On the anterior surface of the first rib, ¾” medial to point where it is crossed by the clavicle
Posterior: On the posterior aspect of the transverse process of C2

Front 13

What chapman's reflexes are used for sinusitis?

Back 13

-Anterior: On the anterior surface of the first rib, ¾” medial to point where it is crossed by the clavicle
-Posterior: On the posterior aspect of the transverse process of C2
-Anterior: On the anterior surface of the 2nd Costal cartilage, ¾” from the sternum
-Posterior: On the superior aspect of the transverse process of C2

Front 14

What are the chapman's reflexes for Tonsilitis?

Back 14

-Anterior: In the first intercostal space close to the sternum (one segment above the heart point)
-Posterior: On the posterior surface of the transverse process of C1

Front 15

What travell trigger symptoms or pain points are associated with eye pain?

Back 15

-Sternal division of Sternocleidomastoid
-Splenius cervicis
-Occipitalis
-Orbicularis Oculi
-Trapezius

Front 16

Where are the Travell Trigger Points for Ear pain, tinnitus, and diminished hearing

Back 16

-Deep portion of Masseter muscle
-Clavicular division of Sternocleidomastoid
-Medial Pterygoid
Occipitalis

Front 17

What are the Travell Trigger Points for nose pain?

Back 17

Orbicularis Oculi

Front 18

Where are the travell trigger point for eustachian tube dysfunction (Otitis Media)

Back 18

Medial Pterygoid

Front 19

What are the travell trigger points associated with throat pain or difficulty swallowing

Back 19

-medial pterygoid
-digastric

Front 20

What are maxillary sinus pain and sinus/nasal stuffiness travell trigger points?

Back 20

-Lateral Pterygoid
-Masseter
-Sternal Division of Sternocleidomastoid

Front 21

Using a biomechanical approach what is a cause of tinnitus?

Back 21

-One cause of tinnitus is temporal bone dysfunction.
-External rotation: Produces a low pitched roar (patent Eustachian tube)
-Internal rotation: Produces a high pitched tinnitus (closed Eustachian tube) and is often associated with chronic or recurrent otitis media.

Front 22

What is the Galbreath Technique?

Back 22

Also known as mandibular drainage, this technique delivers a pumping action to the Eustachian tube to aid in draining the middle ear in cases of chronic serous otitis media, barotitis and mild cases of acute otitis media.

Front 23

How do you do the Galbreath Technique?

Back 23

-The traction applied to the mandible in this technique impacts the medial pterygoid muscle. The fascia of this muscle is continuous with that of the tensor velli palatini muscle, hence the pumping action on the Eustachian Tube
-This pumping action normally occurs during swallowing and yawning. The Galbreath technique mimics the yawn.

Front 24

Where are the neurologic reflex approaches?

Back 24

Sympathetics
-Emanate from the T1-T4 spinal cord levels and can be influenced by both thoracic and costal somatic dysfunction
-They ascend with the vascular tree and are distributed to the mucosa with the blood vessels.
-Visceral afferent fibers follow the various sensory nerves back into the
-CNS
-Trigeminal
-Glossopharyngeal
-Vagus
-Facial
-Occipital
Acute Hypersympathecotonia
Vasoconstriction and decreased tissue turgor.
Chronic Hypersympathecotonia
-Thick viscous secretions
-Drying, cracking and breakdown of the mucosal barrier
-Predisposition to Infection

Front 25

What happens with trigeminal stimulation?

Back 25

-Manual or Thermal stimulation of the Trigeminal nerve causes an acute hypersympathecotonia with vasoconstriction.
-It is this vasoconstriction with decreased tissue turgor that allows the sinus ostia to open and the sinuses to drain.
-Suboccipital inhibition or traction produces the same type of reflex effect through unknown pathways

Front 26

What are the parasympathetic reflex neurologic approach?

Back 26

Nose—Facial nerve via sphenopalatine (pterygopalatine) ganglion. Action-secretomotor: thin watery secretions
-Ear—Glossopharyngeal. Action-vauge, vasodilator?
-Larynx/Pharynx—Vagus. Action-secretomotor as above

Front 27

What is sphenopalatine ganglion stimulation?

Back 27

-Direct digital “irritation” of the ganglion
-Effects thinning of secretions and easier passage of sinus contents through the ostia
-Also causes the eye to water
-Technique is painful to have done, but works

Front 28

What is the vascular approach to ENT problems

Back 28

-85% of venous blood leaving the head drains into the internal jugular vein
-It exits the cranium through the jugular foramen in the petrobasilar suture, a continuation of the occipitomastoid suture
-Cranial somatic dysfunction can narrow this foramen and result in both neurocranial and viscerocranial venous congestion
-The way to address this is with cranial technique

Front 29

What is important with ENT lymphatic approach?

Back 29

Treatment Sequence Matters
-Begin with central lymphatic drainage and then move peripherally

Front 30

Tell me the lymphatic approaches

Back 30

1) Treat Thoracic, Costal, Cervical and Cranial Dysfunctions
2) Open the thoracic inlet
3) Apply Thoracic Pump Technique, also doming the diaphragm if indicated
4) Apply Anterior Cervical Arches Technique
5) Apply Cervical Chain Drainage
6) Apply Mandibular Drainage
7) Apply Auricular Drainage
8) Apply Reflexly mediated techniques (trigeminal stimulation, suboccipital pressure, sphenopalatine ganglion tx)

Front 31

What is the summary of the lymphatic approach to ENT problems?

Back 31

Basically remove any abnormal somato-visceral reflex feed
-Unclog the big sewer lines
-Then get the big pump working
-Then clean out the smaller pipes
-Then apply reflex stimulation

Front 32

Why would you want immune enhancement (asking enzyte's smiling Bob)?

Back 32

-Many common ENT problems stem from infectious etiologies
-Use of either the Miller Thoracic Pump or Splenic Stimulation Techniques will improve the bodies overall immune response

Front 33

How you would apply OMM to Otitis Media?

Back 33

Most common reason for pediatric visits in pt < 5
-Key role of eustachian tube
-Short
-Horizontal orientation 0-4 y/o
-Downward slant >4 y/o => dramatic decrease in OM
-Impaired mobility of petrous portion of temporal bone
-Antibiotics + OMT
-OMT:
-Restore unimpeded physiologic motion of temporal bones, diaphragm, lymphatics
-Address SD in surrounding myofascial structures, including medial + lateral pterygoid muscles

Front 34

How you OMM in ENT to headaches?

Back 34

-Multifactorial
-Migraine, cluster, tension-type headaches
-Possible harbinger of more serious ds
-OMT to C-spine, OCF, soft tissue
(e.g., suboccipital tension release)

Front 35

How would you apply OMM to pharyngitis?

Back 35

-Most commonly d/t rhinovirus
-Adenovirus => rhinitis, posterior cervical lymph node 2nd most common
-Group A beta-hemolytic Streptococcus most common bacterial pathogen
-OMT:
-Lymphatic and splenic pumps
-Compression of 4th ventricle (CV4)
-Anterior cervical fascial release
Muscle Energy (ME)