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133 Cards in this Set
- Front
- Back
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What types of disorders is otarhinolaryngology concerned with?
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Face,
Ears, Oral cavity, Pharynx, URT, Neck, Some intracranial tumors. "from dura to pleura" |
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What does the basic training in ear nose throat consist of?
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Otology,
Rhinology, Laryngology, Head and neck oncology, Facial plastic surgery, Allergy, Reconstructive surgery, Pediactric otolaryngology |
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What does the middle ear consist of? (5)
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TM,
Ossicles, Muscles, Mastoid, Eustachian tube |
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What does the inner ear consist of? (4)
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Cochlea,
Semicircular canals, Vestibule, Internal auditory canal |
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What forms the auricle of the ear?
What type of injuries does this cause the ear to be prone to? |
Cartilage hillocks, elastic cartilage w/ closely adherent skin.
Prone to shearing injury: hematoma, cauliflower ear, perichondritis |
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What should you do for an auricular hematoma?
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Aspirate!
And compression. Do an open procedure if it recurs. |
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How does cauliflower ear occur?
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Usually due to perichondritis that has been drained many times. The cartilage remolds and heals.
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What are keloids?
What can be helpful to treat? |
Exuberant growth of fibrous tissue beyond extent of initial wound. Often recur.
More common in African Americans. Steroid injections can help |
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What is the only skin-lined blind sac in the body?
What is it made of? |
EAC
2/3 bone, 1/3 cartilage. Produces cerumen (GOOD!) |
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What is the outer layer of the TM?
Important notes about the TM? |
Outer layer is skin.
Know the important landmarks. Proper visualization is key to dx middle ear disorders. MUST INSUFFLATE for proper eval!! |
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What foreign body in the EAC is considered an emergency?
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Batteries
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What is an osteoma?
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Bony protrusion. Usually acquired by cold water exposure (scuba diving, etc).
NOT a tumor |
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What is tympanosclerosis?
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A mineral deposit on the TM. Normal variant.
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What is otitis externa aka?
Sx? |
"Swimmer's ear"
Redness, Swelling, VERY painful |
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Usual causative organism of otitis externa?
Tx? |
Pseudomonas.
Abx drops, ear wick, narcs, steroids. |
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What is "malignant" otitis externa?
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Spreading of otitis externa.
Can occur in diabetics and can be fatal! |
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2 things that cause TM perfs?
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Infection,
Trauma |
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Treatment for TM perfs?
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Most traumatic perfs heal spontaneously.
If compression or blast injury: keep dry, can use ototopical drops, check audio, watch for CSF otorrhea! |
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What is the difference between central perforation of the TM and marginal perforation?
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Central does not extend to the margin of the TM. Less severe.
Marginal goes up to and involves the margin. |
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What is the middle ear and it's function?
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Air containing space that connects the eustachian tube to the nasopharynx. Consists of TM, malleus, incus, stapes.
Functions: converts sound energy from air medium to fluid medium. |
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**What is essential for conductive hearing?
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Proper aeration of the middle ear space!
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What components of the ear allow for conductive hearing? (4)
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Auricle,
EAC, TM, Ossicular chain |
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What components of the ear allow for sensorineural hearing (3)?
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Cochlea,
CN VIII, Central pathways |
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What is pure-tone audiogram?
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Hearing testing.
Measures frequency specific hearing threasholds (250-8000 Hz). Able to measure both air and bone conduction. Air (headphones) tests conductive. Bone (mastoid transducer) tests sensorineural. |
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What is the Weber test?
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Fork on forehead or upper teeth.
Sound perceived in ear WITH CONDUCTIVE LOSS or AWAY from ear w/ sensorineural loss. |
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What is the Rinne test?
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POSITIVE test when air>bone (normal).
NEGATIVE test when bone > air (conductive loss). |
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What tuning fork should you use?
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512 mhz (middle C)
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If there is conductive hearing loss, but you don't see any fluid in the ear, what should you suspect?
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There is a bone problem.
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What is 95% of tinnitus secondary to?
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Some type of hearing loss
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2 types of tinnitus?
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Continuous vs pulsatile (could be caused by vascular tumors).
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What is the treatment for tinnitus?
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Audio testing,
Ear eval, Reassurance |
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2 types of pathology that can cause sensorineural hearing loss?
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Cochlear pathology
Retrocochlear pathology |
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Symptoms of cochlear pathology causing sensorineural hearing loss?
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Tinnitus,
usually symmetric loss |
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What are 4 possible causes of cochlear pathology sensorineural hearing loss?
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Presbycusis (age-related),
Ototoxicity, Meningitis, Syphilis/ Lyme |
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Differentiation of retrococholear pathology from sensorineural?
2 causes of retrocochlear pathology? |
Retro: usually ASYMMETRIC loss.
Acoustic neuroma (MRI would dx). Idiopathic: "sudden" SNHL |
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2 main areas of the ear that can cause conductive hearing loss?
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EAC pathology,
middle ear pathology |
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3 causes of EAC pathology causing conductive hearing loss?
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Cerumen build up,
Otitis externa, Atresia |
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4 causes of middle ear pathology causing conductive hearing loss?
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Otitis media,
TM perf, Otosclerosis (stapes becomes stiff, stuck). Ossicular abnormalities. |
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What is a possible treatment for otosclerosis?
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Prosthetic stapes to replace the affected stapes.
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Most ear pain is referred, not from the ear!! What are two things that DO cause otalgia?
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Acute OM,
Otitis externa |
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What are the Ten T's of Otalgia?
Take home point: there are MANY things that can cause ear pain! |
TMJ,
Tonsils, Throat, Thyroid, Teeth, Tongue, Tendons, Trachea, Tube (eustachian), Tics (glossopharyngeal) |
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What is serous otitis media (aka otitis media w/ effusion) usually due to?
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Eustachian tube dysfunction: obstruction, allergy/ sinusitis, cleft palate.
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What would you see in serous otitis media?
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Retracted TM,
Diminished motility |
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Treatment for serous otitis media?
What if it is prolonged? |
Treat any nasal issues.
Valsalva, Antibiotics If prolonged: pressure equalizing tubes |
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What is acute otitis media?
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Bacterial middle ear infection.
Causes pain from TM hyperemia and edema, |
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What bacteria are most likely to cause acute otitis media?
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Pneumococcus
Haemophilus infulenza, Streps |
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Treatment for acute otitis media?
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Amoxicillin is first line
Cephalosporins |
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Complications of acute otitis media?
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Can be severe or life threatening.
Menigitis, mastoiditis, facial nerve paralysis, labyrinthitis |
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What is mastoiditis?
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Abscess in mastoid bone from middle ear infection
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What is chronic otitis media?
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Permanent TM perf w/ middle ear and mastoid dz.
Usually with otorrhea. Can be complicated by cholesteatoma!! |
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What is a cholesteatoma??***
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Skin-lined keratin cyst.
Develops from "retraction pocket" Can be destructive - lead to bone erosion Surgical disease |
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What do you need to consider in ANY case of facial nerve paralysis or paresis?
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Ear pathology.
Facial nerve courses through temporal bone. Bell's palsy is a dx of exclusion! A major ocmplication of facial nerve disorder = eye related. |
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What is dizziness of otologic origin manifested as?
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Vertigo!!** Vertigo is a symptom, not a dx
Only about 50% of dizziness History history history!! |
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What is vertigo?
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Hallucination of movement of pt's body or environment.
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What is the most important physical finding in vertigo?***
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Nystagmus!!**
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What is the most common cause of vertigo that lasts only seconds?
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Benign positional vertigo.
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What are the two most common causes of vertigo that lasts minutes?
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Vertebrovasilar insufficiency,
Migraine |
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What is the most common cause of vertigo that lasts hours?
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Meniere's syndrome
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What are the 4 most common causes of vertigo that lasts days?
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Viral neurolabyrinthitis,
Infarction of labyrinth, Brain stem or cerebellum, Labyrinthe trauma |
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6 functions of the nose?
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Olfaction,
Humidify air for aerodigestive tract, Produce 2 quarts of fluid daily, Filters particles, provides vocal resonance, Drains tear ducts |
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Where does most airflow into the nose go?
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Along the floor.
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When inserting an NG tube, where does the tube need to go?
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Along the floor of the nose.
You can't push down hard enough |
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What is a major concern for infections like furuncles that are near or in the nose?
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This area goes straight back to the cavernous sinus.
Untreated, these infections can --> meningitis |
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What is the rule of thumb in regards to nasal trauma?
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If it looks broken, it is.
If it doesn't, it isn't. If you're not sure, wait. x-rays are NOT necessary!! Do a full eye/midface exam. Examine septum. Control epistaxis. |
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What is septal hematoma?
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Hematoma between septal cartilage and mucoperichondrium.
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What can result from a septal hematoma?
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Infection and
Saddle nose deformity |
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Treatment of a septal hematoma?
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Prompt I&D!!
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4 associated problems with Epistaxis?
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Meds (ASA, coumadin),
Comorbid conditions (HTN, liver dz, immune compromise), Iatrogenic (NG tubes), Rare intranasal tumors |
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Characteristics of an anterior nosebleed (first 2/3rds)?
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Majority (90%),
Kisselbach's plexus** Direct pressure helps, Anterior packs (Merocel), Local cautery |
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Characteristics of a posterior nosebleed (last 1/3rd)?
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Less common (10%),
Sphenopalatine artery, Deep packs, Epistat, surgery or embolization often needed |
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What is epistat?
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Basically a balloon that gets blown up in the nose to stop bleeding.
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What are 3 causes of nasal obstruction?
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Nasal cycle (normal congestion - decongestion cycle. erectile tissue can cause obstruction).
Anatomic (septal deviation, enlarged turbinates), Polyps (unclear etiology, eosinophil filled inflammatory growths) |
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5 physiologic causes of nasal obstruction?
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Allergic rhinitis,
Bacterial rhinitis, Vasomotor rhinitis, Rhinitis medicamentosa, Hormonal rhinitis |
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4 types of tumors that can cause nasal obstruction?
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Squamous cell carcinoma,
Adenocarcinoma, Inverted papilloma, Melanonoma |
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What is rhinitis medicamentosa?
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Rebound swelling from overuse of nasal spray
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What is the difference (time wise) of acute, subacute, recurrent acute and chronic rhinosinusitits?
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Acute: up to 4 weeks w/ total resolution,
Subacute: >4 weeks, <12 wks w/ total resolution. Recurrent acute: 4 or more episodes per year w/ resolution between attacks. Chronic: 12 weeks or more of s/s |
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Characteristics of acute sinusitis?
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Usually from URI,
Tenderness, pain, purulent d/c (rhinorrhea). May need surgery for complications |
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Treatment of acute sinusitis?
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7-14 days abx,
Decongestants |
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4 complications of acute sinusitis that may need surgery?
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Orbit involvement,
Meningitis, Cavernous sinus thrombosis, Facial cellulitis |
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Characterisitics of chronic sinusitis?
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Common health complaint,
Disrupted mucociliary clearance/ anatomy, Ostiomeatal complex, Pain, pressure, congestion |
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What is the treatment for chronic sinusitits?
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Maximize treatment!
Nasal steroids, 3-6 weeks abx. Endoscopic sinus surgery if nec. |
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How can sinusitis effect the orbit?
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Can cause a periorbital cellulitis or abscess.
If only one eye is swollen, don't think allergy! |
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What is the diagnostic method of choice for sinusitis?
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CT
Plain xrays not useful. Coronal images are essential for proper surgical eval. |
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What structures are considered components of the oral cavity? (5)
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Tongue (anterior 2/3rd),
Lips, Hard palate, Teeth, Alveoli (bears teeth) |
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What is Torus Palatinus?
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Bony protrusion on the hard palate. Can be a normal finding. Not tx necessary.
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Treatment for hairy tongue and geographic tongue?
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Nothing or brush/scrape the tongue (hairy tongue)
These conditions are benign. |
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What are the adenoids?
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Lymphoid tissue located in the nasopharynx
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6 conditions that can be caused by the adenoids?
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Hypertrophy (ages 6-12),
Mouth breathing, Nasal obstruction, Sleep apnea, Rhinorrhea, Otitis media |
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In problems with the adenoids, what other facial features often accompany?
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Dark circles under eyes,
Adenoid facies - usually mouth open |
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What should you suspect in adults with adenoid symptoms?***
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Tumor!!
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4 components that comprise the oropharynx?
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Soft palate,
Uvula, Tonsils, Posterior wall |
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What should you consdier if someone has a bifid uvula?
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Feel the soft palate to see if it is intact.
If it is not intact and is a cleft palate, do not take out the adenoids! In a cleft palate, the soft palate doesn't rise as it should to block the nose. The adnoids somewhat take over this function to block nose from food, water, etc. |
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Common causes of pharyngitis?
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Often viral:
- Epstein-Barr, - Parainfluenza, - Adenovirus, - Herpes. Streptococcal |
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Characteristics of streptococcal pharyngitis?
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Usually > 2 yrs old.
Exudateive tonsillitis. Can cause peritonsilar abscess. |
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Symptoms of peritonsilar abscess?
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Severe dysphage and odynophagia.
Trismus (clenched jaw - pterigoid muscle spasm). Hot potato voice. Uvular deviation. |
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Treatment for peritonsillar abscess?
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I & D
or Aspiration |
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4 infectious reasons to do a tonsillectomy and adenoidectomy?
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Recurrent acute tonsillitis,
Chronic tonsillitis, Recurrent peritonsillar abscess, Recurrent OM (adenoids) |
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3 upper airway obstruction causes to do a tonsillectomy and adenoidectomy?
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Symptomatic,
Obstructive sleep apnea, Suspected malignancy |
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What should you suspect if one tonsil is markedly different than the other?
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Malignancy
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What might you see in the oropharynx post tonsillectomy?
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White stuff - not an infection. Just normal healing.
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3 functions of the larynx?
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Protect tracheal bronchial tree
Provide airway Produce phonation |
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What nerve innervates the larynx?
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Recurrent laryngeal nerve off of the vagus.
Innervates almost all of the muscles except the cricho- thyroid muscle. |
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What is dysphonia?
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Hoarseness
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2 inflammatory causes of dysphonia?
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Laryngitis
GERD (LPR: laryngeal pharyngeal reflux) |
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2 neoplastic causes of dysphonia?
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Carcinoma
Papilloma: benign |
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1 functional cause of dysphonia?
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Vocal abuse
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3 neurologic causes of dysphonia?
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Myasthenia gravis
Thyroidectomy Spasmodic dysphonia |
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2 systemic causes of dysphonia?
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Hypothyroidism
Rheumatoid arthritis |
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What is psychogenic as a cause of dysphonia?
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Absence of laryngeal disease.
Vocal cords close when they should be open. |
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What is the treatment for spasmodic dysphonia?
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Botox injection into vocal cords
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Which part of the larynx is mainly used for breathing?
Which part of the larynx is mainly used for phonation? |
The bottom wide part is used for breathing
Upper narrow part used for phonation |
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What is stridor?**
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Noisy breathing from upper airway obstruction.
- usually inspiratory - caused by laryngotracheal narrowing - bronchial narrowing causes wheezing and expiratory stridor |
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7 signs of stridor?
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Cyanosis/ pallor,
Nasal flaring, Accessory muscle use, Tachypnea, Tachycardia, Tracheal plunging, Chest wall recession |
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Is stridor a diagnosis?
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No, it is a symptom due to obstruction from vocal cords or above.
Note* low % sat is a LATE finding in upper airway obstruction |
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3 causes of upper airway obstruction in neonates?
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Cysts/ webs,
Laryngomalacia (immature cartilage of upper larynx collapses during inhalation), Subglottic stenosis |
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5 causes of upper airway obstruction in children?
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Croup,
Supraglottitis/ epiglottitis, Foreign body, Retropharyngeal abscess, Resp papilloma |
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8 causes of upper airway obstruction in adults?
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Laryngeal ca,
Hypopharyngeal ca, Laryngeal trauma, Laryngitis/ epiglottitis, Bilat vocal cord paralysis, Foreign body, Post-radiation laryngeal edema, Cysts/ webs/ papillomas |
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Why is supraglottitis/ epiglottitis rarely seen anymore?
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Because it is most commonly caused by H. influenza but with the HIB vaccine, it's rare.
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Characteristics of epiglottitis?
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Airway emergency.
Caused by group B H. flu Extremely rare in kids now! |
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What type of epiglottis pathology is more common in adults?
Characteristics? |
Supraglottitis.
Less dramatic initially, Can rapidly progress, |
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Treatment for supraglottitis in adults?
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High dose IV abx
steroids |
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Where is a cricothyrotomy inserted?
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Between cricoid cartilate and thyroid cartilage.
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What is the 80/20 rule of neck masses?
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Pediatric: 80% benign, 20% malignant.
Adult: 80% malignant, 20% benign |
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What is the 20/40 rule of neck masses?
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<20: inflammatory, congenital, lymphoma.
20-40: salivary glands, thyroid, chronic infection. >40: metastatic malignancy. Possibilities listed in order of probability. |
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3 types of congenital neck masses?
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Thyroglossal duct cyst.
Branchial cleft cyst. Cystic hygroma (lymphatic lesion) |
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3 types of inflammatory neck masses?
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Cervical lymphadenitis
Ludwig's angina Parapharyngeal abscess |
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What is Ludwig's Angina?
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Causes pain in the chest.
Usually starts from a tooth abscess, but moves down the fascia causing pain in chest. Considered an airway emergency!! |
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What are 95% of all head and neck cancers?
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Squamous cell carcinoma
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Where are head and neck cancers usually found?
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Can present anywhere in the upper aerodigestive tract.
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What are two major etiological factors of head and neck cancer?
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Tobacco
Alcohol |
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Rule of thumb about all neck lumps in adults?
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All should be considered metastatic SCC until proven otherwise!!
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Diagnosis of head and neck cancer?
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Only perform bx after complete head and neck exam.
Fine needle aspirate extremely useful and easy! Avoid "berry picking" |
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Treatment of head and neck cancer?
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Metastatic neck dz depends on finding the primary.
Surgery. Radiation therapy. Chemo. Combinations of these. |
