620 Exam 2: Ears, Nose, Sinuses, Throat

External ear landmarks

Helix, antihelix, tragus, antitragus, lobe

What is otitis externa?

inflammation of external auditory canal aka "swimmer's ear"

How to treat otitis externa? (3 ways)

1) Clean out debris

2) Use ear wick

3) Use ear drops

What is mastoiditis? Causes?

- Infection of air cells in the mastoid bone

- Chronic otitis media or cholesteatoma

What test would you do to confirm mastoiditis?

CT scan

Main treatment of mastoiditis? What to do if it's really bad?

- IV abx

- Incision and drainage surgery

What does ear canal look like with otitis externa?

- Edema

- Red or pale

- Moist with white exudates

How do Eustachian tubes in kids look different than in adults?

More horizontal instead of sloped

What could low set ears (below line of outer canthus of eye) signify? (3)

Down syndrome, Turner's syndrome, kidney disorders

Is a normal TM convex, or concave? In the abnormal option, what could this suggest?

- Convex

- Negative pressure in middle ear (otitis media)

Conductive vs sensorineural hearing loss

- Conductive = sound can't get to inner ear; issue with outer or middle ear

- Sensorineural = issue with inner ear or cranial nerve VIII or brain

What type of infection could cause sensorineural hearing loss? Examples? (3)

- Viral

- Rubella, Meniere's disease, cytomegalovirus

What is presbycusis? What type of hearing loss is it associated with?

Sensorineural hearing loss due to aging (can't hear high pitches)

Which cranial nerve is evaluated when testing hearing?

VIII

During the Weber hearing test, what does it mean when the pt hears better out of the good ear?

Sensorineural hearing loss

During the Weber hearing test, what does it mean when the pt hears better out of the worse ear?

conductive hearing loss

Which is the Rinne test?

Placing the tuning fork against the mastoid process

What type of hearing loss can the Rinne test pick up on?

Conductive

Ear-related sources (dx) of vertigo

Benign positional vertigo, vestibular neuritis, Meniere's disease

Brain related sources (dx) of vertigo

TBI, CVA/stroke, posterior fossa tumor, migraine

Sources of dizziness (3)

Arrhythmia, orthostatic hypotension, vasovagal stimulation

What is the Asthma triad?

Nasal polyps, asthma, and sensitivity to aspirin.

What are causes of septal perforation/ulceration?

- Trauma

- Surgery

- Intranasal cocaine/amphetamine use

What does cobblestoning of the nasal mucosa indicate?

Allergy

Most common area that causes anterior epistaxis

Kesselbach's plexus

3 sets of sinuses

- Frontal

- Sphenoid

- Maxillary

How to treat sinusitis (3 not related to abx/antivirals)

- Antihistamines

- Nasal decongestants

- Saline irrigation

What differentiates strep from mono (besides testing)?

Mono has extreme fatigue

What is odynophagia?

Pain with swallowing

What could be the cause of sudden sore throat onset? (more severe)

Stroke

When to consider tonsillectomy (3)

1) 4+ strep infections per year

2) blocking airway

3) If recurrent sx impact daily life

Serious dx to look for during mouth/throat exam (3)

- Gingivitis

- Oral cancer

- HPV lesions

What nerve does palatal elevation test?

CN X

Uvular deviation suggests problem with which cranial nerves?

IX or X

What is a peritonsillar abscess?

Infection of soft tissue on or around the tonsil. Pushes uvula to the other side

Which 2 infections can show tonsillar exudates?

- Strep

- Mono

Things to note upon the inspection of the external ear

Size, shape, symmetry, landmarks, color, position, deformities/lesions

Things to note upon the inspection of the external auditory canal

Cerumen, discharge, foreign bodies, lesions, color, swelling

Things to note upon the inspection of the tympanic membrane

Landmarks, contour, cone of light, perforations

Things to note upon the inspection of the external nose

size, shape, color, symmetry, septal deviation

Things to note upon the palpation of the external nose

Tenderness, bone shape, cartilage, patency of nares

Things to note upon the inspection of the internal nose

Color, inflammation, septum deviation, discharge, turbinates (inferior ± middle), septum perforation, congestion, patency, polyps, ulcers, foreign bodies

Things to note upon the inspection of the oral cavity

Color, symmetry, edema, lesions, ulcers, deformities, teeth occlusion, cavities, loose/missing, and surface abnormalities

Things to note upon the inspection of the gingiva

lesions, color, tenderness, abrasions/ulcers

Things to note upon the inspection of the tongue

color, texture, symmetry, swelling, ulcerations

Things to note upon the inspection of the throat/pharynx

anterior and posterior pillars,

tonsils: color, symmetry, masses, crypts, swelling, ulceration, grade of size (0-4)

Pharynx: color, swelling, exudate, lesions

Things to note upon the palpation of salivary glands

Tenderness, enlargement, firmness, erythema

CN IX inspection

Gag reflex

CN X inspection

(say aah; symmetrical rise of soft palate+uvula)

CN XII inspection

Stick out your tongue (symmetrical protrusion)