Ear, Nose, Paranasal Sinuses

The External nose has 3 main arterial supply.

identify (3)

• Facial artery → Nasal Branches

• Maxillary artery → Infraorbital branches

• Internal Carotid Artery (ICA) → Ophthalmic branches

Trace out the venous drainage of the External Nose.

Angular + Lateral Nasal Vein → Facial Vein →Common Facial Vein → Internal Jugular Vein (IJV)

**All the Lymphatic Vessels from the Head and Neck ultimately drain into? 

Deep Cervical Lymph Nodes 

• runs along the IJV

Superficial Drainage of the Face

The Anterior Neck drains into which regional lymph node group? 

• Anterior / superficial cervical

• Occipital 

• Mastoid / retroauricular 

• Anterior / superficial cervical

Superficial Drainage of the Face

The Posterior scalp drains into which regional lymph node group? 

• Anterior / superficial cervical

• Occipital 

• Mastoid / retroauricular 

Occipital

Superficial Drainage of the Face

The retro-auricular area drains into which regional lymph node group? 

• Anterior / superficial cervical

• Occipital 

• Mastoid / retroauricular 

Mastoid

Superficial Drainage of the Face

The Upper Lip and lateral Lower lip drains into which terminal lymph node group? 

• Parotid 

• Buccal 

• Submandibular 

• Submental

Submandibular 

Superficial Drainage of the Face

The Eyelids* drains into which terminal lymph node group? 

• Parotid 

• Buccal 

• Submandibular 

• Submental

parotid

** (be careful) True or False? The Right side of the External nose drains into the Thoracic Duct.

False!

Remember 

Right side → Right Lymphatic Duct 

Left side → Thoracic Duct

The external nose is mostly innervated by which 2 nerves?

• Ophthalmic nerve → Nasocilliary branch of V1 

• Maxillary nerve → Infraorbital nerve from V2 

***Which nerve innervates the ala of the nose? 

• Ophthalmic nerve

• Maxillary nerve

Maxillary nerve → Infra-orbital nerve from V2 

What nerve innervates the Tip of the Nose?***

Opthamic Nerve !

What is the Most Anterior part of the Nasal cavity covered by skin and has sebaceous glands, sweat glands and Vibrissae called? 

Nasal Vestibule 

The Nasal Vestibule is lined by what?

• Stratified squamous keratinized epithelium 

• Mucosa

• Stratified squamous keratinized epithelium 

The nasal cavity is lined by?

• Stratified squamous keratinized epithelium 

• Mucosa

Mucosa

The superior 1/3 of the nasal cavity proper is known as the?

Olfactory Region

What is Olfactory epithelium known for?

• Pseudostratified ciliated columnar Eipthelium without Goblet cells. 

• Roof 

• Upper part of the septum 

• upper surface of the superior concha 

• sphenoethmoidal recess 

Are lined by what type of epithelium? 

• Olfactory Mucosa 

• Pseudostratified ciliated columnar epithelium WITHOUT goblet cells 

The inferior 2/3 of the nasal cavity is also known as the Respiratory region. What type of epitheium?

Pseudostratified Ciliated Columnar Epithelium WITH GOBLET Cells 

The Kiesselback’s Area can be found where?

• Roof 

• medial wall of nose 

• Lateral wall of nose

Medial wall = Kiesselback’s area

The Nasal Turbinates (Superior, Middle, Inferior) conchae is found where? 

• Medial Wall 

• Lateral wall 

Lateral wall of nose

Where can the Sphenoethmoidal recess be found?

• Lateral wall 

• Above the superior nasal concha

What do you call the space inbetween each Nasal Chonchae/turbinates? ***

Nasal meatus! 

What are the main cell types found in the Olfactory Mucous Membrane?

• Supporting / sustentacular cell

• Olfactory Cell

• Basal Cell

• Bowman’s Glands 

T or F. Supporting cells are “sandwhiched” in between the Basal and Olfactory Cells 

True!

_ cells can differentiate into either supporting or olfactory cells and is regenerated every 2-3 months.

Basal Cells!

Classify what type of gland Bowman’s glands are.

PURELY SEROUS

Function of Olfactory Epithelium?

Reception of Olfactory stimuli

Function of Respiratory Epithelium?

Warm, Moisten and clean inspired air

Which area in the nose is where

• 5 Arteries Anastomose 

• Prone to Epistaxis 

Kiesselbach’s plexus

What is the anastomosis of the ethmoid and sphenopalatine artery called? 

• Kiesselbach’s plexus 

• Woodruff’s Plexus

• Woodruff’s Plexus

Kiesselbach’s plexus is composed of which 5 arteries?

1. Anterior Ethmoid artery

2. Posterior Ethmoid artery 

3. Sphenopalatine artery 

4. Greater Palatine artery

5. Superior Labial artery

1. The area above the line is innervated by (?) nerve?

2. The area below the line is innervated by (?) nerve?

1. Ophthalmic Nerve V1 

2. Maxillary nerve V2

The external nose is mainly innervated by (?) nerve except (??)

• Ophthalmic Nerve 

• Ala of nose → Maxillary nerve 

The forehead area is mainly innervated by which nerve?

Ophthalmic Nerve

Which sinus is most frequently Infected???

Maxillary Sinus

**The paranasal sinuses are lined by what type of Epithelium?

Respiratory Epithelium

• Pseudostratifed ciliated columnar epithelium with Goblet cells 

Functions of Paranasal Sinuses?

• Resonating chambers for Voice 

• Reduce weight of skull

• Humidify air 

• Support immune defense of nasal cavity

Which PNS is

• rudimentary at birth but enlarges at 8 y/o 

• the Largest 

• pyrimidal shaped

• Most frequently infected sinus in human body

maxillary sinus 

The maxillary sinnus drains into the middle meatus via (???)

SEMILUNAR HIATUS

T or F? The Frontal sinus can only be detected from Age 7 onwards.

true

T or F? The Ethmoidal sinus can be recognized in CT scans before Age 2 BUT NOT IN RADIOGRAPH.

true!

when an infection blocks drainage and causes erosion of the middle wall of the orbit, the infection can spread to which specific structure to cause Optic Neuritis?

A.

The posterior ethmoidal sinus

B.

The orbital floor

C.

The dural nerve sheath that surrounds the optic nerve

D.

The Ophthalmic artery

The dural nerve sheath that surrounds the optic nerve

*Which two vital structures are mentioned as passing through the optic canal?

A.

Oculomotor nerve and Ophthalmic vein

B.

Maxillary nerve and Lacrimal artery

C.

Optic nerve and Ophthalmic artery

D.

Trochlear nerve and Superior orbital artery

Optic nerve and Ophthalmic artery

What are the 3 main parts of the Ear?

1. External 

2. middle tympanic 

3. inner labyrinth

Another name of the External Ear?

Auricle or Pinna

What is the hollow depression in the middle of the Auricle that continues to become the external auditory meatus? 

Concha 

What are the 2 main Arterial supply of the Ear?

• Posterior Auricular artery 

• Superficial temporal artery 

*Both from External Carotid Artery (ECA) 

What are the 2 main Venous drainage of the Ear?

• Posterior Auricular Vein 

• Superficial temporal Vein

Which specific area of the auricle is drained by the Superficial parotid lymph nodes?

A.

The entire medial surface of the auricle

B.

Superior half, lateral surface

C.

Inferior half, both medial and lateral surfaces

D.

Superior half, medial surface

Superior half, lateral surface

According to the clinical correlation, an abscess in the lobule of the auricle would initially cause enlargement and pain in which group of lymph nodes?

A.

Deep cervical group of lymph nodes

B.

Submandibular lymph nodes

C.

Superficial cervical group of lymph nodes

D.

Mastoid/retroauricular lymph nodes

Superficial cervical group of lymph nodes

A patient has an infected boil on the medial surface of the auricle, near the superior half. Which lymph node group is expected to be involved?

A.

Mastoid/retroauricular and deep cervical lymph nodes

B.

Superficial cervical lymph nodes

C.

Superficial parotid lymph nodes

D.

Jugulo-omohyoid lymph nodes

Mastoid/retroauricular and deep cervical lymph nodes

Which nerve, originating from the cervical plexus, provides sensation to the large majority of the inferior and posterior surfaces of the auricle?

A.

Lesser occipital nerve

B.

Auriculotemporal nerve

C.

Great auricular nerve

D.

Auricular branch of the vagus nerve

Great auricular nerve

The auriculotemporal nerve is a branch of which major cranial nerve?

A.

Facial nerve (CN VII)

B.

Trigeminal nerve (CN V), specifically the mandibular branch

C.

Vagus nerve (CN X)

D.

Glossopharyngeal nerve (CN IX)

Trigeminal nerve (CN V), specifically the mandibular branch

If a patient reports numbness in the helix (superior rim) and crus of the helix (the ridge leading into the concha), which nerve is most likely affected?

A.

Great auricular nerve

B.

Auricular branch of the vagus nerve

C.

Lesser occipital nerve

D.

Auriculotemporal nerve

Auricular branch of the vagus nerve

(NOTE!) The cough reflex upon ear cleaning is a clinical phenomenon specifically associated with which part of the nervous system supplying the ear?

A.

Motor innervation of the facial nerve (CN VII)

B.

Sympathetic innervation via the cervical plexus

C.

Sensory innervation of the trigeminal nerve (V3)

D.

Parasympathetic innervation from the vagus nerve (CN X)

Parasympathetic innervation from the vagus nerve (CN X)

The external auditory canal is approximately (? to ?) cm in length.

2-3 cm in length

The outer 1/3 of the External auditory canal is also known as? 

• Cartilaginous portion 

• Osseous portion

outer 1/3 of the External auditory canal = Cartilaginous

The inner 2/3 of the External auditory canal is also known as? 

• Cartilaginous portion 

• Osseous portion

inner 2/3 of the External auditory canal = Osseous portion

What type of glands can be found in the Cartilaginous portion of the External Auditory Canal? 

Ceruminous glands  → Cerumen or Earwax 

Can you find Ceruminous glands in the Inner Osseous portion of the External Auditory Canal? 

No! 

What are the 3 main arterial supplies of the EAC?

1. Superficial Temporal Artery (terminal branch of ECA)

2. Posterior Auricular Artery 

3. Maxillary Artery → Deep Auricular branch 

In INFANTS, the EUC can be straightened by pulling the Pinna (?) and (?) or (?) 

Infants 

• Down and back

• Postero-inferiorly

In Adults, the EUC can be straightened by pulling the Pinna (?) and (?) or (?) 

Adults 

• Up and Back 

• Postero-superiorly

The Tympanic membrane is supported by a fibrocartilaginous ring called?

Annulus Fibrosus Tympanicus

Which part of the tympanic membrane has

• all complete 3 layers 

  • Modified thin skin 

  • Mucous membrane 

  • intermediate fibrous stratum (Middle fibrous layer)

• is supported by the Annulus Fibrosus tympanicus

Pars Tensa

The Pars Flaccida is devoid of which layer? 

Middle Fibrous Layer

is the Pars flaccida supported by the annulus fibrous tympanicus? 

NO

The cone of light is located in which quadrant?

Antero-inferior quadrant

• umbo = most depressed area at the center 

• anterior and posterior malleolar folds = separates pars flaccida and pars tensa

YOU CANNOT INCISE in which quadrant to avoid damaging the cone of light. 

Antero inferior 

You CANNOT incise at the (?) or (?) quadrant to avoid damaging the Ossicles and Chorda Tympani. 

1. Posterior Superior

2. Anterior Superior

Where is the safest area to drain in the Tympanic Cavity?

Postero- INFERIOR quadrant

remember PIQ

Which is the space directly behind the tympanic membrane

• Mesotympanum 

• Epitympanum 

Mesotympanum

What is the space that house portions of the Ossicles ( Malleus + Incus)

• Mesotympanum 

• Epitympanum 

Epitympanum

Which structure closes the Fenestra cochleae (round window) on the Labyrinthine (Medial) wall of the middle ear cavity?

Secondary tympanic membrane

In the event of an untreated middle ear infection (otitis media), erosion of the Tegmen tympani (roof) poses the immediate risk of spreading infection to the:

A.

Internal jugular vein

B.

Dura mater that covers the temporal lobe of the cerebral hemisphere.

C.

Cochlea and semicircular canals.

D.

Internal carotid artery

Dura mater that covers the temporal lobe of the cerebral hemisphere.

The Jugular Wall (Floor) of the middle ear cavity is formed by the fundus tympani and separates the middle ear from which major structure?

A.

Temporal lobe

B.

Superior bulb of the internal jugular vein

C.

Facial nerve canal

D.

Internal carotid artery

Superior bulb of the internal jugular vein

Infection that spreads from the middle ear to the mastoid antrum can cause which clinical condition?

A.

Meningitis

B.

Mastoiditis

C.

Vertigo

D.

Labyrinthitis

Mastoiditis

The Mastoid (Posterior) Wall of the middle ear cavity houses the stapedius muscle in a structure known as the:

A.

Pyramid

B.

Prominence

C.

Aditus ad antrum

D.

Fossa incudis

Pyramid

The Carotid (Anterior) Wall is characterized by two openings above it. One is for the Auditory Tube, and the other is for the:

A.

Fenestra vestibuli

B.

Canal for the facial nerve

C.

Canal (or Semicanal) for the tensor tympani muscle

D.

Aditus ad antrum

Canal (or Semicanal) for the tensor tympani muscle

Which of the following describes the most lateral portion of the Auditory Tube/Eustachian Tube?

A.

Vascular

B.

Membranous

C.

Osseous (bony)

Osseous (bony)

A patient experiences vertigo and dizziness following an upper respiratory tract infection. Based on the notes, this is most likely a complication known as:

Labyrinthitis, inflammation of the inner ear, affects the vestibular system and causes vertigo/dizziness.

What is the Small muscle that dampens the vibrations from the malleus called?

Tensor Tympani

What nerve innervates the tensor Tympani?

Trigeminal Nerve → mandibular branch (V3)

The Chorda Tympani is a branch of which nerve?

facial nerve

The incudomalleolar joint is what type of Joint? 

Saddle Joint (Synovial Joint)

What type of joint is the Incudostapedial joint?

Ball and Socket Joint (Synovial Joint)

Nerve supply of the Middle Ear?

Typanic Plexus

The Osseous or Bony Labyrinth contains what fluid?

Periplymph

The Membranous labyrinth contains what type of fluid?

Endolymph

The Bony labyrinth has what 3 parts

• Vestibule 

• Semicircular canals 

• Cochlea

**T or F? The semicircular DUCTS are part of the Bony labyrinth. 

False! 

The membranous labyrinth is suspended within

• endolymph 

• perilymph 

Perilymph! 

*remember that membranous labyrith contains endolymph inside 

What detects horizontal acceleration?

Utricle

What detects vertical motion?

Saccule

What detects angular motion (rotational)?

Crista ampulllaris

What detects linear acceleration and tilting of the head?

Maculae

(?) is concerned with hearing …

hint… the snail in ur ear is whispering something to u

Cochlear labyrinth