external, middle, and inner ear

External-The auricle (pinna) and external auditory canal

Middle-An air-filled cavity in the temporal bonde containing the ossicles that transmit sound from the tympanic membrane to the oval window of the inner ear.

Inner ear- a membranous curved cavity inside a bony labyrinth consisting of the vestibule, semicircular canal, and cochlea.

T or F

Hearing is the interpretion of sound waves by the brain

T or F

The Nose is a sensory organ that functions in the identification, localization, and interpretation of sound, and aids in the maintenance of equilibrium. 

hard and soft palate, frontal and sphenoid bone

The internal nose is covered by vascular mucous membrane lined with small hares and mucous secretions that collect and carry debris and bacteria from the air to the nasopharynx for swallowing or expectoration. Mucous contains immunoglobulins and enzymes that serve as a defense against infection.

The internal nose is divided by the septum into two anterior cavities called vestibules.

1. identify odors
2. provide passage for inspired and expired air
3. humidify, filer, and warm inspired air
4. provide resonance of larangeal sound

 See figure 12-6 pg 299 for anatomic structures of the nose and nasopharynx

The external nose is formed by skin-covered bone and cartilage.

The nares, are surrounded by the cartilaginous ala nasi and the columella.

The frontal and maxillary bones form the nasal bridge.

Cribriform Plate

Receptors for smell are located in the olfactory epithelium

Turbinates

A meatus below each turbinate is named for the turbinate above it.

The Inferior meatus drains the nasolacrimal duct.

The Medial meatus drains the paranasal sinuses.

The Superior meatus drains the posterior ethmoid sinus.

Paranasal

Only the maxillary sinus (along the lateral wall of the nasal cavity of the maxillary bone) and the frontal sinus (in the frontal bones superior to the nasal cavities) are accessible for physical exam.

The ethmoid sinus (behind the frontal sinus near the superior portion of the nasal cavity) and the sphenoid sinus (deep in the skull behind the ethmoid sinus) are difficult to access for physical exam. 

T or F

The tongue is anchored to the back of hte oral cavity at its base and to the floor of the mouth by the frenulum.

The ____ ducts are parotid gland outlets that open on the buccal mlucosa opposite the second molar on each side of the upper jaw.

The ____ ducts are outlets of the submandibular glands open on eac side of the frenulum under the tongue.

Stensen, Wharton

The sublingual glands have many ducts opening along the sublingual fold.

maxilla and mandible

Adults generally have 32 permanent teeth.

shorter, upward

In addition the eustacian tube is wider, shorter and more horizontal than the adult's which allows easier reflux of nasopharyngeal secretions. With growth it lengthens and the pharyngeal orifice moves inferiorly.

Development of the inner ear occurs during the first trimester and insult during this time can impair hearing.

Children have ___ deciduous teeth that usually erupt between ___ and ____months. Permanent teeth begin forming in the jaw at ___ months, start coming it around ___ age and process is usually complete by ____ age.

1. 20
2. 6-24
3. 6
4. 6
5. 14-15yrs

1. Elevated levels of estrogen cause increased vascularity of the upper respiratory tract
2. Capillaries of nose, pharynx, eustacian tubes become engorged causing nasal stuffiness, dec. sense of smell, epistaxis, sense of fullness in the ears, and impaired hearing.
3. increased vascularity and proliferation of connective tissue of the gums.
4. Laryngeal changes hormonally induced causing hoarseness, deepening, or cracking voice, vocal changes, or persistent cough may occur.

T or F

One half of adults older than 65 have hearing loss.

False

One third have hearing loss

Sensorineural loss occurs first wit high-frequency sounds and then progresses to tones of lower frequency.

The ability to localize sound also diminishes with age.

Conductive hearing loss may result form excess deposition of bone celss along the ossicle chain, causing fixation of the stapes in the oval window, cerumen impaction, or a sclerotic tempanic membrane.

Sense of smell deteriotates after age:

Sense of taste deteriorates after age:

___ and ___ become more prominent with aging r/t continued cartilage formation.

60, 50, ears and nose

LIps and cheeks become more prominent gingival tissue may receed or become vulnerable to trauma, tongue becomes more fissured and there may be altered motor function of the tongue leading to problems with swallowing. Saliva production may decrease r/t disease or meds (anticholinergics and diuretics). Lost teeth may cause diet change or malocclusion and difficulty chewing.

An instant hearing loss may indicate:

A hearing loss over a few hours or days may indicate:

1. exposure to industrial or recreational noise, ototoxic meds
2. genetic disease (M'enie're disease)
3. Neurodegenerative and autoimmune disorders
4. syphillis

1. prenatal factors: maternal infection, irratiation, drug abuse, syphillis
2. birth wt less than 1500g
3. severe hyperbilirubinemia
4. Infection-bacterial meningitis, reccurent episodes of acute otitis media or otitis media with effusion
5. cleft palat, craniofacial abnormalities
6. Ototoxic med use
7. head trauma
8. hypoxic episode

Risk factors for oral cancer include:

1. older than 40
2. gender-men twice the rate of women
3. ethinicity-black
4. excessive alcohol use
5. Ill-fitting dentures, prior oral lesions
6. Tobacco use-risk increases with freq and durating of use/smoking hx of more than 20pk-year
7. Occupation-textile industry, leather manufacturing
8. Systemic disease-pernicious or iron deficiency anemia, HIV Infection, lichen planus, previous malignancy, human papilloma virus.

chromosomal aberrations or renal disorders

Auricular position can be checked by drawing an imaginary line between the canthus of the eye and th most prominent proturberance of the occiput. The top of the auricle should be above this line.

Next Draw a verticle imaginary line perpendicular to the previous line just anterior to the auricle. Position hould be almost verticle with no more than 10 degree lateral posterior angle.

head trauma

If a purulent, fowel-smelling discharge is present this is usually associated with otitis externa, perf. acute otitis media, or a foreign body.

Pull gently on the lobule-if pain the external auditory canal may be inflamed. Tenderness or swelling in the mastoid area may indicate mastoiditis.

1. wet-that is dark and  sticky found predominantly in whites and blacks.
2. Dry- that is light brown to gray, flaky, and sparse. It can lie in the ear canal as a thin flake. Dry occurs predomintately in asians, native americans/american indians.

Tympanic membrane mobility and the middle ear space, such as the presence of middle ear effusions

No movement with positive and negative pressure may be a sign of acute otitis media or otitis media with effusion.

Bulging with no mobility-middle ear effusion due to pus or fluid

Retracted with no mobility or mobility with negative pressure only -Obst. Eustachian tube w/wo middle ear effusion.

Excess mobility in small areas-Healed perforation atrophic tympanic membrane

VIII

The patient should be able to hear a minimum of 3 of six sounds in each ear. Have the patient place a finger in the ear of opposite the one being tested and stand out of the patient's direct line of vision when performing.

Rinne

Vibrate fork and place on mastoid bone have pt tell you when the can no longer hear quickly remove and place 1-2cm from auditory canal and have them tell you when sound no longer heard. Record the time mastoid conduction and auditory conduction. Air conduction should be twice as long as bone conduction.

1. Rhinorrhea
2. Hyperemia
3. Edema of the nasal mucosa
4. White powder may still be present on the nasal hairs.

Signs of chronic use:

1. Scabs on the nasal mucosa
2. Decreased perception of taste and smell
3. Perforation of the nasal septum

chronic nasal obstruction and mouth breathing.

1. allergy-bil watery discharge and associated sneezing and nasal congestion
2. Cerebrospinal fluid leakage-unilateral watery discharge occuring after head trauma
3. Epistaxis or trauma-bloody discharge
4. Rhinitis or upper respiratory infection-bil mucoid or purulent discharge
5. Foreign Body-unilateral, purulent, thick, greenish, malodorous discharge

Cheilitis

Deep fissures at the corners of the mouth known as cheilosis may indicated riboflavin deficiency or overclosure of the mouth, allowing saliva to macerate the tissue.

scarlet fever

Lip pallor-anemia

Cyanosis-resp. or CV problems

Swelling of lips-Infection or Allergy (angioedema)

Round, oval, or irregular bluish grey macules on the lips and buccal mucossa-Peutz-Jeghers syndrome

tongue atrophy or hypoglossa nerve impairment

1. Flattened edges on the teeth-bruxism, compulsive, unconcious grinding of the teeth.
2. Multiple brown areas or caries on the upper or lower incisors-bedtime bottle or juice/milk
3. Teeth with black or gray color-pulp decay or oral iron therapy.
4. Mottled or pitted teeth-tetracycline tx during tooth development or enamel dysplasia.
5. Chalky white lines or speckles on the cutting edges of permanent incisors-excess floride intake.

Conductive hearing Loss is:

Sensoineural Hearing Loss is:

Meniere Disease is:

Reduced transmission of sound to the middle ear

A disorder of the inner ear, damage to CN VIII, genetic disorders, systemic disease, ototoxic medication, trauma, tumors, or prolonged eqposure to loud music.

A disorder of progressive hearing loss that in some cases has a genetic mode of transmission.

Peritonsillar Abscess

When Weber's glands become inflammed, the duct is obstructed leading to cellulitis of the soft palate

Unilateral red and swollen tonsil and adjacent soft palate as well as displacement of the uvula and tonsil may be noted. Trismus (spasm of masicator muscle) may also be seen

Retropharyngeal Abscess

A streptococci and Staphylococcus aureus are common causative organisms.

Displays as an unwillingness to move neck and lateral neck movement increases pain, torticollis  may be present.

Cleft Lip and Palate

Multifactorial causes include genetic disorders, fetal exposure to teratogens, conditions present in the mother i.e..diabetes, folate dificiency, smoking.