- Tuning fork is placed in the middle of the forehead equal distance from the patients' left and right ear. - The patient is asked which side is the loudest.

head and neck Flashcards by . .

What structure make up the outer ear?

pinna
external auditory meatus (ear canal)

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What structures make up the middle ear

tympanic membrane
ossciles (malleus, incus, stapes)
eustachian tube

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what structures does the eustachian tube connect?

the middle ear cavity with the nasopharynx.

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a blocked eucstachian tube leads to increases pressure in the middle ear

a. true
b. false

b. false

decrease in pressure

the middle ear continues to absorb gas which is not replaced by incoming gas

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the facial nerve runs through the middle ear

a, true
b. false

a. true

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otitis media with effusion is an example of conductive hearing loss

a. true
b. false

a. true

because the sound is not getting conducted due to fluid in the middle ear

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what window does the stapes vibrate against on the cochlea?

oval window (membrane covering the entrance to the cochlea)

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Perilymph is contained within the scala media

a. true
b. false

b. false

endolymph

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how is sound amplified in the middle ear

lever action of ossicles - force
reduced surface area from tympanic membrane -> ossicles

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where is the second tympanic membrane located

Round window (exiting cochlea via scala tympani)

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which part of the cochlea contains the organ of corti

scala media

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what is contained within the scala vestibuli and tympani of cochlea?

perilymph

oval window - helicototrema (apex/tip) - round window

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tip of cochlea where the scala vestibuli meets the scala tympani

helicotrema

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what is superior and inferior to the organ of corti?

organ of corti = (outer + inner hair cells with cilia)

are surrounded by basilar membrane (inferiorly) and tectorial membrane (superiorly)

cilia are in contact with both membranes

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what fluid is the scala media filled with?

endolymph (rich in position ions)

rush into hair cell when activated
triggers auditory nerve cells -> cochlear nevrve

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what are the roles of the inner and outer hair cells in the organ of corti

inner hair cells - activate afferent nerve fibres

outer hair cells - modify the response of the inner hair cells (fine-tuning)

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the endolymph surrounding hair cells is rich in K+ ions

a. true
b. false

a. true

Ca+ also found outside cell open when membrane potential is reached

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High frequency tones are picked up most sensitively close to the middle ear

a. true
b. false

a. true

Tonotopic arrangement

High-middle-low frequencies - arrangement goes all the way through the auditory pathway

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Performing both Rinne’s and Weber’s test allows differentiation of conductive and sensorineural deafness.

a. true
b. false

a. true

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what is webers test?

Tuning fork is placed in the middle of the forehead equal distance from the patients’ left and right ear.
The patient is asked which side is the loudest.

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in sensorineural hearing loss - sound is localised to the affected side during webers test

a. true
b. false

b. false

sound is better heard in the unaffected side

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What is a positive result in rhines test?

air conduction > bone conduction

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What is a negative test result in rhines test and what does it indicate

BC > AC
bone conduction > air conduction

(indicates conductive deafness)

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Name two physical properties of sound

- Frequency (tonotopic arrangement) H-M-L - Volume (loudness)

normal range of hearing for audiometry test

o Normal speech is 0-20db (125freq)

in sensorineural hearing loss both AC and BC will be > 20dbs a. true b. false

a.true both are reduced in SNHL

explain the findings of conductive hearing loss during an auidometry reading?

bone conduction will be normal ( 0-20 dbs) air conduction will be > 20dbs (louder to hear given frequency)

what are otoacoutic emissions

low intensity sounds produced by OUTER HAIR CELLS of a normal cochlea

Those with hearing loss of > 25-30 dbs will not produce otoacoustic emissions a. true b. false

a. true

what does tympanogram show?

the amount of sound absorbed (Admittance) by the tympanic membrane at different air pressures in the external auditory canal

When would a tympanogram show the high admittance (absorbed sound)

admittance is highest when the air pressure in the ear canal is equal to the air pressure in the ambient enviorment (0mmHg) Ambient air pressure (enviroment) = middle ear pressure in healthy ears

what would a tympanogegram show in conduction hearing loss

peak admittance of sound with negative pressure s (-200mmhg) lower than air pressure

How is wax beneficial to the ear?

natural barrier to moisture and infection - creates acidic PH - inhibiting infection

The euscachian tube joins?

middle ear to the nasopharynx

role of the euchtasian tube?

* equalise air pressure in the middle ear * drain fluid from the middle ear

what happens when the euctachian tube becomes blocked?

* air pressure cannot equalise * fluid cant drain freely from the middle ear due to this the middle ear fills with fluid

when would someone suit having a cochlear implant?

- Severe hearing loss 90-100 dB - Bi-lateral profound hearing loss - Electrode is placed inside the cochlea – stimulates cochlea (electrical signal directly into cochlea)

Which part of the cochlea contains peri-lymph

Scala media rich in K+ ions

where the scala vestibuli meets the scala tympani

apex - helicotrema

the higest frequency waves stimulate the base of the basilar membrane a. true b. false

a. true (closest to round window) fibres are stiff and short

long floppy fibres are found at the apex of basilar membrane a. true b. false

a.true produces low pitched sounds/responds to low frequency waves

which hair cells primarily respond to soundwaves

inner hair cells (there are fewer of them)

role of outer hair cells

modify/modulating sound

what type of movement do hair cells in the macula of the utricle response to

linear acceleration in the horizontal axis - hair cells are on the floor and pointing upwards

what type of movement do the hair cells in the saccule response to

linear acceleration in the vertical axis (hair cells are on the wall pointing outwards)

what nerve innervates the lacteral rectus muscle of the eye?

CNVI Abducens

3rd cranial nerve

occulomotor nerve

what innervates the medial rectus muslce?

CNIII occulomotor nerve

what semi circular canal are otoconia most likely to get stuck in?

posterior

gated ion channels on the steriocilla open when the cilia move towards the kinocila a. true b. false

a. true *K+ and Ca+ rush into cell - triggers release of glutamate in vesciles - APs sent to vestibular ganglion

Name the two otolith organs?

Utricle - horizontal accerlation Saccule - vertical accerlation

Functions of the nose?

- humidy and warm the inspired air - prevents drying out of lower airways - Remove toxic particles - olfaction - sense organ

where is the olfactory appartus of nose found?

the roof of nasal cavity - receptors are connected to the olfactory nerve cribriform plates -> olfactory bulb -> olfactory tract 0> oflactory cortex

what is th benefit of air flow within the nose moving from laminar to turbulent?

reduces the velocity so air can come into prolonged contact with the nasal mucosa (warming/humidification and trapping of particlees)

the paransal air sinuses are lined with what type of epithelium?

respiratory epithelium pseudostratified ciliated columnar epithelium.

where does the frontal sinus drain?

middle meatus of nasal cavity

what provides sensation to frontal sinus?

V1 - opthalmic nerve (supraorbital branch)

Arterial supply to frontal air sinus?

anterior ethmoidal artery (ICA)

Where does the sphenoid sinus drain to?

sphenoid ethmoidal recess

Innervation of sphenoid sinus

V1 opthalamic

Which sinus allows easy acess to the pituitary gland in the instance of tumours?

sphenoid sinus - trans-sphenoid surgery

innervation of maxillary sinus?

maxillary nerve (V2)

nasolacrimal duct drains to?

Venous drainge of the nose

facial vein -> IJV

Aterial supply to skin of external nose

*supratrochlear -> **opthalamic artery -> ECA** Angular artery and lateral nasal artery ->** FACIAL ARTERY -> ICA**

sensory innervation to external nose

CNV trigeminal nerve - V1/V2

motor innervationto nasal muscles

Facial nerve 7

arterial supply to external nose

* Opthalamic artry (ICA) * Maxillary artery (ECA)

Venous drainage of the external nose

Facial vein -> IJV

sensory innervation to the external nose

CNV trigeminal

motor innervation to nasal muscles

facial nerve CN7

arterial supply to nose that originates from internal carotid arteries?

ICA -> opthalamic artery -> anterior and posterior ethmoid arteries

arteries that supply the internal nose that are branches of ECA

- Sphenopalatine artery - Greater palatine artery - Superior labial artery - Lateral nasal artery

- Commonest site for anterior epistaxis to occur (nose bleeding)

Circular area – Kesselbachs plexus (littles area on plexus) - Anterior septum

- Unilateral glue ear in adults may be a sign of

nasopharyngeal mass/cancer

common site of nose cancer

fossa of rossenmullar - compresses eustachian tubes

Soft palate is part of *oropharynx a. true b. false

a. true

The Subglottis is an anatomical part which region?

layrnx

what test is this from?

constrast swallow

features of a reactive lymph node

- tender - oval - smooth will be able to move around

In a patient presenting with hoarseness which clinical diagnosis MUST be excluded?

laryngeal cancer

A common patient complaint is FOSIT (Feeling of something in throat) when there is no physical cause found. What is the medical term for this condition?

globus pharyngeaus

most common type of Head and Neck Malignancy?

Squamous Cell Carcinoma

With regard to the nose and sinuses: Neuro-olfactory epithelium lines the inferior surface of the cribriform plate. a. true b. false

a. true

Concerning the inner ear: The membranous labyrinth contains endolymph. a. true b. false

a. true bony labyrinth contains perilymph

Concerning the inner ear: The organ of Corti lies within the scala tympani. a. true b. false

b. false The organ of Corti, comprising the hair cells and tectorial membrane, lies in the scala media (or cochlear duct) rather than scala tympani (or tympanic duct).

With regard to the nose and sinuses: The lamina papyracea separates the ethmoid sinuses from the orbital content. a. true b. false

a. true

With regard to the nose and sinuses: The sphenopalatine artery is a branch of the anterior ethmoid artery. a. true b. false

b. false is a terminal branch of the internal maxillary artery originating from the external carotid artery system.

Concerning the inner ear: The medial semicircular canal is one of four semicircular canals within the bony labyrinth. a. true b. false

b. false There are only three semicircular canals ￝ and these are called the anterior, posterior and lateral semicircular canals.

The facial nerve: Changes direction at the geniculate ganglion. a. true b. false

a. true

The facial nerve: Has bilateral supranuclear innervation to the upper face. a. true b. false

a. true The supranuclear innervation is bilateral to the muscles of the forehead and eyes but only contralateral to the muscles of the lower part of the face. This accounts for the sparing of the upper facial muscles with a contralateral cortical lesion.

Concerning the inner ear: High frequency hearing is generated within the basal turn of the cochlea. a. true b. false

true High frequency sounds create most movement of the basilar membrane towards the basal turn of the cochlear, ie close to the oval window.

With regard to the nose and sinuses: The nasolacrimal duct drains into the inferior meatus in the lateral nasal wall. a. true b. false

a. true

The facial nerve: Is a pure motor nerve. a. true b. false

false Although the facial nerve is the main motor nerve for the muscles of facial expression, it also carries a small sensory component. Notably, the sensation of taste from the anterior two thirds of the tongue. You could also argue that it carries proprioceptive sensation from the muscles of the face.

The nasal septum is made up of three parts:

a) the central plate of the ethmoid b) the vomer, c) the septal cartilage plate that extends anteriorly from a) and b).

The main branch of the facial nerve exits the skull through the stylomastoid foramen. a. true b. false

a. true

Concerning the inner ear: The vestibular nerves lie posterior to the facial and auditory nerves within the internal auditory meatus (IAM). a. true b. false

a. true

What is the mainstay of treatment of treatment for nasal polyps?

nasal steriods

What method of hearing assessment would be recommended for a 6 month old child to assess hearing?

distraction test

What is your first line management for a patient with an active epistaxis?

anterior nasal pressure

The products of mast cell degranulation in response to an antigen leads to which of the following important processes?

* Smooth muscle contraction, * Vasodilation, * Leukocyte release

After IgE antibodies are produced in response to an antigen, they bind to mast cells in phase called sensitisation. When the body is exposed again to this antigen, what do mast cells release in response?

***Histamine, leukotrienes and prostaglandins***

head and neck Flashcards

(103 cards)