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OUTLINE OF LECTURES
LECTURE 1
Anatomy, physiology,
LECTURE 2
Hearing is a Public Health and a social issue
Prevention of deafness
Causes of hearing Treatment of hearing loss
LECTURE 3
Anatomy physiology of nose and paranasal sinuses Signs and symptoms of nose and paranasal diseases Sinusitis, rhinitis, epistaxis Treatment of common nasal diseases
LECTURE 4
1.Practical session Otoscopy Rhinoscopy Technique of syringing Examination of buccal cavity 2.Radiology Interpretation of x-rays of common ENT emergencies 3.Quiz end of session exams on E.N.T Disease
LECTURE 1
INTRODUCTION TO
OTORHINOLARYNGOLOGY
FOR NURSES
1. Ear
2. Nose
3. larynx
4. Pharynx
5. Buccal cavity
6. Oesophagus (upper)
INSTRUMENTS
Examination of the ear can be done with otoscope
ROUTINE EXAMS
A routine examination covers the following regions: Oral and buccal cavily and oropharynx nasophrynx and posterior part of nose Hypopharynx and larynx. Nose Ears Neck
Examine as well adjacent structures. Tongue depressors are used in the buccal cavity the pharynx and posterior nasal pharynx
Cotton applicators
Tuning fork
THE EAR
A brief outline of the anatomy and physiology
ANATOMY
The ear can be divided into the following 3 parts: 1. External Ear Consisting of the pinna (Auricle),Tragus, Antetragus, External Auditory Canal/Meatus 2. Middle Ear 3 Ossicles - Incus - Malleus - Stapes
Facial Nerve
Muscles (Stapedius/Tensor Tympani)
3. INNER EAR:
Consisting of the three semi circular canals The Cochlea The vestibula containing the utricle and saccule
The Cartilagenous part of the ear canal contains hair follicles and sebacious and ceruminous glands and hence is a site for furunculosis and other skin disease. WAX is an essential part of the ceruminous glands.
THE MIDDLE EAR Starts with the Tympanic membrane which reflects the situation in the middle ear cavity. The three ossicles
Incus Malleus Stapes
PHYSIOLOGY
THE PHYSIOLOGY OF HEARING
Otalgia - Primary - Secondary Otorrhea/Otorrhagia Tinitus Hearing loss Vertigo Facial paralysis Itch Congenital deformities
REFERRED OTALGIA
Parts of the ear and several structures on the head and neck have a common source of sensory supply GTVF C2, C3 The commonest sources of referred otalgia are:
1. The teeth
2. The temperas mandibular joint 3. The tongue 4. The pharynx 5. The Nasopharynx and the hypophaynx and neck.
Trauma/Foreign Bodies
WAX Obstruction Otitis Externa
WAX OBSTRUCTION
The Ear Canal may be occluded with WAX and cause pain. Small amount
WAX can be syringed with tap water at body temperature. Cold or hot water will cause caloric stimulation vertigo.
Technique of syringing syringing that causes pain must be stopped. Drape patient Direct stream posteriorly
Acute ottis external is the inflammation of the skin linning the external auditory canal it can be acute or chronic. Acute external ottis usually presents as a very painful ear while chronic external ottis is often characterized by itchness and discharge.
AOE
May be localized (circumserbed ottis ext. furuncle. Or diffuse otitis ext.
PREDISPOSING FACTORS
Wet ears swimmers ear Ear trauma caused by pricking of the ear
ORGANISMS
1. Bacteria eg. Staphylococci Steptococci Pseudomanas
ON EXAMINATION
Movement of pinna painful, tragal
tenderness, stenotic canal.
COMPLICATION
Extension to perichondrium as
gabbage ear in older people or
TREATMENT
Antibiotic Local treatment wick ribbon gauze
In chronic otis ext the skin involvement is pronounced eg. Eczematous or seborrheic
TREATMENT
Local treatment Swabs for C/S Tropical ear, ear drops polymyxin Neomycin Cream of these topical drugs and steroid base for the skin condition. Surgery for canal stenosis
TRAUMA
Haematoma - Bony - Blow - Dress Foreign Bodies
Cutlass Cut/Bite
Suture
ETIOLOGY
Children by virtue of shortness of Eustachian tube, feeding cultures, cold Blockage of the eustachian tube exudation of serous fluid in middle ear bulging of tympanic membrane Resolution or natural spontaneous rupture discharging blood and mucous or chronic otitis media hearing loss other complications.
SYMPTOMS
Fever Pyrexia Chills Convulsion Ottalgia Cattarrh Discharging Ear Mucoid General Malaise
OTOSCOPIC FINDINGS
Reddened Tympanic Membrane Bulging and injected tympanic
membrane
Ruptured T.M with perforation
Canal normal
In ASOM Mucopurulent discharge
TREATMENT
Depending on stage
Myringotomy
Antibiotic Nasal decongestant Analgesics Clean pus
Hearing loss
Discharge off/off
FINDINGS
Perforation in T.M central or peripheral with or without pus. Very difficult to treat Antibiotics Antihistamines Keep ear dry Clean ear of discharge Tympanoplasty reconstructive surgery
COMPLICATIONS OF AOM/COM
Meningitis Otitis hydrocyphalus Chronic otitis media Serous otitis media Deafness Facial nerve paralysis Cerebellar asscess Lateral sinus thrombophlebitis Temporal lobe abscess larbyrinthitis
LECTURE 2
HEARING LOSS
May be a symptom of its own
or associated with tinitus, vertigo (triad of symptoms meneres).
A.
Conductive Sensomanual Mixed hearing loss The auditory and vestibular nerves (VIII) are intimately related to CN VII. In the internal auditory meatus
B.
Acquired Congenital H.L
Congenital atresia
WAX, foreign body
Otitis ext
Trauma Tumours Stenosis Exostosis
Tumors
Glue ear The above two produces conductive H.C
Familial
Congenital
Presbycusis
MANAGEMENT OF H.L
Examine ext, middle ear
OTOTOXIC DRUGS
Aminoglycosides antibiotic Quinine Salicylates With some drugs the damage is corrected if withdrawn early others progresses. A patient with renal failure on Aminoglycoside is susceptible to ototoxicity Hearing loss is usually bilateral and symmetrical.
PREVENTION OF DEAFNESS/TREATMENT
EPI Primary prevention Secondary prevention Use of ear protection
FACIAL PARALYSIS
LMN paralysis of all half of face UMN intact emotional movements
Bells palsy
CSOM as a complication Ramsay hunt disease
TINITUS
Noise
Ototoxic
Laribynthitis
WAX
Treat cause
presbycusis.
LECTURE
3
THE NOSE
The external nose it formed by bones and cartilages. The anterior and posterior apertures of the nose are called anterior and posterior choans, respectively. The lateral wall of the nose contains the opening of the paranesal sinuses. It is marked by three turbinates. The interior (independent bone), the middle and superior conchae or turbiantes.
BLOOD SUPPLY
The turbinates are erectile tissues. The nasal septum contains many blood vessels and is called littles area a
speech.
Dryness to crust formation Pain in the nose
Nose bleeding
Trauma: Fracture Nasal Bone
SINUSE SYMPTOMS
Halitosis Sinus headache Tumours of sinus Symptoms of nose and sinus disease can be a part or a manifestation of systematic disease. For example epistaxis can be due to a bleeding diatesis nasal and sinus allergy may occur on a patient with bronchial asthma.
EPISTAXIS
Nose bleed is common. Minor instances are easily treatable or
controlled at home.
Bleeding is unilateral, or bilateral anterior or posterior.
CAUSES
Local and systemic causes local attributable to nose and its structures Trauma Nose prick to littles area
FB
Tumors
GENERAL CAUSES
SCD
Bleeding diathesis Leukemia Arterial hypertension Climatic condition such as harmattan
Altitude
The common cause is nose prick at littles area.
MANAGEMENT
At home pinch nose for 5 mins, sit upright apply ice pack. IN THE HOSPITAL FIND CAUSE Canterize bleeding part littles area
- Chemical
- Electrical Cantery
Posterior Packing
Catheter in Posterior Nasal Space Sedation + Rest
ACUTE/CHRONIC SINUSITIS
Acute sinusitis can involve all the sinuses in one or both sides pansinusitis all. Abology often 20 nasal infection following acute viral infection. catarrh
PREDISPOSAL
Dusty environ
Excessive dryness Instillation of concussion
BACTERIAL INFECTION
Henophilis
Influenza
Stephylococci
Sometimes fungi
SYMPTOMS
Feeling of fullness on the side of face Dull headache
FINDINGS
Tenderness
TREATMENT
Treat infection
Decongest nose Most will resolve if note
SYMPTOMS
Nasal obstruction Halitosis
FINDING
Polyps Caries tooth (if chronic maxillary sinusitis)
Allergy
X-ray - opacity
TREATMENT
Antibiotic Decongestant
Antilustamine
Anthral Lavege
Intranasal Anthrotomy
Coldwell Luc Operation
COMPLICATION OF SINUSITIS Can come from acute of chronic sinusitis 1. Orbit involvement leads to proptasis,
Ostcitis Osteomylitis
Mucocele
Orbital Cellulitis Oroanthral Fistula Intracranial Spread Cavenous Sinus Thrombosis Chronic Pharyngitis, Laryngitis
LECTURE 4
LARYNX AND
PHARYNX
LARYNX
The Larynx forms the lower part of the upper respiratory tract. Apart from the gradual increase in size as childhood progresses, the major change in the Larynx during adolescence the anterior posterior length of the glottis increases by approximately 1cm in males and 3mm to 4mm in females.
The former increase accounts for the voice change in adolescent males. The thyroid cartilage forms the central and anterior walls of the larynx and produces the prominence in the neck referred to as the Adams Apple. Paired cartilages Thyorid Cricoid, Epiglotis. Form the framework of the larynx.
Causes Inflammation
Acute Laryngitis
Ltb
Acute Epigloltitis Laryngeal Dyptheria
CHRONIC
Non specific Polyp Singers node
Chronic laryngitis
Hoarseness of voice in an adult of more than 4 weeks is cancer until proven otherwise.
Laryngea paralysis can give rise to Hoarseness of voice respectively difficulty and aspiration of liquids or solids into the trachea and bronchial tree.
Opening into upper trachea as a result of airway obstruction. INDICATION respiratory obstruction
TRACHEOSTOMY
To bypass obstruction
Lung toileting Reasons accumulation of secretion in tetanus Ventilation for assisted respiration in coma Poisoning
TYPES
Emergency Elective Intubation
Taste
SYMPTOMS
Sore Throat FB throat Tonsillitis Common cold
DYSPHAGIA CAUSES
FB Tumour
Infection
Trauma Ulceration
SORE
Tonsillitis Inflammation of tonsils Bacterial infection
SYMPTOMS
Fever, Malaise, Odynophagia, Ottalgia
TREATMENT
Antibiotic Analgesic
COMPLICATIONS
Peritonsillar Abscess (Quinsy) Parapharyngeal Space Infection Chronic Tonsillitis Aom Glomerulonephritis Pericarditis Rheumatic Fever
SURGERY
TONSILECTOMY
Absolute indications Repeated attack 3 x a year Rec. tonsillitis Huge tonsils causing airway obstruction Snoring History of quinsy
ADENOIDECTOMY
If adenoids so hypertophied, that causing airway obstruction or feeding problems. Snoring and sleeping apnea.
1. Practical Exercises
Otoscopy
Radiology Interpretation
Turning Fork Test Discussion
2. Quiz