Transcript Otolaryngology

Medical Language
Second Edition
CHAPTER
16
Otolaryngology
Medical Language, Second Edition
Susan Turley
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Otolaryngology
• The medical specialty that studies the
anatomy and physiology of the ears, nose,
mouth, and throat (ENT) and uses diagnostic
tests, medical and surgical procedures, and
drugs to treat ENT diseases.
Figure 16-1 Ears, nose, and throat (ENT) system
Anatomy and Physiology
• The ears, nose, and throat (ENT) system is
contained entirely in the head and neck.
• The head contains the external and internal
structures of the ears, nose, and mouth, and
the internal structures of the sinuses.
• The neck contains the internal structures of
the pharynx and larynx.
Anatomy and Physiology (cont’d)
• The ENT system shares some structures with
the gastrointestinal system and the respiratory
system, so it serves as a passageway for both
food and air.
• The ENT system also contains lymphoid tissue
that functions as part of the immune
response.
• The body’s senses of hearing and smell are
also part of the ENT system.
Anatomy of the ENT System
• External Ear
– Known as the auricle or pinna
– The helix is the outer rim of tissue and cartilage
that forms a C and ends at the ear-lobe.
– The external auditory meatus is the opening that
leads into the external auditory canal (EAC).
Figure 16-2 External ear
Anatomy of the ENT System
(cont’d)
• External Ear (cont’d)
– The canal has glands that secrete cerumen, a
waxy, sticky substance that traps dirt and has an
antibiotic action against microorganisms that
enter the canal.
– At the end of the canal is the tympanic membrane
(TM), or eardrum, a thin dividing wall between the
external ear and the middle ear.
Figure 16-3 Tympanic membrane
Pearson Education/PH College
Anatomy of the ENT System
(cont’d)
• External Ear (cont’d)
– The mastoid process is a bony projection of the
temporal bone that lies just behind the external
ear and contains tiny cavities filled with air.
Anatomy of the ENT System
(cont’d)
• Middle Ear
– The middle ear is a hollow area inside the
temporal bone of the skull.
– It contains three tiny bones: the malleus, incus,
and stapes, collectively known as the ossicles.
– It is connected to the nasopharynx by the
eustachian tube.
Anatomy of the ENT System
(cont’d)
• Middle Ear
– The eustachian tube allows air pressure in the
middle ear to equalize with air pressure in the
throat and outside of the body.
Figure 16-4 Structures of the middle ear and inner ear
Anatomy of the ENT System
(cont’d)
• Inner Ear
– Contains three fluid-filled structures:
• Vestibule
• Semicircular canals
• Cochlea
Anatomy of the ENT System
(cont’d)
• Vestibule is the entrance area to the inner ear.
• One end of the vestibule becomes the three
semicircular canals.
• The other end of the vestibule becomes the
coiled cochlea.
Anatomy of the ENT System
• External Nose and Mouth
– The external nose is supported by the nasal bone,
which forms the bridge of the nose and the
dorsum.
– At the nasal tip, the nasal bone becomes cartilage.
– The nares are the external openings, or nostrils;
the flared cartilage on each side of the nostril is a
nasal ala.
Figure 16-5 External nose, mouth, and neck
Anatomy of the ENT System
(cont’d)
• External Nose and Mouth (cont’d)
– The lips, cheeks, and chin are supported by the
maxilla (upper jawbone) and mandible (lower
jawbone).
– The nasolabial fold is the crease in the cheek that
goes from the nose to the corner of the mouth.
– The philtrum is the vertical groove above the
upper lip.
– The chin is also known as the mentum.
Anatomy of the ENT System
(cont’d)
• Sinuses
– A sinus is a hollow cavity within a bone that is
lined with a mucous membrane.
– Four pairs of sinuses: frontal, maxillary, ethmoid,
and sphenoid.
– As a group, these are also known as the paranasal
sinuses.
Figure 16-6 Sinuses
Anatomy of the ENT System
(cont’d)
• Nasal Cavity
– The nasal cavitiy is formed by the ethmoid bone of
the cranium and by the maxilla of the upper jaw.
– The nasal septum is a vertical wall of cartilage that
divides the nasal cavity into right and left sides.
– In the posterior nasal cavity, this cartilage
becomes the ethmoid bone of the cranium.
Figure 16-7 Structures of the internal nose, mouth, and throat
Anatomy of the ENT System
(cont’d)
• Nasal Cavity
– Along the nasal cavity walls are three long, bony
projections − the superior, middle, and inferior
turbinates, or nasal conchae.
– The turbinates divide and slow down inhaled air
and give it warmth and moisture.
– The nasal cavity is lined with nasal mucosa, a
mucous membrane that continuously produces
mucus.
Anatomy of the ENT System
(cont’d)
• Oral Cavity
– Contains the tongue, hard palate, soft palate and
uvula, teeth, and salivary glands
– Lined with the oral mucosa that is known as
buccal mucosa in the cheek area
Anatomy of the ENT System
(cont’d)
• Oral Cavity
– The hard palate or roof of the mouth divides the
oral cavity from the nasal cavity and is made up of
3 different cranial bones: the maxilla at the front
of the mouth, the palatine bone, and the vomer
bone at the back of the mouth.
– Submental lymph nodes in the tissue under the
chin contain lymphocytes and macrophages that
attack bacteria and viruses.
Anatomy of the ENT System
(cont’d)
• Pharynx
– Divided into three areas: the nasopharynx, the
oropharynx, and the laryngopharynx.
– The eustachian tubes open into the nasopharynx.
– The roof and walls of the nasopharynx contain the
pharyngeal tonsil, a collection of lymphoid tissue
commonly known as the adenoids.
Anatomy of the ENT System
(cont’d)
• Pharynx (cont’d)
– The nasopharynx becomes the oropharynx or
middle portion of the throat, which contains the
palatine tonsils.
– The laryngopharynx contains the lingual tonsils on
either side of the base of the tongue.
Anatomy of the ENT System
(cont’d)
• Pharynx (cont’d)
– The tonsils and adenoids are part of the lymphatic
system, and they function in the immune
response; they contain lymphocytes and
macrophages that attack bacteria and viruses in
the tissues around the oral cavity.
Figure 16-8 Pharynx
Anatomy of the ENT System
(cont’d)
• Larynx (cont’d)
– Pharynx divides into two parts: the larynx leads to
the trachea and the esophagus leads to the
stomach.
– The larynx, or voice box, is a short, triangular
structure.
– Is surrounded by two thick rings of cartilage that
can be clearly seen at the front of the neck as the
laryngeal prominence (Adam’s apple)
Anatomy of the ENT System
(cont’d)
• Larynx (cont’d)
– At the superior end of the larynx is the epiglottis;
in the middle of the larynx are the glottis,
ligaments, and the vocal cords.
– When you swallow, the larynx moves superiorly
and closes against the epiglottis to keep food from
entering the lungs.
– Remains open during breathing, speaking, or
singing to allow air to pass over the vocal cords.
Anatomy of the ENT System
(cont’d)
• Larynx (cont’d)
– Muscles in the larynx relax or tighten the vocal
cords to lower or raise the pitch.
– Surface layer of each vocal cord vibrates,
producing sound waves that travel through the
vocal cords and past the soft palate, tongue, and
lips, all of which shape the sound waves into
words.
Physiology of the Sense of Hearing
• The external ear captures sound waves.
• The tympanic membranes move the malleus,
the incus, and then the stapes.
• The stapes transmits this mechanical motion
to the oval window, which causes inner ear
fluid on the other side of the oval window to
move.
Physiology of the Sense of Hearing
(cont’d)
• The vibration is transmitted to the cochlea.
• Tiny hair cells detect the loudness and pitch of
the sound and send this sensory information
as nerve impulses through the cochlear
branch of the vestibulocochlear nerve to the
medulla oblongata in the brainstem.
• From there, the impulses are relayed to the
auditory cortex in the brain.
Figure 16-9 The sense of hearing
Diseases and Conditions
• Ears
– Acoustic neuroma
– Cerumen impaction
Figure 16-10 Cerumen impaction
Diseases and Conditions (cont’d)
• Ears (cont’d)
– Cholesteatoma
– Hearing loss
Diseases and Conditions (cont’d)
• Ears (cont’d)
– Hemotympanum
– Labyrinthitis
– Meniere’s disease
– Motion sickness
Diseases and Conditions (cont’d)
• Ears (cont’d)
– Otitis externa
– Otitis media
Figure 16-11 Myringitis
Figure 16-12 Perforated tympanic membrane
ISM/Phototake NYC
Diseases and Conditions (cont’d)
• Ears (cont’d)
– Otorrhea
– Otosclerosis
– Ruptured tympanic membrane
– Tinnitus
– Vertigo
Diseases and Conditions (cont’d)
• Sinuses, Nose, and Nasal Cavity
– Allergic rhinitis
– Anosmia
– Epistaxis
Diseases and Conditions (cont’d)
• Sinuses, Nose, and Nasal Cavity (cont’d)
– Polyp
– Rhinophyma
– Septal deviation
Diseases and Conditions (cont’d)
• Sinuses, Nose, and Nasal Cavity (cont’d)
– Sinusitis
– Upper respiratory infection (URI)
Figure 16-13 Sinusitis
ISM/Phototake NYC
Diseases and Conditions (cont’d)
• Mouth, Oral Cavity, Pharynx, and Neck
– Cancer of the mouth and neck
– Cervical lymphadenopathy
– Cleft lip and palate
Figure 16-14 Cleft lip and palate
Courtesy of Dr. Elizabeth Peterson
Diseases and Conditions (cont’d)
• Mouth, Oral Cavity, Pharynx, and Neck
(cont’d)
– Cold sores
– Glossitis
– Leukoplakia
Figure 16-15 Leukoplakia
Caliendo/Custom Medical Stock Photo, Inc.
Diseases and Conditions (cont’d)
• Mouth, Oral Cavity, Pharynx, and Neck
(cont’d)
– Pharyngitis
– Temporomandibular joint (TMJ) syndrome
– Thrush
– Tonsillitis
Figure 16-16 Thrush
Caliendo/Custom Medical Stock Photo, Inc.
Figure 16-17 Tonsillitis
Dr. P. Marazzi / Photo Researchers, Inc.
Figure 16-19 Audiometry
Phanie / Photo Researchers, Inc..
Figure 16-20 Rinne test
Pearson Education/PH College
Laboratory and Diagnostic
Procedures (cont’d)
• Laboratory and Radiologic Tests
– Culture and sensitivity (C&S)
– Rapid strep test
– RAST
– Sinus series
Figure 16-21 Throat swab
Medical and Surgical Procedures
• Medical Procedures
– Nose, sinus, mouth, and throat examinations
– Otoscopy
– Romberg’s sign
Figure 16-22 Otoscopy
Saturn Stills/Photo Researchers, Inc.
Medical and Surgical Procedures
(cont’d)
• Surgical Procedures
– Cheiloplasty
– Cochlear implant
– Endoscopic sinus surgery
– Mastoidectomy
– Myringotomy
Figure 16-23 Myringotomy and tympanostomy
Medical and Surgical Procedures
(cont’d)
• Surgical Procedures (cont’d)
– Otoplasty
– Polypectomy
– Radical neck dissection
– Rhinoplasty
Medical and Surgical Procedures
(cont’d)
• Surgical Procedures (cont’d)
– Septoplasty
– Stapedectomy
– Tonsillectomy and adenoidectomy (T&A)
– Tympanoplasty
Drug Categories
• These categories of drugs are used to treat
ENT Diseases and Conditions:
– Antibiotic drugs
– Antihistamine drugs
– Antitussive drugs
– Antiyeast drugs
– Corticosteroid drugs
Drug Categories (cont’d)
• These categories of drugs are used to treat
ENT Diseases and Conditions:
– Decongestant drugs
– Drugs used to treat vertigo and motion sickness
Abbreviations