Diseases of the Eyes, Ears, Nose, and Throat - 4 Dr. Maha Al-Sedik

The Nose

Objectives: Anatomy, physiology of the nose. Patient Assessment. Pathophysiology of the nose.

Susceptible to injury because of prominence Allergens, particles, and chemicals can cause inflammation, infection, and injury. Inside of the nose is extremely vascular. Excellent route for some medicines.

Smelling disorders include: Anosmia: total loss of sense of smell. Dysosmia: distorted sense of smell. Hyperosmia: increased sensitivity to smell.

Anatomy and Physiology of the Nose One of two primary entry points for oxygen Nasal septum: separation between the nostrils Turbinate: 3 layers of bone within each nasal chamber

Patient Assessment Look for environmental clues. Ensure scene safety. Assess airway and breathing. Determine level of distress.

Do not insert a nasopharyngeal airway or attempt naso - tracheal intubation with: Suspected nasal fractures. CSF or blood leakage from the nose. Inquire about history of nose conditions.

Pathophysiology of the nose

Epistaxis Nose bleed Anterior Posterior

Anterior Bleed fairly slowly. Self-limiting and resolve quickly. Posterior More severe. Often cause blood to drain into the throat, causing nausea and vomiting.

Assessment and management: Place a non trauma patient in a sitting position, and pinch nostrils together. Direct the patient not to sniff or blow his or her nose.

Foreign Body Most likely to be seen in pediatric patients Pressure in the nasal passage can cause: Tissue necrosis Inflammation Swelling

foreign body removal set Assessment and management Determine life threats. Any persistent, foul-smelling, purulent discharge should lead to suspicion. Let discharge drain. Transport the patient in a position of comfort. foreign body removal set With hooked end

Rhinitis A nasal disorder that is most common during childhood and adolescence. Generally caused by allergens.

Assessment and treatment: Signs and symptoms may include: Nasal congestion. Itchy runny nose and eyes. Keep the patient in the Fowler position.

The Throat

Objectives: Anatomy, physiology of the pharynx and larynx. Patient Assessment. Pathophysiology of the pharynx and larynx.

Anatomy and Physiology of the throat 1- The Pharynx (throat): Funnel-shaped tube of skeletal muscle that connects to the: Nasal cavity and mouth superiorly. Larynx and esophagus inferiorly. Extends from the base of the skull to the level of the sixth cervical vertebra.

It is divided into three regions Nasopharynx. Oropharynx. Hypopharynx. Oropharynx and laryngopharynx serve as common passageway for food and air.

Hypopharynx : Where the oropharynx and nasopharynx meet Gag reflex is profound. Triggering may cause vagal bradycardia, vomiting, and increased intracranial pressure.

Epiglottis posterior to the tongue keeps food out of airway swallowing Epiglottis posterior to the tongue keeps food out of airway

2- Larynx (Voice Box): It opens into the laryngopharynx superiorly and continuous with the trachea. The three functions of the larynx are: To provide a patent airway To act as a switching mechanism: Closed during swallowing Open during breathing To function in voice production.

Anterior view

Framework of the larynx: It is composed of 9 cartilages connected by membranes and ligaments Thyroid cartilage: with laryngeal prominence ( Adam’s apple ) anteriorly. Cricoid cartilage: inferior to thyroid cartilage: the only complete ring of cartilage: signet shaped and wide posteriorly.

Behind thyroid cartilage and above cricoid: 3 pairs of small cartilages. Arytenoid: anchor the vocal cords. Corniculate. Cuneiform. 9th cartilage: epiglottis.

Posterior view

Vocal Ligaments: Attach the arytenoid cartilages to the thyroid cartilage. Composed of elastic fibers that form mucosal folds called true vocal cords. The medial opening between them is the glottis. They vibrate to produce sound as expired air rushes up from the lungs.

moving arytenoid cartilages

Laryngeal muscles control length and size of opening by moving arytenoid cartilages. Sound is produced by the vibration of vocal cords as air is exhaled.

Neck contains important structures: Thyroid and cricoid cartilage Trachea Thoracic duct Esophagus Thyroid and parathyroid glands Lower cranial nerves

Pathophysiology of the throat

Foreign Body in the Throat Assessment and management Keep the patient calm. Transport in a position where if the object becomes dislodged, gravity will allow it to fall out.

Management: Managing an airway obstruction is a priority. Use age appropriate basic life support foreign body airway obstruction maneuvers to clear the airway. Administer supplemental oxygen, and transport the patient to the closest hospital.

First Aid treatment There are three steps that you should follow for adults and children over 1: 1. Encourage the victim to cough: Always ask the person if he/she can cough and if so encourage it 2. Back slaps: Deliver 5 hard backslaps with the heel of the hand between the shoulder blades. After each slap check if the object has been dislodged.

3. Abdominal thrusts or better known as Heimlich Maneuver The Heimlich Maneuver is most likely one of best known First Aid techniques. You are trying to push the foreign object back out of the trachea / wind pipe by exerting pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it.

Heimlich Maneuver Back slaps

Never to do suction. Epiglottitis Inflammation of the epiglottis Blocks the trachea and obstructs the airway Often a result of the H. influenzae type b virus Never to do suction.

AIR RAID Symptoms and signs may include: Air way closed Increased pulse Restlessness Retraction of inter costal muscles Anxiety Inspiratory stridor Drooling: dropping of saliva. AIR RAID

Assessment and management: Transport to an appropriate hospital. Minimize scene time. Do not start suction. Do not attempt to look in the mouth.

Laryngitis Causes may include: Swelling and inflammation of the larynx Bacterial ( Pneumonia ). Irritants and chemicals Allergies

Assessment and management Symptoms include: Fever. Hoarseness of voice. Swollen lymph nodes or glands. Have the patient follow up with a physician.

Tonsillitis Swelling and inflammation of the tonsils. Usually caused by viral infections. Can also be caused by bacteria. 54

Assessment and management Symptoms: Sore throat Difficulty swallowing Signs: White or yellow coating or patches Swollen tonsils Fever

Peritonsillar Abscess Collection of infected material around the tonsils. 56

Symptoms may include: Facial swelling. Inability to swallow. Sore throat. Difficulty swallowing. 57

Treatment involves antibiotics and draining the abscess. Transport patient to the hospital. 58