anatomy, physiology of ent for paramedics - dr. fuad ridha
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8/6/2019 Anatomy, Physiology of ENT for Paramedics - Dr. Fuad Ridha
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Fuad Ridha Mahabot
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Anatomy of the EarEar - organ of
hearing andmaintainingequilibrium
3 parts:
external earmiddle ear
inner ear
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external ear pinna/auricle
external auditory canal tympanic membrane
middle ear Eustachian tube
tympanic cavity
mastoid air cells
inner ear
cochlea vestibular apparatus
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External Ear
Pinnaframework of a single
piece of cartilage
covered with skin(except for the lobule)
has lateral and medialsurfaces
also has ridges anddepressions
perichondritis infectionof the perichondrium ofpinna extremely painful
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External AuditoryCanalextends from the
concha to the tympanic
membrane24mm long
not a straight tube
2 partsouter 1/3 cartilaginous
(8mm)
inner 2/3 bony (16mm)
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cartilaginous partcontinuation of cartilage
from the pinna
skin coverings - thick,contain ceruminous and
pilosebaceous glands wax
bony part
no hair/glandprox aspect - isthmus -
narrowing part
FB/wax may getimpacted in the isthmus
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Tympanic membrane(drumhead)
forms partitionbetween EAC and
middle earoblique in shape
divided into pars tensa - forms most
of the tympanicmembrane
pars flaccida - situatedabove the lateralprocess of malleus
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Middle Ear
also called as tympanic cavity
between external and middle ear
functions
transmits sound wave from external ear to the innerear through the chain of ear ossicles
transforms air borne vibration liquid bornevibration
increases intensity of sound by 10x withoutchanging the frequency
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contents of middle ear
three ossicles (malleus,incus, stapes)
ligaments of ear ossicles
two muscles (tensortympani and stapedius)
vessels
nerve - chorda tympani andtympanic plexus
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Eustachian Tubeconnects nasopharynx to
the tympanic cavity
adult - runs in a oblique line
child - straight line
closed at rest
2 parts
posterolateral 1/3 - bony
anteromedial 2/3 -
fibrocartilaginous
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functionsregulation of middle ear
pressure
protection against refluxof nasopharyngeal
secretionsmiddle ear clearence of
secretions
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Inner Ear
(Labyrinth)
important organ ofhearing andbalance
consists ofbony labyrinth
membranouslabyrinth
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Bony Labyrinth
complex spaces insidethe petrous part of thetemporal bone filledwith perilymph
consists of
vestibule
semicircular canal
cochlea
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Membranous labyrinth
delicate complexstructures seen insidethe bony labyrinth
contains endolymph
consists of
cochlear duct
utricle/saccule
semicircular ductendolymphatic duct
and sac
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Physiology of Hearing and
EquilibriumDivided into
mechanicalconduction of sound
(conductiveapparatus)
transduction ofmechanical energy to
electrical impulsesconduction of
electrical impulses tothe brain
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sound signal collected by pinna passes throughEAC strikes the tympanic membrane
vibration of tympanic membrane transmitted tostapes footplate through the chain of ossicles
movement of stapes footplate causes pressurechanges in labyrinthine fluid which moves basilarmembrane
thus it stimulates hair cells of organ of Corti acts
as transducer
conduct mechanical energy intoelectrical impulses travel along auditory nerve tothe brain
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Physiology of Equilibrium
Balance of the various parts of the body duringstatic or dynamic positions are maintained by 4organs
Vestibular apparatus (inner ear)Eye
Posterior column of the spinal cord
Cerebellum
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Vestibular Apparatus
Vestibular apparatus of the 2sides act as one unit
Vestibular fluids move withhead movements
Detects head position andmovements needed forpostural adjustments
Head movements can be
Angular acceleration Semicircular canals: Cristae
Linear acceleration
Utricle and saccule: Maculae
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Anatomy of the NoseNoserespiratory passage
organ of smell
External nosepyramidal in shape
osteocartilagenous
framework covered bymuscles and skin
upper 1/3 - bony (nasalbone)
lower 2/3 - cartilaginous
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Nasal Septum
3 parts:Membranous: Medial
crura of alar cartilage
Cartilagenous:
Quadrilateral cartilageBony: Perpendicular plate of
ethmoid
Perpendicular plate of thevomer
Nasal crest of maxilla
Nasal crest of palatine
Rostrum of sphenoid
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Littles area Caudal part of the nasal
septum which has a richsubmucosal arterialnetwork - septal
branches of Anterior ethmoidal
Sphenopalatine Greater palatine Superior labial
Prone for drying effect ofinspired air and tomicrotrauma due to
picking of the nose Commonest cause and site
of epistaxis in children
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Lateral Wall of Nasal
Cavity
marked by threeprojections calledturbinates or conchae.
types
inferior
middle
superior
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inferior meatus
lowermost turbinatescontains opening of
nasolacrimal duct
middle meatusrounded by bulge called
bullae ethmoidalisbelow the bullae - hiatus
semilunaris leads toethmoidal infundibulum
superior meatuspost 3rd of lateral wallcontains opening
through post ethmoidalsinus
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Anatomy of Paranasal
SinusesAir filled spaces in the
facial bones, lined bymucosa which drains into
the nasal cavity bymuco-ciliary function
Functionair-conditioning
resonance to voice
thermal insulators
lighten skull bone
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Two groups
Anterior group: Drainsinto middle meatusMaxillary, frontal and
anterior ethmoids
Posterior group: Drainsinto superior meatusPosterior ethmoids and
the sphenoid
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Physiology of NoseFunction of noserespiration
air conditioning ofinspired air
protection of lowerairway
vocal resonance
nasal reflex function
olfaction
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respiration
natural pathway of breathing
since newborn
air conditioning of inspired air
acts as an air-conditioner
filters and purifies air
adjusts its temperature andhumidity before it passesonto the lungs
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protection of lower
airwaymuco-ciliary
mechanism secretes mucous
secretion
inspired bacteria,viruses and dustyparticles entrappedinto viscous mucous carried out to thenasopharynxswallowed
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vocal resonance
phonating certain nasalconsonants (M/N/NG)
nasal reflexes
several reflexes whichis initiated in nasalmucosa
smell of food reflexsecretion of saliva and
gastric juiceirritation of nasal
mucosa sneezing
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olfaction (smell)
important forpleasure and forenjoying the tastesof food
when nose blocked,food tastes blandand unpalatable
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Anatomy of Larynxlarynx - organ ofproduction of voice
also an air passage
primary functionProtection of tracheo-
bronchial tree
secondary function
Phonation (generation ofsound)
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Framework of the
larynx
Hyoid bone
Unpaired cartilages
EpiglottisThyroid cartilage
Cricoid cartilage
Paired cartilagearytenoid cartilage
corniculate cartilage
cuneiform cartilage
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thyroid cartilage largest of all
vocal cord attached tomiddle of thyroid cartilage
cricoid cartilage
ring shape below thyroidcartilage
epiglottis located at the anterior wall
of laryngeal inletant surface connected to
the tongueand hyoid bone
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arytenoid cartilage
pyramidal in shapebase articulates with
cricoid cartilage
has vocal process togive attachment to vocal
cordcorniculate cartilagearticulates with apex of
arytenoid cartilage
cuneiform cartilagesituated infront ofcorniculate cartilage
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Vocal cords
two pearly white bands
extending from middle ofthyroid angle to vocalprocess of arytenoid
for phonationabductors - posterior
cricoarytenoid
adductors - lateralcricoarytenoid,interarytenoid,thyroarytenoid
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Laryngeal Joints
cricoarytenoid jointhelps by abducting and
adducting vocal cord
cricothyroid jointbetween inferior cornu
and thyroid cartilageand at side of cricoidcartilage
for rotatory and glindingmovement
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Muscles of the Larynx
Intrinsic
Extrinsic
Intrinsic - acts on vocalcord / laryngeal inlet
acting on vocal cords abductors - posterior
cricoarytenoid
adductors - lateralcricoarytenoid,interarytenoid,thyroarytenoid
Posterior cricoarytenoid
Lateralcricoarytenoid
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acting on laryngeal inlet thyroepiglottic
interarytenoid aryepiglottic
Extrinsic - attach larynx tosurrounding structures
elevators -stylopharyngeus,salphingopharyngeus,palatopharyngeus,thyrohyoid (primary);
mylohyoid, digastric,stylohyoid, geniohyoid(secondary)
depressors -sternohyoid,sternothyroid,
omohyoid47
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Physiology of LarynxFunction of larynxprotection of lower
airways
phonation
respiration
fixation of the chest
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protection of lower airways
when food is swallowed, air entry into airpassage is prevented by closure of laryngealopening
respiratory also ceased when food in contact
with post pharyngeal wallif foreign body came in contact with laryngeal
mucosa cough is commenced toexpel/dislodge foreign particle
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phonation
adduction of vocalcord
increase infraglotticair pressure from
lungsair force of open
vocal cord vibration of vocalcord producessound
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Sound ProductionA) Vocal cords closed immediately prior to phonation (voice production).B) Air Pressure develops below vocal cords due to air from lungs during exhalation.C) Vocal cords separate briefly with the release of air. (1) Arrow points to the upper edge ofthe vocal cord.D) Vocal cords re-approximate. (2) Arrow points to the lower edge of vocal cord.
E) Vocal cords together again.51
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