depends on external, middle, and inner ear, CN 8, and central auditory pathways
depends on inner ear, CN 8, and central auditory pathways
Will lateralize OPPOSITE the side with SENSORINEURAL loss or TO the side with CONDUCTIVE hearing loss
Tests air conduction. Air should be louder than bone conduction; if not the test is positive. Will lateralize TO side with CONDUCTIVE hearing loss. In sensorineural hearing loss, both will be reduced equally, so the test will not be positive.
Conductive hearing loss
Due to lesion in either external meatus, tympanic membrane, or middle ear all the way up to oval window. Weber lateralizes TO affected ear; Rinne positive
Sensorineural hearing loss
Due to lesion in the inner ear, CN 8, or central auditory structures. Weber lateralizes AWAY; Rinne negative.
Epistaxis local causes
Trauma (nose picking), septal perf 2/2 cocaine, polyps, infection, angiofibroma of nasopharynx
Epistaxis systemic causes
Infection (malaria, scarlet fever, typhoid), vascular (hereditary hemorrhagic telangiectasia, aortic coarctation), bleeding disorders, overdose of anticoag/antiplatelet medications
Epistaxis initial management
Pinch nostrils against septum and flex head anteriorly. This will stop bleeding originating from Kiesselbach's plexus. If bleeding source is posterior to that, blood will pool up into nasopharynx and get coughed up
What is the only muscle of the pharynx not innervated by CN 10, vagus?
Stylopharyngeus is innervated by CN 12, glossopharyngeal
Possible complications of tonsillectomy
Bleeding is most common. Damage to glossopharyngeal nerve. Damage to internal carotid (runs lateral to the tonsil)
Salivary glands picture
Most common type of salivary gland tumor. Majority of parotid gland tumors are benign. Can affect facial nerve
Most common histologic type of parotid tumor
Pleomorphic adenoma: benign but recurs, rarely undergoes malignant transformation
Oropharyngeal cancer prognosis by location
Best: lips. Worst: hypopharynx
Risk factors: tobacco, EBV association. Bimodal age distribution in teens and 45-55 yo. Radiation therapy is initial treatment for primary nasopharyngeal cancer
Oropharyngeal cancer treatment
Surgery and radiation
Hypopharyngeal cancer treatment
Surgery with postop radiation. Need radical neck dissection because LN mets are frequently not well controlled by radiation alone
Branchial cleft cysts
In children presents as painless lateral neck mass. In adults, more likely to present with infection of cyst. First fistula dissection can injure facial nerve. Second fistula dissection can injure hypoglossal nerve, also adjacent to carotid bifurcation.