OTORRINO P2 Flashcards
(127 cards)
1
Q
Behavioral audiologic measures
A
-pure tone air conduction
-pure tone bone conduction
-speech-recognitios threshold (STR)
-suprathreshold speech recognition socres
2
Q
Objetive physiological measures
A
-otoacousitc emissions
-acoustic admittance test battery
-tympanometry
-acoustic-reflex threshold (adaptation)
3
Q
objective auditory electrophysiologic measures
A
- auditory evoked potentials testing/ electrocochleography (ECochG)
- auditory brainstem response (ABR)
-auditory middle latency response (AMLR)
-auditory steady state response (ASSR)
cortical auditory evoked potentials (CAEPs)
4
Q
puretone audiogram: air-conduction thresholds (AC)
A
-frequencies 250, 500, 1000, 2000, 4000, 8000 hertz
-we can block the none tested ear with masking noise
5
Q
puretone audogram: bone conduction thresholds (BC)
A
-frequencies: 250, 500, 1000, 2000, and 4000 Hz
-with a bone vibrator placed in the mastoid process of temporal bone.
-it shoul be in an isolated room
6
Q
Normal hearing audiogram
A
-10 to 25 db
-x its frequency (Hz)
-y its dB
7
Q
audiogram symbols
A
-red: right
-blue: left
-AC: circule (right) and X (left)
-BC: < (right) and > (left)
-AC masked: triangle (right) and square (left)
-BC masked: [ (right) and ] (left)
BC always arriba de AC
8
Q
que indica HL en AC and BC
A
-AC: heraign problem in the conductive and/or sensorineural
-BC: just sensorineural
9
Q
air bone GAP
A
difference of dB between AC and BC
-in normal hearign its < 10dB
10
Q
normal hearing
A
-AC: < 25
-BC: <25
-ABG: <10
11
Q
normal hearing with significant ABG
A
-AC: <25
-BC: <25
-ABG: >10
12
Q
conductive HL
A
-AC: >25
-BC: <25
-ABG: >10
-ej: otitis media or external, ear wax, tumor on middle or external ear, eustachian tube dysfunction, genetic HL like treacher collins sx
13
Q
sensorineural HL
A
-AC: >25
-BC: >25
-ABG: <10
-Ej: noise-induced HL, presbycusis, ototoxicity, meniere diseas, genetic HL like Connexian 26, Usher sx, acosutic neuroma, esclerosis multiple, sx caratgena, schwannoma
14
Q
mixed HL
A
-AC: >25
-BC: >25
-ABG: >10
-ej: otosesclerosis and presbycusis, uno y uno
15
Q
PTA pure tone average
A
-para ver la magnitud de la HL
-vemos los db de 500, 1000 y 2000 hz, los sumas y dividimos entre 3
-solo los valores de AC
16
Q
Normal PTA
A
<25
17
Q
mild PTA
A
25-40
18
Q
moderate PTA
A
40-55
19
Q
modeately severe PTA
A
55-70
20
Q
severe PTA
A
70-90
21
Q
profound PTA
A
> 90
22
Q
high frequencie audiometry
A
-test at 9000, 10000, 11,200, 12,500, 14.000, 16.000, 18.000 y 20.000 Hz
-nos dice sobre early ototoxic effects (gentamicen, amicasin), early presbycusis or early noise-induced HL
23
Q
interaural attenuation
A
The reduction in intensity of a signal, such as a pure-tone signal, as it travels by BC from the TE to the NTE (where the masking goes)
24
Q
speech audiometry
A
–spondaic or speechrecognition threshold (SRT): based on spondaic words bisyllabic
-es a la intensidad mas baja a la que el px repite las palabras
25
Retrochoclear lession
with more dB, they hear more distortion instead of hearing ir louder
26
tympanometry
measures the movement of the tympanic membrane
-speaker at 225 hz
27
TPP tympanometric peak pressure
-unit: daPa
-its when the air pressure intriduced in to the external ear, equals de pressur ein the middle ear
28
TPP typanometric peak pressure
low: < -50 daPa its not normal, suggestive of eustachian tube dysfunction
normal: >.35 daPa
29
peak-compensated static-acoustic **admittance**
in adultos: 0.35-1.30
-abajo de eso: rigidez
-arriba: ossicular discontinuity or tympanic perforation
30
type A tympanometry
normal TPP
normal peak height
normal middle ear function
31
type Ad
-TPP normal
-admitance higher peak height >1.30
-ej: ossicular discontinuity
32
type As
-reduced height at the peak (admitance < .35)
-normal TPP
-stiffening middle ear, like otoesclerosis
33
type B
flat tympanogram
-stiffening middle-ear pathology or tympanic membrane perforation (or a patent tympanostomy tube), ear wax, foreign body, air fluid levels
34
type C
-negative TPP (<-50)
-eustachian tube-dysfunction
35
little bones:
-malleus (pegado al timpano)
-incus (de enmedio)
-stapes (parece una Y)
36
Acoustic reflex
-se oye un ruido fuerte en un oido, y se contraen los **2** musuclos
-primary muscle involved: stapedius, su origen es in the pyramidal eminene of the tympanic cavity, y se inerva por **1 branch of facial nerve**
-at high intesities: the tensor tympani (inervado por **trigeminal nerve**
37
pathway acoustic reflex
-ipsylateral: Coclea --> NC8 --> nucleo coclear--> facial nerve (7) -->stapiduis
-contralateral: coclea --> NC8 --> nucleo coclear--> contralteral meadlle supirior oliva nucleos --> facila nerve motor --> stapiduis (el contralateral)
38
otoacustic emissions
-records the sound of the movement of the outer hair cells
-dx of hering disordes in infants
39
Auditory brainstem responses (ABRs)/ brainstem auditory evoked potentials (BAEPs)
it evaluates all the auditory pathway
40
anatomy of the external ear (pinna)
-24 mm length with 1-2 ml volume
-lateral 1/3 its fibrocartilage
-medial 2/3 it sbone
-junction de esos es narrowest poinr
41
pinnas skin
-Stratified squamous epithelium
-subcutaneous layer: hair follicles, sabaceos glands and ceruminous glands, 1mm
-osseous canal: 0.2 mm
42
Cerumen
-secreciones glandulares + epitelio desprendido
-hydrophobic
-acid pH
-antibacterial effects
43
pinna innervation
-laterally, inferiorly, and posteriorly by the great auricular nerve (cervical plexus).
-Arnold’s nerve (a branch of the vagus nerve) innervates the inferior bony canal (concha and floor ear canal)
-posterosuperior bony EAC by branches of the facial nerve
-anterior (tragus and roof): auriculotemproal branch of V3 of the trigeminal nerve
44
microtia
-malformaciones evidentes
Marx system:
-G1: deformidad leve el helix y antihelix
-G2: (atypical microtia): tissue deficiency and defromity
-G3: peanut ear
-G4: absence
45
tx microtia
-observation
-protesis
-single stage reconstrutction with implant
-staged autologous costochondral reconstruction. (4 stages)
46
atresia and stenosis
-la microtia esta asociada
-tienen conductive HL moderate severe
-risk of chloesteatoma
-CT scan para ver si es candidato a cx
47
protruding ears (prominauris)
- increase in the distance from the helical rim to the mastoid (due to a lack of the antihelical fold and prominence of the conchal bowl)
-usually bilateral
-normal Auriculocephalic angle 20-25° with Auriculomastoid distance 15-20 mm
tx: otoplasty (esthetic)
48
First branchial cleft anomalies
-10% de las BCA
-Fusion 1st and 2nd branchial arch por incomplete obliration of 1 BC
-hay infeccion, dolor, hinchazon, escurrimiento
-clasificacion Work: tipo 1 (duplicates the membranous EAC ) and tipo 2 (mas comun, duplicates both the membranous and cartilaginous EAC.)
tx: complete excision, no si esta infectada
49
external ear trauma: hematoma auricular
-accumulation of blood in the subperichondrial space
-el cartilago depende de la vascularizacion del pericondrio via **diffusion**
-necrosis del cartilago, predispone a infecciones
-cauliflower ear
tx: quinolones, drainage and ferula
50
auricular laceration
-trauma --> laceracion o avulsion
-reparacionn expedita y prevencion de infecciones
-tx: quinolones, vendaje, secondary reconstruction
51
auricular burns
1st degree: superficial layer of epidermis, red, hurt. Most common junto con la 2)
2nd degree: epidermis and extension to dermis
3rd degree: full thickness of dermis
4th degree: affection of another tissue that’s not the skin (fat, muscle, etc)
Tx: moisturizing creams, silver sulfadiazine (antiseptic cream), debridement, antibiotic ointment
52
otitis externa
-Usually by p. aeruginosa and s. aureus
-Chronic >3 m, acute <3 m
-Tx: topic, NO oral antibiotics, debridement of the EAC, analgesia (AINES), culture, otic drops (acetic and boric acid, gentian violet, thimerosal, alcohol, ofloxacine), avoid water exposure
53
otomycosis
-Fungical 10%
-80% aspergillus
-FR:immunocompromised
tx: debridement of EAC, acifiyng EAC (alcohol), antifungical agents (gentian violetm thimerosal, clotrimazole, nystatin, ketoconazole), avoid water exposure
54
Skull base osteomyelitis/ malignant otitis external
-inmunocomprometidos
-otitis ext que afecta hueso temporal, puede dar meningitis fata, sepsis ,muerte
-progreso: cellulitis, chondritis, osteitis, and osteomyelitis
-travels through: Haversian canals, fissures of Santorini, foramina, and vascularized spaces
-90% pseudomona aeruginosa
-Usually they have facial paralysis
-dx: VSG, PCR, elevadas, cultivo, CT, MRI
55
tx skull base osteomielitis
-long term parenteral antibiotics (6 wks), antipseudomonal (pip-tz, cefepime, ceftazidime, ciprofloxacin, ofloxacin)
-Hyperglycemia control
-Surgical debridement
-Hyperbaric oxygen
56
atopic dermatitis
-cronic, recurrent
-AHF de atopia
-niveles altos de linfocitos T TH2
-lesiones eritematosas y prurito
-> 1 mes
-tx: decloxizine, emollients, soaking baths, topical corticoesteroids, calccineurin inhibitars (tacrolimus, sirolimus)
57
soriasis
-cronica, inflamatoria
-18% lo manifoestan en el oido externo
-triggers: AINE, BB, carbonato de lithium, antimalarial agents, infection, trauma, stress
-papulas eritematosas (sangran si se rasca: signo de Auspitz) roud salmon-pink plaques
-tx: topical nonfluorinated corticoesteroids (mometasone, hydrocortisone), warm water soaks, 1-5% coal tar, oral proralens
58
contact dermatitis
-por concancto con allergents and irritants
-hipersensibilidad type 4
-eritematoso, mal delimitado
tx: pruebas cutaneas, evitar irritante, glucocorticoestoried topicos
59
foreign bodies
-no es emergencia (si es bateria si)
-tx: removal atraumatic manner, oil or glycerin
60
keratosis obturans
-acumulacion de restos descamados
-asociado a broquitis cronica y sinusitis
-diferential dx: cholesteatoma
61
basal cell carcinoma
-maligna **mas comun**de la pinna 45%
-FR: expo cronica al sol
-mutacion en gen p53 y via de señalizacion Hedgehog
-lesion nodular, ulcerada, sangrante
-dx: biopsy
-tx: photodinamic therapy with aminolevulinic acid, Topical 5-fluorouracil, Imiquimod is a topical immunomodulator, RT, Electrodessications, cryosurgery, mohs micrographic surgery
62
squamous cell carcinoma
-hombres mayores
-mayor riesgo de metastasis
-FR: rayos UV, de lesiones precursoras
-acumulacion de mutaciones p53, Wnt, Ras, p 16
-**son placas**
-tx: 5-fluoruoracilo, ablacion con laser, chemical peeles, RT, inhibidores de la tirosina quinasa, **ocal excision and Mohs micrographic surgery (MMS).**
63
melanoma of the external ear
-la mayoria en el helix
-dx: biopsia, rx torax, niveles de lactato deshidrogensasa, TAC, RM
-tx: escicion qx,
64
osteomas
-benigna
-**pediculado, unilateral**
-nucelo fibrovascular rodeado de hueso laminar
65
exostoses
-firme, osea, base ancha (borad-based), de hueso laminar
-lesiones multiples
-FR: agua fria
66
otitis media
-principal FR: disfuncion en tormpa de eustaquio
-**h. influenzae y s. penumoniae y m. catarrhalsi**
inflamacion en la middle ear cleft. hay dos:
-AOM
-OME
67
que musuclo abre la estachian tube
tensor of the elevator palati
-en sanos esta cerrada
-causas de su obstruccion: adenoid hypertrophy, failure of the contraction of tensor veli palating (like in a palsy), cleft palete
68
acute otitis media AOM
-**rapida** aparición de sintomas
-inflamacion secundaria a **infeccion** so hay fever, hyperemia, edema
-timpano red
-**recurrent AOM: >3 en 6 meses o >4 en 12 meses con resolucion entre episodios**
-tx: espontaneo, antibiotico (amoxi)
69
otitis media with effusion OME
-inflamacion con presencia de **effusion**
-tiene air bubbles
-**no sintomas** agudos de infección
-cronica: derrame por > 3 meses
-usually after AOM no resuelta
-my be cancer, so hacer nasalendoscpy
-tx: antibiotic, tympanostomy tubes (en pox con >3 meses y HL) + adenoidectomy (en px mayores a 3 de edad)
70
complicaciones de AOM
-perforacion timpanica
-mastoiditis coalescente aguda
-petrous apicitis (**retro-orbital pain, AOM, and ipsilateral abducens nerve paresis [Gradenigo syndrome]**)
-facial nerve paressi
-laberintitis (sudden sensorineural HL, vertigo and nistagmo, se forma un conducto entre perilymph and the cerebrospinal fluid)
-intracraneal complications
71
Acute coalescent mastoiditis
-complicacion mas comun de AOM
-hay fevers, postauricular erythema tenderness, ear proptosis
-si la infeccion avanza al esternocelidomastoidea, se puede formar absceso profundo --> **Bezold abscess**
-citelli abscess: se expande al digastric muscle
72
intracraneal complications of AOM
-Meningitis (fever, photofobia, fluctuating mental staus, rigidez de nuca, tx: myringotomy)
-Encephalitis
-Otitic hydrocephalus (letargo, papiledema)
-intracraneal abscess (s. aureus, s.pneumonaiea, h. influenzae)
-sigmoid sinus thrombosis ((picket fence fever, torticollis)
*mondid dysplasia (cochlea only 1.5 coils) : meningitis+ congenital senosrineural HL+vestibular symtoms
73
complicaciones de OME
-conductive HL and speech delay
-atelectasis (timpano muy retraida)
-cholesteatoma (primario por atelectasia y secudnario por perforacion timpanica)
74
sensorineural HL
-por perdida de funcion de celulas ciliadas y afectacion del nervio coclear
causas:
-mas comun en adultos es presbycusis
-unilateral: tumor (schawannoma in cerebellum [ataxia, vertigo, HL], meningiomas, etc=
-infections
-TORCH
75
TORCH
toxoplasmosis, otras [sífilis, varicela-zóster], rubéola, citomegalovirus, herpes
76
hair cells
-otoacustic emission: test that measure how the outer HC move
-we have 12, 000 outer HC, and 3,500 inner HC
77
sensorineural HL dx with tuninf fork
-with diapason of 256 hz o 512 hz
-rinne y weber
-normal: AC better then BN
78
rinne
-sensible para conductivas HL
-en el mastoid process
-sensorineural HL: escucha mas AC que BC
-conductive HL: escucha mas por BN que por AC
**negativa indica que AC esta afectada**
**positiva indica que AC esta conservado**
79
weber
-se pone en la cabeza
-se pregunta si escucha en ambos o mejor uno que el otro, se evalua BN
-Conductive HL: se oye mas en el afectado
-sensorineural HL: oye mas el lado sano
*lateralization a cierto lado indica que escucha mas de ese lado
80
etiology of sensorineural HL
-presbycuisis
-infections
teratogenic exposure
-hereditarias: 2/3 so sindormaticas, 1/3 sindromaticas
(genes: GJB2--> conexina 26, o 32delH y 167delT)
81
presbycuisis
-causa mas comun de HL en adultos
-por perida de celulas ciliadas basales
-alelo GRM7
82
prevencion HL sensorineural
-vacunacion contra H. influnzae B, meningitis, measles, mumps, and rubeolla
-evitar ruidos fuertes (earplugs)
83
tx sensorineurla HL
-hearing aids (Lyric, for unilateral: CROS or BAHA)
-implantes cocleares (para sordera profunda)
-brainstem Auditory Implant (px con ambos NC8 por trauam o schawnomas)
-para el tinnitus (abnomral sounds as ringins): masking
84
vertigo
-illusion of movement
-se quejan de dizziness
-presence of nystagmus
*podemos tener nystagmus sin vertigo, pero no vertifo sin nistagmus
-dx: GS videomistagmography (VOR and VER)
85
2 types of vertigo
Peripheral (on the ear), its sudden, the nystagmus its unidirectional
-Benign positionla vertig, meniere diseasem vestibular neuronitits, etc
-Ask for drug use, family history, psychological factors,
Central (on the brain)
- its gradual, the nystagmus its pure vertical multidirectional
86
benign paroxysmal positional vertigo
--1° causa de vertigo
-es repentino, dura seg, cuando giras la cabeza al lado afectado
-sin HL
-nistgmo **latent, geotropic (descendete y rotatorio) and fatigable**
-its cause a semicircular canal has debris either attached to the cupula or free floating in the endolymph
-semicircular mas afectado: posterior, then horizontal y leugo superior
-hay cupulolithiasis y canalolithiasis
87
dx and tx of benign paroxysmal positional vertigo
-MRI a px que no responden a tx
dx: **Dix-hallpike test** (cabeza a 45° y luego lo bajas)
tx: **epley and semontmaneuver**
88
miniere disease/ endolymphatic hydrops
-2° causa de vertigo
-vertigo episdoico de **horas**
-HL fluctuante y unilateral (de low frequencies)
-tinnitus
-plenitud otica
*traes el ataque, se sienten agotados por dias, y pueden tener vomito y nausea
-increased endolymphatic fluid owing to impaired reabsorption in the endolymphatic duct and sac.
89
dx meniere
-audiometria (sensorineural HL de baja frequencia)
-FTA-ABS para descartar sifilis
-RM para descartar patologia retrococlear
-electronistagmografia
-VEMP
-electrocochleography (GS)
90
tx miniere
-dieta restringida en sodio
-diureticos
-ataques: vestibular suppressants (meclizine and diazepam) and antiemetic (prochlorperazine)
-cx: mastoidectomy (open the endolymphatic sac), vestibular nerve section, labyrinthectomy
91
VESTIBULAR NEURONITIS
-3° causa de vertigo
-vertigo agudo
-nistagmo lento: hacia oido lesionado
-nistagmo rapido: hacia oido opuesto
-inestabilidad psotural hacia el oido afectado
-etiology: infeccion viral **(VHS1)**, oclusion vascular (**superior vestibular nerve**), inmune, brainstem or cerebellar stroke (princial de vertigo que drua varios dias)
92
vestibular neuronitis tx
-vestibular suppressants and antiemetics
93
superior semiciruclar canal dehiscence
-fenomeno de tullio (vertigo cuando ruidos fuertes)
-signo de hennebert (vertigo al valsalva)
-They have a piece of bone missing in the semicurlcar canal
-tienen autofonia (se escuchan a si mismos), inner-ear Conductive HL, no tinnitus
-dx: TAC con proyeccion Poschl
94
facial nerve
-Gives the movement of the face
-eye protection, speech articulation, chewing, swallowing, emotional expression
-divide a las parotid glands
-pasa por el fallopian canal
95
bells palsy
-inica con paralisis **unilateral, aguda** < 48 hrs
-asociado con disfucnion de V, VIII, IX, y X
-bell sign: cuando parpadea, un ojo no cierra y se va hacia arriba
96
ramsay hunt sx, VHZ
-asocaida a otalgia y varicela
-se extiende a V, IX, y X y ramas cervicales 2, 3, 4
-mayor incidenai de disfucnión cocleosacular
-meatal foramen like "physiological bottleneck"
97
House Brackman facial paralisis grading system
1. normal
2. complete eye closure easy
3. complete eye closured with effort
4. incomplet eye closure
5. asymmetry at rest
6. no movement
98
dx facial paralisis
1° electromiography
2° electroneurography
>95% necesita descompresion
99
tx paralisisi facial
-steroids: prednisone 1mg/kg/day
-antiviral: acyclovir (in ramsey give it the first hour)
-electrical estimulation, exercises in the mirrori, eye care
-surgery (decompresse the edema)
100
other facila nerve disorders: facial nerve neoplasm
-facial nerve hemangioma: recurrent and progressive more severe unilateral facila palsy
101
other facial nerve dissorders: lyme disease
-por borrelia burgdorferi
-rash adjacent to the site of the tick bite
-eritema migrants
-dx: ELISA para ver IgG y IgM
tx: tetracyclcine (No en niños, dar peniciline)
102
other facial nerve disoirders: AOM and mastoiditis
-acute otitis media and mastoiditis
-chronic otitis media
-necrotizing otitis externa (pathognomonic signs: otoscopic evidence of ear canal inflammation or a breach of the external canal skin [granulation tissue]) (por p. aureiginosa)
103
childohood facila palsy: congenital perinatal facial palsy
-malforaciones que afectan al 1 y 2 arco branquial
-sx de Möbius (dysgenesis at the brainstem) (bilateral, no movement, type 6 brackman) (gen HOX)
-
104
salivary glands
Mayor Salivary Glands (6): 2 parotid glands, 2 submandibular glands, 2 principal sublingual glands
*each one has an acinus (produce saliva)
105
parotid glands
-largest, 25 gr
-lateral an anterior to masseter muscle
-divide by the 7 NC
-Stensen duct pasa
106
submanidbular glands
-2nd largest, 10-15 grs
-divided by the posterior edge of the mylohyoid
-wharton duct
107
sublingual glands
-en la submucosa
-duct of rvinus are mutiple minor ducts
-ducts of bartholin: submandibular ducts + wharton duct
108
Mumps
-most common viral causing parotitis
-bilateral swelling, pain, tenderness, malaise, trismus
-tx: autolimita, NSAIDS
109
acute suppurative sialadenitis
-usually in parotid
-purulent discharge in the duct
-puede haber a la palpación induration and a doughlike consistency of the gland
--submandibular abscess can cause Ludwig
-tx: antibiotics (SARM coverage), sialogogues
110
VIH of the parotid glands
-in the parotid due to presence of intraglandular lymph nodes
-**bilateral** parotid swelling, painless, no fever
dx: CT or USG reveal bilateral multiple cystic masess, serologic test for HIV
tx: drainage, sclerotherapy, gland excision
111
chronic granulomatosis sialadenitis
-acute or chronic uni or bilateral salivary swelling
-minimal pain
-FR: **tuberculosis**
112
sialolithiasis/ hydroxyapatite salivary calculi
-80-90% in submandibular gland
-swelling and pain exacerbated with eating
-hisotry of xerostomia, and sandlike sensation
-**stone in the floor of the mouth**
-tx: intraoral extration (if its on the anterior portion) or surgical excision (stone its too big)
113
Chronic sialadenitis
-decreased production of saliva --> salivary stasis
-inflamacion dolorsa al comer, bilateral
-RF: smoking
-Tx: parotedectomy
114
sjorgren syndrome
-parotid enlargment + xerostomia + keratoconjuntivitis sicca
-SS-A or SS-B autoantiboides
-dx: biopsy >1 focus/4mm^2
-lymphocitic inflitrate in acinars + epimoyoepithelial islands surrounde by lymphoid stroma
-dry eyes. mouth, vagina
115
sialosis
-noninflamatory, enlargement of the parotid and submandibular (bilateral, diffuse)
-FR: alcohol
-dx: acinar enlargemnet
116
parotyd cyst
-**fluctuant** swellign of the salivary glands
-congenital: (brachial cleft anomalies) type 1 (ectodermal) y type2 (mesodermal and ectodermal)
-adquired
117
mucoceles/mocous retentions cyst
-trauma of minor salivary gland ducts
-acumulated mocus secretations
-plane, smooth, bluish
-simple ranula: true cyst
-plunign ranula: pseudocyst
118
xerostomia
dry mouth, alterated taste
119
ptyalism
-saliva hyperproduction
-tx: drying agents or cx of the chroda tympani nerve
120
benign neoplasic disorders
-80% in th parotyd gland
-most common: epithelial tumors
-slow growing, painless, solitary
dx: fine needle aspiration
tx: surgical excision
121
pleomorphic adenoma
-**most common neoplasm of the salivory gland**
-epithelia + myoepithelia +stroma elements
-isolated swelling
122
warthin tumor
-FR: smoking
-only on th parotid gland
-males
-bilaterl and multicentricity
-well defined mass in the posterioinferior segmento del lobulo superior de la parotids
-**oncocytes papilary structures**
123
stridors
inspiratory: obstruction at the larynx or above
expiratory: distal
biphasic: subglottic
124
voice, donde esta la obstruccion
-muffle voice: supraglotic or epiglotis
-hoarse voice: laryngeal
-breathy/cry voice: vocal cord
125
ororfaringeal and nasopharyngeal airways
px < 8 de glasgow
126
tracheotomy
-trasnverse incision 2 anillos abajo de sternal notch. (vertical only in emergency)
127
complicatiosn of tracheotomies
-early: infection, hemorragia, emfisema, penumomediastino, neumotorax, fistual traqueesofagal, RL nerve injury, tube dislacement
-delayed: traqueal innominate artery fistula
-tracheal estenosis
-delayed tracheoesophageal fistual, tracheocutaneo fistula
