Upper Respiratory *Dr. Howell*

Question 1

Whisper Test

Answer 1

Exhale and whisper a
combination of consonants
and numbers (3-U-1); use a
different combination for the
other ear; Consonants use
higher frequencies than
vowels

Ask the patient to repeat the
sequence

Question 2

Whisper test results

Answer 2

 Normal: Correctly repeats
initial sequence

 Normal: patient repeats at
least 3 of the 6 correctly

 Abnormal result: 4 of the 6
number/letter sequence is
incorrect

 Presbycusis: loss of higher
frequency; common in older
adults

 This test is 90-100%
sensitive and 70-87%
specific to detect hearing
loss of >30 decibels

Question 3

Sound travels through air

 Vibrations of the TM are transmitted through the ossicles to the cochlea

 Anything that changes this portion accounts for a __________
loss.

 Cerumen, tympanic perforation, middle ear effusion

Answer 3

Sound travels through air

 Vibrations of the TM are transmitted through the ossicles to the cochlea

 Anything that changes this portion accounts for a conductive hearing loss
loss.

 Cerumen, tympanic perforation, middle ear effusion

Question 4

The ______ and the ________ transmit the impulses to the brain

 Anything that changes this phase accounts for a _________ hearing loss.

Answer 4

The cochlea and the cochlear nerve transmit the impulses to the brain

 Anything that changes this phase accounts for a Sensorineural hearing loss.

Question 5

Weber Test

Answer 5

Place tuning fork on forehead or top of head

 Ask the patient to identify if they hear it on one side or both

Question 6

Rinne Test

Answer 6

Place tuning fork on mastoid process

 When the patient can no longer hear the vibration quickly put it in front of the ear

 NORMAL: AC>BC

 If AC=BC or BC>AC

then there is a conductive loss

Question 7

After using _____ test, use _____ test to further evaluate the type of hearing loss.

Answer 7

After using Weber test**, use **Rinne test to further evaluate the type of hearing loss.

Question 8

________ common boney growth
of hard palate

Answer 8

Torus Palantinus:
common boney growth
of hard palate

Question 9

Obstruction of _________ causes fluid build
up in middle ear.

Answer 9

Obstruction of eustacian tube causes fluid build
up in middle ear.

Question 10

Otitis Media

Answer 10

Presents with ear pain

 Usually unilateral

 Associated with or preceded by cold symptoms

 May have decreased hearing on affected side

 What kind of hearing loss?

 May have fever

Question 11

Unilateral ear pain

 Often has purulent drainage

 Exquisite pain with palpation of tragus, pinna or auricle

 Moisture becomes trapped in canal allowing for overgrowth of normal flora

 Increased risk when ear canals are cleaned with cotton swabs—removes protective cerumen coating

Answer 11

Otitis Externa

AKA Swimmers Ear

Question 12

Presents with facial pressure and pain

 Unilateral>bilateral

 Preceded/associated with cold/uri symptoms

 Cold symptoms get better then onset of unilateral sinus pressure

 May or may not have fever

Answer 12

Bacterial Sinusitis

Question 13

Group A streptococcus: sore throat, fever, lymphadenopathy (ant cervical & tonsilar), pain with swallowing

Answer 13

• Bacterial
• Tonsillitis

Question 14

-external or middle ear problem

Answer 14

Conductive hearing loss

Question 15

–inner ear, cochlear nerve or central brain connections problem

Answer 15

Sensorineural loss

Question 16

Test for lateralization

Answer 16

Weber Test

Normal: sound lateralizes to both ears equally

Not normal: If sound lateralizes to one ear, it is either conduction loss
in that ear or sensorineural loss in the opposite ear.

Question 17

Compares air and bone conduction

Answer 17

Rinne

-Vibrating tuning fork placed on mastoid bone behind ear &
level with the canal. When patient no longer hears sound,
quickly place fork close to ear canal & inquire if can hear
the sound & for how long they hear it.

 Normal: AC>BC

 If AC=BC or BC>AC there is conductive loss to that ear

 If weber was abnormal and Rinne was normal, suspect
sensorineural loss in the opposite ear.

Question 18

_____ sinuses do not open until after 7 years
old

Answer 18

Frontal sinuses

Question 19

Border around lips is called _____ _____

Answer 19

_Vermillion border _

Question 20

Aphthous ulcers

Answer 20

canker sores

Question 21

B12 or iron deficiency

Answer 21

Cheilitis

Question 22

red cracks at corners of mouth

Answer 22

candidisis

Question 23

swelling or ulcerations gums

Answer 23

Gingivitis