Dr. Maha Al-Sedik. Objectives: Anatomy, physiology of the nose. Patient Assessment. Pathophysiology of the nose.

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:

o Suspected nasal fractures.

o 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

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.

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.

Anatomy and Physiology of the throat

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.

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.

1. Arytenoid: anchor the vocal cords.

2. Corniculate.

3. 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.

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.

Management:

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.

Back slapsHeimlich Maneuver

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.

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

Swelling and inflammation of the larynx

Causes may include:

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.

Swelling and

inflammation of the

tonsils.

Usually caused by viral

infections.

Can also be caused by

bacteria.

Tonsillitis

Assessment and management

◦ Symptoms:

Sore throat

Difficulty swallowing

◦ Signs:

White or yellow coating or patches

Swollen tonsils

Fever

Sore throat

Collection of infected

material around the

tonsils.

Peritonsillar Abscess

Symptoms may include:

Facial swelling.

Inability to swallow.

Sore throat.

Difficulty swallowing.

Treatment:

Treatment involves antibiotics and draining the

abscess.

Transport patient to the hospital.