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MEDICAL TERMINOLOGY: Chapter 16 Otolaryngology

Objectives of Chapter 16: 1. Identify structures of the ears, nose, and throat (ENT) system. 2. Describe the process of hearing. 3. Describe common ENT diseases, laboratory and diagnostic procedures, medical and surgical procedures, and drugs. 4. Form the plural and adjective forms of nouns related to otolaryngology. 5. Give the meanings of word parts and abbreviations related to otolaryngology. 6. Divide otolaryngology words and build otolaryngology words. 7. Spell and pronounce otolaryngology words. 8. Research sound-alike and other otolaryngology words. 9. Analyze the medical content and meaning of otolaryngology reports.

Notes: Anatomy and Physiology The ears, nose, and throat (ENT) system is a compact body system that is contained entirely in the head and neck. The head contains the external and internal structures of the ears, nose, and mouth, and the internal structures of the sinuses. The neck contains the internal structures of the pharynx and larynx. The ENT system has several functions. It shares some structures with the gastrointestinal system and the respiratory system, and it serves as a passageway for both food and air. The ENT system also contains lymphoid tissue that functions as part of the immune response. The body’s senses of hearing and smell are also part of the ENT system. The structures of the ENT system (along with those of the respiratory system) are used to generate speech.

Anatomy of the ENT System External Ear The external ear is the auricle or pinna. The helix is the outer rim of tissue and cartilage that forms a C and ends at the earlobe. The external auditory meatus is the opening that leads into the external auditory canal (EAC). The tragus is the triangular cartilage anterior to the meatus. The canal has glands that secrete cerumen, a waxy, sticky substance that traps dirt and has an antibiotic action against microorganisms that enter the canal. At the end of the canal is the tympanic membrane (TM) or eardrum, a thin membrane that divides the external ear from the middle ear. Just behind the external ear is the mastoid process, a bony projection of the temporal bone of the cranium. The mastoid process is not a solid bone; it contains tiny cavities filled with air.

Middle Ear The middle ear is a hollow area inside the temporal bone of the cranium. The middle ear contains three tiny bones: the malleus, incus, and stapes, collectively known as the ossicles . These bones are connected to each other by tiny ligaments to form the ossicular chain. The first bone, the malleus, is shaped like and is known as the hammer. It is connected to the tympanic membrane. Because the tympanic membrane is nearly transparent, the malleus can be seen through it. The second bone, the incus, is shaped like and is known as the anvil. The third bone, the stapes, is shaped like and is known as the stirrup. The stapes fits into an opening in the temporal bone known as the oval window. The -middle ear is connected to the nasopharynx by the eustachian tube. The eustachian tube allows air pressure in the middle ear to equalize with air pressure in the nose and throat and outside the body.

Inner Ear The temporal bone of the cranium divides the middle ear from the inner ear, with openings of the oval window (to the stirrup) and the round window (to the vestibule) connecting the two cavities. The inner ear cavity contains three fluid-filled structures: the vestibule, the semicircular canals, and the cochlea. The vestibule is the entrance to the inner ear. The superior part of the vestibule becomes the three

semicircular canals. Each of these canals is oriented in a different plane: horizontally, vertically, and obliquely. When you move your head, the semicircular canals send information to the brain about the position of your head and this helps you keep your balance. The inferior part of the vestibule becomes the coiled cochlea. The cochlea sends sensory information to the brain about the frequency (pitch) and intensity (loudness) of the sound waves entering the ear. Together, all of the structures of the inner ear are known as the labyrinth .

External Nose and Mouth The external nose is supported by the nasal bone, which forms the bridge of the nose and the dorsum. At the nasal tip, the nasal bone becomes cartilage. The nares are the external openings or nostrils. The flared cartilage on each side of the nostril is a nasal ala. The lips, cheeks, and chin are supported by the maxilla (upper jawbone) and mandible (lower jawbone). The nasolabial fold is the crease in the cheek that goes from the nose to the lip at the corner of the mouth. The philtrum is the vertical groove in the skin of the upper lip. The chin is also known as the mentum.

Sinuses A sinus is a hollow cavity within a bone that is lined with a mucous membrane. There are four pairs of sinuses, each located within the skull bone for which they are named. The frontal sinuses are within the frontal bone, just above each eyebrow. The maxillary sinuses , the largest of the sinuses, are within each maxilla on either side of the nose. The ethmoid sinuses , which are groups of small air cells rather than a hollow cavity, are within the ethmoid bone, between the nose and the eyes. The sphenoid sinuses are

within the sphenoid bone, posterior to the nasal cavity and near the pituitary gland of the brain. Together, these sinuses are known as the paranasal sinuses .

Nasal Cavity The nasal septum is a vertical wall of cartilage that divides the nasal cavity into right and left sides. In the posterior nasal cavity, this cartilage becomes the ethmoid bone of the cranium. The walls of the nasal cavity are formed by the ethmoid bone of the cranium and maxilla of the upper jaw. Along the walls are three long, bony projections—the superior, middle, and inferior turbinates. These are also known as the nasal conchae. They are covered with mucosa, a mucous membrane that continuously -produces mucus . They divide and slow down inhaled air and give it warmth and moisture.

Oral Cavity

The oral cavity or mouth contains the tongue, hard palate, soft palate, uvula, and teeth. The oral cavity is lined with oral mucosa; it is known as buccal mucosa in the cheek area. The hard palate or roof of the mouth divides the oral cavity from the nasal cavity. The hard palate is made up of the maxilla at the front of the mouth, then the palatine bone, and the vomer bone at the back. The hard palate transitions to the tissue of the soft palate and the uvula, which is the fleshy hanging part of the soft palate. The mandible forms the floor of the mouth, and the base of the tongue is attached to it. Each end of the mandible is attached to the temporal bone of the cranium at the moveable temporomandibular joint (TMJ). The salivary glands secrete saliva into the oral cavity. Submental lymph nodes under the chin contain lymphocytes and macrophages that attack bacteria and viruses in the oral cavity.

Pharynx The pharynx or throat is divided into three areas: the nasopharynx, the oropharynx, and the laryngopharynx. As the nasal cavity continues posteriorly, it becomes the nasopharynx. The eustachian tubes from the middle ears connect with the nasopharynx. The roof and walls of the nasopharynx contain a collection of lymphoid tissue known as the adenoids . The oropharynx is the middle portion of the throat. It contains the palatine tonsils, which are lymphoid tissue on either side of the soft palate. The laryngopharynx extends from the base of the tongue to the entrances to the esophagus and larynx. The laryngopharynx contains the lingual tonsils on either side of the base of the tongue. The adenoids and tonsils are part of the lymphatic system, and they function in the immune response. They contain lymphocytes and macrophages that attack bacteria and viruses in the oral cavity and throat.

Larynx At its inferior end, the pharynx divides into the larynx that leads to the trachea and the esophagus that leads to the stomach. The larynx, or voice box, is a short, triangular structure. It is surrounded by cartilage that can be clearly seen at the front of the neck as the laryngeal prominence (Adam’s apple). At the superior end of the larynx is the epiglottis, a lid-like structure. In the middle of the larynx is the glottis, a V-shaped structure of cartilage, ligaments, and the vocal cords. When you swallow, the larynx

moves up and closes against the epiglottis to keep food from entering the lungs. Otherwise, the larynx remains open during breathing, speaking, or singing to allow air to pass over the vocal cords. The vocal cords relax or tighten to lower or raise the pitch of the voice. Men have a large larynx and long vocal cords that vibrate at a slow frequency and produce a lower-pitched voice. Women have shorter vocal cords and a higher-pitched voice. The volume of air from the lungs affects how loud or soft the voice is. The voice also resonates in the sinuses, adding fullness to the sound.

Physiology of the Sense of Hearing The external ear captures sound waves. They travel through the external auditory canal to the tympanic membrane. There, the sound waves are converted to mechanical motion as they cause the tympanic membrane to move. As the tympanic membrane moves, it moves the malleus, the incus, and then the stapes of the middle ear. The stapes transmits this mechanical motion to the oval window. This causes the fluid-filled vestibule of the inner ear to vibrate. This vibration is transmitted to the cochlea. Down the length of the cochlea, tiny hair cells detect the loudness (intensity) and pitch (frequency) of the sound. The loudness of the sound correlates to the degree to which the hair cells are distorted. The various frequencies in the sound correlate to the location in the cochlea of the stimulated hairs. (When the vibration has traveled through the cochlea, it comes back to the vestibule where it causes the round window to bulge. The round window acts as a safety valve in the otherwise rigid bony walls of the inner ear.) Then the loudness of the sound and its pitch (as detected by the tiny hair cells of the cochlea) travel as nerve impulses through the cochlear branch of the vestibulocochlear nerve (cranial nerve VIII) to the medulla oblongata in the brainstem. From there, the impulses travel to the auditory cortex in each temporal lobe of the brain to be interpreted for the sense of hearing.

Diseases Ears Word or Phrase Acoustic Neuroma

Cerumen Impaction

Description Benign (not cancerous) tumor of the vestibulocochlear nerve. Depending on the location of the tumor, it can cause pain, dizziness, or hearing loss. Treatment: Surgical removal. Cerumen (earwax), epithelial cells, and hair form a mass that occludes the external auditory canal. It occurs most commonly in older adults because of dry skin, thick cerumen, growth of hair in the external auditory canal and/or the presence of a hearing aid. Treatment: Ear drops to soften the cerumen and irrigation with a saline solution and bulb syringe to wash it out; removal with forceps

Cholesteatoma

Hearing Loss

Hemotympanum

Labyrinthitis

Benign, slow-growing tumor in the middle ear. It contains cholesterol deposits and epithelial cells. It can eventually destroy the bones of the middle ear and extend into the air cells within the mastoid process. The underlying cause usually is chronic otitis media. Treatment: Treat the underlying otitis media. Surgical removal of the cholesteatoma. Progressive, permanent decline in the ability to hear sounds in one or both ears. A foreign body or infection in the external auditory canal, perforation of the tympanic membrane, fluid behind the tympanic membrane, degeneration of the ossicles, or otosclerosis (see description on page 796) of the middle ear keep sound waves from reaching the inner ear. These are types of conductive hearing loss. Other causes of hearing loss include disease of the cochlea, damage to the inner ear from excessive noise, or changes due to aging that hinder the production or sending of sensory impulses to the vestibulocochlear nerve. These are types of sensorineural hearing loss. A combination of both conductive and sensorineural hearing loss is a mixed hearing loss. Low-frequency hearing loss is the inability to hear low-pitched sounds. High-frequency hearing loss is the inability to hear high-pitched sounds. Presbycusis is bilateral hearing loss due to aging. Patients with a hearing loss are said to be hearing impaired or hard of hearing. Total deafness is known as anakusis. Deaf-mutism is deafness coupled with the inability to speak. Treatment: Correct the underlying cause; hearing aid; in some cases a cochlear implant may be needed. Blood in the middle ear behind the tympanic membrane. It can be caused by infection or trauma. Treatment: Antibiotic drugs to treat an infection. Bacterial or viral infection of the semicircular canals, causing severe vertigo.

Meniere’s Disease

Motion Sickness

Otitis Externa

Otitis Media

Treatment: Antibiotic drug for a bacterial infection. Viruses are not sensitive to antibiotic drugs. Edema of the semicircular canals with destruction of the cochlea, causing tinnitus, vertigo, hearing loss, and nystagmus. It can be caused by head trauma or middle ear infection. Treatment: Correct the underlying cause. There is dysequilibrium with headache, dizziness, nausea, and vomiting. It is caused by riding in a car, boat, or airplane. Treatment: Drug to treat motion sickness. Bacterial infection of the external auditory canal. There is throbbing earache pain (otalgia) with a swollen, red canal and serous or purulent drainage. It is caused by a foreign body in the ear or by the patient scratching or probing inside the ear. In swimmers whose ear canals are rubbed by ear plugs or softened by exposure to water, it is known as swimmer’s ear . Treatment: Correct the underlying cause; topical or oral antibiotic drug Acute or chronic bacterial infection of the middle ear. There is myringitis (redness and inflammation of the tympanic membrane), otalgia, a feeling of pressure, and bulging of the tympanic membrane. There can be an effusion (a collection of fluid behind the tympanic membrane that creates an air-fluid level). This fluid can be serous (clear) or suppurative (with pus). In children, the effusion can be so thick that it is called glue ear . Chronic otitis media can cause a perforation of the tympanic membrane. The mastoid process of the temporal bone can also become infected (mastoiditis). Otitis media is common in young children because the short eustachian tube is in a nearly horizontal position that allows bacteria to enter from the nasopharynx. If otitis media is left untreated, the tympanic membrane can rupture or the bones of the middle ear can degenerate, resulting in permanent hearing loss. Treatment: Antibiotic drug; surgery to insert tubes to drain the middle ear.

Otorrhea

Otosclerosis

Ruptured Tympanic Membrane

Tinnitus

Vertigo

Drainage of serous fluid or pus from the ear. It can be caused by otitis externa or otitis media (with a ruptured tympanic membrane). It can also be caused by a fracture of the temporal bone of the cranium with leakage of cerebrospinal fluid into the ear. Treatment: Correct the underlying cause. Abnormal deposits of bone in the middle ear, particularly between the stapes and the oval window. The stapes becomes immoveable, causing conductive hearing loss. Certain families have a genetic predisposition to develop otosclerosis. Treatment: Hearing aid, stapedectomy. Tear in the tympanic membrane due to excessive pressure or infection. In pilots and deep sea divers, unequal air pressure in the middle ear compared to the surrounding air or water pressure can rupture the tympanic membrane. Treatment: Tympanoplasty. Sounds (buzzing, ringing, hissing, or roaring) that are heard constantly or intermittently in one or both ears, especially in a quiet environment. It is caused by repeated exposure to excessive noise and is associated with hearing loss. It can also be related to the overuse of aspirin. Treatment: Soft background noise (hum of a fan or a device that generates “white noise”) to mask tinnitus and allow the patient to sleep. Sensation of motion and dizziness when the body is not moving. It is caused by a head cold, middle ear or inner ear infection, head trauma, degenerative changes of the semicircular canals, labyrinthitis, or Meniere’s disease. Treatment: Correct the underlying cause.

Sinuses, Nose, and Nasal Cavity Word or Phrase Allergic Rhinitis

Description Allergic symptoms in the nose. In response to an inhaled antigen (pollen, dust, animal dander, mold), the immune system produces histamine.

This causes nasal stuffiness, sneezing, rhinorrhea (clear mucus discharge from the nose), hypertrophy (enlargement) of the turbinates in the nose with red, edematous, and boggy mucous membranes, and postnasal drip (PND). When this occurs in spring or fall and coincides with the blooming of certain trees and plants (grasses, maple trees, roses, goldenrod), it is known as seasonal allergy or hay fever.

Anosmia

Epistaxis

Polyp

Rhinophyma

Septal Deviation

Sinusitis

Treatment: Antihistamine drug, decongestant drug, corticosteroid drug. The temporary or permanent loss of the sense of smell. It is most often caused by head trauma. Treatment: Correct the underlying cause. Sudden, sometimes severe bleeding from the nose. It is due to irritation or dryness of the nasal mucosa and the rupture of a small artery, or it can be caused by trauma to the nose. It is known as a nosebleed. Treatment: Pack the nostril with gauze or use cautery to stop the bleeding. Benign growth of the mucous membrane in the nose or sinuses. A single polyp may grow large enough to limit the flow of air, or there may be several polyps. Treatment: Polypectomy. Redness and hypertrophy (enlargement) of the nose with small-to-large, irregular lumps, usually in men. It is caused by the increased number of sebaceous glands associated with acne rosacea of the skin. Treatment: Topical drug for acne rosacea. Lateral displacement of the nasal septum, significantly narrowing one nasal airway. This can be a congenital condition or it can be caused by trauma to the nose. Treatment: Surgical correction (septoplasty). Acute or chronic bacterial infection in one or more of the sinus cavities. There is headache, pain in the forehead or cheekbones over the sinus, postnasal drainage, fatigue, and fever.

Pansinusitis involves all the sinuses or all of the sinuses on one side of the face.

Upper Respiratory Infection

Treatment: Antibiotic drug; endoscopic sinus surgery. Bacterial or viral infection of the nose that can spread to the throat and ears. The nose is a part of the respiratory system as well as the ENT system. This is also known as a common cold or head cold. Treatment: Antibiotic drug for a bacterial infection.

Mouth, Oral Cavity, Pharynx, and Neck Word or Phrase Cancer of the Mouth and Neck

Cervical Lymphadenopathy

Cleft Lip and Palate

Cold Sores

Description Malignant tumor (carcinoma) of squamous epithelial cells in the oral cavity (lips, tongue, gums, cheeks), throat, or larynx. Smoking and using smokeless chewing tobacco can cause this. Treatment: Surgery to remove the tongue (glossectomy) or larynx (laryngectomy), or jawbone and neck muscles (radical neck dissection). Enlargement of the lymph nodes in the neck. It is caused by infection, cancer, or the spread of a cancerous tumor from another site. Treatment: Correct the underlying cause. Congenital deformity in which the lip or the bones of the right and left maxilla fail to join in the center before birth. The resulting cleft in the skin and bone can be unilateral or...