clinical skills of ENT课件.pptVIP

Weber test--lateralization of hearing 傳音性聽力障礙Conductive hearing loss 聲音轉移(lateralized) 到病耳 感音性聽力障礙Sensorineural hearing loss 聲音轉移(lateralized) 到正常耳 音叉試驗—Weber test 傳音性聽力障礙 感音性聽力障礙 正常耳 Rinne(-): BCAC 傳音性聽力障礙 Rinne(+): AC ≧ BC 正常或mild to moderate 感音性聽力障礙 Rinne test—比較 AC 與 BC Rinne test—比較 AC 與 BC Rinne(-): BCAC 傳音性聽力障礙 Rinne(+): AC ≧ BC 正常或mild to moderate 感音性聽力障礙 THANKS GOOD LUCK Clinical skills of ear, nose and throat Basic equipment and technique耳鼻喉科的基本器械與技巧 head mirror(頭鏡)—凹面鏡 直徑 9cm, 中心孔 1.3 cm, 聚光距離 36cm light source(光源) 150 Watt 燈泡 Position(姿勢): as comfortable as possible Head mirror頭鏡 Head light 頭燈 攜帶方便 便宜 構造簡單, 故障少 無放大效果 技術問題 較笨重 昂貴 維修 具放大效果 易上手 EAR 之局部治療 Dry and Clean Instrument Preparations Gently Safe Microscope 耳鏡檢查 光源(light ) 耳鏡大小(speculum size ) 弄直外耳道(straighten ear canal ) adults - up and back children - down and back Insert GENTLY 耳膜的評估—耳鏡(otoscope) 成人—往後上拉 幼兒— 往下拉 氣導Air conduction (AC) 與骨導 Bone conduction(BC) 氣導: 經由一般外耳?中耳?內耳的傳音路徑 骨導: 直接經由頭骨震動耳蝸 正常：氣導優於骨導 (AC ≧BC) Discharge Crusts Suction (Valsalva) Inside out Antibiotic ear solution Preparations: H2O2, BAAG, BAG, Bonain, Ceruminal solution NOSE: inspection Instrument: Nasal speculum, Bayonet forceps Preparations Gently Otoscope suction for infants and children Sinoscope 下鼻甲(I) 中鼻甲(M) 各種鼻中隔彎曲 後鼻孔 鼻息肉 I I I M M Preparations Normal saline Xylocain ( 1%, 2%, 4%) Bosmin Cocain ( 2%, 5%) Ephedrine compound AgNO3, TAA THROAT: inspection Instruments Tongue depressor Indirect nasopharyngoscope Indirect laryngoscope Fiberoptic nasopharyngoscopy and laryngoscopy 口腔的檢查與評估 Indirect nasopharyngoscopy 深部咽喉的檢查 Indirect laryngoscopy Preparations Astringents: AgNO3 solution (3%) Protargol solution Lugol solution Mandel solution Menthal alcohol 1% ZnCl2 solution 頸部 胸鎖乳突肌Sternocleidomastoid muscle 前三角區(Anterior triangle)