Summary

Samenvatting NKO

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Course
Zintuigen 2: NKO en MKA

Institution
Katholieke Universiteit Leuven (KU Leuven)

Book
Zakboek keel-, neus-, oorheelkunde

KU Leuven, 2e master - zintuigen 2 Dit is een samenvatting van het deel 'NKO'. Het bevat alle leerstof van de powerpoints van prof Hens, prof Van Gerven. Sommige delen van het handboekje zijn mee samengevat voor meer uitleg bij bepaalde onderwerpen. Alle modules van Sofia + de vragen (uitz modul...

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Uploaded on January 21, 2025
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Number of pages 144
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Type Summary

nko
neus
keel
oor
farynx
verkoudheid
rinitis
sinusitis
anatomie
fysiologie
otitis media
oorpijn
gehoorverlies
rinne
weber
faryngitis
heesheid
sofia
hoofdhals

Book Title:Zakboek keel-, neus-, oorheelkunde

Author(s):F. Debruyne, H.A.M. Marres

Edition:Unknown
ISBN:9789463441148
Edition:1

Institution
Katholieke Universiteit Leuven (KU Leuven)
Education
Geneeskunde
Course
Zintuigen 2: NKO en MKA

zGNK

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INHOUD

Neus ...................................................................................................................................................1
Hoofdstuk 1: anatomie en onderzoek van de neus .................................................................................1
Anatomie .........................................................................................................................................1
Histologie ........................................................................................................................................2
Respiratoir epitheel .......................................................................................................................2
Olfactoir epitheel ..........................................................................................................................2
Functies...........................................................................................................................................3
Esthetiek ......................................................................................................................................3
Ademhaling ..................................................................................................................................4
Afweer..........................................................................................................................................4
Spraak..........................................................................................................................................4
Onderzoek neus ...............................................................................................................................4
Anterieure rhinoscopie ..................................................................................................................4
Neusendoscopie ..........................................................................................................................5
Test van zwaardemaker .................................................................................................................5
Hoofdstuk 2: aandoeningen van de neus ...............................................................................................6
Aangeboren functionele afwijkingen ..................................................................................................6
Aangeboren structurele afwijkingen...................................................................................................6
Ontsteking uitwendige neus ..............................................................................................................7
Ontsteking inwendige neus ...............................................................................................................7
Infectieuze rinitis of rinosinusitis ....................................................................................................7
Allergische rinitis of rinosinusitis ....................................................................................................9
Niet-infectieuze of niet-allergische rinitis of rinosinusitis ............................................................... 11
Neusobstructie bij volwassenen ...................................................................................................... 12
Unilateraal ................................................................................................................................. 12
Bilateraal .................................................................................................................................... 12
Neusobstructie bij kinderen ............................................................................................................ 13
Reukverlies .................................................................................................................................... 13
Hoofdstuk 3: epistaxis en trauma ........................................................................................................ 15
Epistaxis ........................................................................................................................................ 15
Vascularisatie ............................................................................................................................. 15
Oorzaken .................................................................................................................................... 15
Behandeling ............................................................................................................................... 16
Syndroom van Rendu-Osler-Weber .............................................................................................. 16
Trauma .......................................................................................................................................... 17

Neus

, Diagnose .................................................................................................................................... 17
Behandeling ............................................................................................................................... 18
Farynx .............................................................................................................................................. 19
Hoofdstuk 4: keelpijn ......................................................................................................................... 19
Anatomie en functies van de farynx ................................................................................................. 19
Nasofarynx ................................................................................................................................. 19
Orofarynx ................................................................................................................................... 20
Hypofarynx ................................................................................................................................. 21
Onderzoek farynx ........................................................................................................................... 21
Klinisch onderzoek ...................................................................................................................... 21
Beeldvorming ............................................................................................................................. 21
Aangeboren afwijkingen .................................................................................................................. 22
Acute keelpijn ................................................................................................................................ 22
Acute faryngitis ........................................................................................................................... 22
Acute tonsillitis ........................................................................................................................... 23
Peritonsillair abces ..................................................................................................................... 24
Chronische keelpijn........................................................................................................................ 25
Chronische faryngitis .................................................................................................................. 25
Slikstoornissen .............................................................................................................................. 25
Stoornis in neuro-musculair slikmechanisme ............................................................................... 25
Divertikel van Zenker ................................................................................................................... 25
Farynxtumoren ........................................................................................................................... 26
Hoofdstuk 5: snurken ......................................................................................................................... 28
Prevalentie ..................................................................................................................................... 28
Mechanisme .................................................................................................................................. 28
Gevolgen .................................................................................................................................... 28
Oorzaken .................................................................................................................................... 29
Diagnose ....................................................................................................................................... 29
Behandeling ................................................................................................................................... 30
Larynx............................................................................................................................................... 31
Hoofdstuk 6: anatomie en onderzoek van de larynx .............................................................................. 31
Anatomie larynx ............................................................................................................................. 31
Glottis ........................................................................................................................................ 32
Onderzoek van de larynx ................................................................................................................. 33
Hoofdstuk 7: aandoeningen van de larynx ........................................................................................... 34
Neonatus met inspiratoire stridor .................................................................................................... 34
Kind met inspiratoire stridor ............................................................................................................ 34

Neus

, Acute laryngitis ........................................................................................................................... 34
Acute epiglottitis ......................................................................................................................... 35
Laryngitis subglottica (pseudokroep)............................................................................................ 35
Patiënt met hese stem .................................................................................................................... 36
Acute laryngitis ........................................................................................................................... 36
Chronische laryngitis .................................................................................................................. 36
Leukoplakie ................................................................................................................................ 37
Oedeem van Reinke .................................................................................................................... 37
Stembandnoduli (knobbeltjes) ..................................................................................................... 38
Stembandpoliep ......................................................................................................................... 38
Stembandcyste .......................................................................................................................... 39
Stembandgranuloom .................................................................................................................. 39
Laryngocoele .............................................................................................................................. 39
Papillomatose van larynx............................................................................................................. 40
Maligne larynxtumor ................................................................................................................... 40
Stembandverlamming ................................................................................................................. 42
Trauma....................................................................................................................................... 43
Hals .................................................................................................................................................. 46
Hoofdstuk 8: zwelling in de hals .......................................................................................................... 46
Anatomie ....................................................................................................................................... 46
Ontstekingen ................................................................................................................................. 47
Tumoren ........................................................................................................................................ 47
Benigne – glomustumoren (paragangliomen) ................................................................................ 47
Maligne ...................................................................................................................................... 48
Congenitale cysten en fistels .......................................................................................................... 48
Schildklierzwellingen ...................................................................................................................... 49
Indicaties voor operatie ............................................................................................................... 49
Mogelijke complicaties................................................................................................................ 50
Nazorg na ontslag uit ziekenhuis .................................................................................................. 50
Oor ................................................................................................................................................... 51
Hoofdstuk 9: anatomie en onderzoek van het oor................................................................................. 51
Anatomie ....................................................................................................................................... 51
Fysiologie ...................................................................................................................................... 52
Aangeboren afwijkingen van de oorschelp ....................................................................................... 52
Anatomie oorschelp .................................................................................................................... 52
Aangeboren afwijkingen .............................................................................................................. 52
Onderzoek van oor: otoscopie ......................................................................................................... 53

Neus

, Gehoorgang ................................................................................................................................ 53
Hoofdstuk 10: oorpijn ......................................................................................................................... 55
Kind met oorpijn ............................................................................................................................. 55
Otitis media acuta (OMA) ............................................................................................................ 55
Volwassene met oorpijn ................................................................................................................. 56
Otitis externa .............................................................................................................................. 56
Herpes zoster oticus ................................................................................................................... 57
Myringitis bullosa ........................................................................................................................ 57
Chondrodermatitis nodularis helices ........................................................................................... 57
Basaalcel carcinoma .................................................................................................................. 58
Othematoom .............................................................................................................................. 58
Traumatische trommelvliesperforatie .......................................................................................... 58
Andere ....................................................................................................................................... 59
Chronische oorloop ........................................................................................................................ 60
Chronische mucosale otitis media ............................................................................................... 60
Cholesteatoom ........................................................................................................................... 61
Hoofdstuk 11: slechthorendheid ......................................................................................................... 62
Normaal gehoor ............................................................................................................................. 62
Middenoor .................................................................................................................................. 62
Cochlea ..................................................................................................................................... 62
Gehooronderzoek........................................................................................................................... 62
Stemvorkproeven........................................................................................................................ 62
Toonaudiogram .......................................................................................................................... 63
Spraakaudiogram ....................................................................................................................... 64
Tympanogram............................................................................................................................. 64
Brainstem evoked response audiometry (BERA) ............................................................................ 65
Otoakoestische emissies (OAE) ................................................................................................... 65
Bij jonge kinderen........................................................................................................................ 66
Prelinguaal gehoorverlies ................................................................................................................ 66
Erfelijke slechthorendheid ........................................................................................................... 66
Pre- en perinatale oorzaken ......................................................................................................... 67
Bacteriële meningitis .................................................................................................................. 67
Aanpak prelinguale doofheid ....................................................................................................... 68
Kind met gehoorverlies ................................................................................................................... 68
Otitis media met effusie (OME) .................................................................................................... 68
Volwassene met gehoorverlies ........................................................................................................ 69
Tubadisfunctie ............................................................................................................................ 69

Neus

, Trommelvlies perforatie .............................................................................................................. 70
Ketenonderbreking ..................................................................................................................... 70
Tympanosclerose ....................................................................................................................... 70
Otospongiose: otosclerose ......................................................................................................... 71
Plotse doofheid (sudden deafness) .............................................................................................. 71
Ototoxiciteit ............................................................................................................................... 72
Brughoektumor ........................................................................................................................... 72
Lawaaitrauma............................................................................................................................. 73
Oudere met gehoorverlies ............................................................................................................... 74
Presbyacusis .............................................................................................................................. 74
Samenvatting gehoorverlies ............................................................................................................ 76
Hoofdstuk 12: tinnitus ........................................................................................................................ 78
Objectieve tinnitus ......................................................................................................................... 78
Subjectieve tinnitus ........................................................................................................................ 78
Neurofysiologisch model ............................................................................................................. 79
Hoofdstuk 13: duizeligheid ................................................................................................................. 80
Anatomie van het evenwichtsorgaan ............................................................................................... 80
Fysiologie van het evenwichtsorgaan ............................................................................................... 80
Functies ..................................................................................................................................... 80
Oorzaken ....................................................................................................................................... 81
Vestibulair (vertigo) ..................................................................................................................... 81
Niet-vestibulair (ijlhoofdigheid) .................................................................................................... 82
Anamnese ..................................................................................................................................... 82
Klinisch onderzoek ......................................................................................................................... 82
Hoofdstuk 14: n facialis ...................................................................................................................... 84
Oorzaken ....................................................................................................................................... 84
Anamnese ..................................................................................................................................... 84
Klinisch onderzoek ......................................................................................................................... 85
Aangezichtsverlamming .................................................................................................................. 85
Casussen .......................................................................................................................................... 86
Vragen Sofia ...................................................................................................................................... 92
Module 2: rinitis en sinusitis ............................................................................................................ 92
Module 3: neusobstructie ............................................................................................................... 97
Module 4: epistaxis en trauma ......................................................................................................... 99
Module 5: reukverlies.................................................................................................................... 101
Module 6: keelpijn ........................................................................................................................ 102
Module 7: snurken ........................................................................................................................ 105

Neus

, Module 8: stemklachten ............................................................................................................... 107
Module 9: stridor .......................................................................................................................... 114
Module 11: zwelling in de hals ....................................................................................................... 118
Module 12: oorpijn........................................................................................................................ 121
Module 13: gehoorverlies .............................................................................................................. 127
Module 14: audiometrie ................................................................................................................ 132
Module 15: duizeligheid ................................................................................................................ 135
Module 16: n. facialis .................................................................................................................... 137

Neus

,NEUS
HOOFDSTUK 1: ANATOMIE EN ONDERZOEK VAN DE NEUS

ANATOMIE

Opbouw binnenkant

1. Lamina cribrosa
2. Concha nasalis superior
3. Sinus sphenoidalis
4. Tuba auditiva
5. Concha nasalis media
6. Concha nasalis inferior
7. Onderste neusgang
8. Middenste neusgang
9. Bovenste neusgang

- Vestibulum nasi
- Lamina quadrangularis
- Lamina perpendicularis ethmoid
- Vomer
- Choanae = overgang tussen neusholte en nasofarynx
- Nares = neusgaten
- Neusseptum = neus tussenschot
o Scheiding van 2 neuscaviteiten (cavum nasi) → zorgt voor lamellaire stroom
o Indien opening: ontstaan turbulente stroom
- Palatum durum = harde verhemelte (neusbodem)
- Palatum molle = zachte verhemelte (posterieur)

Opbouw buitenkant

- Bovenste 1/3: benig deel = ossa nasalia
- Onderste 2/3: kraakbenig deel = triangulaire + alaire kraakbeenderen

Neus 1

,HISTOLOGIE

- Vestibulum nasi (opp): meerlagig plaveiselepitheel (met haartjes)
- Cavum nasi (diep): respiratoir epitheel
- Cavum nasi (hoog): olfactoir epitheel

RESPIRATOIR EPITHEEL
- Trilhaarcellen
- Basale cellen: regeneratie van epitheel
- Slijmbekercellen: mucusproductie (samen met sub-epitheliale klieren)

Mucociliair transport

- Gellaag = oppervlakkige, viskeuze laag
- Sollaag = diepe, vloeibare laag
- Trilharen bewegen viskeuze bovenlaag voort via trilhaarslagen
o Effectieve slag: top van trilhaar raakt gellaag van slijm
o Herstelfase: verslapte haar trekt zich terug binnen de sollaag
o Alle trilharen slaan gecoördineerd in zelfde ritme en zelfde richting
o Trilhaar gaat terug ontspannen en naar oorspronkelijke positie
 Slijm wordt vanuit de sinussen via welbepaalde patronen naar de neusholte getransporteerd
(anterieur → posterieur)
 Vanuit neusholte verder transport naar farynx en afvoer via spijsverteringsstelsel

Pathologie: primaire ciliaire dyskinesie

OLFACTOIR EPITHEEL
- Lamina cribrosa (bot in schedelbasis met gaatjes)
- Bulbus olfactorius
- Fila olfactoria
- N olfactorius (n I)
- Olfactoir epitheel

Opbouw

- Zintuigcellen = olfactorische receptorcellen
o Gespecialiseerde neuronen: detecteren odoranten
▪ Via cilia in slijmlaag binden met odoranten
- Basale cellen = stamcellen
o Regeneratie van zintuigcellen

Hoofdstuk 1: anatomie en onderzoek van de neus 2

, - Steuncellen
o Ondersteuning van zintuigcellen
→ structurele stabiliteit + stofwisseling
- Klieren van Bowman
o Afscheiden van slijmlaag waarin geurstoffen oplossen
o Essentieel voor detectie door zintuigcellen

Proces geurperceptie

1. Geurmoleculen bereiken het olfactorisch epitheel via de ingeademde lucht
2. In de slijmlaag binden de moleculen aan specifieke receptoren op de cilia van de zintuigcellen
3. De binding activeert een signaaltransductieproces in de zintuigcellen, wat leidt tot een
actiepotentiaal (elektrisch signaal)
4. Dit signaal wordt doorgegeven via de zenuwvezels van de olfactorische cellen (= fila olfactoria),
die door de lamina cribrosa naar de bulbus olfactorius gaan
5. In de bulbus olfactorius worden de signalen verder verwerkt en doorgestuurd naar
hersengebieden die verantwoordelijk zijn voor geurherkenning en -interpretatie
 Cruciaal voor het waarnemen van geuren, wat bijdraagt aan smaakperceptie, herinneringen en emoties
 Ook retrograad ruiken: bij kauwen komen geurstoffen vrij vanuit de mond

Anosmie = verlies van reukzin

- Door schade aan olfactoir epitheel of lamina cribrosa
o Bv craniocerebraal trauma: brein gaat naar voor bewegen → axonen zijn fragiel en
worden door shear stress afgerukt → transiënt of permanent reukverlies
o Pas later opgemerkt door patiënt, want in acute fase wordt vooral levensreddend gehandeld
- Smaakzin is nog intact, maar vaak klachten van ‘niet meer kunnen proeven’ door het nauw
verband met olfactoir epitheel

FUNCTIES
Functies neus

- Esthetiek
- Ademhaling
- Afweer tegen infecties
- Reuk en smaak
- Spraak

Functies neusbijholten (sinussen)

- Hersenen lichter maken?
- Kreukelzone vormen om hersenen te beschermen?

ESTHETIEK
- Neus heeft centrale positie tussen ogen en mond → esthetisch voor aangezicht
- Neuscorrectie een van de meest gevraagde esthetische ingrepen

Hoofdstuk 1: anatomie en onderzoek van de neus 3

, ADEMHALING
- Efficiënte airconditioning van ingeademde lucht
o Verwarming
▪ Door grote inwendige oppervlak van neusmucosa
▪ Door rijke bloedvoorziening in submucosa
o Bevochtiging
▪ Verzadiging van ingeademde lucht met waterdamp
▪ 500 ml waterdamp verliezen per dag via neus
(afhankelijk van omgeving)
o Reiniging
▪ Grotere partikels: door haren in vestibulum
▪ Kleinere partikels: vasthouden in slijm en afvoer via mucociliair transport
- Luchtweerstand
o Door vullingsgraad van vasculaire plexussen (in onderste neusschelp)
o Controle autonoom ZS
▪ Neus tijdens slaap minder doorgankelijk
▪ Neus tijdens dag meer doorgankelijk
o Zwelling van neusholten (li en re) alterneert
→ telkens een van beide meer doorgankelijk
▪ Afwisselen elke 1-5 uur
▪ Totale weerstand blijft gelijk = neuscyclus

DOOR REINIGING VAN INGEADEMDE LUCHT IS NEUSADEMHALING GEZONDER DAN MONDADEMHALING. BV
BIJ INSPANNINGSASTMA ZORGT NEUSADEMHALING VOOR MINDER BRONCHOCONSTRICTIE

AFWEER
- Specifieke immuunreacties in neusmucosa (want bevatten immuuncellen)
o Immunoglobulines
o Lymfocyten
o Mastcellen

SPRAAK
- Rol als klankkast bij uitspreken van nasale medeklinkers (M, N, NG)
- Enige klanken waarbij nasofarynx niet aansluit op weke verhemelte → lucht wordt tijdens spreken
via neus uitgeademd en niet via mond

Hyponasaliteit = moeilijker deze klanken uitspreken bij neusobstructie

ONDERZOEK NEUS

ANTERIEURE RHINOSCOPIE
- Benen van neus speculum verticaal openen ( horizontaal: pijn)
- Anterieure rhinoscopie van re neusgang
o Neusseptum
o Kop van onderste neusschelp

Hoofdstuk 1: anatomie en onderzoek van de neus 4

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