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Eye, Ear & Maxillofacial Pathologies

Eye, Ear & Maxillofacial Pathologies. Kimberly Lakhan, PA-C SMDC ENT. Eye Anatomy. How to Use a Ophthalmoscope. Preparing your Equipment. Check the battery Cover off Familiarize self with dials & levers, set all to “0” Light should be bright, round, white Turn light down, dim.

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Eye, Ear & Maxillofacial Pathologies

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  1. Eye, Ear & Maxillofacial Pathologies Kimberly Lakhan, PA-C SMDC ENT

  2. Eye Anatomy

  3. How to Use a Ophthalmoscope

  4. Preparing your Equipment • Check the battery • Cover off • Familiarize self with dials & levers, set all to “0” • Light should be bright, round, white • Turn light down, dim

  5. Preparing your patient • Warn then about the light • Position – sitting, looking on fixed spot over your shoulder - slightly out (Be Specific)

  6. Your Position • Eye to Eye (Left to left, Right to Right) • Try and keep your other eye open • Begin at arm’s length by shining light into the patient’s pupil. • Continue to move forward until your forehead rests on your thumb. The closer you are the wider your field of view. • Turn dial to focus on disc

  7. What am I looking for? • Red reflex • Optic disc • Vessels • Macula

  8. Eye Pathology • Conjunctivitis • Hyphema • Lacerated Eye Lid • Corneal Abrasion • Orbital Fx • Ruptured Globe • Detached Retina • Strabismus • Aniscoria • Stye • Raccoon Eyes

  9. Conjunctivitis

  10. Hyphema

  11. Lacerated Eyelid

  12. Corneal Abrasion

  13. Orbital Fracture (“Blow-Out”)

  14. Rupture of Globe

  15. Retinal Detachment

  16. Strabismus

  17. Anisocoria

  18. Stye

  19. Raccoon Eyes • Bilateral Temporal Bone Fractures • Also look for bleeding from the ear canals and/or a hemotympanum (blood behind the ear drum)

  20. Eye Referral • Embedded object • Decreased or partial vision • Hyphema • Diplopia • Laceration of eyelid • Strabismus • Nystagmus • Inverted or everted eye • Eye swollen shut • Abnormal pupil size

  21. Nasal Anatomy

  22. Nasal Anatomy

  23. Nasal Pathology • Epistaxis • Nasal Fracture • Deviated septum • Perforated septum • Polyps

  24. Epistaxis • Control the bleeding

  25. Nasal Fracture

  26. Deviated Septum

  27. Perforated Septum

  28. Nasal Polyps

  29. Nasal Referral • Unable to breath out of one or both nostrils • CSF coming from nose/Halo Sign • Fx • Uncontrollable epistaxis

  30. Ear Anatomy

  31. Tympanic Membrane

  32. Use of the Otoscope in Athletic Training

  33. Objectives • Briefly discuss the types and features of the otoscope • Provide an overview of otoscopic assessment procedures • Present a clinical teaching model for teaching your students to properly use the otoscope • Provide educational resources for teaching otoscopy

  34. Types & Features of the Otoscope

  35. Types of Otoscopes • Pocket style • < $50 • Clinical model • $200 - $400+ Pocket style Clinical model

  36. Features of the Otoscope • Power source • Battery (most common in athletic training clinical setting) • Electric • Light source • Incandescent bulb (produces a yellow light) • Hallogen bulb (best – produces a white light)

  37. Features of the Otoscope • Magnifier • Not available on all models • Provides better view of tympanic membrane, particularly for beginners

  38. Features of the Otoscope • Speculum • Variety of sizes • Reusable or disposable

  39. Overview of Otoscopic Assessment

  40. Examination of the Ear • History • Observation • Palpation • Specialtests • Otoscopic assessment

  41. Examination of the Ear • History • Trauma • Allergies, colds, sinus drainage • Changes in pressure (flying, diving) • Dizziness • Changes in hearing • Duration of symptoms

  42. Examination of the Ear • Observation • Redness • Swelling • Drainage • Foreign object • Cuts, scrapes, bruises

  43. Examination of the Ear • Palpation • Gentle pressure on tragus

  44. Examination of the Ear • Palpation • Traction on ear lobe & pinna

  45. Otoscopic Assessment • Evaluate the noninvolved ear first • This practice provides a basis for comparison AND prevents cross-contamination

  46. Otoscopic Assessment • Step 1: • Place your patient in a seated position with his/her head turned slightly downward and away from the ear to be examined

  47. Otoscopic Assessment • Step 1 (cont.): • the “puppy position” (puppies always cock their heads to the side when you talk to them)

  48. Otoscopic Assessment • Step 2: • Select the largest possible speculum that can be comfortably inserted into the ear

  49. Otoscopic Assessment • Step 2 (cont.): • When inserted, the speculum should fit snugly in the outer third of the canal and rest against the tragus and anterior wall of the canal Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

  50. Otoscopic Assessment • Step 2 (cont.): • Choosing a speculum that is too small will cause movement within the canal • Excessive movement can cause discomfort for your patient Modified from Middle Ear Conditions. Anatomical Chart Co. Skokie, IL, 1999.

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