Chapter 13

1. Chapter 13 Ears, Nose, Mouth, and Throat Copyright 2002, Delmar, A division of Thomson Learning

2. Competencies • Identify the structures of the ears, nose, mouth, and throat. • Discuss the system-specific history for the ears, nose, mouth, and throat. • Describe normal findings in the physical assessment of the ears, nose, mouth, and throat. (continues) Copyright 2002, Delmar, A division of Thomson Learning

3. Competencies • Describe common abnormalities found in the physical assessment of the ears, nose, mouth, and throat. • Explain the pathophysiology of common abnormalities of the ears, nose, mouth, and throat. • Perform the physical assessment of the ears, nose, mouth, and throat. Copyright 2002, Delmar, A division of Thomson Learning

4. Anatomy and Physiology of the Ear • Frequency range of 20 to 20,000 Hz • Decibel range 0 to 140 • External ear • Auricle or pinna (continues) Copyright 2002, Delmar, A division of Thomson Learning

5. Anatomy and Physiology of the Ear • Middle ear • Ossicles • Malleus (hammer) • Incus (anvil) • Stapes (stirrup) • Eustachian tube (continues) Copyright 2002, Delmar, A division of Thomson Learning

6. Anatomy and Physiology of the Ear • Inner ear • Labyrinth • Vestibule • Semicircular canals • Cochlea Copyright 2002, Delmar, A division of Thomson Learning

7. Anatomy and Physiology of the Nose • Turbinates • Nasal mucosa • Olfactory receptor cells • Paranasal sinuses Copyright 2002, Delmar, A division of Thomson Learning

8. Anatomy and Physiology of the Mouth and Throat • Mouth and throat • Lips • Cheeks • Buccal mucosa • Hard palate • Soft palate • Teeth Copyright 2002, Delmar, A division of Thomson Learning

9. Health History • Ears • Hearing loss • Excessive cerumen • Nose • Deviated septum • Mouth and throat • Tooth loss • Gum disease • Decreased taste Copyright 2002, Delmar, A division of Thomson Learning

10. Common Chief Complaints • Hearing loss • Tinnitus • Nasal blockage or congestion • Halitosis • Oral lesions Copyright 2002, Delmar, A division of Thomson Learning

11. Evaluation of Chief Complaint • Quality • Associated manifestations • Aggravating factors • Alleviating factors • Timing Copyright 2002, Delmar, A division of Thomson Learning

12. Past Health History • Medical • Otitis media or externa • Nasal polyps, sinusitis, allergic rhinitis • Tonsillitis, dental caries, upper respiratory infections • Chronic diseases, such as diabetes mellitus, renal disease, hypertension, immunosuppression (continues) Copyright 2002, Delmar, A division of Thomson Learning

13. Past Health History • Dental pathology • Nutritional disturbances • Surgical • Oral surgery • Cosmetic surgery of head or neck • Repair of deviated septum • Tympanostomy tubes (continues) Copyright 2002, Delmar, A division of Thomson Learning

14. Past Health History • Medications • Antibiotics, antihistamines, decongestants, steroids, chemotherapy, immunosuppressive drugs • Allergies • Severity of signs and symptoms • Seasonal or environmental (continues) Copyright 2002, Delmar, A division of Thomson Learning

15. Past Health History • Accidents/injuries • Foreign bodies • Trauma • Sports injuries • Special needs • Use of assistive devices (hearing aids) • Speech disorders • Childhood illnesses • Frequent tonsillitis or ear infections Copyright 2002, Delmar, A division of Thomson Learning

16. Social History • Alcohol use • Tobacco use • Drug use • Sexual practices • Work/home environment • Hobbies/leisure activities • Stress Copyright 2002, Delmar, A division of Thomson Learning

17. Health Maintenance Activities • Sleep • Diet • Use of safety devices • Healthy checkups Copyright 2002, Delmar, A division of Thomson Learning

18. General Approach to Assessment • Greet the patient • Explain assessment techniques • Quiet, well-lit environment • Sitting position • Compare right to left • Systematic approach Copyright 2002, Delmar, A division of Thomson Learning

19. Equipment • Otoscope • Nasal speculum • Penlight • Tuning fork • Cotton-tipped applicators • Tongue blade • Watch • Gauze square Copyright 2002, Delmar, A division of Thomson Learning

20. Assessment of the Ear • External ear • Inspection • Note position, size, color, and shape • Palpation • Auricle (continues) Copyright 2002, Delmar, A division of Thomson Learning

21. Assessment of the Ear • Normal findings • Flesh color • Positioned centrally and in proportion to the head • No foreign bodies, redness, drainage, deformities, nodules, or lesions Copyright 2002, Delmar, A division of Thomson Learning

22. Assessment of the Ear • Abnormal findings • Small- or large-size ears • Pale, red, cyanotic • Purulent drainage • Clear or bloody drainage • Pain or tenderness on palpation • Tumor • Hematoma behind ear over mastoid (continues) Copyright 2002, Delmar, A division of Thomson Learning

23. Auditory Screening • Voice-whisper test • Normal finding: able to repeat words whispered at a distance of 2 feet • Weber test • Normal finding: able to hear sound equally in both ears • Rinne test • Normal finding: air conduction > bone conduction Copyright 2002, Delmar, A division of Thomson Learning

24. Otoscopic Assessment • Inspect both ears • Normal findings • No redness, swelling, tenderness, lesions, drainage, foreign bodies • Tympanic membrane is pearly gray with well-defined landmarks • Light reflex present at 5 o’clock in right ear and 7 o’clock in left ear • Tympanic membrane moves when the patient blows against resistance (continues) Copyright 2002, Delmar, A division of Thomson Learning

25. Otoscopic Assessment • Abnormal findings • Redness, swelling, narrowing, pain • Drainage • Hard, dry, very dark yellow cerumen • Reddened tympanic membrane • Severe pain • Chalk patches on tympanic membrane Copyright 2002, Delmar, A division of Thomson Learning

26. Risk Factors for Otitis Media • Less than 2 years of age • Frequent upper respiratory infections • Cold weather • Males (continues) Copyright 2002, Delmar, A division of Thomson Learning

27. Risk Factors for Otitis Media • Caucasians, Native Americans, Alaskan natives • Family history • Smoky environment • Bottle fed • Down syndrome Copyright 2002, Delmar, A division of Thomson Learning

28. Assessment of the Nose • Inspection of external nose • Location, symmetry, bleeding, masses, swelling, lesions • Patency • Nostrils • Inspection of internal nose • Otoscope with nasal speculum (continues) Copyright 2002, Delmar, A division of Thomson Learning

29. Assessment of the Nose • Normal findings • Located in midline of face • No swelling, bleeding, lesions, or masses • Both nostrils patent • Septum midline • Nasal mucosa is pink or dull red (continues) Copyright 2002, Delmar, A division of Thomson Learning

30. Assessment of the Nose • Abnormal findings • Broken, misshapen, swollen nose • Occluded nasal passages • Septum is deviated • Nasal mucosa is red and swollen • Purulent drainage Copyright 2002, Delmar, A division of Thomson Learning

31. Assessment of the Sinuses • Inspection • Palpation and percussion • Normal findings • No evidence of swelling • Resonance heard on percussion • No discomfort during palpation or percussion Copyright 2002, Delmar, A division of Thomson Learning

32. Assessment of the Mouth • Inspection • Lips, tongue • Gums, buccal mucosa • Teeth (continues) Copyright 2002, Delmar, A division of Thomson Learning

33. Assessment of the Mouth • Normal findings • Pink, moist lips • Tongue midline, adequate movement • No lesions • Tongue, gums, buccal mucosa are pink, moist, smooth • No bleeding • Smooth, white teeth, no dental caries (continues) Copyright 2002, Delmar, A division of Thomson Learning

34. Assessment of the Mouth • Abnormal findings • Lesions, growths • Dry, cracked lips • Vesicles or blisters • Red, tender, inflamed tongue, gums, buccal mucosa • Thrush • Coating on tongue • Bleeding gums Copyright 2002, Delmar, A division of Thomson Learning

35. Inspection of the Throat • Gag reflex • Posterior pharynx • Uvula • Color of oropharynx • Presence of swelling, exudate, lesions (continues) Copyright 2002, Delmar, A division of Thomson Learning

36. Inspection of the Throat • Normal findings • Soft palate and uvula rise when patient says, “ah” • Uvula is midline • No swelling, exudate, or lesions • Gag reflex is present (continues) Copyright 2002, Delmar, A division of Thomson Learning

37. Inspection of the Throat • Abnormal findings • Posterior pharynx is red with white patches • Tonsils and uvula are red and swollen • Hoarse voice • Grayish membrane covering tonsils, uvula, soft palate Copyright 2002, Delmar, A division of Thomson Learning

38. Gerontological Variations • Presbycusis • Diminished sense of smell and taste • Periodontal disease • Oral alterations due to disease or side effects of medications • Tooth loss Copyright 2002, Delmar, A division of Thomson Learning