Chapter 13 Ears Nose Mouth and Throat Copyright

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

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

Competencies l l l Identify the structures of the ears, nose, mouth, and throat.

Competencies l l l 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

Competencies l l l Describe common abnormalities found in the physical assessment of the

Competencies l l l 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

Anatomy and Physiology of the Ear l l l Frequency range of 20 to

Anatomy and Physiology of the Ear l l l 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

Anatomy and Physiology of the Ear l Middle ear £ Ossicles £ Malleus (hammer)

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

Anatomy and Physiology of the Ear l Inner ear Labyrinth £ Vestibule £ Semicircular

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

Anatomy and Physiology of the Nose l l Turbinates Nasal mucosa Olfactory receptor cells

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

Anatomy and Physiology of the Mouth and Throat l Mouth and throat Lips £

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

Health History l Ears Hearing loss £ Excessive cerumen £ l Nose £ l

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

Common Chief Complaints l l l Hearing loss Tinnitus Nasal blockage or congestion Halitosis

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

Evaluation of Chief Complaint l l l Quality Associated manifestations Aggravating factors Alleviating factors

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

Past Health History l Medical Otitis media or externa £ Nasal polyps, sinusitis, allergic

Past Health History l 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

Past Health History Dental pathology £ Nutritional disturbances £ l Surgical Oral surgery £

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

Past Health History l Medications £ l Antibiotics, antihistamines, decongestants, steroids, chemotherapy, immunosuppressive drugs

Past Health History l Medications £ l 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

Past Health History l Accidents/injuries Foreign bodies £ Trauma £ Sports injuries £ l

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

Social History l l l l Alcohol use Tobacco use Drug use Sexual practices

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

Health Maintenance Activities l l Sleep Diet Use of safety devices Healthy checkups Copyright

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

General Approach to Assessment l l l Greet the patient Explain assessment techniques Quiet,

General Approach to Assessment l l l 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

Equipment l l l l Otoscope Nasal speculum Penlight Tuning fork Cotton-tipped applicators Tongue

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

Assessment of the Ear l l External ear Inspection £ l Note position, size,

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

Assessment of the Ear l Normal findings Flesh color £ Positioned centrally and in

Assessment of the Ear l 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

Assessment of the Ear l Abnormal findings Small- or large-size ears £ Pale, red,

Assessment of the Ear l 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

Auditory Screening l Voice-whisper test £ l Weber test £ l Normal finding: able

Auditory Screening l Voice-whisper test £ l Weber test £ l Normal finding: able to repeat words whispered at a distance of 2 feet 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

Otoscopic Assessment l l Inspect both ears Normal findings No redness, swelling, tenderness, lesions,

Otoscopic Assessment l l 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 £ Copyright 2002, Delmar, A division of Thomson Learning (continues)

Otoscopic Assessment l Abnormal findings Redness, swelling, narrowing, pain £ Drainage £ Hard, dry,

Otoscopic Assessment l 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

Risk Factors for Otitis Media l l Less than 2 years of age Frequent

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

Risk Factors for Otitis Media l l l Caucasians, Native Americans, Alaskan natives Family

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

Assessment of the Nose l Inspection of external nose £ l Patency £ l

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

Assessment of the Nose l Normal findings Located in midline of face £ No

Assessment of the Nose l 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

Assessment of the Nose l Abnormal findings Broken, misshapen, swollen nose £ Occluded nasal

Assessment of the Nose l 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

Assessment of the Sinuses l l l Inspection Palpation and percussion Normal findings No

Assessment of the Sinuses l l l 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

Assessment of the Mouth l Inspection Lips, tongue £ Gums, buccal mucosa £ Teeth

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

Assessment of the Mouth l Normal findings Pink, moist lips £ Tongue midline, adequate

Assessment of the Mouth l 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

Assessment of the Mouth l Abnormal findings Lesions, growths £ Dry, cracked lips £

Assessment of the Mouth l 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

Inspection of the Throat l l l Gag reflex Posterior pharynx Uvula Color of

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

Inspection of the Throat l Normal findings Soft palate and uvula rise when patient

Inspection of the Throat l 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

Inspection of the Throat l Abnormal findings Posterior pharynx is red with white patches

Inspection of the Throat l 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

Gerontological Variations l l l Presbycusis Diminished sense of smell and taste Periodontal disease

Gerontological Variations l l l 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