Eyes Ears Nose Throat PN 2 Summer Semester

Eyes, Ears, Nose & Throat PN 2 Summer Semester

Eyes Infants and Children: • At birth eyes symmetrical; pupils equal and respond to light • Iris is brown or slate gray-blue • By 3 months colour changes • Eyelids edematous; little or no tears which begin a 4 weeks • Vision in both eyes begin at 6 weeks • Eyes fully grown at age 8 • Red reflex at birth

Eyes Pregnant Female: • May c/o dry eyes (contact lenses) • Visual changes d/t shifting fluid in cornea • Blurriness or distortion of vision can occur because of temporary changes in shape of eye in last trimester and first 6 weeks post partum.

Eyes Older Adults: • Age 45 lens looses elasticity; ciliary muscle becomes weaker = near vision become a problem (presbyopia) • Droopy eye lids d/t decrease fat • Decrease tear formation • Cornea cloudy • Light reflex slower • Cateracts; macular degeneration • Narrow blood vessels

Considerations Cultural and environmental: • Blindness in poorer countries • Excessive sun exposure • Vitamin A deficiency • Discard makeup after 3 mos • Trauma in the workplace • Excessive sun may lead to cataracts

Doing the Eye Assessment • • • General questions Questions r/t illness or infection Questions r/t symptoms or behaviours Questions r/t to pain Questions r/t to age Questions r/t occupations/environment

Physical Assessment • Provide specific clear instructions • If you ask someone to read something…make sure they can read. • Place card over “closed” eye; do not actually close or apply pressure • Lighting in room should be adjustable • Need at least 20 feet of space • Use standard precautions

Snellen Eye Chart • Results recorded as fractions • Numerator=distance from chart • Denominator=distance where ct with normal vision can read line • Normal 20/20 • 20/30 = at 20 ft ct can read what normal person reads at 30 ft. • If ct is unable to read ½ of line, record the number of line above • Smaller the fraction=worse vision • 20/200 is legal blindness

Visual tests • We will do these when we do cranial nerve assessment • Visual fields • 6 cardinal fields of gaze • Corneal light reflex • Cover test • Pupillary response

Eye lids • • Conjunctiva Sclera Skin cancer Eye lid inflammation Cataract Conjunctiva Ectropian/entropion Trauma

Ears, Nose and Throat Infants and Children: • Auditory canal is short with upward curve • Children (age 3) have horizontal tube • Nose of child is too small to really examine • Salivation begins at 3 months • Drooling occurs until baby learns to swallow

ENT Pregnant Female: • Estrogen levels cause increase vascularity • Vessels change in middle ear • Increase blood flow in sinuses • Sense of smell increases • Edema of vocal cords • Sometimes over growth of gums

ENT Older Adult • Hair in ears • Ears become more prominent • Tympanic membrane paler and thicker • Lips and buccal mucosa become thinner and less vascular • More fissures on tongue; decreased taste, saliva • Gums recede and tooth decay

Psychosocial Considerations • Stress = mouth ulcers and lip biting • Clenching or grinding of teeth Cultural and Environmental Considerations • Teeth size and decay • Occupation and hearing • Finances/health care insurance

Interview General questions Questions r/t illness and infection Questions r/t to symptoms and behaviour Questions r/t pain Questions r/t environment Questions r/t age Questions r/t nose and sinus; mouth and throat

Physical Assessment • Inspection; palpation; percussion; trans illumination of sinuses • Tuning fork, otoscope and nasal speculum

Ear/hearing • Binaural hearing • Ears symmetrical in size, shape, colour and configuration • External auditory canal is patent and free of drainage • External ear and mastoid process are free of lesions and tragus is movable • When viewing through otoscope the external ear is open, non tender, free of lesions, inflammation and F/O’s • Cerumen is soft and small amt.

Ear/hearing • Tympanic membrane is flat, gray and translucent • Malleolar process and reflected light are visible on tympanic membrane • TM flutters with Valsalva • During hearing test, air conduction is longer than bone conduction • Adults are able to maintain balance

Hearing loss • Noise induced hearing loss from exposure to loud music or machinery common cause of hearing loss in adult aged 20 to 40 • Hearing loss in older adults common and is either senorineural or conductive loss • Presbycosis: occurs around age 50 and gets worse

Nose/Sinuses • Infants: obligatory nose breathers • Nose is only external organ of the resp track • Nasal mucosa is rich in blood supply and filters inspired air. • Olfactory cells are in roof of nose • Sinuses are mucous lined, air-filled cavities that warm, filter and moisten air

Mouth and Throat • Teeth, lips, gums (buccal mucosa), cheeks, tongue, hard and soft palate, uvula, manibular arch and maxillary arch • Tongue: check for adhesions; taste • Palate: check for cleft • Throat: tonsils