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 Before 6 weeks babies fixate on bright or moving object Red reflex: a glowing red colour that fills the pupil as light from the opthalmascope reflects off of the retina Peripheral vision may be assessed Assess extraocular muscle function as early as possible in young children because delay can lead to permanent visual damage.

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 Light coloured eyes have lighter retna and better night vision but more sensitive to bright sunlight and artifical light. Vit A deficiency nitght blindness Meds may cause dryness, vission changes, make up should be discarded after 3 mos. Trauma to eyes in sports workplace

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 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 Can examine nose with speculum at puberty Both sets of teeth develop before birth; deciduous teeth begin to erupt between six mos and twelve mos Permanent teeth between age six and teens.

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. Hearing and balance/equilibrium Low set ears; ears positioned greater than 15-degree angle; or malformed ears are often associated with genetic disorders and develomental delay Children prone to inner ear infections vs adults

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