1. Chapter 12 Ears, Nose, Mouth, and Throat

2. Anatomy and Physiology
Ear
Sensory organ of hearing
Nose
Sensory organ of smell
Mouth and throat
Sensory organ of taste
First part of digestive system

3. Anatomy and Physiology The Ear

4. Anatomy and Physiology The Ear (cont.)
External Structures
Gather sound waves
Funnel down ear canal to tympanic membrane

5. Anatomy and Physiology The Ear (cont.)
Middle Ear
Tympanic membrane
Ossicles
Malleus
Incus
Stapes
Inner Ear
Hearing Pathway
Cochlea
Semicircular canals
Auditory nerve
CN VIII (Vestibulocochlear nerve)
Equilibrium

6. Anatomy and Physiology The Ear (cont.)
Hearing Pathways

7. The Health History The Ear
Common or concerning symptoms
Hearing loss
Earache
Discharge
Tinnitus
Vertigo

8. The Health History The Ear (cont.)
Ear history
Hearing loss?
Conduction versus sensorineural
Earaches?
Frequency, sharp, dull
Discharge?
Ear wax, pus, smell

9. The Health History The Ear (cont.)
Ear history
Tinnitus?
Which ear, frequency, other symptoms
Vertigo?
Clarify patient’s definition/understanding
Frequency, other symptoms, effect on daily life

10. The Health History The Ear (cont.)
Past history
Hearing loss
Removal of cerumen
“Swimmer’s ear”
Surgery
Trauma
Infection
Noise exposure
History of disease

11. The Health History The Ear (cont.)
Family history
Hearing loss
Allergies
Smoking or exposure to cigarette smoke

12. The Health History The Ear (cont.)
Lifestyle Habits
Occupation/hobbies/activities
Use of listening devices
Use of loud tools
Use of ear plugs/ear protection
Use of hearing aids
Medication and/or drug use that interfere with hearing or cause dizziness

13. Lumps On or Near the Ear
Keloid
Chondrodermatitis Helicis

14. Lumps On or Near the Ear (cont.)
Tophi
Basal Cell Carcinoma

15. Lumps On or Near the Ear (cont.)
Cutaneous Cyst
Rheumatoid Nodules

16. Eardrum
Normal Right Eardrum
Perforation

17. Eardrum (cont.)
Tympanosclerosis
Serous Effusion

18. Eardrum (cont.) Acute Otitis Media With Purulent Effusion
Bullous Myringitis

19. Hearing Loss
Conductive Loss
Sensorineural Loss

20. Question The ossicles consist of all of the following except: A. Incus
B. Malleus
C. Stapes
D. Mastoid

21. Answer The ossicles consist of all of the following except: D. Mastoid
The mastoid bone is a part of the cranium. The three ossicles are the malleus, incus, and stapes.

22. Anatomy and Physiology The Nose and Paranasal Sinuses
Function
Inspiration and expiration
Filtration, warmth, and moisturization of the air exchanged
Sensation of smell
Resonance of speech

23. Anatomy and Physiology The Nose and Paranasal Sinuses
Outer Structures

24. Anatomy and Physiology The Nose and Paranasal Sinuses (cont.)
Medial wall of left nasal cavity (mucosa removed)

25. Anatomy and Physiology The Nose and Paranasal Sinuses (cont.)
Lateral Wall: Nasal Cavity

26. Anatomy and Physiology The Nose and Paranasal Sinuses (cont.)
Cross Section of Nasal Cavity, Anterior View

27. Anatomy and Physiology The Paranasal Sinuses (cont.)

28. The Health History The Nose and Paranasal Sinuses (cont.)
Rhinorrhea
Type of discharge
Congestion
Medications, infections
Epistaxis
May indicate bleeding disorder
Change in sense of smell

29. The Health History The Nose and Paranasal Sinuses (cont.)
Past history
Sinus infections
Upper respiratory infections
Allergies
Trauma or injury
Nasal or sinus surgery
Polyps
Dental history

30. The Health History The Nose and Paranasal Sinuses (cont.)
Family history
Allergies
Asthma
Lifestyle habits
Air quality
Pets
Alcohol, tobacco, recreational drugs

31. Anatomy and Physiology Mouth and Pharynx

32. Anatomy and Physiology Mouth and Pharynx (cont.)

33. Anatomy and Physiology Mouth and Pharynx (cont.)
A Tooth
The Upper Teeth

34. Anatomy and Physiology Mouth and Pharynx (cont.)

35. Anatomy and Physiology Mouth and Pharynx (cont.)

36. The Health History The Mouth and Pharynx
Common or concerning symptoms
Sore throat
Upper respiratory infection
Hoarseness
Smoking, allergies, voice abuse, hypothyroidism, tuberculosis, tumors
Lesions
Aphthous ulcers, nutritional deficiency

37. The Health History The Mouth and Pharynx (cont.)
Common or concerning symptoms (cont.)
Sore tongue
Nutritional deficiency
Bleeding gums
Gingivitis
Toothache
Dysphagia
Any particular foods

38. The Health History The Mouth and Pharynx (cont.)
Past history
Sore throat
Loss of voice
Dental, mouth, or throat surgery
Trauma or injury
History of infections
Oral cancer
Sexually transmitted infection (STI)

39. The Health History The Mouth and Pharynx (cont.)
Family history
Allergies
Smoking or exposure to cigarette smoke
Stroke
Tuberculosis

40. The Health History The Mouth and Pharynx (cont.)
Lifestyle habits
Brush and/or floss teeth?
Use tobacco products?
Smoke recreational drugs?
Drink alcohol?
Past and present occupations?
Use of dental dams?

41. Abnormalities of the Lips
Angular Cheilitis
Actinic Cheilitis

42. Abnormalities of the Lips (cont.)
Herpes Simplex
Angioedema

43. Abnormalities of the Lips (cont.)
Hereditary Hemorrhagic Telangiectasia
Peutz–Jeghers Syndrome

44. Abnormalities of the Lips (cont.)
Chancre of Syphilis
Carcinoma of the Lip

45. Question
Patients should be encouraged to maintain good dental hygiene, that would include which of the following? (Choose all that apply.)
A. Daily brushing
B. Flossing
C. Routine dental visits
D. Good nutrition

46. Answer
Patients should be encouraged to maintain good dental hygiene, that would include which of the following? (Choose all that apply.)
A. Daily brushing
B. Flossing
C. Routine dental visits
D. Good nutrition
All of these steps will help maintain good dental hygiene and should be encouraged.

47. Physical Examination The Ear
Equipment
Tuning fork
Otoscope
Speculum
Tongue blade
Gloves
Penlight

48. Physical Examination The Ear (cont.)
Pinna (Auricle)
Inspect tissues for deformities, lumps, or skin lesions.
Pain, discharge, inflammation
Movement painful in otitis externa
Tenderness behind ear may be present with otitis media

49. Physical Examination The Ear (cont.)
Ear Canal and Drum

50. Physical Examination The Ear (cont.)
Ear Canal and Drum (cont.)

51. Physical Examination The Ear (cont.)
Right Eardrum
Acute Otitis Externa

52. Physical Examination The Ear (cont.)
Auditory acuity
Test one ear at a time
Occlude nontested ear
Speak numbers or words with two equal syllables
Do not let patient read your lips
Ask them to repeat what they hear

53. Physical Examination The Ear (cont.)
Air and Bone Conduction
Weber test
Lateralization

54. Physical Examination The Ear (cont.)
Air and Bone Conduction
Rinne test
Air versus bone
conduction

55. Physical Examination The Ear (cont.)
Rinne test
Compare air conduction (AC) and bone conduction (BC)
Conductive hearing loss
BC = AC or BC > AC
Sensorineural hearing loss
AC > BC

56. Physical Examination The Nose
Equipment for examination
Penlight
Otoscope
Nasal speculum or largest speculum available
Gloves

57. Physical Examination The Nose (cont.)

58. Physical Examination The Nose (cont.)
Inspect anterior and inferior surfaces
Test for nasal obstruction
Inspect inside of nose
Observe nasal mucosa, septum, and any abnormalities
Palpate for sinus tenderness

59. Physical Examination The Nose (cont.)

60. Physical Examination Mouth and Pharynx
Equipment
Penlight
Tongue blade
Gloves
Gauze pad

61. Physical Examination Mouth and Pharynx (cont.)
Lips
Color, moisture, lumps, ulcers, cracking, scaliness
Oral mucosa
Color, ulcers, white patches, nodules
Gums and teeth
Color, swelling, ulcerations
Teeth alignment, caries, looseness
Dentures

62. Physical Examination Mouth and Pharynx (cont.)
Oral Mucosa
Canker Sore

63. Physical Examination Mouth and Pharynx (cont.)
Findings in or Under the Tongue

64. Physical Examination Mouth and Pharynx (cont.)
Roof of mouth
Color
Architecture of hard palate
Tongue and floor of mouth
Symmetry of CN XII
Color, texture

65. Physical Examination Mouth and Pharynx (cont.)
Cleft palate
Asymmetric protrusion

66. Physical Examination Mouth and Pharynx (cont.)
Ask patient to say “ah.”
Use tongue depressor as needed.
Inspect soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx.
Note color and symmetry.
Note exudates, swelling, ulceration, and tonsillar enlargement.

67. Physical Examination Mouth and Pharynx (cont.)
Tonsils graded by size
+1: visible
+2: between tonsillar pillars and uvula
+3: touching uvula
+4: touching each other
CN X paralysis

68. Question Oral sex is a safe technique to use when practicing safe sex.
A. True
B. False

69. Answer Oral sex is a safe technique to use when practicing safe sex.
B. False
This is a myth among adolescents and young adults. STIs are readily contracted via oral sex, with the organisms then infecting the mouth and pharynx.

70. Findings in Gums and Teeth
Marginal Gingivitis
Acute Necrotizing Ulcerative Gingivitis

71. Findings in Gums and Teeth (cont.)
Gingival Hyperplasia
Pregnancy Tumor (Epulis, Pyogenic Granuloma)

72. Findings in Gums and Teeth (cont.)
Attrition of Teeth; Recession of Gums
Erosion of Teeth

73. Findings in Gums and Teeth (cont.)
Abrasion of Teeth With Notching
Hutchinson Teeth

74. Findings in or Under the Tongue
Geographic Tongue
Hairy Tongue

75. Findings in or Under the Tongue (cont.)
Fissured Tongue
Smooth Tongue (Atrophic Glossitis)

76. Findings in or Under the Tongue (cont.)
Candidiasis
Hairy Leukoplakia

77. Findings in or Under the Tongue (cont.)
Varicose Veins
Aphthous Ulcer (Canker Sore)

78. Findings in or Under the Tongue (cont.)
Mucous Patch of Syphilis
Leukoplakia

79. Findings in or Under the Tongue (cont.)
Tori Mandibulares
Carcinoma, Floor of the Mouth

80. Findings in the Pharynx, Palate, and Oral Mucosa
Large Normal Tonsils
Exudative Tonsillitis

81. Findings in the Pharynx, Palate, and Oral Mucosa (cont.)
Pharyngitis

82. Findings in the Pharynx, Palate, and Oral Mucosa (cont.)
Diphtheria
Thrush on the Palate (Candidiasis)

83. Findings in the Pharynx, Palate, and Oral Mucosa (cont.)
Kaposi Sarcoma in AIDS
Torus Palatinus

84. Findings in the Pharynx, Palate, and Oral Mucosa (cont.)
Fordyce Spots (Fordyce Granules)
Koplik Spots

85. Findings in the Pharynx, Palate, and Oral Mucosa (cont.)
Petechiae
Leukoplakia

86. Record Your Findings Ears Acuity Structures Nose Mouth and Pharynx
Color

87. Health Promotion, Disease Prevention, and Education The Ears
Hearing screening
Important to catch hearing deficits early
Language development delay
Increased potential for loss due to overexposure to high levels of noise (work, play, home)

88. Health Promotion, Disease Prevention, and Education The Ears (cont.)
Hearing loss
Use appropriate ear protective devices
Limit overexposure to high levels of noise
Presbycusis
> 50 years 20% to 40%
> 80 years 80%

89. Health Promotion, Disease Prevention, and Education The Mouth and Pharynx
Dental issues
Diet
Tobacco products
Alcohol use
Medication use—xerostomia
Proper fit and use of dentures

90. Question
Use of tobacco products and excessive alcohol consumption are principal risk factors for oral carcinoma.
A. True
B. False

91. Answer
Use of tobacco products and excessive alcohol consumption are principal risk factors for oral carcinoma.
A. True
Research has shown that the use of tobacco products and excessive alcohol consumption are principal risk factors for developing oral carcinoma.