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Ear, Nose, Mouth, and Throat
Physical assessment Ear, Nose, Mouth, and Throat
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Anatomy and Physiology Review
Internal and external ear Nose and sinuses Oral cavity Pharynx or throat
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Ear Sensory organ that functions in hearing and equilibrium
External ear Auricle or pinna Helix Tragus Lobule External auditory canal Lined with yellow-brown cerumen (wax)
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Ear Middle ear Tympanic membrane Ossicles Eustachian tube
Separates external and middle ear Ossicles Malleus Incus Stapes Eustachian tube Connects middle ear and nasopharynx
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Ear Inner ear Controls equilibrium Hearing sensors
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Figure External ear. 6
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Figure 16.2 The three parts of the ear.
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Nose and Sinuses External and internal structures of nose
Bridge and tip of nose Septum and turbinates Function to clean, warm, moisten air Nasal mucosa Paranasal sinuses Mucus-lined, air-filled cavities that surround the nasal cavity
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Nose and Sinuses Paranasal sinuses
Function to clean, warm, moisten air Olfactory cells connect to the olfactory nerve (cranial nerve I) and are responsible for the sense of smell Another function to provide resonance for voice
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The nose 10
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Nasal sinuses 11
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Mouth Maxilla Mouth Teeth Tongue Gums Uvula
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Mouth Lips Inside of the cheeks Palate Mandible Hard palate
Soft palate Mandible
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Oral cavity 14
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Innervation of the tongue
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Throat Known as pharynx Leads to esophagus and trachea Sections
Nasopharynx Oropharynx Laryngopharynx Epiglottis Tonsils
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Special Considerations
Age Developmental level Race Ethnicity Work history Living conditions Socioeconomics Emotional well-being
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Lifespan Considerations
Infants and children Shorter auditory canal Increased incidence of otitis media Beginning of salivation in infants Development of deciduous and permanent teeth in children Slightly enlarged, noninfected tonsils common in children ages 4 to 8
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Lifespan Considerations
The pregnant female Fullness or earaches Rhinitis Epistaxis Heightened sense of smell Edema of vocal cords
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Lifespan Considerations
The older adult Loss of high-frequency hearing Gradual hearing loss (presbycusis) Decreased sense of taste and smell Decreased production of saliva Receding gums Tooth loss
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Psychosocial Considerations
Mouth ulcers Lip biting Involuntary muscle spasms (tics) Relaxation techniques may help relieve stress-related behaviors.
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Cultural and Environmental Considerations
Variances among ethnic ancestry Cleft uvula, lip, and palate Occupational risk for hearing loss Financial constraints Lower socioeconomic status places children at risk for otitis media.
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Focused Interview Observe patient and be active listener
Consider in relation to normative parameters and expectations of function as well as other factors Follow-up questions may be necessary.
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Table 16.2 Potential Secondary Sources for Patient Data Related to the Ears, Nose, Mouth, and Throat
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Focused Interview Focused interview questions General
Illness or infection Symptoms, pain, and behaviors Environment Internal External continued on next slide
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Assessment Techniques
Inspection Palpation Percussion Transillumination
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Table 16.6 (continued) Overview of Disorders of the Mouth and Throat
continued on next slide
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Assessment Techniques
Inspection of the external ear Palpation of the auricle and tragus Palpation of the mastoid process Inspection of the auditory canal using the otoscope Examination of the tympanic membrane using the otoscope
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Assessment Techniques
Administration of the whisper test Administration of the Rinne and Weber tests using the tuning fork Administration of the Romberg test
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Palpating the tragus. 30
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Palpating the mastoid process.
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Pulling the pinna to straighten the canal.
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Assessment Techniques
Otoscope Auditory canal Inserting the otoscope Handle up or down Straightening the ear canal Tympanic membrane
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Two techniques for holding and inserting an otoscope
Two techniques for holding and inserting an otoscope. Otoscopic examination with otoscope handle in downward position. continued on next slide 34
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Two techniques for holding and inserting an otoscope
Two techniques for holding and inserting an otoscope. Otoscopic examination with otoscope handle in upward position. 35
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Performing the whisper test.
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Activating the tuning fork.
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Rinne test. Bone conduction.
continued on next slide 38
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Rinne test. Air conduction.
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Weber test. 40
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Romberg test. 41
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Assessment Techniques
Nose and sinuses Inspection of the nose and patency testing Palpation of the external nose Inspection of the nasal cavity using a nasal speculum Palpation of the sinuses Percussion of the sinuses Transillumination of the sinuses
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Inspection of the nose. 43
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Using the otoscope for nasal inspection.
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Palpating the frontal sinuses.
continued on next slide 45
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Palpating the maxillary sinuses.
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Percussion of frontal sinuses.
continued on next slide 47
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Percussion of maxillary sinuses.
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Transillumination of the frontal sinuses.
continued on next slide 49
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Observing transillumination of the frontal sinuses.
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Transillumination of the maxillary sinuses.
continued on next slide 51
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Transillumination of the maxillary sinuses using alternate technique.
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Assessment Techniques
Mouth and throat Inspection and palpation of the lips Inspection of the teeth Inspection and palpation of the buccal mucosa, gums, and tongue Inspection of the salivary glands Inspection of the throat
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Inspecting the teeth. 54
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Palpating the tongue. 55
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Inspecting the throat. 56
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Abnormal Findings Lesions Deformities Infectious processes
Dental problems
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Table 16.6 (continued) Overview of Disorders of the Mouth and Throat
continued on next slide
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Table 16.6 (continued) Overview of Disorders of the Mouth and Throat
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