1. Ears, Nose, Mouth, and Throat
Chapter 13
Ears, Nose, Mouth, and Throat
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2. Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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.
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3. Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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.
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4. Anatomy and Physiology of the Ear
Frequency range of 20 to 20,000 Hz
Decibel range 0 to 140
External ear
Auricle or pinna
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5. Anatomy and Physiology of the Ear
Middle ear
Ossicles
Malleus (hammer)
Incus (anvil)
Stapes (stirrup)
Eustachian tube
(continues)
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6. Anatomy and Physiology of the Ear
Inner ear
Labyrinth
Vestibule
Semicircular canals
Cochlea
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7. Anatomy and Physiology of the Nose
Turbinates
Nasal mucosa
Olfactory receptor cells
Paranasal sinuses
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8. Anatomy and Physiology of the Mouth and Throat
Lips
Cheeks
Buccal mucosa
Hard palate
Soft palate
Teeth
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9. Copyright 2002, Delmar, A division of Thomson Learning
Health History
Ears
Hearing loss
Excessive cerumen
Nose
Deviated septum
Mouth and throat
Tooth loss
Gum disease
Decreased taste
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10. Common Chief Complaints
Hearing loss
Tinnitus
Nasal blockage or congestion
Halitosis
Oral lesions
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11. Evaluation of Chief Complaint
Quality
Associated manifestations
Aggravating factors
Alleviating factors
Timing
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12. Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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
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13. Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
Dental pathology
Nutritional disturbances
Surgical
Oral surgery
Cosmetic surgery of head or neck
Repair of deviated septum
Tympanostomy tubes
(continues)
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14. Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
Medications
Antibiotics, antihistamines, decongestants, steroids, chemotherapy, immunosuppressive drugs
Allergies
Severity of signs and symptoms
Seasonal or environmental
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15. Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
Accidents/injuries
Foreign bodies
Trauma
Sports injuries
Special needs
Use of assistive devices (hearing aids)
Speech disorders
Childhood illnesses
Frequent tonsillitis or ear infections
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16. Copyright 2002, Delmar, A division of Thomson Learning
Social History
Alcohol use
Tobacco use
Drug use
Sexual practices
Work/home environment
Hobbies/leisure activities
Stress
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17. Health Maintenance Activities
Sleep
Diet
Use of safety devices
Healthy checkups
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18. General Approach to Assessment
Greet the patient
Explain assessment techniques
Quiet, well-lit environment
Sitting position
Compare right to left
Systematic approach
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19. Copyright 2002, Delmar, A division of Thomson Learning
Equipment
Otoscope
Nasal speculum
Penlight
Tuning fork
Cotton-tipped applicators
Tongue blade
Watch
Gauze square
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20. Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
External ear
Inspection
Note position, size, color, and shape
Palpation
Auricle
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21. Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
Normal findings
Flesh color
Positioned centrally and in proportion to the head
No foreign bodies, redness, drainage, deformities, nodules, or lesions
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22. Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
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
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23. Copyright 2002, Delmar, A division of Thomson Learning
Auditory Screening
Voice-whisper test
Normal finding: able to repeat words whispered at a distance of 2 feet
Weber test
Normal finding: able to hear sound equally in both ears
Rinne test
Normal finding: air conduction > bone conduction
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24. Copyright 2002, Delmar, A division of Thomson Learning
Otoscopic Assessment
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
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(continues)

25. Copyright 2002, Delmar, A division of Thomson Learning
Otoscopic Assessment
Abnormal findings
Redness, swelling, narrowing, pain
Drainage
Hard, dry, very dark yellow cerumen
Reddened tympanic membrane
Severe pain
Chalk patches on tympanic membrane
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26. Risk Factors for Otitis Media
Less than 2 years of age
Frequent upper respiratory infections
Cold weather
Males
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27. Risk Factors for Otitis Media
Caucasians, Native Americans, Alaskan natives
Family history
Smoky environment
Bottle fed
Down syndrome
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28. Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
Inspection of external nose
Location, symmetry, bleeding, masses, swelling, lesions
Patency
Nostrils
Inspection of internal nose
Otoscope with nasal speculum
(continues)
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29. Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
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)
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30. Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
Abnormal findings
Broken, misshapen, swollen nose
Occluded nasal passages
Septum is deviated
Nasal mucosa is red and swollen
Purulent drainage
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31. Assessment of the Sinuses
Inspection
Palpation and percussion
Normal findings
No evidence of swelling
Resonance heard on percussion
No discomfort during palpation or percussion
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32. Assessment of the Mouth
Inspection
Lips, tongue
Gums, buccal mucosa
Teeth
(continues)
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33. Assessment of the Mouth
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)
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34. Assessment of the Mouth
Abnormal findings
Lesions, growths
Dry, cracked lips
Vesicles or blisters
Red, tender, inflamed tongue, gums, buccal mucosa
Thrush
Coating on tongue
Bleeding gums
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35. Inspection of the Throat
Gag reflex
Posterior pharynx
Uvula
Color of oropharynx
Presence of swelling, exudate, lesions
(continues)
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36. Inspection of the Throat
Normal findings
Soft palate and uvula rise when patient says, “ah”
Uvula is midline
No swelling, exudate, or lesions
Gag reflex is present
(continues)
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37. Inspection of the Throat
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
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38. Gerontological Variations
Presbycusis
Diminished sense of smell and taste
Periodontal disease
Oral alterations due to disease or side effects of medications
Tooth loss
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