1. Eyes, Ears, Nose & Throat
PN 2
Summer Semester

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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.

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. 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