Chapter 12 Ears, Nose, Mouth, and Throat

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

Anatomy and Physiology The Ear

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

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

Anatomy and Physiology The Ear (cont.) Hearing Pathways

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

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

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

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

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

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

Lumps On or Near the Ear Keloid Chondrodermatitis Helicis

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

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

Eardrum Normal Right Eardrum Perforation

Eardrum (cont.) Tympanosclerosis Serous Effusion

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

Hearing Loss Conductive Loss Sensorineural Loss

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

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.

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

Anatomy and Physiology The Nose and Paranasal Sinuses Outer Structures

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

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

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

Anatomy and Physiology The Paranasal Sinuses (cont.)

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

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

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

Anatomy and Physiology Mouth and Pharynx

Anatomy and Physiology Mouth and Pharynx (cont.)

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

Anatomy and Physiology Mouth and Pharynx (cont.)

Anatomy and Physiology Mouth and Pharynx (cont.)

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

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

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)

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

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?

Abnormalities of the Lips Angular Cheilitis Actinic Cheilitis

Abnormalities of the Lips (cont.) Herpes Simplex Angioedema

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

Physical Examination The Nose (cont.)

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

Physical Examination The Nose (cont.)

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

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

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

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

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

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

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.

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

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

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.

Findings in Gums and Teeth Marginal Gingivitis Acute Necrotizing Ulcerative Gingivitis

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

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

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

Findings in or Under the Tongue Geographic Tongue Hairy Tongue

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

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

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

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

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

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

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

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

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

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

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

Record Your Findings Ears Acuity Structures Nose Mouth and Pharynx Color

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)

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%

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

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

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.