Ear, Nose, Mouth, and Throat Physical assessment Ear, Nose, Mouth, and Throat

Anatomy and Physiology Review Internal and external ear Nose and sinuses Oral cavity Pharynx or throat

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)

Ear Middle ear Tympanic membrane Ossicles Eustachian tube Separates external and middle ear Ossicles Malleus Incus Stapes Eustachian tube Connects middle ear and nasopharynx

Ear Inner ear Controls equilibrium Hearing sensors

Figure 16.1 External ear. 6

Figure 16.2 The three parts of the ear.

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

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

The nose 10

Nasal sinuses 11

Mouth Maxilla Mouth Teeth Tongue Gums Uvula

Mouth Lips Inside of the cheeks Palate Mandible Hard palate Soft palate Mandible

Oral cavity 14

Innervation of the tongue 15

Throat Known as pharynx Leads to esophagus and trachea Sections Nasopharynx Oropharynx Laryngopharynx Epiglottis Tonsils

Special Considerations Age Developmental level Race Ethnicity Work history Living conditions Socioeconomics Emotional well-being

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

Lifespan Considerations The pregnant female Fullness or earaches Rhinitis Epistaxis Heightened sense of smell Edema of vocal cords

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

Psychosocial Considerations Mouth ulcers Lip biting Involuntary muscle spasms (tics) Relaxation techniques may help relieve stress-related behaviors.

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.

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.

Table 16.2 Potential Secondary Sources for Patient Data Related to the Ears, Nose, Mouth, and Throat

Focused Interview Focused interview questions General Illness or infection Symptoms, pain, and behaviors Environment Internal External continued on next slide

Assessment Techniques Inspection Palpation Percussion Transillumination

Table 16.6 (continued) Overview of Disorders of the Mouth and Throat continued on next slide

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

Assessment Techniques Administration of the whisper test Administration of the Rinne and Weber tests using the tuning fork Administration of the Romberg test

Palpating the tragus. 30

Palpating the mastoid process. 31

Pulling the pinna to straighten the canal. 32

Assessment Techniques Otoscope Auditory canal Inserting the otoscope Handle up or down Straightening the ear canal Tympanic membrane

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

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

Performing the whisper test. 36

Activating the tuning fork. 37

Rinne test. Bone conduction. continued on next slide 38

Rinne test. Air conduction. 39

Weber test. 40

Romberg test. 41

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

Inspection of the nose. 43

Using the otoscope for nasal inspection. 44

Palpating the frontal sinuses. continued on next slide 45

Palpating the maxillary sinuses. 46

Percussion of frontal sinuses. continued on next slide 47

Percussion of maxillary sinuses. 48

Transillumination of the frontal sinuses. continued on next slide 49

Observing transillumination of the frontal sinuses. 50

Transillumination of the maxillary sinuses. continued on next slide 51

Transillumination of the maxillary sinuses using alternate technique. 52

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

Inspecting the teeth. 54

Palpating the tongue. 55

Inspecting the throat. 56

Abnormal Findings Lesions Deformities Infectious processes Dental problems

Table 16.6 (continued) Overview of Disorders of the Mouth and Throat continued on next slide

Table 16.6 (continued) Overview of Disorders of the Mouth and Throat