copyright 2002, delmar, a division of thomson learning chapter 13 ears, nose, mouth, and throat

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 13

Ears, Nose, Mouth, and Throat


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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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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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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Anatomy and Physiology of the Ear Middle ear

Ossicles Malleus (hammer) Incus (anvil) Stapes (stirrup)

Eustachian tube


Anatomy and Physiology of the Ear Inner ear

Labyrinth Vestibule Semicircular canals Cochlea


Anatomy and Physiology of the Nose Turbinates Nasal mucosa Olfactory receptor cells Paranasal sinuses


Anatomy and Physiology of the Mouth and Throat Mouth and throat

Lips Cheeks Buccal mucosa Hard palate Soft palate Teeth


Health History Ears

Hearing loss Excessive cerumen

Nose Deviated septum

Mouth and throat Tooth loss Gum disease Decreased taste


Common Chief Complaints Hearing loss Tinnitus Nasal blockage or congestion Halitosis Oral lesions


Evaluation of Chief Complaint Quality Associated manifestations Aggravating factors Alleviating factors Timing


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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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Past Health History

Dental pathology Nutritional disturbances

Surgical Oral surgery Cosmetic surgery of head or neck Repair of deviated septum Tympanostomy tubes


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Past Health History Medications

Antibiotics, antihistamines, decongestants, steroids, chemotherapy, immunosuppressive drugs

Allergies Severity of signs and symptoms Seasonal or environmental


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


Social History Alcohol use Tobacco use Drug use Sexual practices Work/home environment Hobbies/leisure activities Stress


Health Maintenance Activities Sleep Diet Use of safety devices Healthy checkups


General Approach to Assessment Greet the patient Explain assessment techniques Quiet, well-lit environment Sitting position Compare right to left Systematic approach


Equipment Otoscope Nasal speculum Penlight Tuning fork Cotton-tipped applicators Tongue blade Watch Gauze square


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Assessment of the Ear External ear Inspection

Note position, size, color, and shape Palpation

Auricle


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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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


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

Copyright 2002, Delmar, A division of Thomson Learning (continues)

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


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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Risk Factors for Otitis Media Less than 2 years of age Frequent upper respiratory

infections Cold weather Males


Risk Factors for Otitis Media Caucasians, Native Americans,

Alaskan natives Family history Smoky environment Bottle fed Down syndrome


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Assessment of the Nose Inspection of external nose

Location, symmetry, bleeding, masses, swelling, lesions

Patency Nostrils

Inspection of internal nose Otoscope with nasal speculum


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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


Assessment of the Nose Abnormal findings

Broken, misshapen, swollen nose Occluded nasal passages Septum is deviated Nasal mucosa is red and swollen Purulent drainage


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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Assessment of the Mouth Inspection

Lips, tongue Gums, buccal mucosa Teeth


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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


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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Inspection of the Throat Gag reflex Posterior pharynx Uvula Color of oropharynx Presence of swelling, exudate,

lesions


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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


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


Gerontological Variations Presbycusis Diminished sense of smell and taste Periodontal disease Oral alterations due to disease or

side effects of medications Tooth loss

copyright 2002, delmar, a division of thomson learning chapter 13 ears, nose, mouth, and throat

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