ears, nose, mouth

7/31/2019 Ears, Nose, Mouth

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D yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M AN

Ears and Hearing

Assessment of the ear includes:

Inspection and palpation of the external ear

Inspection of the remaining parts of the ear byan otoscope, and

Determination of auditory acuity

Ears usually assessed during initialphysical examination


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Parts of the Ear

Divided into 3 parts:


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External Ear Canal

Curved, about 2.5cm (1 inch) long(adult) and ends @ the tympanic

membraneCovered w/ skin, w/ fine hairs, glandand nerve endings

Glands secrete cerumen lubricatesand protects ear canal

Infant and toddler upward curvatureBy age 3 more downward curvature


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Middle Ear

Air-filled cavityContains 3 ossicles (bones of soundconduction):

Malleus (hammer)

Incus (anvil)

Stapes (stirrups)

Eustachian tube stabilizes air pressurebet. external atmosphere and themiddle ear

preventing rupture of tympanic membrane anddiscomfort produced by marked pressuredifference


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Inner Ear

Cochlea

Seashell-shaped structure

Essential for sound transmission and hearing

Vestibule and semicircular canals contains organs of equilibrium


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Dyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA NDyana M . M. Sap lan , RN , MA N

ears and hearing

Chapter 30Chapter 30Chapter 30Chapter 30

(pp. 594(pp. 594(pp. 594(pp. 594 598)598)598)598)


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Sound Transmission

Sound transmission and hearing arecomplex processes

Sound can be transmitted by airconduction or bone conduction.

Air-conducted transmission occurs bythis process:


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Air-conducted transmission occurs bythis process:

A sound stimulusenters the externalcanal and reaches

the tympanicmembrane Sound waves vibratethe tympanic

membrane

reachthe ossicles Opening inner ear(oval window)

Cochlea receives thesound vibrations Stimulus travels auditory nerve (8th

cv) and the cerebralcortex


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Bone-conducted sound transmission

Occurs when skull bones transport thesound directly to the auditory nerve


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Common Hearing Deficit w/ Age

Audiometric evaluations w/c measurehearing @ various decibels

recommended for children and eldersLoss of ability to hear high-frequencysounds such as f, s, sh, and ph

Neurosensory hearing deficit

does not respond well to use of hearing aid


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Common Hearing Deficit w/ Age

Conduction hearing loss

the result of interrupted transmission of sound

waves thru the outer and middle ear structuresCauses: tear in the tympanic membrane or an

obstruction due to swelling or other causes

Sensorineural hearing lossResult of damage to the inner ear, the auditory

nerve, or the hearing center in the brain

Mixed hearing loss

combination


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Assessing the Auricles

Inspect for color, symmetry of size, andposition

Position note the level @ w/c the superioraspect of the auricles attaches to the head inrelation to the eye

N: color same as facial skin; symmetrical;

aligned w/ outer canthus of eye (10 fromvertical)

D: earlobes bluish color; pallor (frostbite);

excessive redness (inflammation/fever); lowset ears (assoc. w/ cong. anomaly, such asDown syndrome


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Assessing the Auricles

Palpate for texture, elasticity, areas oftenderness

Gently pull auricle upward, downward, and backward

fold pinna forward (it shd. recoil)

push in on the tragus

Apply pressure to the mastoid process

N: mobile, firm, and not tender; pinnarecoils after it is folded

D: lesions (cysts); flaky, scaly skin(seborrhea); tenderness when moved orpressed (inflammation or infection of

external ear)


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External Ear Canal and Tympanic Membrane

Using an otoscope, inspect external earcanal for cerumen, skin lesions, pus,

and bloodAdult: straighten ear canal by pulling the pinna

up and back (superior, posterior)

Children: down and back (inferior, posterior)

Inspect the tympanic membrane forcolor and gloss.


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D yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AND yana M . M. Sap lan , RN , M ANDyana M . M. Sap lan , RN , M AN

Inserting an otoscopeInserting an otoscopeInserting an otoscopeInserting an otoscope Inserting an otoscopeInserting an otoscopeInserting an otoscopeInserting an otoscope

Normal TympanicNormal TympanicNormal TympanicNormal Tympanic

membranemembranemembranemembrane


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Gross Hearing Acuity Tests

Watch Tick testTicking of a watch has a higher pitch than thehuman voice

Tuning Fork TestsWebers test to assess bone conduction by

examining the lateralization (sidewardtransmission) of soundsN: sound heard on both ears or localized @ thecenter of the head = Weber (-)

D: sound is better heard in Impaired ear (boneconductive hearing loss); heard better in ear w/oproblem (sensorineural disturbance) = Weber (+)


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Rinne test to compare air conductionto bone conduction

Normal: Air-conducted (AC) hearing is greaterthan bone-conducted (BC) hearing

AC > BC = (+)Rinne

Deviation: bone-conduction time is equal to orlonger than air-conduction time

BC > AC or

BC = AC(-)Rinne - indicates a conductivehearing loss


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Whisper test

Accurate phrase identification

Client should be able to repeat the phrasescorrectly

Romberg test

Done to detect balance and equilibrium


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Lifespan Considerations

Infants

To assess gross hearing ring a bell from

behind the infant or have the parent call thechilds name to check for a response

Newborns will quiet to the sound and may open

eyes wider3 4 mos. will turn head and eyes toward the

sound


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Children

To inspect ext. canal and tympanicmembrane -


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Elders

Pinna es in width and length; earlobeelongates

Sensorineural hearing loss occursGeneralized hearing loss (prebycusis) occursin all frequencies

1st

Sx: loss of high-frequency sounds(f, s, sh, ph)


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Nose andSinuses


(pp. 600(pp. 600(pp. 600(pp. 600 601)601)601)601)


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Nose and Sinuses

Inspect nasal passagesw/ flashlight

Nasal speculum and a penlight or an

otoscope w/ a nasal attachmentfacilitates examination of the nasalcavity

Assessment includes:Inspection and palpation of the external nose(upper 1/3 of the nose is bone; remainder is

cartilage)Patency of the nasal cavities; and

Inspection of nasal cavities


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Inspection and examination


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Assessment

If client reports difficulty orabnormality in smell, nurse may test

clients olfactory sense by asking clientto identify common odors such ascoffee or mint

Done by asking client to close eyes and placingvials containing the scent under clients nose


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Assessing the Nose and Sinuses

Inspect external nose for any deviations inshape, size, or color and flaring or dischargefrom nares

Lightly palpate to det. any areas of tenderness,masses, displacement of bone and cartilage

Det. patency of both nasal cavitiesClose mouth, exert pressure on one naris and breathe thruthe opposite naris; repeat

Inspect nasal cavities using flashlight or nasalspeculum

Observe for presence of redness, swelling,growths, discharges

Inspect nasal septum bet. nasal chambers


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Infants

Speculum usually not necessary

Ethmoid and maxillary sinuses present @birth

Frontal sinuses begin to develop by 1 2

years of ageSphenoid sinuses develop later

Have fewer sinus problem than older children

and adolescents


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Children

Speculum not necessary cause child to be

apprehensiveEthmoid sinuses develop by age 6

Pre-adolescent cough and runny nose

common signs of sinusitisAdolescents may have headaches, facial

tenderness, and swelling (similar signs to adults)


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Elders

Sense of smell markedly diminishes - in the

no. of olfactory nerve fiber and atrophy ofremaining fibers

Less able to identify and discriminate odors

Nosebleeds may result from hypertensivedse. Or other arterial vessel changes


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Mouth andOropharynx


(pp. 601(pp. 601(pp. 601(pp. 601 605)605)605)605)


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Structures of the Mouth and Oropharynx

LipsInner and buccalmucosa

Tongue and thefloor of the mouthTeeth and gums

Hard and softpalateUvulaSalivary glands

Tonsillar pillarstonsils


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Problems affecting the Teeth

Dental Caries (cavities)Periodontal dse. (pyorrhea)

Plaqueinvisible soft film that adheres to the enamelsurface of the teeth; consists of bacteria,molecules of saliva, remnants of epithelial cells

and leukocytes

Tartar (dental calculus)Visible, hard deposit of plaque and deadbacteria that forms @ the gum lines

Can alter the fibers that attach the teeth to thegum and eventually disrupt bone tissue


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Pl


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Plaque

P bl ff i h T h


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P i d t l di ( h )


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Periodontal disease (pyorrhea)

P i d t l d


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Periodontal dse.

P i d t l Di


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Periodontal Disease

GingivitisRed, swollen gingiva (gums)

Bleeding, receding gum lines, and

Formation of pockets bet. teeth and gums

Advanced periodontal dse. teeth are

loose and pus evident when gums arepressed


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Other problems:


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Other problems:

Other deviations:


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Other deviations:

TonsillitisTonsillitisTonsillitisTonsillitis

Bifid uvulaBifid uvulaBifid uvulaBifid uvula

Other deviations


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Other deviations

Cleft lip andCleft lip andCleft lip andCleft lip and

PalatePalatePalatePalate

Dentures


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Dentures

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