Sensory Disorders
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Sensory Disorders






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Sensory Disorders Sensory Disorders Presentation Transcript

  • SENSORY DISORDERS Nelia B. Perez RN, MSN PCU – MJCN Class 2015
  • CONTENTS • Review Of Anatomy and Physiology • Common Sensory Disorders
  • Ears
  • Anatomy •The ear is responsible for hearing and balance •Consists of 3 regions • External ear • Middle ear • Inner ear
  • Structure and Function • External Ear > auricle/pinna - movable cartilage covered with skin - Mastoid process= important Landmark External Auditory Canal - S-shaped pathway leading to the ME - 2.5 to 3 cm. long in adult
  • - Its skeleton of bone and cartilage is covered with sensitive skin ( outer 1/3 is cartilage, inner 2/3 consists of bone) - This canal lining is protected and lubricated with cerumen
  • - Lymphatic drainage of the external ear flows into parotid , mastoid, superficial cervical nodes
  • MIDDLE EAR air filled cavity in the temporal bone - >It contains the ossicles ( malleus, incus,stapes) that transmit sound from the TM to the oval window of the inner ear >
  • MIDDLE EAR >Tympanic membrane (eardrum) separates external and middle ear. • Translucent membrane • Pearly, gray color • Cone of light reflection when using otoscope • Oval and slightly concave shape, pulled in at center by malleus
  • Middle ear >Openings to Outer ear covered by tympanic membrane Inner ear = oval and round windows Eustachian tube connects middle ear to the nasopharnyx for air passage (normally closed, opens with swallowing/yawning)
  • Middle ear has 3 functions 1. Conducts sound vibration from outer ear to inner ear 2. Protects the inner ear by reducing the amplitude of loud sounds 3. Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes)
  • Inner Ear • Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium 1. Vestibule 2. Semicircular canals 3. Cochlea (contains the central hearing apparatus)
  • Function of hearing • 3 levels 1. Peripheral > ear transmits sound and converts its vibrations into electrical impulses > The electrical impulses are conducted by the auditory process of cranial nerve VIII (Acoustic) to the brain stem 1. Amplitude=loudness 2. Frequency=pitch
  • Sound waves cause the eardrum to vibrate > Vibrations travel via the ossicles thru the oval window > the cochlea > to the round window where they are dissipated
  • Vibrations in the basilar membrane of the cochlea that contain the organ of Corti receptor hair cells > translate the vibrations to electric impulses > The stimulated impulses go to the brainstem via Acoustic nerve (VIII)
  • 2. Brain stem - permits identification of sound and locating the direction of a sound in space. - Sensitive to intensity and timing from the ears depending on head position 3. Cerebral cortex - Intreprets the meaning of the sound and begins the appropriate response
  • Pathways of hearing 1. Air conduction (AC)– normal pathway of hearing, the most efficient 2. Bone conduction (BC)– bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve
  • Physical Examination • The Auricle 1) inspect each auricle for size , shape, symmetry, color, position on the head, deformities, nodules and lesions 2) If ear pain, discharge or inflammation is present, move the auricle up and down
  • 3) Note tenderness of pinna and mastoid area. Press the tragus and press firmly behind the ear
  • Physical Examination • Auricle -Extends slightly outward from the skull - Positioned in a nearly vertical plane - The origin of the helix should be on a horizontal line with corner of the eye - It should have the same color as the facial skin w/o moles, cysts & other lesions
  • Otoscopic Exam 1) Tip the patient’s head to the opposite side 2)Grasp the auricle firmly but gently, while pulling it upward, backward and slightly outward 3)Insert into the canal, sl down and forward, the largest ear speculum that the canal will accommodate
  • 4) Observe the ff: - patency of the ear canal - describe the walls of the ear canal. Note any redness or swelling - identify any discharge, presence of cerumen or FB in the ear canal - tympanic membrane
  • Inspect using Otoscope • External canal • Color • Swelling • Lesions • Discharge ; color and odor. Clean or change speculum before examining other ear.
  • Tympanic membrane • Color – normal is shiny, translucent, pearl-grey • Landmarks ( umbo, handle of malleus, light reflex) • Position – flat, slightly pulled in at the center and flutters when person holds nose and swallows • Integrity of membrane – intact
  • •Perform the otoscope exam prior to hearing tests.
  • Hearing Evaluation 1.Rough quantitative test for hearing loss 2.Whisper test 3.Tuning fork
  • • Rough quantitative test for hearing loss - begins when the patient responds to your questions and directions. The patient responds without excessive requests for repetition - Speech with a monotonous tone and erratic volume may indicate hearing loss
  • WHISPER TEST •Begins with the historyConversational tone •The following tests may indicate the presence of hearing loss but not the degree.
  • • Place your mouth at the side of the patient’s head ( 2 ft.) from her ear with the far ear covered • Whisper test questions that can’t be answered by yes or no • Test consistently with loud, medium and soft tones
  • • Repeat on the opposite ear using another word, have the client identify the words (Used to detect high-tone loss) • Normal Response to Voice test • Correct identification of whispered words bilaterally
  • TUNING FORK TESTS • Measure hearing by air conduction and bone conduction • Frequency of fork is 256-1024 cycles/sec. • To activate the tuning fork, hold it by the stem and strike the tines softly on the back of the hand
  • TUNING FORK TEST • Weber test > used when hearing is reported as better in one ear than the other ( bone conduction) > with normal neurosensory hearing and no conductive loss, the sounds are equal in both ears
  • > lateralization of the sound to one ear indicates a conductive loss on the same side or a perceptive loss/sensorineural loss on the other side
  • • Weber Test
  • • Rinne test – compares bone conduction and air conduction 1. Normally sound is heard 2X as long by air conduction as by bone conduction 2. Normal response ; positive Rinne Test = AC>BC Bilaterally Sound is heard longer by BC with a conductive loss.
  • • Rinne Test
  • Weber test Rinne test
  • Summary of any symptom should include PQRSTU • P= provocative or palliative • Q= quality or quantity • R= region or radiation • S= severity scale • T= timing (onset, duration, frequency)
  • Subjective data • Earaches • Tinnitus • Vertigo • Dizziness • Discharge • Hearing loss
  • HISTORY Always ask the following: • Tinnitus –ringing in the ears causes: a.Outer ear- cerumen, foreign body,polyp in the external auditory canal b. Middle ear – inflammation ,otosclerosis c. Internal ear- fever, suppuration of the labyrinth, SY,acoustic nerve tumor
  • internal ear – fracture at the base of the skull, meniere syndrome d.Drugs quinine, salicylates, aminoglycosides, gentamicin
  • •Ear pain ( Otalgia ) - pain may arise from inflammation of structure in the ear or be referred from other pharyngeal sites including the thyroid
  • Causes: Auricletrauma,hematoma,frostbite,burn, eczema, lnsect bites, impetigo, herpes zoster External auditory canalotitis externa ,carbuncle, eczema, hard cerumen, FB, herpes zoster
  • Middle earacute otits media, acute mastoiditis Referred pain- unerrupted lower third molar, carious teeth, tonsillitis, carcinoma of pharynx, trigeminal neuralgia , subacute thyroiditis
  • • Dizziness - patient has a sense of disturbed relation to space - described as being unsteady, weak, light headed or having the feeling of turning Causes: Endocrine hypothyroidism,pregnancy, hypoparathyroidism
  • Idiopathic multisystem atrophy Infectious tabes dorsalis, meningitis, encephalitis, brain abscess Metabolic/ nutritional pellagra, Vit.B12 def.,fluid & electrolyte imbalance
  • Mechanical/trauma skull fracture, otosclerosis, eye muscle imbalance glaucoma Neoplastic Brain tumors Neurologic migraine, peripheral neuropathy Psychosocial anxiety disorder Vascular hypertension, orthostatic hypotension
  • • Vertigo - persistent stimulation of the semicircular canals or vestibular nucleus when the head is at rest - It gives a hallucination of motion - When the eyes open, the pts.surrounding seems to be whirling or spinning - When the eyes closed, the pt.continues to feel in motion
  • Causes: Peripheral labyrinthine System - otitis media with effusion, otosclerosis, temporal bone fracture Central labyrinthine system - migraine, cerebellar hemorrhage, intracranial abscess
  • Cranial V111 infections - Acute meningitis, tuberculous meningitis, tumors Brainstem nuclei - encephalitis, brain abscess, hemorrhage, multiple sclerosis
  • • Hearing loss a. Conductive- seen in people with external or middle ear problem Causes: -obstruction of external auditory canal (FB, impacted cerumen) - Disorder of the eardrum & middle ear ( perforated TM, pus/blood in the ME ) - Overgrowth of bone with fixation of the stapes ((Otosclerosis)
  • b. Sensorineural hearing loss ( Perceptive) - involves the inner ear Causes: - disorders of the cochlea or the acoustic nerve (CN 8) - Aging ( Presbycusis ) due to nerve degeneration - Trauma - Drug toxicity - Tumors - infections - Heredity/congenital deafness
  • EAR SIGNS • EXTERNAL EAR a) Malformations of the Pinna microtia – smaller than normal macrotia – unusually large lop or bat ear- pinna may protude at R angle aztec or cagot ear – failure of development of the lobule
  • Macrotia or large ear Before Surgery After Surgery
  • Before Surgery After surgery
  • Lop or Bat ear - pinna may protrude at right angle
  • Lop or Bat Ears
  • satyr ear- pointed pinna cauliflower ear- untreated hematomas heal as nodular and bulbous irregularities of the helix and and antihelix - result of blunt trauma and necrosis of the underlying cartilage
  • Cauliflower Ears
  • b) Pinna nodule Darwin tubercle- harmless developmental eminence in the upper 3rd of the posterior helix Gouty tophus – small, whitish uric acid crystals along the peripheral margins of the auricles, olecranon bursa, tendon sheaths - nodules are painless hard, and irregular
  • Gouty deposits
  • b)External acoustic meatus Cerumen Impaction - due to excessive production of wax or a narrowed meatus leads to partial or complete obstruction of the canal - complete obstruction leads to partial deafness acc. by tinnitus or dizziness
  • Otorrhea( ear discharge) yellow discharge- melted cerumen serous discharge- eczema in the meatal wall, early ruptured acute OM bloody discharge- temporal bone fracture purulent discharge- chronic external otitis, chronic suppurative OM, cholesteatoma, TB, polyps
  • Foreign body Insect invaders Polyps Furuncle
  • • Tympanic membrane Retracted Tympanic membrane : - Seen in Serous Otitis media - more concave TM - accentuated bony landmarks - distorted light reflex
  • Normal Tympanic Membrane Retracted Tympanic Membrane
  • Bulging Tympanic membrane: - seen in Acute suppurative otitis media - more conical - loss of bony landmarks - distorted light reflex
  • Normal Tympanic Membrane Bulging Tympanic Membrane
  • Perforated Tympanic membrane: - previous suppurative middle ear infection has eroded thru the membrane producing holes - perforation appears as oval holes thru which the darkened middle ear cavity is seen
  • Perforated Tympanic Membrane
  • Perforated Tympanic Membrane
  • COMMON DISORDERS OF THE EAR • Otitis Externa a) Acute external otitis -due to Ps.aeruginosa, staph, strep, proteus - pain maybe mild or severe accentuated by movement of the pinna - swimmers’ ear - preauricular, postauricular , Ant cervical LN
  • b) Chronic external otitis - commonly due to bacteria and fungal - pruritus is the main complain instead of pain - aural discharge maybe present
  • • Otitis Media a) Chronic suppurative otitis media - ass. with permanent perforation of the eardrum -hearing is always impaired - painless aural discharge - pain and vertigo indicates development of complications like brain abscess
  • b) Cholesteatoma - collection of desquamated epithelial cells in the middle ear - foul smelling discharge, marginal perforation,hearing loss, pearly gray mass superior part of tympanic membrane - eustachian tube dysfunction causes retraction of tympanic membrane
  • • Vertiginous disorder a) Acute Labyrinthitis - most frequent cause of vertigo - patient gradually develop a sense of whirling that reaches a climax in 24-48 hrs. disappear gradually in 36 wks. - N/V may occur at the height of symptoms - no accompanying tinnitus or hearing loss
  • b) Benign Paroxysmal positional Vertigo (BPPV) - Calcium deposits in the labyrinth ( otoliths) are dislodged and move in response to gravity eliciting a feeling of motion - More common in older individuals - Sudden onset, often when rolling over in bed or arising in the morning - No headaches/fever but with nausea and inability to stand - Avoid any head motion to lessen symptoms
  • Thank You
  • Nose, Throat and Mouth
  • Nose • First segment of the respiratory system • Warms, moistens and filters inhaled air • Sensory organ for smell • Resonance of laryngeal sound
  • External parts • Bridge – frontal and maxillary bones • Tip • Nares – anterior openings of the nos • Columella - divides the nares • Ala nasi –lateral outside wing of the nose bilaterally • Upper 1/3 nose is bone; rest is cartilage
  • Internal • Nasal cavity -floor of the nose ( hard and soft palate) - roof of the nose ( frontal and sphenoid bone) • Nasal hair • Nasal Septum-divides cavity into 2 passages • Nasal turbinates
  • Internal • Superior, middle, inferior turbinates- 3 parallel bony projections on lateral walls of each cavity • Meatus- cleft/ groove underlying each turbinate.
  • •Inspired air enters thru the nares > passes thru the vestibule> to the choanae which are posterior openings > leading to the nasopharynx
  • Internal • Olfactory receptors - roof of the nasal cavity & upper part of septum above the superior turbinate. -merge into the olfactory nerve (I) > goes to the temporal lobe of the brain • Kiesselbach plexus - a vascular network located superficially on the anterior superior portion of the septum - site of most anterior nosebleeds
  • SINUSES • Paranasal sinuses - air-filled paired extensions of the nasal cavities within the bones of the skull - lined with mucous membranes and cilia that move secretions along excretory pathways - sinus openings are narrow, susceptible to occlusion> resulting in inflammation /sinusitis. - drained into the medial meatus
  • • Purpose • Serve as resonators for sound • Provide mucous for the nasal cavity Types: 1. Frontal sinuses 2. Maxillary sinuses 3. Ethmoid sinuses 4. Sphenoid sinuses Frontal & Maxillary sinuses are accessible to examination
  • Physical Examination
  • • Nose – Inspect and palpate • INSPECT for: • • • • • • Symmetry, deformity Inflammation Skin lesions Color Nasal flaring discharges
  • • Palpate - ridge & soft tissues of the nose - note any displacement of the bone, cartilage - note for tenderness & any mass - The nasal structures should be firm and stable to palpation - if with injury, palpate gently
  • •Test for sense of smell (CN 1) •Evaluate the patency of the nose - nasal breathing should be noiseless and easy thru the open nares
  • Nasal Cavity  Use the nasal speculum and good light source to inspect the nasal cavity a) Nasal mucosa - inspect for color, discharge, lesions, masses - it should appear deep pink ( pinker than the buccal mucosa) & glistening
  • b) nasal septum - In normal adult, the nasal septum is seldom precisely a midline structure - No perforations, bleeding or crusting should be apparent - a film of clear discharge is often apparent on the nasal septum
  • c) Nasal Turbinates - only the inferior and middle turbinates will be visible - it should be the same color as the surrounding area and have a firm consistency
  • • Paranasal Sinuses: Inspect and Palpate • Press thumbs over frontal & maxillary sinuses ( palpate the cheeks and supraorbital ridges) • No tenderness or swelling over the soft tissue should be present
  • •Transillumination test a) Frontal & Maxillary sinuses b) nasal septum - Best perform in a dark room - Look for a bright light in the supraorbital ridge and maxilla - Look for deviation, perforation, masses in the transilluminated septum
  • SYMPTOMS • Loss of smell ( anosmia ) - lesion of CN 1 or nasal obstruction - commonly due to closed head trauma - invariably accompanied by a perceived change in taste of food ( bland & unpalatable)
  • • Abnormal smell/ taste (dysgeusia) - this is a common complaint in patients who have loss of smell - if it is paroxysmal and associated with behavioral symptoms, it suggests complex partial seizures
  • Basal Cell Carcinoma
  • SIGNS • Discharge - Describe discharge as to its character ( watery, mucoid, purulent , bloody) - color ( greenish, whitish, bloody) - bilateral or unilateral
  • • • Running Nose
  • . 1.Unilateral - Choanal atresia - Foreign body- foul purulent discharge - neoplasm – bloody discharge - Head injury or surgery – clear spinal fluid 2. Bilateral - allergy - infection ( upper respiratory)
  • Foreign Body
  • . Unilateral - Choanal atresia - Foreign body - neoplasm - Head injury or surgery
  • • Epistaxis ( nosebleed) -Kiesselbach plexus – most common site of bleeding anteriorly - Back 3rd of the Inferior Meatus – most common site posteriorly
  • Causes: 1. Local - coughing - sneezing - nose pricking - fracture - foreign bodies
  • 2. Generalized - Congenital – hereditary telangiectasia - inflammatory/immune – wegener granulomatosis - infectious – typhoid fever, dengue, diphtheria - Metabolic/toxic – aspirin, scurvy
  • - Mechanical – change in atmospheric pressure ( mountain climbing, flying), exertion - Neoplastic – nasopharyngeal Ca leukemia - vascular- hemophilia, thrombocytopeni
  • - trauma- nasal and maxillary fracture - Elevated venous pressure- Cor pulmonale Congestive Heart failure - Elevated arterial pressure – HPN, coarctation of aorta
  • • Nasal septum a) Deviation - the cartilagenous and bony septum may deviate as a hump, spur, shelf to enroach on one nasal chamber occlusion causing obstruction
  • b) Perforation - a hole in the nasal septum (transillumination test) is commonly caused by chronic infection, nasal surgery, repeated trauma in picking off crusts, cocaine abuse - rarely due to SY, TB
  • Nasal Septum Perforation
  • Nasal Syndromes • Acute Rhinitis ( infectious) ( common cold) - Rhinoviruses infect the mucous membranes of the nose & sinuses causing inflammation and inc. nasal secretions - Watery nasal discharge, sneezing, discharge becomes purulent acc. by fever and body malaise
  • -Symptoms 3-10 days -Severe local pain suggest a complication-bacterial sinusitis
  • • Allergic rhinosinusitis - itching of the nose & eyes, rhinorrhea, lacrimation, sneezing - headache is common - maybe seasonal or perennial - common allergens are pollens, molds, house dust, mites, coachroach, animal danders
  • • Vasomotor Rhinitis - nonallergic mucosal edema and rhinorrhea ass. with vasodilatation of the nasal vessels, mucosal edema & inc. mucous production - due to chronic environmental irritants ( dust , smoke, strong odor, cold air), pregnancy, estrogens, progesterone
  • • Suppurative Paranasal Sinusitis - due to Strep. pneumonia, H. influenza - severe pain in the face occuring 714 days after signs & symptoms of an acute URTI - pain & pressure without fever suggest sinus obstruction requiring decongestants
  • • Cavernous Sinus Thrombosis -This is the most feared complication of nasal infections. It can cause blindness or death - Infection spreads from the nose>angular veins> cavernous sinus> septic thrombosis
  • -patient eyes complains of pain deep in the - Both eyes are involved, immobilization of the globes, periorbital edema, chemosis - May involve CN 3,4, &6 - Sudden chills, high fever, prostated, comatose, death within 2-3 days
  • Mouth • First segment of the digestive system • Airway for the respiratory system • ORAL CAVITY • Lips • Palate 1. Hard 2. Soft 3. Uvula – hangs down from the soft palate
  • • Cheeks- side walls of cavity • Tongue 1. Papillae- rough, bumpy elevations on dorsal 2. Frenulum 3. Taste buds • Teeth – 32 permanent
  • • Salivary glands 1. Parotid- largest of the glands, located in the cheeks, front of the ear. Stenson’s duct opens in buccal mucosa 2. Submandibular- walnut size, beneath the mandible at the angle of the jaw. Wharton’s duct either side of the frenulum 3. Sublingual –smallest, almond shape, under tongue
  • Throat  Area behind the mouth & nose  Oropharynx – separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars  Tonsils – lymphoid tissue behind pillars
  • • Posterior pharyngeal wall located behind the tonsils • Nasopharynx continues from the oropharynx but it is above it and behind the nasal cavity. -It holds the adenoids and the eustachian tube openings.
  • Physical Examination
  • • Preparation for examination a) Face the patient with both of you seated at the same level b) Remove any dentures to see the mucosa underneath c) Hold the tongue blade in the left hand and penlight in the right hand d) A good light source is needed
  • INSPECT AND PALPATE Use gloves, tongue depressor, light • Lips • Teeth • Gums • Tongue • Buccal mucosa • Mouth ( roof and floor of the mouth)
  • • Lips - remove lipstick - should be pink , smooth surface, free of lesions. - distinct border between the lips and facial skin should not be interrupted by lesions - Vertical and horizontal symmetry both at rest and with movements
  • Rest r e s t Movement
  • - Inspect the inner surface of the lips by retracting them with a tongue blade
  • Retraction of the Upper Lip Retraction of the lower Lip
  • • Teeth - ask patient to clench his/her teeth , smile and observe the occlusion of the teeth. - facial nerve is also tested - Make sure teeth are firmly anchored, probing each with a tongue blade - Generally ivory white in color with 32 permanent teeth in adults
  • Proper Occlusion of Teeth
  • • Buccal mucosa - with mouth open, using a tongue blade, inspect for color, pigmentation, nodules, white patches - normally pinkish red, smooth, moist - orifice of the stensen duct should appear as a whitish yellow or whitish pink protrusion in alignment with the 2nd upper molar
  • Retraction of the cheek to view the Buccal Mucosa Buccal Mucosa with prominent Papilla of Stensen Duct
  • • Gums - using a tongue blade, gums should have pink appearance with clearly defined tight margin at each tooth - gum surface beneath dentures should be free of inflammation, swelling or bleeding - Using gloves, palpate gums for tenderness, mass, induration, thickening
  • • Tongue - should fit well in the floor of the mouth - ask the patient to extend the tongue while you inspect for color, lesions, deviation, tremor, limitation of movement - Ask the patient to touch the tongue tip to the hard palate area directly behind the upper central incisors. There should be no difficulty.
  • - Inspect the dorsum of the tongue it should appear dull red ,moist, glistening note also for any swelling, coating, ulcerations - Inspect the ventral surface of the tongue it should be pink and smooth with large veins bet. the frenulum and fimbriated folds
  • - Wharton ducts should be apparent on each side of the frenulum
  • Mouth >Roof of the mouth - hard and soft palate Floor of the mouth - tongue Take note of the smell coming from the oral cavity Ask the patient to tilt his head to inspect the palate and uvula
  • Uvula , soft palate, bilateral fauces
  • Throat Tonsils - usually blend into the pink surface of the pharynx - surface of the tonsils have crypts where cellular debris and food collect - in normal adult, tonsils seldom protrude beyond the faucial pillars
  • Posterior wall of the pharynx -It should be smooth and glistening pink mucosa with some irregular spots of lymphatic tissue and small blood vessels -Test CN 9 and 10 touch the posterior wall of the pharynx on each side (+) gag reflex
  • Larynx - immediately behind and below the oral cavity - it is on the anterior wall of the pharynx - it is viewed in the laryngeal mirror held behind it
  • • Lips
  • Cyanotic Lips
  • Chapped dry lips
  • > Cheilitis - dry cracked lips due to dehydration from wind chapping, dentures , braces, or excessive lip licking - angular cheilitis due to candidiasis
  • Chapped Lips with Cheilitis
  • Cheilosis ( angular stomatitis) - ulcerations of skin at the corners of the mouth due to crusting 2ndary to riboflavin deficiency or ill fitting dentures
  • Cheilosis (Angular Stomatitis)
  • Cleft lip - due to incomplete fusion of the frontonasal process with the 2 maxillary processes
  • Cleft Lip
  • Retraction of the Lower Lip showing white scars Traumatized Lip (Green arrows)
  • • Hard palate Maxillary Torus
  • Maxillary torus - bony protuberance at the midline - no clinical significance
  • Cleft palate - a midline opening in the hard palate - congenital failure of the fusion of the maxillary process - usually ass. with cleft palate
  • Cleft Palate
  • • Tonsils Enlarged tonsils
  • - Grading tonsillar enlargement • Grade size 1+ visible • …………….2+ ½ way b/t tonsillar pillars and uvula • …………….3+ touching the uvula • …………….4+ touching each other
  • • Uvula Deviation of the uvula
  • • Posterior pharyngeal wall After tonsillectomy
  • Posterior Pharyngeal Wall With a yellow Pseudocyst Posterior Pharyngeal Wall with White removable mass of mucus
  • Acute viral pharyngitis - mucosa of oropharynx shows lymphoid tissue are elevated but noo edema - sore throat, rhinorrhea, malaise, myalgia Streptococal or staphylococcal pharyngitis - Pharyngeal mucosa is bright red, swollen, edematous studded with white or yellow follicles - Tonsils maybe enlarged
  • Pharyngeal diptheria - patch of white membrane in the tonsils. - pharyngeal mucosa bleeds on surface, reddened , reddened, swollen ,edematous Candidiasis - shining raised white patches on posterior pharynx, buccal mucosa and tongue
  • • Tongue Lingual Deviation
  • Tongue-tie or shortened frenulum
  • Folliate Papillae(Green) Circumvallate Papillae(blue) Elongated filiform Papillae
  • Large reddened fungiform Papillae Circumvallate Papillae
  • • Gums Gingival Fibrous Nodule At the mucogingival junction
  • Bleeding gums local causes: traumatic – toothbrush, laceration, dental caries, tartar on the teeth infection – pyorrhea alveolaris, stomatitis neoplasm – epulis, papilloma of gums
  • General causes: Scurvy, syphilis Metal poisoning –phosporous, lead, mercury Blood dyscrasia – hemophilia, leukemia, thrombocytopenia
  • Deep red or purple gums - tender , swollen, spongy and easily bleeds - due to scurvy ( ascorbic acid deficiency)
  • • Teeth Malocclusion of teeth
  • Periodontitis ( Pyorrhea Alveolaris) - lower teeth are involved - with purulent and retracted gums Epulis - fibrous tumor arising from periosteum and emerges from between the teeth.
  • • Larynx > hoarseness acute laryngitis – most common cause of hoarseness > laryngeal edema signs of obstruction – hoarseness, dyspnea and stridor
  • Laryngeal spasm - acute obstruction of the upper airways accompanied by hoarse brassy cough, dyspnea in children - due to allergy, infection, FB, neoplasm Laryngeal paralysis - Due to immobile vocal cords
  • • Halitosis ( fetor Oris) bad breath - Poor hygiene - Dental or tonsillar infections - Atrophic rhinitis - Putrefaction of food in the stomach from pyloric obstruction - Infected sputum form lung abscess and bronchiectasis