HEALTH ASSESSMENT AND DIAGNOSTIC TESTS OF EYE AND ENT DISORDERSDIAGNOSTIC TESTS FOR EYE DISORDERS.pdf

HEALTH ASSESSMENTAND DIAGNOSTIC TESTS
OF EYE AND ENT DISORDERS
MRS. JISHA SRIVASTAVA, FACULTY RAKCON

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OBJECTIVES

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At the end of the class students will be able to :
1.Describe the structures of the Eye and ENT.
2.Describe the functions of Eye and ENT.
3.Explain age affect on the Eye and ENT. .
4.Explain the techniques used in a physical examination of Eye
and ENT.
5.List down the diagnostic tests for the disorders of the Eye and
ENT.
6.Distinguish between normal and abnormal findings.
7.Explain the Nursing Interventions for diagnostic tests for the
disorders of Eye and ENT.

ANATOMY AND PHYSIOLOGY
OF EYE
External structures
The bony orbit (eye socket)
The orbit is formed from
portions of the frontal, lacrimal,
ethmoid, maxillary, zygomaticus,
sphenoid and palatine bones.

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OF EYE
External structures
The eyeball is moved by six ocular
muscles
The four rectus muscles (the medial,
lateral, superior, and inferior) move the
eyes horizontally and vertically.
The two oblique muscles (superior
and inferior) rotate the eye in circular
movements to allow vision at all angles.
The upper and lower eyelids are folds
of skin that close to protect the anterior
eyeball.
When the eyelids close, they distribute
tear film

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OF EYE
External structures
The elliptic space between the two
open lids is the palpebral fissure .
The corners of the fissure are
called the canthi.
The medial, or inner canthus is
next to the nose; the lateral, or
outer, canthus is the outside corner.
Oil-secreting meibomian glands
are embedded in both upper and
lower lids.

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OF EYE
External structures
The lacrimal gland, in the upper lid
over the outer canthus, produces
tears that reach the eyeball through
secretory ducts.
Tiny openings (puncti) in both the
upper and lower lids at the inner
canthus direct tears to the lacrimal
sac.
The nasolacrimal duct directs the
flow of tears into the nose.
The tear film is composed of lipids
and dissolved salts, glucose, urea,
protein, and lysozyme

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Internal Structures
The conjunctiva is a thin
transparent layer of mucous
membrane that lines the eyelids
and covers the eyelid .
The cornea is a transparent
avascular structure with a
brilliant, shiny surface.
It is convex in shape, is about 0.5
mm thick, and acts as a powerful
lens to bend and direct (refract)
rays of light to the retina.

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OF EYE

Internal Structures
The cornea is composed of five
layers. It derives oxygen from
the atmosphere.
A rich network of nerve fibers
in the outer layer (epithelium)
produce sensation of pain
whenever the fibers are exposed
or stimulated.

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OF EYE

Internal Structures
The sclera is the fibrous protective
coating of the eye. It is white,
dense, and continuous with the
cornea. ln children, the sclera is
thin and appears bluish because of
the underlying pigmented
structures.
In old age, it may become
yellowish from degeneration.

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OF EYE

Internal Structures
The uveal tract, the middle
vascular layer of the eye furnishes
the blood supply to the retina.
The lens is a biconvex, avascular,
colourless, and almost completely
transparent structure, about 4 mm
thick and 9 mm in diameter.
The lens is surrounded by a
transparent envelope (the
capsule). The lens of the eye
consists of about 65% water and
35% protein.

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OF EYE

Internal Structures
The vitreous body is a clear,
avascular, jelly like structure,
vitreous chamber.
It helps maintain the shape and
transparency of the eye.

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OF EYE

Internal Structures
Retina: The retina is a thin,
semitransparent layer of nerve tissue that
forms the innermost lining of the eye.
It consists of 10 distinct layers of highly
organized, delicate tissue.
The retina contains all the sensory
receptors for the transmission of light
and is actually part of the brain. There are
two types of retinal receptors: rods and
cones.
About 125 million rods are distributed in
the periphery of the retina; they function
best in dim light.
Damage to these structures results in
night blindness.

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OF EYE

Internal Structures
Optic Nerve and Neural Pathways
The optic nerve is located at the
posterior portion of the eye and
transmits visual impulses from the
retina to the brain.
The head of the optic nerve (optic
disc) can be Seen by
ophthalmoscopic examination.
The optic nerve* contains no
sensory receptors (rods or cones)
and represents a blind spot in the
eye.

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OF EYE

FUNCTION OF THE
VISUAL SYSTEM
Transmission of light
Visual receptors of Retina: Cones and
Rods
Image processing

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The major visual changes with ageing include decreases in
(1) Visual acuity
(2)Tolerance of glare
(3) Ability to adapt to dark and lightPeripheral vision.
(4)Each of these decreases is related to changes in the eye
structure and each affects the quality and intensity of the
light able to reach the retina.
EFFECTS OF AGEING ON
VISION

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2. AUDITORY SYSTEM
1. External Ear
Auricle (Pinna): The auricle (pinna)
is attached to the side of the head by
skin at approximately a 20 to 30 degree
angle.
External Auditory Canal (Ear
Canal): The ear canal extends from the
concha of the pinna to the tympanic
membrane. In adults, this slightly S
shaped canal is approximately 2.5 cm (1
inch) in length .The sebaceous and
ceruminous glands secrete a golden to
black substance called cerumen (wax).

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2. AUDITORY SYSTEM
1. External Ear
Tympanic Membrane:
The tympanic membrane
(eardrum) is an oval disk
(approximately 1 cm in
diameter); it covers the end
of the auditory canal and
separates the canal from
the middle ear.

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2. AUDITORY SYSTEM
2. Middle Ear
Ossicles:The outermost and
largest ossicle is the malleus
(hammer), which is firmly attached
to the tympanic membrane. The
innermost and smallest ossicle is
the stapes (stirrup); its footplate
occupies the oval window, in direct
contact with the perilymph of the
inner ear. The incus (anvil) lies
between the other two and is
shaped like a tooth with two roots.

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2. AUDITORY SYSTEM
2. Middle Ear
Windows: The round window is
an opening in the inner ear from
which sound vibrations exit. The
oval window is an opening in the
inner ear into which sound
vibrations enter.
Eustachian Tube: The eustachian
tube is a narrow channel
approximately 35 mm (1% inches)
long and only 1 mm wide at its
narrowest end. This tube connects
the middle ear to the nasopharynx.

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2. AUDITORY SYSTEM
2. Middle Ear
Mastoid Bone: The mastoid section
of the temporal bone includes the
cone-shaped mastoid process; the
mastoid antrum, a large cavity
posteriorly continuous with the middle
ear; and the mastoid air cells, which
extend from the antrum and fill the
temporal bone with air pockets. The
mastoid bone is a bony protuberance
behind the lower portion of the pinna.

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2. AUDITORY SYSTEM
3. Inner Ear (Labyrinth)
The bony labyrinth is the rigid capsule (otic
capsule) that surrounds and protects the delicate
membranous labyrinth. The vestibule connects the
cochlea (for hearing) to the three semicircular canals
(for balance). The cochlea, which looks like a snail
shell with 2% turns, is approximately 7 mm in
diameter .
The membranous labyrinth, lying within but not
completely filling the bony labyrinth, is bathed in a
fluid called perilymph, which communicates with the
cerebrospinal fluid (CSF) via the cochlear duct. The
membranous labyrinth consists of the utricle, the
saccule, the semicircular canals, the cochleaar duct,
and the organ of Corti (the end organ for division of
the acoustic nerve to the brain).

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EFFECTS OF AGEING ON
HEARING
Loss of auditory neurons in the organ of Corti and cochlear
hair cell degeneration create an inability to hear high-
frequency sounds.
The hairs become coarser during the ageing process; thus
retention of wax is more of a problem.
Presbycusis, a gradual sensorineural loss caused by nerve
degeneration in the inner ear or auditory nerve, even in
people living in a quiet environment.

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ANATOMY AND PHYSIOLOGY OF NOSE AND
THROAT

External meatus. Triangular-shaped
projection in the center of the face.
External nostrils. Two chambers
divided by the septum.
Septum. Made up mainly of cartilage
and bone and covered by mucous
membranes. The cartilage also gives
shape and support to the outer part of
the nose.
Nasal passages. Passages that are
lined with mucous membranes and tiny
hairs (cilia) that help to filter the air.
NOSE

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Ethmoid sinus. This sinus is located inside
the face, around the area of the bridge of the
nose. It is present at birth, and continues to
grow.
Maxillary sinus. This sinus is located inside
the face, around the area of the cheeks. It is
also present at birth, and continues to grow.
Frontal sinus. This sinus is located inside
the face, in the area of the forehead. It does
not develop until around 7 years of age.
Sphenoid sinus. This sinus is located deep
in the face, behind the nose. It does not
typically develop until the teen years.
NOSE

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THROAT
The throat is a ring-like muscular tube. It is the
passageway for air, food, and liquid. It also helps
in forming speech. The throat is made up of:
Voice box (larynx). The larynx is a cylindrical
grouping of cartilage, muscles, and soft tissue
that contains the vocal cords. The vocal cords
are the upper opening into the windpipe
(trachea), the passageway to the lungs.
Epiglottis. A flap of soft tissue located just
above the vocal cords. The epiglottis folds
down over the vocal cords to prevent food
and irritants from entering the lungs.
Tonsils and adenoids. They are made up of
lymph tissue and are located at the back and
the sides of the mouth. They protect against
infection. But they don't really have a
function after childhood.

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ASSESSMENT OF EYE
•≈
Biographical and Demographic Data:
• Age and gender.
• The incidence of cataracts, dry eye, retinal detachment,
glaucoma, esotropia (eyes turning inward), and exotropia
(eyes turning outward) increases with age.
• Hereditary color vision deficits are more common in men
than in women.

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ASSESSMENT OF EYE
•≈
Current Health:There may be a fear of vision loss or
uncorrectable visual manifestations

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ASSESSMENT OF EYE:
HISTORY
•≈
Chief Complaint
Change or loss of vision.
Headache or eyestrain.

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1. ABDOMEN INSPECTION.
Past Medical History :
Diabetes mellitus, rheumatoid arthritis, and thyroid disorders,
vaccinations, particularly for measles (rubella), hypertension,
multiple sclerosis, and myasthenia gravis.
If the client wears eyeglasses or contact lenses, ask when the last eye
examination took place and when the prescription was last changed.
History of head or eye trauma, must be assessed.

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ASSESSMENT OF EYE

Surgical History:
Corrective vision surgery such as laser-assisted in-situ
Keratomileusis (LASIK), radial keratotomy (RK), Cataract removal,
glaucoma treatment, or eye muscle correction.
Some eye surgeries, such as those for glaucoma, precipitate other
eye issues (cataracts).
History of brain or facial surgeries should also be assessed as there
have potential to affect vision.

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ASSESSMENT OF EYE

Allergies: Note any allergies to medications (eye drop) and other
substances, such as inhalants (dust, chemicals or pollen)
Medications: over-the counter (OTC), eye drops, as those with
antihistamines and decongestants can dry the ocular surface.
Record eye and systemic medications being used, and current and
past ocular disorders.

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ASSESSMENT OF EYE

Dietary Habits: Herbal remedies and dietary supplements
(vitamins).
Some clients may consume large doses of vitamins, believing
these substances will prevent the development of vision problems
such as cataracts and macular degeneration.
Studies have shown that diets rich in fruits, vegetables, and fish,
or supplements of antioxidants C, E, and beta-carotene, have
potential to reduce the incidence of visual problems like macular
degeneration. harmful.

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ASSESSMENT OF EYE

Social History:
Occupational hazards, leisure activities and hobbies, and health
management behaviours.
Assess the client's work and/or hobbies that may include
exposure to harmful fumes, smoke or airborne particles.
Assess participation in activities that increase risk for head
trauma such as racquetball or baseball

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ASSESSMENT OF EYE

1. HEIGHT, WEIGHT, AND
BODY MASS INDEX
Family History: strabismus, glaucoma, myopia, hyperopia,
glaucoma, cataracts, night blindness (retinitis pigmentosa),
color blindness, diabetes mellitus, retinoblastoma, and
macular degeneration also tend to appear in families

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ASSESSMENT OF EYE

ASSESSMENT OF ORAL
CAVITY
Pain (Ophthalmalgia). Eyestrain, pulling, pressure,
fullness, or generalized headache. The pain may be periocular,
ocular, or retrobulbar (behind the globe). Deeper internal
aching may indicate glaucoma, inflammation, muscle spasm,
or infection.

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CLINICAL
MANIFESTATIONS:EYE

ASSESSMENT OF ORAL
CAVITY
Abnormal Vision. Refractive (focusing) error; lid ptosis
(drooping eyelid); clouding lens, or aqueous or vitreous space
and malfunction of the retina, optic nerve.

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CLINICAL
MANIFESTATIONS:EYE

ASSESSMENT OF ORAL
CAVITY
Abnormal Appearance. Lesions, edema, ptosis, and
abnormal position. The most common abnormal appearance is
a red eye .
Abnormal Sensation. Reflex spasm of the ciliary muscle
and iris sphincter that occurs with inflammation may produce
brow ache and photophobia (sensitivity to light) or a
constricted pupil (miosis).
Itching is usually a sign of allergic reaction.

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Clinical Manifestations:EYE
CLINICAL
MANIFESTATIONS:EYE

ASSESSMENT OF ORAL
CAVITY
Eye numbness: Diabetes nmellitus, peripheral neuropathy,
Conjunctivitis, stroke
EYE pain :Injury, infection, inflammation, glaucoma, foreign
body, eye strain, sinusitis, corneal abrasions, hypertension,
migraine, multiple sclerosis, tumor
Flashes: Retinal detachment, blow to the head, ocular
migraine

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Clinical Manifestations:EYE
CLINICAL
MANIFESTATIONS:EYE

ASSESSMENT OF ORAL
CAVITY
Floaters :Red and white blood cells or gel-like clumps in the
vitreous, retinal tear or detachment, normal part of aging.
Foreign body: Object in eye, corneal scratches, abrasions or
Foreign body, erosion, dry eye, conjunctivitis, contact lens issue,
keratitis
Itching :Blepharitis (eyelid infection), conjunctivitis, contact
lens issues, ocular allergy

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ASSESSMENT OF EYE
CLINICAL
MANIFESTATIONS:EYE

ASSESSMENT OF ORAL
CAVITY
Headache :Eyestrain, migraine headache, cluster headache,
sinusitis, shingles, conjunctivitis, corneal abrasion or ulcer
Light Sensitivity Tearing :Acute glaucoma, iritis, scleritis,
corneal ulcer, thyroid disease, ectropion/entropion
Tearing: Blocked tear duct, dry eye, infection of lacrimal sac,
ectropion (everted lid) or entropion (inverted lid).

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ASSESSMENT OF EYE
CLINICAL
MANIFESTATIONS:EYE

EXTERNAL EYE
External Eye: eyebrows, eyelashes eyelids, the lacrimal apparatus,
anterior portion of the eyeballs.
Eye Position: symmetry and alignment.
Eyebrows: eyebrows for symmetry, hair distribution, skin conditions, and
movement. The eyebrows normally move up and down smoothly
Eyelids and Eyelashes: placement and symmetry, lesions, I blink
response. Blinking is an involuntary reflex that occurs bilaterally up to 20
times a minute.
PHYSICAL EXAMINATION

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EXTERNAL EYE
Eyeballs and Lacrimal Apparatus :
To palpate the eyeballs, instruct the client to close the eyes and look down.
Place the tip of the index fingers on the upper eyelids, over the sclerae, and palpate
gently.
Normally, the eyeballs feel firm and symmetrical.
Visualize the lacrimal apparatus by retracting the upper lid and having the client look
down.
The area should be free of swelling, edema, and excessive moisture, and there should
be no regurgitation of fluid from the sac or puncta.
Intraocular inflammation, iris adhesions, systemic or ocular medication side effects, or
surgical alteration.

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EXTERNAL EYE
Conjunctivae and Sclerae:
Inspect the conjunctivae and sclerae for color changes,
texture, vascularity, lesions, thickness, secretions, and foreign
bodies.
The bulbar conjunctivae are colorless and transparent,
allowing the sclerae to be seen.
Small blood vessels may be visible.
Healthy conjunctivae are pink to light red.

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EXTERNAL EYE
Cornea and Anterior Chamber:
Inspect the cornea and anterior chamber from an oblique angle
while shining a penlight on the corneal surface.
The iris are easily visible. In older adults, a thin, greyish white
ring around the edge of the cornea (arcus senilis) may be seen.
The anterior chambers should appear clear and transparent
with no cloudiness or shadows cast on the irides.
The depth of the chamber between the cornea and iris is
normally about 3 mm.

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EXTERNAL EYE
Iris and Pupil :
Inspect the iris and the pupil with the same from the penlight.
The iris should light up and have a consistent color.
The light should also cause iris to constrict as the optic nerves
are stimulated, using the pupil to become smaller.
Neurologic disease, intraocular inflammation, iris adhesions,
systemic or ocular medication side effects, or surgical
alteration.

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INTERNAL EYE

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Direct Ophthalmoscopy
In a darkened room, the instrument is held 1 to 2 inches away from the client's eye for
examination
Retinal veins radiate from the disc and are darker, and slightly thicker, than arteries.
They should not be pulsating, although as a normal variation you may see an occasional
spontaneous pulsation.
The retinal background is pink in Caucasian people and heavily pigmented in people with a
dark complexion.
Choroidal vessels may appear as linear orange streaks.
The presence of a cataract, or cloudy cornea, may impair examination.
Abnormal findings include an altered arteriovenous ratio, narrowed arteries, widened
veins, pinched off vessels, abnormal arterial light reflex, exudates, white patches, and focal
hemorrhage.

INTERNAL EYE
Indirect ophthalmoscopy
The light source comes from a head-mounted light.
The examiner holds a convex lens in front of the client's eye and,
through a viewing device attached to the headband, sees an
inverted reversed image.
The indirect ophthalmoscope provides for binocular visual
inspection with depth perception and permits a wider field of
view compared with the direct method.

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OF EYE
INSPECTION
Visual acuity 20/20.
Eyebrows full, mobile.
Eyelashes curve out and away from eyelids.
Ptosis absent.
Eyelids without Eyes moist.
Palpebral conjunctivae pink, bulbar conjunctivae clear.
Scleral color even, without redness.
Corneal light reflection symmetrical.
PERRLA,(pupils equal, round, reactive to light and accommodation)
Cornea smooth; lens and anterior chamber clear, irides evenly coloured.
EOMs (extra ocular movement)full, without nystagmus.
Conjugate movement.
No strabismus.
Visual fields full to confrontation.

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OF EYE
PALPATION
Eyeballs firm. Orbits without edema. No regurgitation from
puncta. Tenderness absent over lacrimal apparatus.
FUNDUSCOPIC EXAMINATION
Red reflexes visualized. AV(Artery to vein) ratio approximately
2:3. Vessels without tortuosity, narrowing, pulsation.
Disc margins clear, no cupping, cup-to-disc ratio 1:3.
No evidence of retinal hemorrhage, patches, spots.

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Corneal reflexes: Assesses function of fifth cranial nerve. Client
looks straight ahead, bring sterile cotton wisp from behind and lightly
touch cornea; may also use syringe to puff air gently across cornea.
Blinking and tearing indicate intact (trigeminal) nerves.
Corneal light reflex test (Hirschberg’s test): Determines eye
alignment. Shine penlight 12-15 inches from bridge of nose with client
staring straight ahead; observe light reflection from both corneas.
Symmetrical reflection is normal Asymmetrical reflection can indicate
strabismus, esotropia (deviates to nose), exotropia (deviates away
from nose). hyperopia (vertical up), or hypotropia (vertical down).
PHYSICAL EXAMINATION TEST OF
THE EYE: REFLEXES AND
MOTILITY

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Ocular motility:Gathers information about extraocular muscles; orbit;
oculomotor, trochlear, and abducens nerves; brain stem connections; and
cerebral cortex. Client tracks target by both eyes as it is moved through the 6
cardinal directions of gaze . Eyes normally move parallel to each other in
smooth unison. Involuntary , rapid oscillating movement of eyeball
(nystagmus).
Cover-uncover test: Client stares at fixed point 20 inches away; cover one eye
with opaque card and observe uncovered eye for lateral or medial movement as
it focuses on fixed point; remove cover and observe that eye for movement as it
focuses on fixed point Repeat for other eye. No movement is a normal finding
Test may need to be repeated several times to confirm abnormal findings
TEST OF OF THE EYE:

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ABNORMAL PHYSICAL
EXAMINATION FINDING
Eye position: Sunken or protruding eyes, such as protrusion of one eye or both eyes
(exophthalmos).
Lids: Sagging of upper lids that covers part of pupil (ptosis) Eyelids that turn
inward (entropion) or outward (ectropion) Lid eversion and inversion.
Blink: Rapid, infrequent, or asymmetrical blinking Asymmetrical blinking.
Eyeball : Asymmetrical, hard, or soft
lacrimal apparatus: Swelling, edema, excessive moisture, and regurgitation of fluid
Conjunctiva: Paleness or a bright red color
Cornea: Surface irregularity and cloudiness (opacity)
Anterior chamber: Shallow or deep chambers (3 mm is normal) are abnormal
Cloudy or nontransparent
Iris: Bulging or uneven colouring
Pupil: Light intolerance(photophobia). Light intolerance (photophobia), Irregular
or unequal pupils that do not react to light

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VISION TESTING
Abnormal acuity implies uncorrected refractive error or pathology. Normal is 20/20. Myopia
(nearsighted)is 20/30 or more. Farsighted is 20/15 or less, but may be greater than average acuity.
20/200 with corrected
Visual acuity :
Determines clarity of cornea, lens, and vitreous; determines function. Position client 20 ft in front
of Snellen chart. Client sits with one eye covered.
Ask client to read smallest line of print seen of visual pathway from retina to brain.
Examples: 20/20 is normal; client reads at 20 ft what person with normal vision reads at 20 ft
20/60 means client reads at 20 ft what person with normal vision reads at 60 ft , 20/15 means
client reads at 20 ft what person with normal vision reads at I5ft.
Snellen chart generally placed at a distance of 20 feet, the distance at which rays of light from an
object are practically parallel and little accommodation effort is needed.
Sizes of symbols are identified according to the distances at which they are normally visible. For
example, the largest symbols can be read 200 feet away by people with unimpaired vision.

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VISION TESTING
Visual fields
To evaluate peripheral vision , use confrontational method or a
computerised method. Gross visual field abnormalities can be detected. If
found, refer for further exam.
Visual field alteration may be caused by CNS disorders lesions, syphilis) or
ocular disorders (glaucoma, retinal detachment).
Client sits 2 ft away from you, looking into your eyes.
Cover your right eye and client's left.
To evaluate peripheral vision, you can use confrontational method (at right)
or a computerized
Hold a penlight equidistant between you and client, just out of view of
peripheral visual field.
Starting with superior field, bring object down until client states it is visible.
Repeat at 45degree angles, through superior, temporal, inferior and nasal
fields.

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SELECTED EYE AND VISION
DISORDERS INFLUENCED BY
GENETIC FACTORS.
Albinism
Aniridia
Color blindness
Glaucoma
Homocystinuria
Isolated familial congenital cataracts
Leber hereditary optic neuropathy
Marfan syndrome
Retinitis pigmentosa

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BIOGRAPHICAL AND
DEMOGRAPHIC DATA

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Demographic data relevant to otologic assessment include the
client's age. Hearing impairment may occur as a consequence
of the ageing process

CURRENT HEALTH

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Hearing problems can affect a client's ability to communicate
as well as limit their social activities and job opportunities.
A reduction in their physical, functional, and social activities,
attributable to ear problems or hearing loss, can interfere with
the client's independence, which can lead to isolation and
depression.
Hearing loss can result in feelings of frustration,
embarrassment, and loneliness.

CHIEF COMPLAINT

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When discussing ear complaints, ask about common clinical
manifestations of the ear. The client may also complain of
associated nausea or vomiting.
Complete an analysis of clinical manifestations to determine
the onset, duration, frequency, and precipitating and relieving
factors.
Explore the client's past health history to determine the
chronicity of the problem and the probable cause.

CLINICAL
MANIFESTATIONS
Hearing Loss: Hearing loss may occur suddenly or gradually and can
accompany the normal ageing process. The loss may be conductive, a result of
damage to the middle ear or otosclerosis; sensory neural, a result of disease the
inner car, nerve pathways or a result of loss of hair cells; or related to a CNS
disorder.
Vertigo. Vertigo is a sensation of motion while the person is not moving. A client
may feel that either he or she or the room is moving. Dizziness is a sensation of
unsteadiness and a feeling of movement within the head or lightheadedness.

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CLINICAL
MANIFESTATIONS
Tinnitus. Tinnitus (ringing in the ears) may be reported as high-
pitched or low-pitched, roaring, humming. This sensory neural
form of auditory disorder occurs even in the absence of sound
waves.
Ear Drainage (Otorrhea). Ear drainage can be bloody
(sanguineous), clear (serous), mixed (serosanguineous), or it may
contain pus (purulent). Drainage may also be accompanied by
odor and pain.

66

CLINICAL
MANIFESTATIONS
Infection. Ear infections in infants can impair their ability to
hear spoken words and impede the development of the auditory
nerve used for hearing and speech.
Pain (Otalgia). Pain may be perceived as a feeling of fullness in
the ear. It may be intensified by movement and relieved by
holding the head still or by applying heat. Pain may occur in and
around the ear and it may be intense. Fever, headache, nausea,

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PAST MEDICAL HISTORY
Infectious diseases with ear sequelae includes mumps, measles,
and meningitis. Specifically inquire whether the Haemophilus
influenza type b (Hib). In utero exposure to maternal influenza
or rubella may result in congenital hearing loss in the child.

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SURGICAL HISTORY
History of t any surgical procedures that may
have been performed. This may include a
mastoidectomy, tympanoplasty, stapedectomy,
or a labyrinthectomy, myringoplasty for repair
of perforation of the eardrum.

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PSYCHOSOCIAL HISTORY
occupational hazards, environmental exposure,
and leisure activities and hobbies. Leisure
activities should include questions about
swimming. Contaminated water can provoke an
External car infection and, if the tympanic
membrane is perforated, may lead to infection
in the middle car.

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ALLERGIES
In addition to asking about allergies to medications and other
substances, inquire about allergies resulting in nasal stuffiness
and congestion. Close proximity of the eustachian tubes to the
nasal mucosa may result in edema, which obstructs the flow of
air between the middle ear and nose so that air pressure cannot
be equalised.

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MEDICATION HISTORY
Aspirin is a common cause of tinnitus. Other
drugs include aminoglycosides, analgesics,
salicylates, quinine, chemotherapeutic agents,
and antiprotozoal agents. Review the use of
herbal remedies. Ginger (Zingiber Officinale) is
known for its antinausea effect and can be used
for the relief of motion sickness. Ginkgo biloba
has been used for tinnitus and vertigo.

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DIETARY HISTORY
Adequacy of nutrient supply to local tissues should be
considered. Inquire about dietary restrictions, use of
food supplements (e.g.vitamins), ability to swallow and
chew, and a history of any feeding problems. Ménière's
disease may present with attacks of vertigo and
tinnitus. Recent findings have indicated the use of a
low-salt diet may be involved with the initial treatment
of the disease.

73

FAMILY HISTORY
Ask about a history of ear surgery or earring loss in the family.
Determine the age at onset of hearing loss or changes in in
hearing acuity

74

OTOTOXIC DRUGS
AMINOGLYCOSIDE ANTIBIOTICS: Streptomycin,
Neomycin ,Gentamicin, Tobramycin,
Amikacin,Kanamycin ,Netilmicin
OTHER ANTIBIOTICs: Vancomycin, Viomycin, Polymyxin
B ,Polymyxin E, Erythromycin, Capreomycin , Chloramphenicol ,
Minocycline
OTHER DRUGS: Chemotherapeutic agents (bleomycin, cisplatin,
nitrogen, Salicylates )Quinine drugs Quinidine Chloroquine
DIURETICS: Furosemide, Ethacrynic acid, Acetazolamide,
Bumetanide, Mannitol
CHEMICALS:Metals (lead, mercury, gold, arsenic),
Alcohol,Aniline dyes,Caffeine, Carbon monoxide, Nicotine,
Potassium bromate Povidine)

75

INSPECTION
• Auricles symmetrical, superior portion level with outer canthus of eye.
• Outer canals clear.
• Pre auricular and post auricular areas without swelling, masses, or
lesions.
• Whisper heard at 3 feet.
• Note any lumps, skin lesions, or cysts, and record approximate size and
location.
• Perform palpation and manipulation of the pinna to detect tenderness,
nodules, or trophi (small, hard nodules in the helix that are deposits of
uric acid crystals characteristic of gout).

76

PALPATION
Tenderness over tragus and mastoid absent. No masses.

77

OTOSCOPIC
EXAMINATION
Soft cerumen present in canals.
No discharge.
TM intact, gray.
Cone of light at 4:00 in right ear and at 7:00 in left ear.
Landmarks visualized.
No retraction or bulging.
TM freely movable with pneumatic pressure.

78

THE EAR
Extra cartilage tags/pre-auricular sinuses or pits.
Signs of trauma to the pinna.
Suspicious skin lesions on the pinna, including neoplasia.
Skin conditions of the pinna and external canal.
Infection/inflammation of the external ear canal, with
discharge.
Signs/scars of previous surgery.

79

EAR CANAL
Direct Observation. Canal skin, and the presence of wax,
foreign tissue, or discharge. The mobility of the eardrum can
be evaluated using a pneumatic speculum, which attaches to
the otoscope.

80

TESTS FOR AUDITORY
ACUITY

81
The tuning fork: also provides a general estimate of hearing loss. A
frequency of 512 Hz is recommended. The two major tuning fork
tests date from the 19th century and are named after their
originators: Weber and Rinne.
Whisper Test: To exclude one ear from the testing, the examiner
covers the untested ear with the palm of the hand. Then the
examiner whispers softly from a distance of 1 or 2 feet from the
unoccluded ear and out of the patient’s sight. The patient with
normal acuity can correctly repeat what was whispered.

TESTS FOR AUDITORY
ACUITY

82
Weber Test: The Weber test uses bone conduction to test lateralization of sound.
A tuning fork (ideally, 512 Hz), set in motion by grasping it firmly by its stem and
tapping it on the examiner’s knee or hand, is placed on the patient’s head or forehead.
A person with normal hearing will hear the sound equally in both ears or describe the
sound as centered in the middle of the head.
In cases of conductive hearing loss, such as from otosclerosis or otitis
media, the sound is heard better in the affected ear.
In cases of sensorineural hearing loss, resulting from damage to the cochlear or
vestibulocochlear nerve, the sound lateralizes to the better-hearing
ear. The Weber test is useful for detecting unilateral hearing loss

TESTS FOR AUDITORY
ACUITY

83
Rinne Test: In the Rinne test, the examiner shifts the stem of a vibrating tuning fork
between two positions: 2 inchesfrom the opening of the ear canal (ie, for air conduction)
and against the mastoid bone (ie, for bone conduction).
As the position changes, the patient is asked to indicate which tone is louder or when the
tone is no longer audible. Normally, sound heard by air conduction is audible longer than
sound heard by bone conduction.
The Rinne test is useful for distinguishing between conductive and sensorineural hearing
losses.
With a conductive hearing loss, bone-conducted sound is heard as long as or longer than
air-conducted sound, whereas with a sensorineural hearing loss, air-conducted sound is
audible longer than bone conducted sound. In a normal hearing ear, air-conducted sound
is louder than bone-conducted sound.

TESTS FOR VESTIBULAR
ACUITY ROMBERG TEST

84
A tandem Romberg test should also be performed. Instruct the
client to walk forward and backward, heel to toe. A peripheral
vestibular leision can cause marked swaying or falling.

ACUITY ROMBERG TEST

85
A past pointing test can also indicate a labyrinthine disorder.
While the client is seated, facing you with eyes open, hold out
your index finger at the client's shoulder level.
Instruct the client to touch your finger with the right index
finger. Ask the client to lower the arm, close the eyes, and
touch your finger again.
A labyrinthine disorder can lead to past-pointing when the
eyes are closed. Cerebral lesions are indicated when past-
pointing occurs whether the eyes are open or closed.

ACUITY ROMBERG TEST

86
Test for Nystagmus. Nystagmus is involuntary, rhythmic
oscillation of the eyes associated with vestibular dysfunction.
Nystagmus occurs normally when a client watches a rapidly
moving object or looks beyond 30 degrees laterally (end-point
nystagmus).
To assess for gaze nystagmus, place your finger directly in
front of the client at eye level. Ask the client to follow (track)
the finger without moving the head.

SELECTED HEARING DISORDERS INFLUENCED BY
GENETIC FACTORS
• Autosomal dominant hearing loss
• Autosomal recessive hearing loss (eg, connexin 26 gene)
• Otosclerosis
• Pendred syndrome
• Usher syndrome
• Waardenburg syndrome

A. LACTOSE
INTOLERANCE BREATH
History
Smoking.
Pets at home.
Occupation.
History of previous surgery.
Previous trauma.
General medical history.
Seasonal or daily variation in symptoms.

89

EXTERNAL NOSE
INSPECTION TEST
Inspect the external surface of the nose
from the front, side and behind the
patient to identify any abnormalities.
Inspect for skin lesions: Basal cell
carcinoma: pearly lesions with
telangiectasia and rolled edges.
Squamous cell carcinoma: scaly lesions,
sometimes with associated ulceration
and hyperpigmentation.
Keratoacanthoma: raised lesions with a
core of scaly keratin.

90
•
• Basal cell carcinoma 1 Squamous cell carcinoma 2
•

EXTERNAL NOSE
INSPECTION
Deviation in the nasal bones or
cartilage suggestive of a fracture.
This is best performed by standing
behind the patient with their head
tilted slightly backwards.
Epistaxis is bleeding from the nose,
caused by damage to the blood
vessels of the nasal mucosa.
Epistaxis can be caused by bleeding
from anterior or posterior nasal
structures.

91

BRIEF ASSESSMENT TEST
1. Sit facing the patient with your knees together and to one side of the patient’s
legs. It is not pleasant for the patient to be straddled.
2. Ask the patient to look forward, keeping their head in a neutral position.
3. Carefully elevate the tip of the nose with your thumb, so that the nasal cavity
becomes visible. Use a pen torch or otoscope as a light source to externally
illuminate the cavity (elevating the tip of the nose will also assess for dislocated
septal cartilage).
4. Inspect the nasal mucosa (including the septum) for any abnormalities.
5. Inspect and compare nasal cavity alignment (note any septal deviation).
Further assessment
Further assessment can be performed using an otoscope with
a large speculum attached (inserting only the very tip into the nose) or using
a nasal speculum (also known as Thudiculum’s speculum) which widens the nasal
cavity to allow you to peer in using a light source.

92

NASAL AIRFLOW
1. Place your thumb over the nostril not being assessed to
occlude airflow.
2. Ask the patient to breathe in through their nose and note
the degree of airflow.
3. Repeat assessment on the other nostril, noting any
difference in apparent airflow.
Interpretation
Reduced airflow through a particular nostril may indicate the
presence of something blocking that air passage, such as a
polyp, deviated nasal septum or foreign body

93

LIPS, ORAL MUCOSA AND
GUMS

95
Evaluate the lips, noting color and moisture level.
Scaliness or cracking may be indicative of pathology.
Evaluate the oral mucosa for ulcers, color changes or
nodules.
Note the color of the normally pink gums, recognizing that in
people of color, brown patches may be normal.
Evaluate the dentition and note the presence of gum
erythema or edema suggestive of gingivitis.
Inspect the color and shape of the hard and soft palates.
Normal mucosa is pink with a ridged hard palate.
Torus palatinus may be present, and is a variation of normal.

TONGUE

96
Inspect for symmetry.
The normal architecture of the tongue includes papillae that
get bigger toward the rear of the tongue.
Inspect the top, sides and undersurface of the tongue,
noting any color variation, ulcerations or nodular lesions.

EXAMINATION OF THE
NECK
Inspection:
Examination of the neck includes inspection for any scars, masses, glandular
or nodal enlargement. Inspect the trachea, noting any deviation. Next inspect
the thyroid gland as the patient swallows, noting any enlargement.
Palpation:
Evaluate by palpation the lymphatic chains as well as the presence of any
masses in the neck. When evaluating lymph nodes for pathology, note
their size, shape, consistency, mobility, and tenderness. Palpate the thyroid
gland noting size, shape, consistency as well as presence of any nodules.

97

DIAGNOSTIC TESTS OF EYE

99

DIRECT
OPHTHALMOSCOPY
A direct ophthalmoscope is a hand-held instrument with various
plus and minus lenses.
The lenses can be rotated into place, enabling the examiner to
bring the cornea, lens, and retina into focus sequentially. The
examiner holds the ophthalmoscope in the right hand and uses
the right eye to examine the patient’s right eye.
The examiner switches to the left hand and left eye when
examining the patient’s left eye.
During this examination, the room should be darkened, and the
patient’s eye should be on the same level as the examiner’s eye.
The patient and the examiner should be comfortable, and both
should breathe normally.
The patient is given a target to gaze on and is encouraged to
keep both eyes open and steady.
When the fundus is examined, the vasculature comes into focus
first. The veins are larger in diameter than the arteries. The
retina of a young person often has a glistening effect, which is
sometimes referred to as a cellophane reflex.

100

INDIRECT
OPHTHALMOSCOPY
It produces a bright and intense
light.
The light source is affixed with a
pair of binocular lenses, which
are mounted on the examiner’s
head.
The ophthalmoscope is used with
a hand-held, 20-diopter lens.
This instrument enables the
examiner to see larger areas of
the retina, although in an
unmagnified state.

101

SLIT-LAMP
EXAMINATION
The slit lamp is a binocular
microscope mounted on a table.
This instrument enables the user
to examine the eye with
magnification of 10 to 40 times
the real image.
Cataracts may be evaluated by
changing the angle of the light.

102

COLOUR VISION TESTING
Color vision deficits can be inherited. For example,
red/green color deficiencies are inherited in an X-
linked manner, affecting approximately 8% of men
and 0.4% of women.
Acquired color vision losses may be caused by
medications (eg, digitalis toxicity) or pathology such
as cataracts.
Changes in the appreciation of the gradations of the
color red can indicate macular or optic nerve
disease.. The most common color vision test is
performed using Ishihara polychromatic plates.
Patients with diminished color vision may be unable
to identify the hidden shapes. Patients with central
vision conditions (eg, macular degeneration) have
more difficulty identifying colors than those with
peripheral vision conditions (eg, glaucoma) because
central vision identifies color.

103

AMSLER GRID
The Amsler grid is a test often used for patients
with macular problems, such as macular
degeneration.
It consists of a geometric grid of identical squares
with a central fixation point. The grid should be
viewed by the patient wearing normal reading
glasses. Each eye is tested separately.
The patient is instructed to stare at the central
fixation spot on the grid and report any distortion
in the squares of the grid itself.
For patients with macular problems, some of the
squares may look faded, or the lines may be wavy.
Patients with age-related macular degeneration are
commonly given these Amsler grids to take home.

104

D. COMPUTED
TOMOGRAPHY
Tonometry measures IOP by determining
the amount of force necessary to indent or
flatten (applanate) a small anterior area of
the globe of the eye.
The three most common types of
tonometers are indentation, applanation,
and noncontact. The procedure is
noninvasive and is usually painless.
A topical anesthetic eye drop is instilled in
the lower conjunctival sac, and the
tonometer is then used to measure the
IOP.

105

GONIOSCOPY
Gonioscopy visualizes the angle of
the anterior chamber to identify
abnormalities in appearance and
measurements.
The gonioscope uses a refracting
lens that can be a direct or
indirect lens.

106

PERIMETRY TESTING
Perimetry testing evaluates the field of vision. A
visual field is the area or extent of physical
space visible to an eye in a given position.
Its average extent is 65 degrees upward, 75
degrees downward, 60 degrees inward, and 95
degrees outward when the eye is in the primary
gaze (ie, looking directly forward).
It is most helpful in detecting central scotomas
(ie, blind areas in the visual field) in macular
degeneration and the peripheral field defects in
glaucoma and retinitis pigmentosa.
The two methods of perimetric testing are
manual and automated perimetry.

107

FUNDUS PHOTOGRAPHY
Special retinal cameras are used to
document fine details of the
fundus for study and future
comparison.
Photographs are compared over
time to identify subtle changes in
disc shape and color

108

MRI
MRI allows
multidimensional views to
be obtained without
repositioning client.
MRI is used to image the
areas of demyelination,
and vascular lesions.

109

ULTRASONOGRAPHY
High-frequency sound waves
transmitted through a probe placed
directly on the eyeball.
A-scan measures axial length (distance
from cornea to retina) to determine
the refractive power of an intraocular
lens in cataract surgery.
B-scan US is used to evaluate lesions
and their growth over time, or the
presence o foreign body

110

EXOPHTHALMOMETERY
It is designed to measure
forward protrusion of the eye.
An exophthalmometer is an
instrument used for measuring
the degree of forward
displacement of the eye
in exophthalmos.

111

X-ray study, tomography, and computed tomography (CT) are
useful in evaluation of orbital and intracranial conditions, as
well as detection of foreign bodies.
OPHTHALMIC
RADIOGRAPHY

112

Is a test that exerts
pressure on the sclera with
a spring plunger while
retinal vessels emerging
from the disc are observed.
This instrument gives an
approximate measuring the
relative pressures in the
central retinal arteries and
indirectly assesses carotid
arterial Flow.
OPHTHALMODYNAMOMETRY

113

ELECTRORETINOGRAPHY
(ERG)
ERG measures the change in
electrical potential of the eye
caused by a diffuse flash of light
through incorporated onto a
contact lens that is placed
directly on the eye.
To assess the status of the retina
in eye diseases in human patients
and in laboratory animals used
as models of retinal disease.

114

VISUAL EVOKED
RESPONSE (VER)
VER is similar to ERG in that it
also measures the electrical
potential resulting from a
visual stimulus. Visual
pathway from the retina to the
cortex can be evaluated
through placement of
electrodes on the scalp

115

DIAGNOSTIC TESTS FOR EAR DISORDERS

116

AUDIOMETRY
Audiometric testing is of two kinds: pure-
tone audiometry, in which the sound
stimulus consists of a pure or musical tone
(the louder the tone before the patient
perceives it, the greater the hearing loss)
speech audiometry, in which the spoken
word is used to determine the ability to hear
and discriminate sounds and words.
When evaluating hearing, three
characteristics are important:frequency,
pitch, and intensity.
The normal human ear perceives sounds
ranging in frequency from 20 to 20,000 Hz.

117
LOSS IN DECIBELS
INTERPRETATION
0–15 Normal hearing
>15–25 Slight hearing loss
>25–40 Mild hearing loss
>40–55 Moderate hearing loss
>55–70 Moderate to severe
hearing loss
>70–90 Severe hearing loss
>90 Profound hearing loss

TYMPANOGRAM
A tympanogram, or impedance
audiometry, measures middle
ear muscle reflex to sound
stimulation an compliance of
the tympanic membrane by
changing the air pressure in a
sealed ear canal. Compliance is
impaired with middle ear
disease.

118

PURE TONE AUDIOMETRY
During this test, an electrical machine
produces sounds at different volumes
and pitches in ear, usually while wearing
some type of earphones.
This test is commonly used for children,
and the child is simply asked to respond
in some way when the tone is heard in
the earphone.

119

EVOKED POTENTIAL (EP)
EP testing uses two sets of
electrodes to assess
hearing or sight, especially
in infants and children.

120

AUDITORY BRAIN STEM
RESPONSE
The auditory brain stem response is a
detectable electrical potential from cranial
nerve VIII and the ascending auditory
pathways of the brain stem in response to
sound stimulation.
Electrodes are placed on the patient’s
forehead. Acoustic stimuli, usually in the form
of clicks, are made in the ear.
The resulting electrophysiologicmeasurements
can determine at which decibel level a patient
hears and whether there are any impairments
along the nervepathways (eg, tumor on cranial
nerve VIII).

121

ELECTRONYSTAGMOGRAPHY
Electronystagmography is the
measurement and graphic recording of the
changes in electrical potentials created by
eye movements during spontaneous,
positional, or calorically evoked nystagmus.
It is also used to assess the oculomotor and
vestibular systems and their corresponding
interaction.
It helps in diagnosing conditions such as
Ménière’s disease and tumors of the
internal auditory canal or posterior fossa.
Any vestibular suppressants, such as
sedatives, tranquilizers, antihistamines,
and alcohol are withheld for 24 hours
before testing.
Prior to the test the procedure is explained
to the patient.

122

Platform posturography is used to investigate
postural control capabilities. The integration of
visual, vestibular, and proprioceptive cues (ie,
sensory integration) with motor response
output and coordination of the lower limbs is
tested.
The patient stands on a platform, surrounded
by a screen, and different conditions such as a
moving platform with a moving screen or a
stationary platform with a moving screen are
presented.
The responses from the patient on six different
conditions are measured and indicate which of
the anatomic systems may be impaired.
Preparation for the testing is the same as for
electronystagmography.
PLATFORM POSTUROGRAPHY

123

Sinusoidal harmonic
acceleration, or a rotary
chair, is used to assess the
vestibulo-ocular system by
analyzing compensatory eye
movements in response to
the clockwise and
counterclockwise rotation
of the chair.
SINUSOIDAL HARMONIC ACCELERATION

124

MIDDLE EAR ENDOSCOPY
To evaluate suspected perilymphatic fistula and new-
onset conductive hearing loss, the anatomy of the round
window before transtympanic treatment of Ménière’s
disease, and the tympanic cavity before ear surgery to
treat chronic middle ear and mastoid infections.
The tympanic membrane is anesthetized topically for
about10 minutes. Then, the external auditory canal is
irrigated with sterile normal saline solution.
With the aid of a microscope, a tympanotomy is created
with a laser beam or a myringotomy knife, so that the
endoscope can be inserted into the middle ear cavity.
Video and photo documentation can be accomplished
through the scope.

125

DIAGNOSTIC TESTS OF NOSE AND THROAT

126

A narrow tube with a
lighted magnifying
lens or tiny camera
(nasal endoscope)
enables to perform a
detailed examination
inside nose and
sinuses.
NASAL ENDOSCOPY

127

This imaging method
uses X-rays and CT
scan technology to
give a clear look at
sinus cavities
SINUS COMPUTER TOMOGRAPHY (CT OR CAT) SCANS

128

Images obtained with
computerized tomography (CT) can
help to pinpoint the size and
location of polyps in deeper areas
of sinuses and evaluate the extent
of swelling and irritation
(inflammation).
These studies may also help to rule
out other possible blockages in
nasal cavity, such as structural
abnormalities or another type of
cancerous or noncancerous growth.
3. IMAGING STUDIES.

129

ALLERGY TESTS
With a skin prick test, tiny
drops of allergy-causing agents
(allergens) are pricked into the
skin of your forearm or upper
back. Your doctor or nurse then
observes your skin for signs of
allergic reactions.If a skin test
can't be performed, your doctor
may order a blood test that
screens for specific antibodies
to various allergens.

130

TEST FOR CYSTIC
FIBROSIS
A child diagnosed with nasal polyps, may
be suggested testing for cystic fibrosis,
an inherited condition affecting the
glands that produce mucus, tears, sweat,
saliva and digestive juices.
The standard diagnostic test for cystic
fibrosis is a noninvasive sweat test,
which determines whether the child's
perspiration is saltier than most people's
sweat is.

131

Low levels of vitamin D,
which are associated with
nasal polyps.
BLOOD TEST

132

It is used to diagnose
certain infections of the
respiratory system.
The flu
COVID-19
Respiratory syncytial
virus (RSV)
Whooping cough
Meningitis
MRSA (methicillin-
resistant Staphylococcus
aureus)
NASAL SWAB

133

A laryngoscope is a thin,
flexible lighted scope that
can be inserted into the
throat to look at the larynx
(voice box). Laryngoscopy
is used check for masses,
vocal cord irregularities,
pooling of secretions and
to see if the vocal cords are
working normally.

134
FLEXIBLE LARYNGOSCOPY

It is a swallowing test that uses X-Rays
to monitor the swallowing process as
you eat and drink food that contains
barium. A series of X-Rays then show
the progress of the substance through
the throat, allowing the doctor to
identify any problems that may affect
swallowing.
VIDEO FLUOROSCOPIC SWALLOW
STUDY (VFSS)

135

If a suspicious mass or unusual-
looking bit of tissue in the throat,
a small sample – a throat biopsy –
and send it to the lab for analysis.
C. ENDOSCOPIC RETROGRADE

136
THROAT BIOPSIES

This involves a series of X-rays
taken while you swallow a chalky
substance called barium. The
barium coats the inside of your
throat so any swallowing changes
can be seen on the X-rays.

137
BARIUM SWALLOW OR
ESOPHAGOGRAM

This test measures electrical
activity in the muscles of the
throat to help identify nerve
problems. A thin needle is
put into some of the neck
muscles while electrodes
send signals from the
muscles to a computer.

138
LARYNGEAL
ELECTROMYOGRAPHY (EMG)


139
STROBOSCOPY OR VIDEOSTROBOSCOPY
This test uses a strobe light and
a video camera to see how the
vocal cords are vibrating
during speech.

Understanding the complexity of ocular structures and the
physiology of vision is essential to providing comprehensive
nursing care for clients with Ocular disorders. Hearing and
balance are vital to a person's safety and independence.
Understanding the physiology of hear ing and balance is essential
to providing comprehensive nursing care for clients with ear
disorders.Ophthalmic and otolaryngology registered nurses
perform the roles of educator, technician, counselor, and
coordinator in the diagnostic setting.
SUMMARY AND CONCLUSION

140

RESEARCH
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 11, Issue 4
(Nov.- Dec. 2013), PP 87-92 www.iosrjournals.org www.iosrjournals.org 87 | Page Ophthalmic Manifestations in ENT
Diseases & Surgical Procedures Vikas Sikarwar1 , R.S Bisht1 , Dharmendra Kumar1 , R.K Shukla2 1Department of E.N.T
and Head & Neck Surgery; Veer Chandra Singh Garhwali Govt. Medical Science and Research Institute, Srinagar, UK,
India. 2Department of E.N.T and Head &Neck Surgery NSCB Medical College, Jabalpur , MP , India. Abstract Objective:
A prospective study was conducted in the department of ENT to see the incidence, Prevalence, Symptoms, signs and
etiopathogenesis in relation to ophthalmic manifestations in ENT diseases and various ENT surgical procedures
(iatrogenic).
Material and methods: 35 cases were selected from IN and OUT patients of the department between July 1st 2008 to
June 30th of 2009. 26 cases of orbital complications were due to various ENT diseases and 9 cases were of ENT surgical
procedures with orbital complications. The standard otolaryngological and ophthalmological examination was carried
out and thereafter proper hematological, radiological and histopathological examinations were done. After reaching the
diagnosis, proper management was carried out. Result :35 cases of orbital complications were reported in ENT
Department. Out of which, 29 cases were due to various ENT diseases and 6 cases were iatrogenic, caused by various
ENT surgical procedures. Commonest ENT disease responsible for orbital complication is sinonasal tumours. Carcinoma
maxilla was the most common tumour responsible for the orbital complications. Sinonasal tumours involving eye were
found in wide age group range of 11 to 75 years, with higher incidence in males. Incidence of sinusitis complicating orbit
is decreasing. Variety of ENT surgical procedures can involve orbital . Total maxillectomy has higher incidence of orbital
complications. Conclusion: A variety of ENT diseases & surgical procedures can present with orbital complications due
to anatomical association of orbit with the surrounding head and neck structures. Orbital involvement must be ruled out
whenever an ENT patient presents with orbital complaints .Rapid diagnosis and treatment is necessary for preserving
vision and life in these patients. Teamwork between ophthalmologist and the otolaryngologist is required for the
appropriate management of such lesions.

BIBLIOGRAPHY
Brunner & suddarth’s, Medical-Surgical nursing,(2015) 10th edition, Page1743-47
Joyce.M.Black, Medical-Surgical nursing,(2020) 6th edition, Page 1687-1708
Williams.S. Linda,Understanding Medical Surgical Nursing, 3rd edition(2007),
page 678-690
Taylor Carol, Fundamentals of nursing(2010), 5th edition
Chintamani, Lewis Medical-surgical nursing,( 2011), 2nd edition,CBS
Publications
Priscilla Lemonne, Medical Surgical Nursing, 2nd edition
https://accesspharmacy.mhmedical.com/data/interactiveguide/physexam/
heent/neckexamination.html
https://pubmed.ncbi.nlm.nih.gov/21250067/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858710/

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