2. 13–2
Objectives
Identify the structures of the ears, nose,
mouth, and throat.
Discuss the system-specific history for the
ears, nose, mouth, and throat.
Describe normal findings in the physical
assessment of the ears, nose, mouth, and
throat.
Describe common abnormalities found in the
physical assessment of the ears, nose, mouth,
and throat.
Perform the physical assessment of the ears,
nose, mouth, and throat.
3. 13–3
Anatomy and Physiology of the Ear
Three sections
External ear
Middle ear
Inner ear
External ear
Auricle or pinna
External auditory canal
15. 13–15
Allergies
Signs and symptoms
Pollen, insect stings, animal dander
Injuries and accidents
Foreign bodies
Trauma
Sports injuries
Special needs
Use of assistive devices (hearing aids)
Speech disorders
Childhood illnesses
Frequent tonsillitis or ear infections
16. 13–16
Social History
Alcohol use
Drug use
Tobacco use
Sexual practices
Work and home environment
Hobbies and leisure activities
Stress
18. 13–18
General Approach to
Assessment
Greet patient
Explain assessment techniques
Quiet, well-lit environment
Sitting position
Compare right to left
Systematic approach
20. 13–20
Assessment of the Ear
Examination consists of three parts:
1. Auditory screening
2. Inspection and palpation of external
ear
3. Otoscopic assessment
21. 13–21
Take history of:
_Ear aches
Infections
Discharge
Hearing loss
Environmental noise
Tinnitus
Vertigo
Self care
22. 13–22
Auditory Screening
Voice-whisper test and Vestibular apparatus
Normal finding: able to repeat words whispered at
a distance of 2 feet
Tuning fork tests
Weber test
Rinne test
Determine whether hearing loss is conductive or
sensorineural
23. 13–23
Voice whisper and balance test
Test hearing acuity: Conversational speech note
behavioral response to conversational speech ( lip
reading, frowning, straining forward, turning to catch
sounds asks you to repeat, misunderstands your
questions)
Voice test: Test one ear at time cover opposite ear ,
shied lips 1 to 2 feet whisper two syllable words have
patient repeat
Romberg Test: (vestibule apparatus) test stand with
feet together and arms at sides, close eyes should hold
position for 20 seconds without loosing balance
24. 13–24
Tuning fork test
Weber Test: Place vibrating tuning fork
midline on the skull ask if tone is equal
bilaterally or better in one ear.
Rinne test: have patient signal when the
vibrating tuning fork can no longer be
heard place fork near the ear cannel
should still hear sound AC>BC
25. 13–25
Otoscopic Examination
Otoscopic exam external canal- color ,
redness, swelling for cerumen, discharge,
foreign bodies, lesions,.
Tympanic membrane- normal is shiny
translucent with pearl-gray color, flat
slightly pulled in at center flutters with
swelling membrane should be intact.
26. 13–26
Normal findings
Weber test
Normal finding: able to hear sound
equally in both ears
Rinne test
Normal finding: air conduction > bone
conduction
28. 13–28
Normal findings
Flesh color
Positioned centrally and in proportion
to the head
No foreign bodies, redness, drainage,
deformities, nodules, or lesions
29. 13–29
Abnormal findings
Pale, red, cyanotic
Small-size or large-size ears
Purulent drainage
Clear or bloody drainage
Hematoma behind ear over mastoid
Pain or tenderness on palpation
30. 13–30
Otoscopic Assessment
Inspect both ears
External ear canal:
lesions, swelling, discharge, hairs,
foreign body, cerenum
Tympanic memebrane
Pull auricle upward and back ward to
straighten the auditory canal
34. 13–34
Normal findings
Tympanic membrane is pearly gray with
well-defined landmarks
Light reflex present at 5 o’clock in right
ear and 7 o’clock in left ear
Tympanic membrane moves when patient
blows against resistance
No redness, swelling, tenderness, lesions,
drainage, foreign bodies
35. 13–35
Abnormal findings
Chalky patches on tympanic membrane
Severe pain
Redness, swelling, narrowing, pain
Drainage
Hard, dry, very dark yellow cerumen
Reddened tympanic membrane
36. 13–36
(continues)
Risk Factors for Otitis
Media
Less than 2 years of age
Frequent upper respiratory infections
Cold weather
Male gender
Family history
Smoky environment
Bottle fed
Down syndrome
38. 13–38
Structure and function :
Nose, Mouth, and Throat
Nose
Function in the respiratory system
External nose
Nasal cavity
Septum
Turbinate
Paranasal sinuses
Frontal
Maxillary
Ethmoid
Sphenoid
40. 13–40
Mouth
Function in the digestive and respiratory
system
Hard and soft palates
Uvula
Tongue
Salivary glands
Parotid
Submandibular
Sublingual
Teeth
43. 13–43
Equipment for examination of Nose,
Mouth and Throat
Otoscope with short, wide-tipped nasal
speculum
Pen light
Two tongue blades
Cotton gauze pad
Gloves
44. 13–44
Assessment of the Nose
Take history of:
Discharge
Frequent colds
Sinus pain
Trauma
Epistaxis
Allergies
Altered smell
45. 13–45
Inspection and palpation of nose
External nose
Tenderness, discharge ,trauma, bleeding, lesions,
masses, swelling, asymmetry
Test patency of nostril
Inspection of internal nose
Speculum or otoscope with nasal speculum
Nasal cavity
Nasal septum
Turbinates
Sinus Areas- Palpate
Frontal and maxillary sinuses
Transillumination
46. 13–46
Normal findings
Located in midline of face
No swelling, bleeding, lesions, or masses
Both nostrils patent
Septum midline
Nasal mucosa is pink or dull red
47. 13–47
Abnormal findings
Broken, misshapen, swollen nose
Occluded nasal passages
Septum is deviated
Nasal mucosa is red and swollen
Purulent drainage
48. 13–48
Assessment of the Sinuses
Inspection (Sinus Transillumination)
Palpation and percussion
Normal findings
No discomfort during palpation or
percussion
Resonance heard on percussion
49. 13–49
(continues)
Assessment of the Mouth
Inspect Mouth
Lips
Teeth and gums
Tongue
U-shaped areas under the tongue
Buccal mucosa
Uvula
Hard and soft palate
50. 13–50
Mouth inspection and palpation
LIPS inspect for color, moisture, cracking,
or lesions. Palpate lips, and face for mass
and tenderness
TEETH/gums note any diseased absent,
loose teeth gums should be pink or coral,
check for swelling, retraction of gum
margins spongy, bleeding discolored gums.
TONGUE color pink and even dorsal side
roughened, ventral smooth, glistening,
shows veins Inspect under tongue for
nodules, lesions, ulcerations
51. 13–51
Cont…
Buccal mucosa looks pink, smooth,
moist, dark skinned people may have
patchy hyperpigmentation
Uvula fleshy pendant midline uvula and
soft palate rise with “ahhh” sound.
anterior hard palate is white with
irregular transverse rugae the posterior
soft palate is pinker smooth, and
upwardly movable.
52. 13–52
Normal findings of Mouth
Breath is fresh
Pink, moist lips
Tongue midline, symmetrical, with adequate
movement
No pockets between gums and teeth
No bleeding
Smooth, white teeth; proper alignment, no
dental caries
54. 13–54
(continues)
Inspection of the Throat
Position, size, color,and general
appearance of tonsils and uvula
Gag reflex
Color of oropharynx
Presence of swelling, exudate,
lesions
55. 13–55
Assessment of tonsils
Enlarged tonsils are graded
Grade 1 – wnl
Grade 2 – tonsils b/w pillars
and uvula
Grade 3 – tonsils touching
uvula
Grade 4 – tonsils touching
each other (kissing tonsils)
58. 13–58
Normal findings
Soft palate and uvula rise when patient
says “ah”
Uvula is midline
Throat is pink and vascular
No swelling, exudate, or lesions
Gag reflex is present
59. 13–59
Abnormal findings
Posterior pharynx is red with white
patches
Tonsils and uvula are red and swollen
Hoarse voice
Grayish membrane covering tonsils,
uvula, soft palate