Sensory Disorders


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Sensory Disorders

  1. 1. SENSORY DISORDERS Nelia B. Perez RN, MSN PCU – MJCN Class 2015
  2. 2. CONTENTS • Review Of Anatomy and Physiology • Common Sensory Disorders
  3. 3. Ears
  4. 4. Anatomy •The ear is responsible for hearing and balance •Consists of 3 regions • External ear • Middle ear • Inner ear
  5. 5. 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
  6. 6. - 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
  7. 7. - Lymphatic drainage of the external ear flows into parotid , mastoid, superficial cervical nodes
  8. 8. 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 >
  9. 9. 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
  10. 10. 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)
  11. 11. 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)
  12. 12. 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)
  13. 13. 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
  14. 14. 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
  15. 15. 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)
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 3) Note tenderness of pinna and mastoid area. Press the tragus and press firmly behind the ear
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. Inspect using Otoscope • External canal • Color • Swelling • Lesions • Discharge ; color and odor. Clean or change speculum before examining other ear.
  24. 24. 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
  25. 25. •Perform the otoscope exam prior to hearing tests.
  26. 26. Hearing Evaluation 1.Rough quantitative test for hearing loss 2.Whisper test 3.Tuning fork
  27. 27. • 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
  28. 28. WHISPER TEST •Begins with the historyConversational tone •The following tests may indicate the presence of hearing loss but not the degree.
  29. 29. • 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
  30. 30. • 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
  31. 31. 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
  32. 32. 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
  33. 33. > 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
  34. 34. • Weber Test
  35. 35. • 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.
  36. 36. • Rinne Test
  37. 37. Weber test Rinne test
  38. 38. 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)
  39. 39. Subjective data • Earaches • Tinnitus • Vertigo • Dizziness • Discharge • Hearing loss
  40. 40. 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
  41. 41. internal ear – fracture at the base of the skull, meniere syndrome d.Drugs quinine, salicylates, aminoglycosides, gentamicin
  42. 42. •Ear pain ( Otalgia ) - pain may arise from inflammation of structure in the ear or be referred from other pharyngeal sites including the thyroid
  43. 43. Causes: Auricletrauma,hematoma,frostbite,burn, eczema, lnsect bites, impetigo, herpes zoster External auditory canalotitis externa ,carbuncle, eczema, hard cerumen, FB, herpes zoster
  44. 44. Middle earacute otits media, acute mastoiditis Referred pain- unerrupted lower third molar, carious teeth, tonsillitis, carcinoma of pharynx, trigeminal neuralgia , subacute thyroiditis
  45. 45. • 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
  46. 46. Idiopathic multisystem atrophy Infectious tabes dorsalis, meningitis, encephalitis, brain abscess Metabolic/ nutritional pellagra, Vit.B12 def.,fluid & electrolyte imbalance
  47. 47. Mechanical/trauma skull fracture, otosclerosis, eye muscle imbalance glaucoma Neoplastic Brain tumors Neurologic migraine, peripheral neuropathy Psychosocial anxiety disorder Vascular hypertension, orthostatic hypotension
  48. 48. • 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
  49. 49. Causes: Peripheral labyrinthine System - otitis media with effusion, otosclerosis, temporal bone fracture Central labyrinthine system - migraine, cerebellar hemorrhage, intracranial abscess
  50. 50. Cranial V111 infections - Acute meningitis, tuberculous meningitis, tumors Brainstem nuclei - encephalitis, brain abscess, hemorrhage, multiple sclerosis
  51. 51. • 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)
  52. 52. 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
  53. 53. 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
  54. 54. Macrotia or large ear Before Surgery After Surgery
  55. 55. Before Surgery After surgery
  56. 56. Lop or Bat ear - pinna may protrude at right angle
  57. 57. Lop or Bat Ears
  58. 58. 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
  59. 59. Cauliflower Ears
  60. 60. 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
  61. 61. Gouty deposits
  62. 62. 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
  63. 63. 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
  64. 64. Foreign body Insect invaders Polyps Furuncle
  65. 65. • Tympanic membrane Retracted Tympanic membrane : - Seen in Serous Otitis media - more concave TM - accentuated bony landmarks - distorted light reflex
  66. 66. Normal Tympanic Membrane Retracted Tympanic Membrane
  67. 67. Bulging Tympanic membrane: - seen in Acute suppurative otitis media - more conical - loss of bony landmarks - distorted light reflex
  68. 68. Normal Tympanic Membrane Bulging Tympanic Membrane
  69. 69. 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
  70. 70. Perforated Tympanic Membrane
  71. 71. Perforated Tympanic Membrane
  72. 72. 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
  73. 73. b) Chronic external otitis - commonly due to bacteria and fungal - pruritus is the main complain instead of pain - aural discharge maybe present
  74. 74. • 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
  75. 75. 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
  76. 76. • 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
  77. 77. 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
  78. 78. Thank You
  79. 79. Nose, Throat and Mouth
  80. 80. Nose • First segment of the respiratory system • Warms, moistens and filters inhaled air • Sensory organ for smell • Resonance of laryngeal sound
  81. 81. 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
  82. 82. 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
  83. 83. Internal • Superior, middle, inferior turbinates- 3 parallel bony projections on lateral walls of each cavity • Meatus- cleft/ groove underlying each turbinate.
  84. 84. •Inspired air enters thru the nares > passes thru the vestibule> to the choanae which are posterior openings > leading to the nasopharynx
  85. 85. 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
  86. 86. 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
  87. 87. • 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
  88. 88. Physical Examination
  89. 89. • Nose – Inspect and palpate • INSPECT for: • • • • • • Symmetry, deformity Inflammation Skin lesions Color Nasal flaring discharges
  90. 90. • 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
  91. 91. •Test for sense of smell (CN 1) •Evaluate the patency of the nose - nasal breathing should be noiseless and easy thru the open nares
  92. 92. 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
  93. 93. 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
  94. 94. 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
  95. 95. • 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
  96. 96. •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
  97. 97. 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)
  98. 98. • 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
  100. 100. Basal Cell Carcinoma
  101. 101. SIGNS • Discharge - Describe discharge as to its character ( watery, mucoid, purulent , bloody) - color ( greenish, whitish, bloody) - bilateral or unilateral
  102. 102. • • Running Nose
  103. 103. . 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)
  104. 104. Foreign Body
  105. 105. . Unilateral - Choanal atresia - Foreign body - neoplasm - Head injury or surgery
  106. 106. • Epistaxis ( nosebleed) -Kiesselbach plexus – most common site of bleeding anteriorly - Back 3rd of the Inferior Meatus – most common site posteriorly
  107. 107. Causes: 1. Local - coughing - sneezing - nose pricking - fracture - foreign bodies
  108. 108. 2. Generalized - Congenital – hereditary telangiectasia - inflammatory/immune – wegener granulomatosis - infectious – typhoid fever, dengue, diphtheria - Metabolic/toxic – aspirin, scurvy
  109. 109. - Mechanical – change in atmospheric pressure ( mountain climbing, flying), exertion - Neoplastic – nasopharyngeal Ca leukemia - vascular- hemophilia, thrombocytopeni
  110. 110. - trauma- nasal and maxillary fracture - Elevated venous pressure- Cor pulmonale Congestive Heart failure - Elevated arterial pressure – HPN, coarctation of aorta
  111. 111. • 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
  112. 112. 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
  113. 113. Nasal Septum Perforation
  114. 114. 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
  115. 115. -Symptoms 3-10 days -Severe local pain suggest a complication-bacterial sinusitis
  116. 116. • 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
  117. 117. • 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
  118. 118. • 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
  119. 119. • 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
  120. 120. -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
  121. 121. THANK YOU
  122. 122. THANK YOU
  123. 123. 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
  124. 124. • Cheeks- side walls of cavity • Tongue 1. Papillae- rough, bumpy elevations on dorsal 2. Frenulum 3. Taste buds • Teeth – 32 permanent
  125. 125. • 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
  126. 126. 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
  127. 127. • 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.
  128. 128. Physical Examination
  129. 129. • 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
  130. 130. INSPECT AND PALPATE Use gloves, tongue depressor, light • Lips • Teeth • Gums • Tongue • Buccal mucosa • Mouth ( roof and floor of the mouth)
  131. 131. • 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
  132. 132. Rest r e s t Movement
  133. 133. - Inspect the inner surface of the lips by retracting them with a tongue blade
  134. 134. Retraction of the Upper Lip Retraction of the lower Lip
  135. 135. • 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
  136. 136. Proper Occlusion of Teeth
  137. 137. • 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
  138. 138. Retraction of the cheek to view the Buccal Mucosa Buccal Mucosa with prominent Papilla of Stensen Duct
  139. 139. • 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
  140. 140. • 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.
  141. 141. - 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
  142. 142. - Wharton ducts should be apparent on each side of the frenulum
  143. 143. 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
  144. 144. Uvula , soft palate, bilateral fauces
  145. 145. 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
  146. 146. 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
  147. 147. 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
  148. 148. SIGNS
  149. 149. • Lips
  150. 150. Cyanotic Lips
  151. 151. Chapped dry lips
  152. 152. > Cheilitis - dry cracked lips due to dehydration from wind chapping, dentures , braces, or excessive lip licking - angular cheilitis due to candidiasis
  153. 153. Chapped Lips with Cheilitis
  154. 154. Cheilosis ( angular stomatitis) - ulcerations of skin at the corners of the mouth due to crusting 2ndary to riboflavin deficiency or ill fitting dentures
  155. 155. Cheilosis (Angular Stomatitis)
  156. 156. Cleft lip - due to incomplete fusion of the frontonasal process with the 2 maxillary processes
  157. 157. Cleft Lip
  158. 158. Retraction of the Lower Lip showing white scars Traumatized Lip (Green arrows)
  159. 159. • Hard palate Maxillary Torus
  160. 160. Maxillary torus - bony protuberance at the midline - no clinical significance
  161. 161. Cleft palate - a midline opening in the hard palate - congenital failure of the fusion of the maxillary process - usually ass. with cleft palate
  162. 162. Cleft Palate
  163. 163. • Tonsils Enlarged tonsils
  164. 164. - Grading tonsillar enlargement • Grade size 1+ visible • …………….2+ ½ way b/t tonsillar pillars and uvula • …………….3+ touching the uvula • …………….4+ touching each other
  165. 165. • Uvula Deviation of the uvula
  166. 166. • Posterior pharyngeal wall After tonsillectomy
  167. 167. Posterior Pharyngeal Wall With a yellow Pseudocyst Posterior Pharyngeal Wall with White removable mass of mucus
  168. 168. 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
  169. 169. 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
  170. 170. • Tongue Lingual Deviation
  171. 171. Tongue-tie or shortened frenulum
  172. 172. Folliate Papillae(Green) Circumvallate Papillae(blue) Elongated filiform Papillae
  173. 173. Large reddened fungiform Papillae Circumvallate Papillae
  174. 174. • Gums Gingival Fibrous Nodule At the mucogingival junction
  175. 175. Bleeding gums local causes: traumatic – toothbrush, laceration, dental caries, tartar on the teeth infection – pyorrhea alveolaris, stomatitis neoplasm – epulis, papilloma of gums
  176. 176. General causes: Scurvy, syphilis Metal poisoning –phosporous, lead, mercury Blood dyscrasia – hemophilia, leukemia, thrombocytopenia
  177. 177. Deep red or purple gums - tender , swollen, spongy and easily bleeds - due to scurvy ( ascorbic acid deficiency)
  178. 178. • Teeth Malocclusion of teeth
  179. 179. Periodontitis ( Pyorrhea Alveolaris) - lower teeth are involved - with purulent and retracted gums Epulis - fibrous tumor arising from periosteum and emerges from between the teeth.
  180. 180. • Larynx > hoarseness acute laryngitis – most common cause of hoarseness > laryngeal edema signs of obstruction – hoarseness, dyspnea and stridor
  181. 181. 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
  182. 182. • 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
  183. 183. THANK YOU