The document provides assessment guidelines for the ears, nose, and throat. It describes how to inspect the ears for color, shape, size, position, and lesions, and how to examine the ear canals and eardrums. Hearing tests like the whisper, watch tick, Weber, and Rinne tests are outlined. The nose is inspected for symmetry, drainage and nasal structure. Sinuses are palpated. The throat is inspected for the oropharynx, tonsils, uvula, and gag reflex while palpating lymph nodes.

1. ASSESSMENT OF EAR,
NOSE, THROAT
Mr. Binu Babu
M.Sc. Nursing
Mrs. Jincy Ealias
M.Sc. Nursing

2. EARS
Inspection
Color
Shape
Size: Greater than 4 cm and smaller than 10 cm.
Position: Draw an imaginary line from outer canthus of eye to
Helix of ear.
Helix

3. Lesions
Drainage: Cerumen or wax is the only normal drainage.
Examination with otoscope: visual examination of the
auditory canal and tympanic membrane using an otoscope.

4. Hearing acuity : hearing tests
 Whisper test: Ask the patient to obstruct one ear with the index
finger. The nurse should whisper some words. Have the patient
repeat the words heard.
 Watch tick test:

5.  Tunning fork test:
Weber test : The Weber test assesses lateralization of sound. To
perform the test, place a vibrating tuning fork on top of patient’s
head or forehead. Ask the patient if the vibration sounds is same
in both ears or different. Normally, the vibration is heard equally
in both ears.

6.  Rinne test:
 This test is used to compare air conduction and bone
conduction.
 To perform this test, place a vibrating tuning fork on
patient’s mastoid process.
 When the sound is no longer heard, immediately place
the vibrating fork about 1 inch in front of the external
auditory canal and continue until the patient can no
longer hear the sound.
 Normally, air conduction > bone conduction

8. Romberg’s test: Make patient to stand with
feet together, eyes opened, and then eyes
closed. Note patient’s ability to maintain
balance.

9. Palpation
Ears: normally soft and non tender
Mastoid bone: normally non tender

10. NOSE
Inspection
Symmetry
Nasal drainage: normally absent
Nasal flaring: normally absent
Examine the internal structures using nasoscope or
nasal speculum and pen torch.

11. Sinuses: Inspect frontal sinuses above the
eyes and maxillary sinuses below the eyes.
Normal finding is no evidence of swelling

12. Palpation
Palpate external nose: Cartilaginous portion is slightly mobile.
Non tender, no masses.
Nasal septum: Midline placement is normal. Deviated nasal
septum is abnormal.
Nasal patency: Occlude each nostril and check patency.

13.  Sinuses
 Palpate frontal sinuses by pressing upward just
below eyebrows.
 Palpate maxillary sinuses by pressing below eyes.

14. Inspection
Have the patient sit with the head tilted
backward and the mouth opened wide.
 Oropharynx : Inspect for color, lesions, and drainage.
Inspect the oropharynx using a tongue depressor and penlight.
Tonsils: Check for color and size.
Uvula: Have patient say “AH!” and note symmetrical rise of the
uvula. Normally it is midline, pink, moist, without lesions.
Gag reflex: Elicit the gag reflex by pressing the posterior
tongue with a tongue depressor.
THROAT

15.  Palpation
 Lymph nodes: Palpate the nodes using finger pads
around neck. Normally not palpable.