ear nose throat(ENT) examination and drugs

1. TROLLEY PREPARATION FOR
EAR, NOSE AND THROAT
EXAMINATION
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2. ENT EXAMINATION
Purpose:
To detect any abnormalities of
ear, nose and throat.

3. ANATOMY OF EAR

4. EQUIPMENTS FOR EAR
EXAMINATION

5. HEAD LIGHT
 Used to get clear vision of the ear canal or
ENT procedure.

6. TUNING FORK
• To determine whether a
hearing loss is conductive or
perceptive.
• Can be Weber test or Rinne
test.

7. OTOSCOPE
To examines the auditory canal and
tympanic membrane for infection or
blockage due to the presence of a
foreign object or build up of wax.

8. AURAL
SPECULUM
A cone or funnel shaped
attachment for an
otoscope which is
inserted into the ear canal
to examine the eardrum.

9. ZOELLNER
SUCKER
• used for suction in
middle ear.

10. CROCODILE
FORCEP
• To remove foreign body
from ear, nose, throat
(ENT) procedure.

11. JOBSON-HORNE PROBE
used for removal of wax and cleaning of ears.

12. ANATOMY OF NOSE

13. EQUIPMENTS FOR NOSE
EXAMINATION

14. J - SUCKER
 Used for removal of crust at nose or discharge at
opening ears.

15. THUDICUM NASAL
SPECULUM
• Used for visualization of external nose.

16. VIENNA NASAL
SPECULUM
used in:
• Anterior nasal packing
• Septoplasty
• Removal nasal foreign body
and rhinolith (calculus
present in the nasal cavity).

17. RIGID SCOPE
This exam allows a complete
and detailed visualization of
all nasal mucosa, nasal
turbinates, openings into the
sinuses, and nasopharynx.

18. FLEXIBLE
SCOPE
• To help examine places
that are hard to reach.

19. TILLEY FORCEP
• To perform anterior nasal packing.
• To remove foreign bodies, crusts or
packs from the nose.
• To pack the nose with gauze strips
during nasal surgeries or sinus
surgeries.
• To remove cartilage and bone pieces
during septoplasty

20. SINUS FORCEP
 Used for removing or inserting
dressing packs.

21. ANATOMY OF THROAT

22. EQUIPMENTS FOR THROAT
EXAMINATION

23. To suppress the tongue to allow
for examination of the mouth
and throat

24. LACK’S
SPATULA
 Airway patency can be tested by
placing a cold Lack's depressor
underneath and asking the
patient to exhale
 To depress the tongue

25. Pentorch
Glove

26. LARYNGEAL
MIRROR
For oral examinations.

27. POSTERIOR
LARYNGEAL
MIRROR / PNS
MIRROR
For posterior rhinoscopy (seeing
the inner parts of the nose like the
choanae)

28. FLEXIBLE SCOPE
To help examine places that are
hard to reach.

30. WHAT IS OTOTOXIC DRUG
 Medications that can damage the ear, resulting
in hearing loss, ringing in the ear, balance
disorders and deaf.

31. WHAT IS OTOTOXICITY
 Ototoxicity is damage to the hearing or balance
functions of the ear by drugs or chemicals.
 Ototoxic drugs may cause lack of hearing, and
loss of sense of balance.

32. DRUG CAN CAUSE
OTOTOXITY :
1. Antibiotics
 streptomycin
 neomycin
 gentamicin (Garamycin)
 erythromycin (E-Mycin, Eryc)
 kanamycin (Kantrex)
 tobramycin (Nebcin)
 netilmycin (Netromycin)
 vancomycin (Vancocin)

33. CONT
2. Anti-cancer drugs
 cisplatin (Platinol AQ)
 bleomycin (Blenoxane)
 vincristine (Oncovin)

34. CONT
3. Diuretics
 acetazolamide (Diamox)
 furosemide (Lasix)
 bumetanide (Bumex)
 ethacrynic acid (Edecrine)

35. CONT
4. CARDIOVASCULAR AGENTS
 Captopril
 Digitalis
 Guanfacine
 Metroprolol
 Minoxidil (also for alopecia)
 Quinidine
 Tocainide

36. ENT MEDICATION

37. OTIC/EAR AGENT

38. OTIC/EAR AGENT
 ANTIBIOTIC
 LOCAL ANALGESICS
 STEROIDS
 WAX EMULSIFIERS

39. ANTIBIOTIC
 Indication :
- To reduce the inflammation & itching associated with
ear infection.

40. ANTIBIOTIC con’t
 Example :
i) Neomycin
ii) Ciprofloxacin (Cetraxal)
iii) Ofloxacin (Floxcin Otic)
iv) Gentamycin
v)Gramicidin
vi) Nystatin
vii) Framycetin

41. LOCAL ANASTHETICS
 Inducation
-To reduce pain in the ear.
 EXAMPLE:
i)Benzocaine (Americaine Otic and Otocain)
ii)Pramoxine

42. STEROID
 Indication :
-To treat inflammation of the skin of the ear canal.
 Example:
i)Hydrocortisone
ii)Dexamethasone (Dexasol)
iii)Fluocinolone acetonide (Dermotic Oil Ear Drops).

43. WAX EMULSIFIER
(CERUMENOLYTIC)
 Indication :
 Loosen and remove impacted cerumen(ear wax)
 EXAMPLE:
i)Carbamide peroxide (Debrox)
ii)Triethanolamine polypeptide oleate (Cerumenex)

44. COMBINATION OF EARDROP
 Indication :
-To treat multiple aspects of otitis media or otitis externa (anti-
inflammatory , anti-pruritic,anti-allergic)
Example:
 A) Combination of Antipyrine and Benzocaine
(Brand names: Antiben, Auralgan,Otocalm).

45. Combination Ear Drops (cont..)
 B)Antibiotic and Steroid :
 Chloroxylenol/hydrocortisone/pramoxine (Brand name:
Aero Otic HC, Cortamox)
 Chloroxylenol/pramoxine
(Brand Name: Pramotic, Uni-Otic)
 Hydrocortisone/neomycin/polymyxin B
(Brand Names: Cortisporin Otic)
 Ciprofloxacin/dexamethosone
(Brand Name: Ciprodex).

46. DRUGS FOR NOSE

47. DRUGS FOR NOSE
 ANTIHISTAMINES
 Indication :
- To treat allergic rhinitis
 Example :
i) Cetrizine
ii) Chlorphinaramine diphenhydramine ( benadryl)

48. DRUGS FOR NOSE con’t
DECONGESTANTS
- Commonly used for their ability to shrink engorged
nasal mucus membrane & relieve nasal stiffness.
 Indication :
- Acute & chronic rhinitis , common cold
- Sinusitis , fever & other allergies

49. EXAMPLE OF DECONGESTANT
DRUG
 1) Nasal prophylaxis :
 Budesonide (Pulmicort Tubuhaler, Rhinocort)
 2) Treatment of seasonal & perennial allergic rhinitis :
 Nasacort (Trimcinolone)
 3) Bronchodilator:
 Atrovent (Ipratropium)
 4) Nasal congestion and as adjunct for sinusitis :
 Naphazoline (Privine)

50. DRUGS FOR THROAT

51. DRUGS FOR THROAT
ANTITUSSIVES
 Indication :
- To stop cough reflex whe the cough is non productive
or harmful.
- Reduce runny nose & postnasal drip.

52. Example of Drugs
1) Codeine (Opoid Antitussives)
2) Dextromethor (Non-opoid Antitussive)
3) Hydrocodone (Hycodan)

54. EAR DROP
 Also known as otic drop.
 It is liquid medicine administered into the ear.
 Must be discard after 30 days once open.
 Do not share ear drop: 1 medication 1 patient.

55. OTIC AGENTS:
 Antibiotics
 Antifungals
 Anti-inflammatory agents
 Wax emulsifiers
 Local analgesics

56. ANTIFUNGAL AND
ANTIBACTERIA
 Indication: treatment of superficial infections of
the external auditory canal caused by
organisms.
 Side effects: burning, redness, rash, swelling
and other sign of topical irritation
 E.g: chloramphenicol & gentamycin

57. ANTIBIOTIC AND STEROID
COMBINATION
 Indication: to reduce the inflammation and
itching associated with ear infection.
 E.g: pramoxine, benzalkonium chloride,

58. WAX EMULSIFIER
 To soften the ear wax / cerumen.
 Contraindication:
-Otitis external
-Dermatitis
-Perforated ear drum
 E.g: Carbamide peroxide.

59. EQUIPMENT
 Tray
 Cotton buds
 Sterile galipot
 Normal saline
 Ear drop as prescribe
 Receiver (kidney dish)
 MOAR
 Cotton ball

60. TECHNIQUE
> Adult
- Pull upward and backward.
> Child
- Pull downward and backward..

61. IMPLEMENTATION
1. Greet and explain clearly about the
procedure to the client.
- Purpose of instillation
2. Ask for client’s name and date of
birth, compare with client’s ID tag.
3. Check doctor’s prescription.
- Choose correct ear drop and check with
the prescription.

62. Con’t…
4. Position the client lie in the bed on unaffected
ear.
5. Clean the ear using swab sticks moistened with
normal saline.
6. Check ear drop medication with 8 R.

63. Con’t…
7. Pull ear upward and backward for
adult, downward and backward for children.
8. Hold tip of the bottle 1cm directly above
meatus.
9. Instill the ear drops.

64. Con’t…
10. Apply tragus pressure lightly.
11. Make sure client still in this position at least 3-5
minute.
12. Clean the equipment.
13. Document administration of medication.