1) The document provides details on examining the nose, oral cavity, throat, and related structures. It describes inspecting the external nose, nasal cavity, paranasal sinuses, oral cavity, salivary glands, tonsils, pharynx and larynx.
2) Examination techniques are explained, including anterior and posterior rhinoscopy, nasal speculum use, transillumination of sinuses, and bimanual palpation of structures.
3) Common abnormalities are mentioned, such as deviated nasal septum, sinusitis, oral ulcers, salivary gland swellings, and tonsillar enlargement. The goal of the examination and associated tests is to evaluate the structures
1. The document discusses several disorders of the nasal cavity including foreign bodies, rhinoliths, nasal myiasis, nasal synaechia, choanal atresia, and CSF rhinorrhoea.
2. Foreign bodies are commonly seen in children and can be organic or inorganic materials that enter the nose. Rhinoliths form around a nucleus like a blood clot and grow large within the nasal cavity.
3. Nasal myiasis involves maggot infestation in the nose from fly eggs, which can cause extensive tissue destruction if untreated.
The document discusses various diseases and conditions that can affect the external nose and nasal vestibule. It describes cellulitis, nasal deformities like saddle nose and hump nose, and various types of tumors including dermoid cysts, encephaloceles, and basal cell carcinoma. It also discusses injuries to the nose including nasal fractures and injuries to the paranasal sinuses. Other conditions mentioned include furuncles, vestibulitis, stenosis of the nares, and epistaxis (nosebleeds). The treatments involve antibiotics, steroids, surgery, and procedures to repair nasal fractures and deformities.
This document discusses various congenital malformations and abnormalities of the nose, including choanal atresia, dermoid cysts, gliomas, and bifid nose. It provides details on symptoms, diagnosis, and treatment options for these conditions. Choanal atresia involves closure of the posterior nares and can cause respiratory distress in bilateral cases. Dermoid cysts are congenital midline cysts on the nose dorsum that may require excision. Gliomas are intra-nasal tumors that do not increase in size with coughing. Treatment options discussed include surgical procedures like excision or reconstruction with grafts.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
A foreign body in the nose is an object that is lodged where it does not belong. Common foreign bodies include small toys, beads, and food items. Button batteries can cause severe damage by releasing toxic chemicals. Symptoms include nasal obstruction, discharge, and pain. Examination and imaging may identify the object. Various techniques are used to remove foreign bodies, depending on factors like size, location, and cooperation. General anesthesia may be needed for complicated or posterior cases.
In this PPT description of various basic instruments, anterior rhinoscopy, Posterior rhinoscopy, septum examination, nasal valve patency examination, paranasal sinus examination, etc.
This document discusses various complications that can arise from otitis media infections, including both intracranial and extracranial complications. It classifies complications into two broad groups: intracranial complications such as extradural abscess, subdural abscess, brain abscess, meningitis, sigmoid sinus thrombosis, and otic hydrocephalus; and extracranial complications including mastoiditis, otitis externa, facial nerve palsy, petrositis, labyrinthitis, internal jugular vein thrombosis, and adhesive otitis media. It provides details on symptoms, causes, and treatments for several of these complications.
This document provides guidance on examining the nose and throat. It describes how to inspect the nose, including shape, deformities, discharge, and speculum examination of the nasal cavities. It also outlines how to assess the nasal airway and palpate for polyps. Regarding the throat exam, it details inspecting the lips, mouth, tonsils, soft palate and assessing hydration. The document provides images and describes inspecting and palpating the parotid glands as well.
1. The document discusses several disorders of the nasal cavity including foreign bodies, rhinoliths, nasal myiasis, nasal synaechia, choanal atresia, and CSF rhinorrhoea.
2. Foreign bodies are commonly seen in children and can be organic or inorganic materials that enter the nose. Rhinoliths form around a nucleus like a blood clot and grow large within the nasal cavity.
3. Nasal myiasis involves maggot infestation in the nose from fly eggs, which can cause extensive tissue destruction if untreated.
The document discusses various diseases and conditions that can affect the external nose and nasal vestibule. It describes cellulitis, nasal deformities like saddle nose and hump nose, and various types of tumors including dermoid cysts, encephaloceles, and basal cell carcinoma. It also discusses injuries to the nose including nasal fractures and injuries to the paranasal sinuses. Other conditions mentioned include furuncles, vestibulitis, stenosis of the nares, and epistaxis (nosebleeds). The treatments involve antibiotics, steroids, surgery, and procedures to repair nasal fractures and deformities.
This document discusses various congenital malformations and abnormalities of the nose, including choanal atresia, dermoid cysts, gliomas, and bifid nose. It provides details on symptoms, diagnosis, and treatment options for these conditions. Choanal atresia involves closure of the posterior nares and can cause respiratory distress in bilateral cases. Dermoid cysts are congenital midline cysts on the nose dorsum that may require excision. Gliomas are intra-nasal tumors that do not increase in size with coughing. Treatment options discussed include surgical procedures like excision or reconstruction with grafts.
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
A foreign body in the nose is an object that is lodged where it does not belong. Common foreign bodies include small toys, beads, and food items. Button batteries can cause severe damage by releasing toxic chemicals. Symptoms include nasal obstruction, discharge, and pain. Examination and imaging may identify the object. Various techniques are used to remove foreign bodies, depending on factors like size, location, and cooperation. General anesthesia may be needed for complicated or posterior cases.
In this PPT description of various basic instruments, anterior rhinoscopy, Posterior rhinoscopy, septum examination, nasal valve patency examination, paranasal sinus examination, etc.
This document discusses various complications that can arise from otitis media infections, including both intracranial and extracranial complications. It classifies complications into two broad groups: intracranial complications such as extradural abscess, subdural abscess, brain abscess, meningitis, sigmoid sinus thrombosis, and otic hydrocephalus; and extracranial complications including mastoiditis, otitis externa, facial nerve palsy, petrositis, labyrinthitis, internal jugular vein thrombosis, and adhesive otitis media. It provides details on symptoms, causes, and treatments for several of these complications.
This document provides guidance on examining the nose and throat. It describes how to inspect the nose, including shape, deformities, discharge, and speculum examination of the nasal cavities. It also outlines how to assess the nasal airway and palpate for polyps. Regarding the throat exam, it details inspecting the lips, mouth, tonsils, soft palate and assessing hydration. The document provides images and describes inspecting and palpating the parotid glands as well.
Otosclerosis is a disease characterized by abnormal bone growth in the middle ear that causes hearing loss. It is caused by bone remodeling that fixes the stapes bone, preventing sound vibration. Symptoms include progressive, asymmetric conductive hearing loss, tinnitus, and dizziness. Diagnosis involves audiogram and physical exam. Treatment options include hearing aids, sodium fluoride to arrest progression, and stapedectomy or stapedotomy surgery to restore hearing. Post-operative care involves rest and avoiding pressure changes or water entry into the ear during healing.
Secretory otitis media (SOM), also known as serous otitis media or glue ear, is a non-purulent inflammation of the middle ear caused by an accumulation of fluid. It most commonly affects school-aged children between 3-8 years old. The pathogenesis involves malfunction of the Eustachian tube, which fails to ventilate and drain the middle ear, as well as increased secretory activity of the middle ear mucosa. Symptoms include hearing loss, delayed speech development, and mild ear aches. Treatment involves medical management with decongestants and antibiotics or surgical procedures like myringotomy with ventilation tube insertion to drain the fluid. Complications can include atelectasis, oss
Ototoxicity refers to damage to the inner ear caused by certain drugs or chemicals. Common ototoxic drugs include aminoglycoside antibiotics, loop diuretics, cytotoxic agents, antiprotozoals, antiepileptics, and environmental chemicals. Symptoms of ototoxicity include hearing loss, tinnitus, and balance disorders and can be temporary or permanent depending on the offending agent. Diagnosis involves assessing a patient's exposure history and test results. While there are no treatments to reverse damage, management focuses on rehabilitation and avoiding further ototoxic exposure.
Ms. Elizabeth presented on age-related hearing loss (presbycusis). It is a common condition linked to aging where hearing is slowly lost in both ears, with about 30 out of 100 adults over 65 having some hearing loss. Causes include long-term noise exposure, aging, genetics, certain health conditions, medications, race, income level, infections, and smoking. Symptoms are difficulty hearing conversations, high pitches, or sounds that seem too loud. Diagnosis involves tests of the ear canal, eardrum, hearing levels, and middle ear function. Treatments include hearing aids, assistive devices, speech reading, cochlear implants, and middle ear implants. Nursing considerations are involving family, speaking slowly
This document provides information about otitis media with effusion (OME), also known as glue ear. It defines OME as a chronic accumulation of mucus or non-purulent effusion in the middle ear cavity lasting more than 12 weeks. The document discusses the etiology, symptoms, examination findings, and treatment options for OME. Treatment may involve watchful waiting, medical management using decongestants or mucolytics, or surgical insertion of ventilation tubes to drain the middle ear.
Tumours of the ear can arise in the external ear, middle ear, and inner ear. Benign tumours of the external ear include sebaceous cysts, dermoid cysts, haemangiomas, and papillomas. Malignant tumours include basal cell carcinoma and squamous cell carcinoma. Glomus tumours are the most common benign tumour of the middle ear, arising from glomus bodies. Malignant tumours of the middle ear may be primary carcinomas or sarcomas or may spread secondarily from other sites. Tumours are diagnosed using imaging such as CT or MRI and treated with surgery, radiation, or embolization depending on the type and extent of disease.
This document discusses chronic otitis media (COM), a long-standing middle ear infection characterized by persistent ear discharge through a perforated eardrum. It defines the two main types - tubotympanic and atticoantral disease - and describes their signs, symptoms, causes, investigations, and treatment options including medical management and surgical procedures like myringoplasty, tympanoplasty, and ossiculoplasty. COM is more common in developing nations and usually starts in childhood, affecting hearing if left untreated. Accurate diagnosis involves examination, tests like audiograms and CT scans, and ruling out complications.
The nose has several important functions: respiration, protection of the lower respiratory tract, vocal resonance, olfaction, drainage of secretions, and maintaining eustachian tube function. It filters and conditions air through mechanisms like mucociliary clearance and the nasal cycle. Secretions produced in the nose help fight infections and allergens with lysozymes, immunoglobulins, and interferons. The olfactory epithelium allows for smell detection which is important for functions like regulating food intake and detecting toxins.
This document discusses otitis media, including definitions, classifications, stages, types, etiology, pathophysiology, clinical manifestations, diagnosis, and management of both acute and chronic otitis media. It provides details on the catarrhal, exudation, suppuration, and healing stages of acute otitis media. It also describes tubotympanic and atticoantral types of chronic suppurative otitis media and covers surgical and nonsurgical treatment approaches.
The document provides an overview of common otologic, nasal, facial, oral and pharyngeal infections and emergencies that may present to the emergency department. It discusses the anatomy and various disorders that can affect the ear, nose, face, mouth and throat. It describes the evaluation, treatment and management of conditions such as epistaxis, sinusitis, cellulitis, peritonsillar abscess, epiglottitis, retropharyngeal abscess and more.
This document discusses differential diagnoses of nasal obstruction and neoplasms of the nose and paranasal sinuses. It provides a list of structural, infectious, allergic and other causes of unilateral and bilateral nasal obstruction. It also classifies benign and malignant nasal tumors and describes the presentation, diagnosis and treatment of inverted papilloma and sinonasal carcinomas such as maxillary sinus carcinoma. The treatment of maxillary sinus carcinoma includes surgery such as total maxillectomy with options like orbital exenteration or anterior cranio-facial resection depending on tumor extent.
Chronic suppurative otitis media tubotympanic (CSOM TT) involves a permanent abnormality of the eardrum (pars tensa) resulting from previous ear infections. It is characterized by intermittent ear drainage through a perforation in the eardrum. Examination may reveal various sizes of eardrum perforations. Treatment involves cleaning the ear, antibiotics, and surgery to repair the eardrum perforation (myringoplasty) if the condition is inactive. The goal of treatment is to stop ear drainage, improve hearing if the ossicles are intact, and prevent complications.
1) Otitis media with effusion (OME), also known as glue ear, is a chronic accumulation of fluid in the middle ear behind an intact but retracted eardrum that can cause hearing loss.
2) It commonly affects young children, with the highest prevalence between ages 2-5 years old. Risk factors include age, male gender, family history, and exposure to smoke.
3) The fluid is caused by eustachian tube dysfunction preventing drainage and ventilation of the middle ear, which can be due to infections, allergies, or adenoid hypertrophy among other factors.
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
This document discusses nasal congestion and nasal polyps. It defines nasal congestion as some blockage of the nose or nasal cavity and lists several potential causes including dust, foreign bodies, large adenoids, and infections. It then discusses clinical features such as breathing difficulty, mouth breathing, and dryness. The document also discusses diagnosis methods like health history, physical exam, CT scans, and X-rays. Treatment options mentioned include nasal steroid sprays, antibiotics, antihistamines, functional rhinoplasty, and septoplasty. Nasal polyps are defined as non-cancerous growths on the nasal passages that can cause obstruction, anosmia, headaches, and rhinorrhoea. Diagnosis
This document provides instructions for examining the nose and related structures. It describes examining the nose externally and internally using anterior and posterior rhinoscopy. Key parts of the nose that are examined include the nasal septum, turbinates, floor, roof and lateral walls. Functional tests like the spatula and cotton wisp tests evaluate nasal patency. The sense of smell is also tested. Related areas like the paranasal sinuses and cervical lymph nodes are inspected and palpated. The overall examination evaluates the nose, nasal passages and surrounding structures in detail.
This document discusses earwax, also known as cerumen, and methods for removing impacted earwax. It describes the structure and composition of earwax, noting that it helps clean and lubricate the ear canal while also playing an antibacterial and antifungal role. When earwax becomes impacted, it can cause symptoms like a blocked ear sensation, discomfort, pain, tinnitus, and hearing impairment. The document outlines common techniques for removing impacted earwax, including using cerumenolytic drops to soften the wax, syringing the ear canal with water, and instrumental removal with tools like a cerumen hook. Complications from improper removal are also discussed.
This document discusses tympanic membrane perforation, which is a rupture of the eardrum. It can be caused by ear infections, trauma, or foreign objects in the ear canal. Symptoms include ear pain, bleeding, hearing loss, and drainage from the ear. Diagnosis involves examination of the ear. Small perforations may heal on their own with antibiotics and pain medication, while larger perforations require surgery like myringoplasty or tympanoplasty to repair the eardrum. Post-operative care involves keeping the ear dry and avoiding heavy lifting or air pressure changes for a few weeks.
Examination of Nose & Throat Aditi G - Copy.pptxSoumyajitJana7
The document provides details on examining the nose, throat, and related structures. It begins with an overview of the nose examination, including inspecting the external nose and nasal cavity. This is followed by descriptions of anterior and posterior rhinoscopy to examine the nasal passages. Examination of the paranasal sinuses and oral cavity is also outlined. Specific structures of the throat, such as the tonsils, salivary glands, and larynx are then discussed. Examination techniques including inspection, palpation, and specific tests are described for each anatomical area.
The document provides instructions for performing a physical examination of the nose. It describes using a nasal speculum to examine the nasal cavity and septum. Key things to note include crusting, discharge, deviations or perforations of the septum, and erythema or swelling of the mucosa. It also describes transilluminating the maxillary sinuses to check for secretions that could indicate sinusitis.
Otosclerosis is a disease characterized by abnormal bone growth in the middle ear that causes hearing loss. It is caused by bone remodeling that fixes the stapes bone, preventing sound vibration. Symptoms include progressive, asymmetric conductive hearing loss, tinnitus, and dizziness. Diagnosis involves audiogram and physical exam. Treatment options include hearing aids, sodium fluoride to arrest progression, and stapedectomy or stapedotomy surgery to restore hearing. Post-operative care involves rest and avoiding pressure changes or water entry into the ear during healing.
Secretory otitis media (SOM), also known as serous otitis media or glue ear, is a non-purulent inflammation of the middle ear caused by an accumulation of fluid. It most commonly affects school-aged children between 3-8 years old. The pathogenesis involves malfunction of the Eustachian tube, which fails to ventilate and drain the middle ear, as well as increased secretory activity of the middle ear mucosa. Symptoms include hearing loss, delayed speech development, and mild ear aches. Treatment involves medical management with decongestants and antibiotics or surgical procedures like myringotomy with ventilation tube insertion to drain the fluid. Complications can include atelectasis, oss
Ototoxicity refers to damage to the inner ear caused by certain drugs or chemicals. Common ototoxic drugs include aminoglycoside antibiotics, loop diuretics, cytotoxic agents, antiprotozoals, antiepileptics, and environmental chemicals. Symptoms of ototoxicity include hearing loss, tinnitus, and balance disorders and can be temporary or permanent depending on the offending agent. Diagnosis involves assessing a patient's exposure history and test results. While there are no treatments to reverse damage, management focuses on rehabilitation and avoiding further ototoxic exposure.
Ms. Elizabeth presented on age-related hearing loss (presbycusis). It is a common condition linked to aging where hearing is slowly lost in both ears, with about 30 out of 100 adults over 65 having some hearing loss. Causes include long-term noise exposure, aging, genetics, certain health conditions, medications, race, income level, infections, and smoking. Symptoms are difficulty hearing conversations, high pitches, or sounds that seem too loud. Diagnosis involves tests of the ear canal, eardrum, hearing levels, and middle ear function. Treatments include hearing aids, assistive devices, speech reading, cochlear implants, and middle ear implants. Nursing considerations are involving family, speaking slowly
This document provides information about otitis media with effusion (OME), also known as glue ear. It defines OME as a chronic accumulation of mucus or non-purulent effusion in the middle ear cavity lasting more than 12 weeks. The document discusses the etiology, symptoms, examination findings, and treatment options for OME. Treatment may involve watchful waiting, medical management using decongestants or mucolytics, or surgical insertion of ventilation tubes to drain the middle ear.
Tumours of the ear can arise in the external ear, middle ear, and inner ear. Benign tumours of the external ear include sebaceous cysts, dermoid cysts, haemangiomas, and papillomas. Malignant tumours include basal cell carcinoma and squamous cell carcinoma. Glomus tumours are the most common benign tumour of the middle ear, arising from glomus bodies. Malignant tumours of the middle ear may be primary carcinomas or sarcomas or may spread secondarily from other sites. Tumours are diagnosed using imaging such as CT or MRI and treated with surgery, radiation, or embolization depending on the type and extent of disease.
This document discusses chronic otitis media (COM), a long-standing middle ear infection characterized by persistent ear discharge through a perforated eardrum. It defines the two main types - tubotympanic and atticoantral disease - and describes their signs, symptoms, causes, investigations, and treatment options including medical management and surgical procedures like myringoplasty, tympanoplasty, and ossiculoplasty. COM is more common in developing nations and usually starts in childhood, affecting hearing if left untreated. Accurate diagnosis involves examination, tests like audiograms and CT scans, and ruling out complications.
The nose has several important functions: respiration, protection of the lower respiratory tract, vocal resonance, olfaction, drainage of secretions, and maintaining eustachian tube function. It filters and conditions air through mechanisms like mucociliary clearance and the nasal cycle. Secretions produced in the nose help fight infections and allergens with lysozymes, immunoglobulins, and interferons. The olfactory epithelium allows for smell detection which is important for functions like regulating food intake and detecting toxins.
This document discusses otitis media, including definitions, classifications, stages, types, etiology, pathophysiology, clinical manifestations, diagnosis, and management of both acute and chronic otitis media. It provides details on the catarrhal, exudation, suppuration, and healing stages of acute otitis media. It also describes tubotympanic and atticoantral types of chronic suppurative otitis media and covers surgical and nonsurgical treatment approaches.
The document provides an overview of common otologic, nasal, facial, oral and pharyngeal infections and emergencies that may present to the emergency department. It discusses the anatomy and various disorders that can affect the ear, nose, face, mouth and throat. It describes the evaluation, treatment and management of conditions such as epistaxis, sinusitis, cellulitis, peritonsillar abscess, epiglottitis, retropharyngeal abscess and more.
This document discusses differential diagnoses of nasal obstruction and neoplasms of the nose and paranasal sinuses. It provides a list of structural, infectious, allergic and other causes of unilateral and bilateral nasal obstruction. It also classifies benign and malignant nasal tumors and describes the presentation, diagnosis and treatment of inverted papilloma and sinonasal carcinomas such as maxillary sinus carcinoma. The treatment of maxillary sinus carcinoma includes surgery such as total maxillectomy with options like orbital exenteration or anterior cranio-facial resection depending on tumor extent.
Chronic suppurative otitis media tubotympanic (CSOM TT) involves a permanent abnormality of the eardrum (pars tensa) resulting from previous ear infections. It is characterized by intermittent ear drainage through a perforation in the eardrum. Examination may reveal various sizes of eardrum perforations. Treatment involves cleaning the ear, antibiotics, and surgery to repair the eardrum perforation (myringoplasty) if the condition is inactive. The goal of treatment is to stop ear drainage, improve hearing if the ossicles are intact, and prevent complications.
1) Otitis media with effusion (OME), also known as glue ear, is a chronic accumulation of fluid in the middle ear behind an intact but retracted eardrum that can cause hearing loss.
2) It commonly affects young children, with the highest prevalence between ages 2-5 years old. Risk factors include age, male gender, family history, and exposure to smoke.
3) The fluid is caused by eustachian tube dysfunction preventing drainage and ventilation of the middle ear, which can be due to infections, allergies, or adenoid hypertrophy among other factors.
Tonsils and adenoids
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
This document discusses nasal congestion and nasal polyps. It defines nasal congestion as some blockage of the nose or nasal cavity and lists several potential causes including dust, foreign bodies, large adenoids, and infections. It then discusses clinical features such as breathing difficulty, mouth breathing, and dryness. The document also discusses diagnosis methods like health history, physical exam, CT scans, and X-rays. Treatment options mentioned include nasal steroid sprays, antibiotics, antihistamines, functional rhinoplasty, and septoplasty. Nasal polyps are defined as non-cancerous growths on the nasal passages that can cause obstruction, anosmia, headaches, and rhinorrhoea. Diagnosis
This document provides instructions for examining the nose and related structures. It describes examining the nose externally and internally using anterior and posterior rhinoscopy. Key parts of the nose that are examined include the nasal septum, turbinates, floor, roof and lateral walls. Functional tests like the spatula and cotton wisp tests evaluate nasal patency. The sense of smell is also tested. Related areas like the paranasal sinuses and cervical lymph nodes are inspected and palpated. The overall examination evaluates the nose, nasal passages and surrounding structures in detail.
This document discusses earwax, also known as cerumen, and methods for removing impacted earwax. It describes the structure and composition of earwax, noting that it helps clean and lubricate the ear canal while also playing an antibacterial and antifungal role. When earwax becomes impacted, it can cause symptoms like a blocked ear sensation, discomfort, pain, tinnitus, and hearing impairment. The document outlines common techniques for removing impacted earwax, including using cerumenolytic drops to soften the wax, syringing the ear canal with water, and instrumental removal with tools like a cerumen hook. Complications from improper removal are also discussed.
This document discusses tympanic membrane perforation, which is a rupture of the eardrum. It can be caused by ear infections, trauma, or foreign objects in the ear canal. Symptoms include ear pain, bleeding, hearing loss, and drainage from the ear. Diagnosis involves examination of the ear. Small perforations may heal on their own with antibiotics and pain medication, while larger perforations require surgery like myringoplasty or tympanoplasty to repair the eardrum. Post-operative care involves keeping the ear dry and avoiding heavy lifting or air pressure changes for a few weeks.
Examination of Nose & Throat Aditi G - Copy.pptxSoumyajitJana7
The document provides details on examining the nose, throat, and related structures. It begins with an overview of the nose examination, including inspecting the external nose and nasal cavity. This is followed by descriptions of anterior and posterior rhinoscopy to examine the nasal passages. Examination of the paranasal sinuses and oral cavity is also outlined. Specific structures of the throat, such as the tonsils, salivary glands, and larynx are then discussed. Examination techniques including inspection, palpation, and specific tests are described for each anatomical area.
The document provides instructions for performing a physical examination of the nose. It describes using a nasal speculum to examine the nasal cavity and septum. Key things to note include crusting, discharge, deviations or perforations of the septum, and erythema or swelling of the mucosa. It also describes transilluminating the maxillary sinuses to check for secretions that could indicate sinusitis.
The document summarizes the examination of the nose and paranasal sinuses. It describes various instruments used in the examination like speculums, mirrors, and probes. It details the different parts of the examination including inspection of the external nose, anterior and posterior rhinoscopy, and tests to evaluate nasal patency and smell. Common complaints, nasal obstructions, and findings related to the sinuses are also outlined. The examination aims to thoroughly evaluate the nose and related structures.
The paranasal sinuses develop as outgrowths of the nasal mucosa and have mucous membranes continuous with the nasal cavity. In newborns, sinuses are not present. Mucous builds up in the sinuses due to swelling, plugging the openings into the nose. Cilia move mucous toward the nasopharynx where it is swallowed. The four main sinuses are the sphenoid, ethmoid, maxillary, and frontal sinuses. Functions include lightening the skull, resonating voice, facilitating tooth eruption and facial bone growth. Diagnostic methods for sinus diseases include eliciting sinus tenderness, transillumination, radiological exams, diagnostic puncture, sinoscopy, ech
This document provides information about maxillary sinus anatomy, oroantral communications, and their management. It begins with definitions of key terms like maxillary sinus and oroantral fistula. It then discusses the causes, signs, diagnosis, and various treatment approaches for oroantral communications depending on factors like size and chronicity. Surgical procedures like buccal flap advancement are described for repairing communications. Post-operative care instructions are also provided. The document provides a thorough overview of maxillary sinus anatomy and management of oroantral fistulae and communications.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
This document provides information about nasal polyps through three parts. Part 1 discusses the anatomy of the nasal cavity and its relationship to polyps. It describes the structures of the nasal septum and lateral walls. Part 2 defines nasal polyps and classifies them according to location. It also discusses their etiology, pathogenesis, symptoms, signs, diagnosis and treatment options. Part 3 presents two case studies of patients presenting with nasal polyps - one involving an antrochoanal polyp and the other involving bilateral ethmoid polyps. Both cases discuss the relevant history, examination findings, investigations, diagnoses and treatment plans.
This document provides information about the maxillary air sinus (antrum). It discusses the embryology, anatomy, functions, clinical importance and diseases of the maxillary sinus. The maxillary sinus begins developing in the fourth month of gestation and reaches adult size by age 18. It is pyramidal in shape with thin walls. Diseases discussed include acute and chronic sinusitis, polyps, cysts and tumors. Surgical procedures for treating maxillary sinus diseases like antral lavage and Caldwell-Luc operation are also summarized.
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1) Sinusitis is inflammation of the paranasal sinuses, the air-filled cavities around the nose. The four main sinus cavities are the maxillary, frontal, ethmoid, and sphenoid sinuses.
2) Acute sinusitis is caused by viral or bacterial infection following a cold or allergy. Symptoms include facial pain, nasal congestion, and discolored nasal discharge. Maxillary sinusitis commonly involves pain in the cheek.
3) Treatment involves antibiotics, nasal decongestants, pain relievers, and surgery if symptoms persist. Surgical treatments include antral puncture to drain pus from the maxillary sinus or functional endoscopic sinus surgery. Comp
This document discusses odontogenic diseases of the maxillary sinus. It begins with the embryology and anatomy of the maxillary sinus, noting its development, location, dimensions, and openings. It then covers clinical examination and features of sinusitis. The majority of the document discusses causes of maxillary sinusitis, distinguishing between odontogenic (dental-related) and non-odontogenic causes. It provides details on signs, symptoms, and treatments for both acute and chronic maxillary sinusitis. Surgical treatment including the Caldwell-Luc procedure is also summarized.
Developmental disorders of the nasal septum are rare, occurring in about 1 in 10,000 births. The septum can be involved in conditions like choanal atresia, congenital midline nasal masses, and cleft lip and palate. Cleft lip and palate are among the most common birth defects involving the septum. Septal trauma is also very common and can cause issues like septal hematomas, abscesses, and fractures. Physical examination of the nose includes inspecting the septum and nasal cavity to diagnose septal pathology. Conditions like deviations, perforations, and structural deformities can be identified. Septoplasty is often performed to correct significant septal abnormalities that cause nasal obstruction or other symptoms
The document discusses the paranasal sinuses. There are four pairs of paranasal sinuses located around the nasal cavity that develop from invaginations of the nasal cavity mucosa into the bones. The maxillary sinus is the largest sinus and most clinically relevant as it is close to the teeth. Sinusitis is inflammation of the sinuses which can be acute or chronic and is usually caused by infection, trauma, dental issues or tumors. Anatomical relationships between the sinuses and structures like the orbit and teeth are important for dentists to understand.
Dr. Ornouma Sriwanishvipat at Yanhee International Hospital in Bangkok, Thailand treats various nose problems including nasal obstruction, nasal polyps, and cosmetic rhinoplasty. Common procedures performed are septoplasty to straighten a deviated septum and functional endoscopic sinus surgery to clear sinuses and remove polyps without external incisions. The document also provides details on nasal anatomy, functions, common nasal issues like polyps, deviated septums, and their treatments.
This lecture provides an introduction to nose pathology and covers several topics:
- It defines otorhinolaryngology and discusses the anatomy and functions of the nose and sinuses.
- Common nose diseases are described such as acute and chronic rhinitis, septal deviations, and furuncles.
- Diagnosis involves anterior rhinoscopy and differential diagnosis.
- Treatment for acute rhinitis includes decongestants, analgesics, and mucolytics. Chronic rhinitis types and their treatments are also outlined.
- Side effects of nasal decongestants are discussed. Examples of medication doses are provided.
The summary highlights the key information about nose anatomy, common
The document provides information on the nose, nasal cavity, paranasal sinuses, and pharynx. It describes the boundaries and structures of the nasal cavity including the nasal septum, nasal conchae and meati. It discusses the paranasal sinuses, their locations and functions. It also describes the three parts of the pharynx and identifies the muscles and structures found in each part.
Allergic rhinitis is an IgE-mediated inflammation of the nasal mucosa caused by exposure to allergens like pollen, dust or foods. It affects 10-20% of the population. Symptoms include sneezing, nasal congestion and discharge. Diagnosis involves skin prick tests and measuring IgE levels. Treatment includes avoidance of triggers, immunotherapy, antihistamines, nasal steroids and surgery for nasal polyps or severe cases.
Similar to Examination of Nose & Throat Aditi G.pptx (20)
Patient Positionin OT & AT Class a detailed descriptionSoumyajitJana7
The document discusses guidelines for proper patient positioning during surgery. It outlines various surgical positions like supine, prone, lithotomy, and their goals in providing optimal exposure and circulation while preventing injury. Risk factors for complications related to positioning are described. The roles of operative nurses in correctly positioning patients and using devices to support different positions are explained.
This document summarizes a study assessing pre-operative outcomes and their correlation with intra-operative findings for laparoscopic cholecystectomies. It introduces cholelithiasis and laparoscopic cholecystectomy as the gold standard treatment. The study aims to evaluate factors that make laparoscopic cholecystectomy difficult. It employs a pre-operative scoring system based on patient history, exam, and ultrasound findings, and compares it to intra-operative scoring of difficulty. The results show a 91.5% correlation between pre-operative and intra-operative scores. Most pre-operative risk factors were significantly correlated with difficulty. The scoring system was found to reliably predict difficulty of laparoscopic cholecyst
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A hydrocele is an abnormal collection of fluid in the tunica vaginalis, usually caused by a congenital defect in the processus vaginalis. There are two main types of hydrocele: primary/congenital hydroceles which occur naturally due to defects, and secondary hydroceles which occur due to conditions like epididymitis, hernia repair, or tumors. Characteristics of secondary hydroceles include a lax and moderate sized swelling where the testis is still palpable. Hydrocele fluid is amber in color with a specific gravity of 1.022-1.024 and contains water, salts, albumin and other substances. Treatment depends on the size and type of hydrocele,
1) A 38-year-old female presented with abdominal pain and distension and was found to have a growth causing intestinal obstruction requiring an emergency surgery.
2) Post-operatively, the patient developed complications including pleural effusions, sepsis, and a non-functional stoma requiring further surgeries.
3) Despite aggressive management including three surgeries, the patient's condition deteriorated with sepsis and multiple organ dysfunction leading to her death on the 24th post-operative day.
The document provides guidance on performing a full nose examination. A full nose examination assesses nasal function, airway resistance, and sometimes sense of smell. It involves external inspection of the nose, anterior and posterior rhinoscopy to examine the nasal cavities, and examination of surrounding areas like the mouth, neck and sinuses. Key steps include inspecting the nasal tip, vestibule and airway, and examining the nasal septum, turbinates, mucosa and sinuses using anterior and posterior rhinoscopy. The nose examination also evaluates nasal patency and sense of smell.
This presentation provides tips for making effective presentations using awesome backgrounds to engage audiences and capture their attention. It discusses using backgrounds and features of Product A and Product B to enhance presentations.
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3. Specific surgical techniques like Bassini, Shouldice, Lichtenstein, and mesh repairs are explained in detail. Indications for surgery and surgical approaches are also summarized.
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Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
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তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
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3. INTRODUCTION
Full nose examinations assess the function,
airway resistance and occasionally sense of smell.
It includes looking into the mouth and pharynx.
Common symptoms of nasal disease include:
Airway obstruction.
Rhinorrhoea (runny nose).
Sneezing.
Loss of smell (anosmia).
Facial pain caused by sinusitis.
Snoring (associated with nasal obstruction).
4. Plan of Examination
Introduce yourself
Position patient
Examination of external nose
Inspect the nasal tip, vestibule, and nasal airway.
Anterior rhinoscopy
Posterior rhinoscopy
Post nasal examination
5. Examination of External Nose
INSPECTION :
The external is observed from a distance from the
front as well as side for any signs such as:
Nasal bridge deformity- Saddle Nose/ Hump deformity
Swelling
Ulcers
Sinuses
Growths on skin
Scars
Broadening of nose
Inflammation/ cellulites
6. Contd..
External deformities of the nose like external deviation of
nose, nasal hump, depressed nasal bridge, nasal injury,
congenital anomaly, any inflammation or swelling, benign
conditions like rhinophyma are observed.
Depressed Nasal Bridge : occurs in leprosy, syphilis or
tuberculosis of nose and also in cretinism, thalassemia major.
Nasal Injury : common after road vehicular accident. Deviated
Nose : common in boxers.
Congenital Swelling : glioma is present since birth.
Benign Condition : Rhinophyma (Potato nose) is due to
hypertrophy of sebaceous glands.
Broadening of Nose : seen in antrochoanal polyp.
Frog Face Deformity : seen in juvenile nasopharyngeal
angiofibroma.
Crepitus : felt in fracture nasal bone.
7. Contd..
PALPATION : Following thorough inspection, we
proceed to palpation, where our inspectory
conclusions are verified and additional assessment is
performed.
Crepitation
Tenderness
8. Cold Spatula Test
Tongue depressor is kept about a cm. below the nostril and
the amount of fogging on the spatula is observed. If fogging is
less on one side, it indicates obstruction of that side of nasal
cavity. In summers fogging is not appreciated so this test
should be carried out in an air-conditioned room or after
dipping the spatula in cold water. The amount of fogging can
also be measured on the graphic chromium plate.
9. Anterior Rhinoscopy
THUDICUM NASAL SPECULUM
A Thudicum or Vienna type of nasal speculum is held in the left
hand and assists in widening the vestibule (Figs 6A and B). The
blades of speculum are inserted into the less sensitive skin line
vestibule and should not touch the septal mucosa which is very
sensitive and vascular. The nasal speculum is closed while introducing
and opened during examination and remains partially
open when removing from the nose (avoid picking vibrissae).
The size of the nasal speculum should be chosen according to
the age of patient and size of the nose.
11. Nasal Cavity
Examination:
Patient’s head needs to be tilted in different directions to examine
different sites in the nose: septum, inferior turbinate and meatus, middle
turbinate and meatus and floor of the nose (Box 1).
1. Septum: It is rarely straight and mild deviations are not
significant. In some cases, even gross looking deviations do
not cause any functional problem. Note for any perforations,
granulations, deviations.
2. Inferior and middle turbinates: Compensatory hypertrophy
of middle and inferior turbinates is common on the concave side of
deviated nasal septum. In cases of chronic and allergic rhinitis, there can
occur hypertrophy of inferior margins and posterior ends of middle and
inferior turbinates. Middle turbinate concha bullosa (contains air cells),
paradoxical shape (convex lateral surface) and polypoidal changes are
common findings.
12. Contd..
3. Inferior and middle meatuses: Inferior meatus is rarely
visible. Most nasal polyps first appear in middle meatus.
Purulent secretions in middle meatus can come from
infections of anterior paranasal sinuses (maxillary, anterior
ethmoid and frontal) as they all drain in it.
4. Floor of nose: A swelling in the floor of nose may extend
from hard palate and alveolar process of maxilla. A floor
ulcer may communicate with oral cavity. Foreign bodies are
usually seen between septum and inferior turbinate.
Topical nasal decongestant:
The solution of xylocaine with adrenaline brings about vasoconstriction
(shrinkage of mucous membrane) and local anesthesia and facilitates the
proper nasal examination.
13. Contd..
Probe test:
It is done under topical anesthesia. A probe is passed on all
surfaces of mass and helps in ascertaining the site of
attachment, consistency, mobility, vascular nature and
sensitivity of the growth. Ulcers should be probed to know the
exposed underlying bone. Probing of an ulcer in the floor of nose
can exclude or confirm its oral cavity communication. Rhinolith
gives a grating sensation on probing.
Posture test:
Drainage of purulent discharge from various sinuses depends
upon the posture of patient. After wiping out, the purulent
discharge from the middle meatus note the timings of discharge
and the posture of patient
14. Contd..
Frontal sinus: Pus reappears immediately if thepatient is
sitting in upright position (Head forward chin down
position).
Ethmoidal sinus: Pus reappears after some time (10–15
minutes) if the patient is sitting in upright position.
Maxillary sinus: Pus reappears if the head is so bent that
the affected maxillary sinus is in upward position.
15. Patency of Nasal Cavities
„
Spatula test (Fig): A clean cold tongue depressor is
held below the nose while patient exhales. Each area of
mist formation on either side is compared.
Cotton-wool test: A fluff of cotton is held against each
nostril and its movements indicate the nasal blow of air
while the patient inhales or exhales.
„
Alae nasi movements: In cases of inspiratory
obstruction, alae nasi collapse onto the septum.
Cottle test: In this test, which is done for the
abnormality of the nasal valve, cheek is drawn laterally
while patient breathes quietly. If there is subjective
improvement in nasal airway, the test is positive, which
indicates nasal valve compromise. The test also can be
performed by lateralizing the ULC with a cotton-tipped
applicator or cerumen curette.
16. Posterior Rhinoscopy
It consists of examining the nasopharynx and posterior part of nasal
cavity by the postnasal mirror (Fig.). The patient opens his mouth and
breathes quietly. Postnasal mirror is warmed but should not be hot. It is
always better to test on the back of hand before introducing. The
examiner depresses the patient’s tongue with a tongue depressor that is
held in left hand and introduces posterior rhinoscopic mirror (postnasal
mirror). The mirror should be held in right hand like a pen and carried
behind the soft palate, along the tongue but without touching the
posterior third of tongue (to avoid gag reflex). The reflected light from
the head mirror illuminates the area of nasopharynx and the examiner
sees the reflected image of the postnasal space in the postnasal mirror. If
the patient is quiet and relaxed, then usually soft palate does not
contract and hide the view. This procedure especially needs
concentration, patience and practice.
17. Contd..
Structures seen in Posterior Rhinoscopy:
Anteriorly
1. Posterior end of Nasal septum.
2. Posterior end of middle and inferior turbinate
3. Posterior end of superior turbinate
4. Posterior part of superior & middle meatus
5. Nasal Surface of the soft palate & the uvula on tilting the mirror
further anteriorly.
18. Contd..
Laterally:
1. Eustachian tube opening on either side with Tubal
Elevations seen behind the posterior end of inferior
turbinate.
2. Fossa of Rosenmuller behind the eustachian tube
orifice.
Superiorly:
1. Roof of Nasopharynx.
2. Superior part of posterior pharyngeal wall.
21. Contd..
They are examined by inspection, palpation and
transillumination. The anterior group of sinuses
(maxillary, frontal and anterior ethmoid) drains in
middle meatus. The posterior ethmoid drains into
superior meatus. The sphenoid sinus opens into
sphenoethmoidal recess.
All the structures, which are adjacent to the different
walls of these sinuses, need attention of the examiner.
Sphenoid sinus, which opens in the sphenoethmoidal
recess, lies deep and is not easy to examine directly.
Frontal sinus has three walls: anterior, posterior and
floor but only the anterior wall can be examined
externally.
22. Contd..
Tenderness:
Tenderness of the sinuses can be
elicited by pressure or percussion with a
finger on their walls.
„
Frontal sinus: Anterior and inferior walls
above the medial part of eyebrow and above
the medial canthus.
Maxillary sinus: Anterior wall over the
cheek lateral to nose.
Anterior ethmoids: Medial wall of orbit just
behind the root of nose.
23. Contd..
Transillumination
Maxillary sinus: A specially made light source is placed
in the mouth and the mouth is closed. Normally, a crescent
of light in the inferior fornix and glow in the pupil, which
are equally bright on either side can be seen. The affected
side maxillary sinus will not transmit light if there is pus,
thickened mucosa or a neoplasm.
Frontal sinus: A small light source is placed in the
superomedial angle of the orbit. The transmission of light
from the anterior wall of the both side frontal sinuses is
compared.
26. EXAMINATION OF ORAL CAVITY
A. INSPECTION:
Examine all the different parts of oral cavity by both inspection,
as well as palpation (Box 1). Tongue depressors (Fig. 3) are
used in the examination of oral cavity and oropharynx and are
available in different sizes for children and adults.
o „
„
Lips: Lips have an outer (cutaneous), an inner (mucosal) surface
and a vermilion border.
o Buccal mucosa: is examined by asking the patient to open the
mouth and then retracting the cheek with a tongue depressor.
o „
„
Vestibule of mouth: Examine the complete vestibule of mouth.
Look for not only the change in color but also change in surface
appearance. Parotid duct opening may be red, swollen and
discharging. It can be seen opposite the crown of upper second
molar tooth. Examine the skin of the cheek because carcinoma of
buccal mucosa can invade the same.
27. Contd..
Teeth and gums: Examine gums and teeth of both upper and lower jaws.
Cheeks and lips are retracted with the help of tongue depressor for
examining the outer surface of gums while tongue is pushed away for
examining the inner surface of gums.
Hard palate: See for any swelling (Fig. 5), ulcer and cleft.
Anterior two-third tongue: Only anterior two-third tongue, which consists
of the tip, dorsum, lateral borders and undersurface, is included in the oral
cavity. Tongue should be examined in its natural position and then patient is
asked to protrude it and move it in different directions (Figs 6 to 11).
Floor of mouth: The floor of mouth consists of the area that lies under the
tongue and two lateral gutters (Fig. 12). The latter are examined by two
tongue depressors that retract tongue and cheek. The submandibular duct
opens on the summit of raised papilla on either side of the tongue frenulum.
The swellings in the floor of mouth are examined by bimanual palpation,
which help in differentiating between submandibular salivary gland and
submandibular lymph nodes.
29. Tongue Depressor
One blade of Lack’s tongue depressor is slightly bent at the
end. The bent end is used for holding the depressor and
supports the little finger of the examiner. The other blade
depresses the tongue and is used like a lever to depress
anterior two-thirds of the tongue with the fulcrum over the
lower teeth.
Uses: It is used for examining the oral cavity and
thepharynx. In addition to the depressing of tongue it
canalso be used for:
Squeezing the tonsil
Retraction of cheek
Test for gag reflex
Checking nasal air blast (cold spatula test)
Spatula test for suspected case of tetanus
30. Contd..
B. PALPATION:
1. Tongue:
Ideally the tongue should be kept in the oral cavity to keep the tongue
muscle relaxed. To look for induration, ulcers, swelling.
2. Palate:
Any ulcer or cyst (nasoalveolar or nasopalatine cyst) is examined
in theusual way. Alveolar abscess causes tender fluctuating
swelling close to the alveolar process.
3. Floor of Mouth:
It should be palpated bimanually. Translucency is tested if there
is anycystic swelling. Ranula is translucent but sublingual
dermoid cyst is nottranslucent. The submandibular duct is
palpated for any stone.
31. Contd..
4. Buccal Mucosa:
The mucus membrane and the cheek should be carefully palpated
to know involvement of skin of cheek by malignant growth.
33. Examination of Salivary Glands
A. INSPECTION:
Swelling:
Parotid swelling appears below, in front, and behind the lobule of ear
causing usually lifting of the lobule. It also obliterates the normal fissure
behind the ramus of mandible.
Submandibular gland swelling is present in the submandibular triangle.
Duct:
The Stensen’s duct (parotid duct) is seen on the buccal surface, opposite
to the upper 2nd molar tooth. In suppurative parotitis, pus may come out
of the duct on pressing the gland while in malignant growth, blood may
come out. We ask the patient to touch the palate by the tip of tongue, the
opening of submandibular duct (Wharton’s duct) on either side of
frenulum linguae or sublingual duct (Bartholian's duct) is seen. It may be
inflamed or swollen.
34. Contd..
B. PALPATION:
The parotid duct may be palpated on the masseter muscle by rolling
the finger across it while patient clinches the teeth by making the
muscle taut. The terminal part of duct is palpated bidigitally between
index finger in the mouth and thumb over the cheek.
The submandibular gland and duct is palpated bidigitally. A finger is
inserted inside the mouth along the groove between the alveolus and
the tongue and pressed on the floor of mouth. The finger of the other
hand is placed under the jaw. The gland and duct are palpated from
behind. This bidigital palpation helps to differentiate it from the
enlarged submandibular lymph node. The finger inside the mouth
can feel the deeper part of salivary gland but not the lymph node (as
salivary gland is situated above the mylohyoid muscle while lymph
node is situated below the muscle.)
35. Contd..
Saliva Flow Test : Test the flow of saliva by asking the
patient to suck lemon. In absence of any stone or
obstruction in the duct, saliva flows freely from the duct. If
duct is obstructed by the stone, the salivary outflow is
markedly obstructed and there is obvious swelling of the
gland.
36. EXAMINATION OF TONSIL AND PHARYNX
TONSILS
We ask the patient to open the mouth and Lack’s tongue
depressor is introduced to press the tongue. The tongue
depressor should never press the posterior part of tongue as
this causes gag reflex (due to the glossopharyngeal nerve).
Examination of the tonsil for its size, crypts, anterior pillar
and posterior pillar is done.
37. Contd..
Tonsillitis can be acute or chronic:
1. Acute Tonsillitis :
a. Acute Follicular Type: There is acute inflammation of crypts
and exudation from the crypts marks the reddened surface
with white or yellow spots.
b. Acute Parenchymatous type: There is inflammation of whole
tonsil.
c. Acute Membranous type: Another variant of follicular
tonsillitis in which exudation from the crypts may coalesce to
form the confluent membrane over the tonsil. It should be
differentiated from diphtheric tonsillitis, in which membrane
bleeds on removal. (while membranous tonsillitis does not
bleed.)
38. Contd..
2. Chronic Tonsillitis : It is the complication of acute
tonsillitis. It can be chronic follicular or chronic
parenchymatous tonsillitis.
Cardinal Signs of chronic tonsillitis :–
1. Flushing of anterior pillar
2. On pressing the anterior pillar, cheesy material comes out of
tonsil
3. Enlarged tender jugulodigastric lymph node, when there is
no other reason for it.
Out of these 3 signs, if 2 signs are present it is suggestive of
chronic tonsillitis.
39. Contd..
Chronic Fibroid Tonsillitis :
It is the condition where tonsils are buried between the
pillars. They are innocent looking, though they are not as
repeated inflammation causes more fibrosis and reduction in
size. It tends to bleed more during tonsillectomy.
40. NASOPHARYNX
Examination of Nasopharynx can be carried out by the
following ways:
A. Anterior Rhinoscopy
B. Posterior Rhinoscopy
C. Digital Examination
D. Endoscopy.
41. Contd..
A. Anterior rhinoscopy:
Some part of the nasopharynx can be seen in decongested nose
(with vasoconstrictors); even on anterior rhinoscopy.
B. Posterior rhinoscopy:
Posterior rhinoscopy provides fragmented view of nasopharynx,
which is mentally reconstituted by the examiner. The examiner
has to tilt the mirror in different directions to visualize the
structures present on different walls of the nasopharynx.
Retraction of soft palate with catheters: It facilitates postnasal mirror
examination in some difficult cases and requires good local or general
anesthesia. In this method, a soft rubber catheter is passed through each
nostril and then taken out from the mouth through the oropharynx. Both
ends of catheter are held together, and pulled forward. Retraction of soft
palate makes the mirror examination easy. This method has been becoming
obsolete with the advent of sinuscope and flexible
nasopharyngolaryngoscopy.
42. Contd..
C. Digital examination:
Digital examination though uncomfortable for the patient, is a simple
method to palpate the nasopharynx. Examiner, standing behind and right
to the patient invaginates patient’s cheek with his left finger and
introduces right index finger behind and above the soft palate into the
nasopharynx. This method is usually avoided in cases of angiofibroma.
D. Endoscopy:
Endoscopy gives a bright and magnified view of the nose and
nasopharyngeal structures. It can be performed by either rigid or flexible
fiber-optic scope.
Rigid nasal endoscope (sinuscope or rhinoscope): They are available
in different sizes and angles and introduced through the nose after instilling
or spraying local anesthetic and decongestant. See details of sinuscopy
examination in chapter Operations of Nose and Paranasal Sinuses.
Flexible nasopharyngolaryngoscope: It offers views of nose, pharynx
and larynx. See chapter Laryngeal symptoms and Examination in
section of larynx, trachea and bronchus.
44. OROPHARYNX
The examination begins by asking the patient to open the mouth widely. Tongue
depressor is used to examine tonsillolingual sulcus, and to express contents of
tonsillar crypts. The base of tongue is examined by laryngeal mirror. The structures
of oropharynx and their common lesions are mentioned in Box added up next.
„
1. Tonsils and pillars: For expressing the material from tonsil crypts,
pressure on the anterior pillar is applied with the edge of tongue depressor.
Palpation should always be performed with a gloved finger to know the
consistency of the mass. There is uniform congestion of the pillars, tonsils
and pharyngeal mucosa in acute tonsillitis; however, congestion of only
anterior pillars indicates chronic tonsillitis. Ulcer and proliferative growth
may extend to or from the tonsil, base of tongue, and the retromolar
trigone.
2. „
Soft palate: In cases of peritonsillar abscess, uvula becomes edematous,
and displaced to the opposite side. To note the movement of soft palate,
patient is asked to say “AA”. Deviation of the uvula and soft palate occurs
to the healthy side in cases of vagus palsy, which may be associated with
paralysis of posterior pharyngeal wall that manifests as a “curtain effect”
(the paralyzed side moves like a sliding curtain to the healthy side). In
cases of submucous cleft palate, in addition to bifid uvula, a notch can be
palpated in the midline of the posterior part of hard palate.
46. Contd..
3. Base of tongue: Posterior one-third of tongue is best examined by
indirect laryngoscopy and finger palpation. It lies between the V-
shaped row of circumvallate papillae and the valleculae. Valleculae
are two shallow depressions that lie between the base of tongue and
the epiglottis.
„
Palpation:
Palpation of oropharynx including base of tongue is very important, as
it helps in locating the infiltrative growth and its extension which is
usually missed during inspection. If the patient fails to relax, and does
not cooperate even after 4% xylocaine spray, palpation must be
conducted under general anesthesia. The examiner must insert his/her
finger in patient’s cheek (especially in children) between the upper and
lower teeth to prevent biting on the examiner’s finger.
47. Examination of Larynx
EXTERNAL EXAMINATION:
It includes inspection (Figs 1 and 2) and palpation (Box 2) of area
of hyoid bone, thyroid cartilage, thyroid notch, cricoid cartilage
and the tracheal rings for redness of skin, bulging or swelling,
widening of larynx, surgical emphysema, change in contour or
displacement of larynx, movements of larynx with deglutition and
breathing and post laryngeal crepitus.
Laryngeal Crepitus: We move the larynx from side to side. A
crepitus sound is felt. It is a normal sound produced by the
movement of laryngeal cartilage against the cervical spine but
absence of this sound (Boaca’s sign) may be due to the
possibility of growth between the laryngeal framework and the
cervical spine (postcricoid carcinoma).
48. Contd..
INTERNAL EXAMINATION :
Indirect Laryngoscopy:
Laryngeal mirror: It is used for the indirect examination of oropharynx,
laryngopharynx and larynx. It is available in various sizes from 6 mm to 30 mm
diameter.
Method: For indirect laryngoscopy (Figs 3 to 5), patient sits erect with the head
and chest leaning slightly towards the examiner. Patient protrudes out the tongue,
which is wrapped in a piece of gauze cloth and then held by the examiner between
the thumb and middle finger. Index finger of the examiner retracts out the patient’s
upper lip and moustache. To prevent fogging, a laryngeal mirror is always warmed
over a spirit lamp or in hot water. It is advisable to test mirror’s warmness on the
back of hand before inserting into the mouth, because hot mirror can damage the
mucosa. The warmed laryngeal mirror is introduced into the mouth and held firmly
against the uvula and soft palate while the light is focused on the laryngeal mirror.
Patient is asked to breathe quietly. Then the systematic examination begins from the
oropharynx, laryngopharynx and larynx. Movements of both the cords are observed
when patient takes deep inspiration (abduction of cords) and say “Aa” (adduction of
cords) and “Eee” (for adduction and tension).
49. Indirect Laryngoscopy Contd..
Merits:
Three-dimensional view of larynx with good color resolution.
Good visualization during phonation.
Demerits:
Epiglottis may obstruct the view during respiration.
Examination is not satisfactory in cases of difficult anatomy
and strong gag reflex.
51. ENDOSCOPY
The continuous light of endoscope helps in studying
gross structure and function of larynx, while strobe
light assesses mucosal health and vibration pattern.
Examiner should keep in mind that reactions to
topical xylocaine or vasovagal attack can occur. Some
of the methods of carrying out endoscopy are as
follows:
Rigid 90° Fiberoptic Laryngoscope (Telescope).
Flexible Rhinolaryngoscope (Nasopharyngolaryngoscope).
Laryngeal Videoendoscopy.
52. Endoscopy Contd..
Patient’s Tasks
The patient is instructed to perform following tasks during the
endoscopic examination of larynx:
„
Breathing at rest
„
Deep breathing
„
Easy coughing or throat clearing
„
Laryngeal diadochokinesis: Rapid repetitions of “ee” with glottal stops
between productions. Laryngeal diadochokinesis “hee”.
„
Sustained “ee”
„
Quick sniffing through nose
„
Speaking
„
Singing
„
Swallowing
„
Valsalva maneuver.
53. Contd..
The structures seen on indirect laryngoscopy are :
a) Anterior part of larynx-epiglottis and anterior commissure
(seen towards the top of the mirror).
b) Posterior part of the larynx - the arytenoids and the posterior
commissure (seen at the lower portion of the mirror).
54. Contd..
The patient’s right vocal cord is seen on the left side of the
mirror as the examiner looks at it. We first examine the
vallecula and the tip of epiglottis and then the ary-epiglottic
fold and the pyriform fossa on each side. Then postcricoid
region, arytenoids, false cords (ventricular folds) and vocal
cords (vocal folds) are inspected. Sometimes it is possible
to see upper few cms. of trachea. Finally movement of vocal
cords are studied by asking patient to phonate ‘ee’ and
breathe gently alternately several times. Also examination
of the colour of mucosa all around is seen.
55. Contd..
The following things are examined :
a. Epiglottis:
The normal colour of epiglottis is pinkish.
Bright red, swollen epiglottis is seen in acute laryngitis. X-ray
neck lateral view shows thumb sign.
Pale, swollen epiglottis is seen in allergic laryngitis.
56. Vocal Cords Contd..
b. Vocal Cords :
Colour : The normal vocal cords are pearly white in colour. In
acute laryngitis they are congested.
Oedema : Oedema of vocal cords is seen in Reinke’s oedema (it
is oedema of the Reinke’s space of the vocal cords).
Edge: Vocal nodules (Singer’s nodules) are seen at the junction
of anterior 1/3rd and posterior 2/3rd of the vocal cords.
The malignant growth may be seen anywhere in the vocal
cords and requires its removal and histopathological
examination.
Any solitary nodule can be solitary papilloma.
Surface : Observe for any cyst, ulcer, leucoplakic patch or
granulations.
57. Vocal Cords Contd..
Movement :
The movements of vocal cords are examined at :
gentle breathing during phonation
forced inspiration
on coughing
at rest
The movement of vocal cord is restricted in abductor or adductor
paresis, in infiltration by growth or in arthritis of crico-arytenoid
joint.
58. Vocal Cords Contd..
Position of Vocal Cords :
There are different positions of vocal cords:
Median position
Paramedian position
Cadaveric position
Gentle abduction
Full abduction
59. c. Arytenoids
d. Ary-epiglottic folds
e. Inter-arytenoids area: Congestion of this area occurs in tuberculosis of
the larynx.
f. Glottic chink: Glottic chink is reduced in vocal cord paralysis or any
malignant growth.
g. Postcricoid area: Any growth of this area along with absent laryngeal
crepitus is highly suspicious of malignancy of this area.
h. Pyriform fossa: Fullness of this area is highly suspicious of malignancy.
Pooling of saliva in both the pyriform fossa (Jackson’s sign) is
suspicious of post cricoid malignancy.
i. Upper few cm. of trachea
j. Vallecula, median glosso epiglottic fold and base of tongue is also examined
after completing examination of larynx.