This document outlines the process for conducting a physical examination of the ears, nose, mouth, and throat. It describes inspecting and palpating each area and provides normal findings. Key tests include the Weber test to assess hearing lateralization using bone conduction, the Rinne test comparing bone and air conduction, and examining the external ear canal, tympanic membrane, and sinuses. The mouth and oropharynx are also examined, including inspecting the lips, teeth, gums, tongue, palate, uvula, and tonsils.

1. Physical Examination
Ear, nose , mouth and throat
Dr. Nahla Shaaban khalil
Assist professor
Critical Care Nursing Department
Cairo University

2. Physical Examination
Ears

4. 4

5. 5

6. Process of hearing

7. •1-Note the position of the auricle in relation
to an imaginary line from the outer canthus
of the eye to the auricle. The ear should be
almost vertical with no more than a 10-
degree lateral posterior slant.

9. 1-Inspect and palpate both external ear
and mastoid process for tenderness,
swelling, and nodules

10. The ears need to be closely inspected, including behind the ears.
Palpate the ears between two fingers for any masses or tenderness.
Now is a good time to ask the patient if he/she has noticed any change in their
hearing.

11. Auditory acuity needs to be tested in both ears independently.
•Having the patient cover their other ear and lightly rubbing your fingers from 3 feet and ask the
patient to tell you when they hear it, and move your fingers closer to the patient can approximate
auditory acuity.
•The patient's eyes need to be closed if you use the finger rub to test acuity, since they may see
your arm or clothing move.You could also cover your mouth and whisper numbers or letters from
three (3) feet and move closer to the patient and have the patient repeat what you are saying.
•The person with normal hearing will be able to hear your fingers anywhere from when you start to

12. Place a vibrating tuning fork at the top of the
client's head or forehead. Normally the client
perceives the sound equally in both ears.
Weber
Test

13. Weber Test : The Weber test uses bone conduction to test
lateralization of sound. A tuning fork (ideally, 512 Hz), set in
motion by grasping it firmly by its stem and tapping it on the
examiner's knee or hand, is placed on the patient's head or
forehead. A person with normal hearing hears the sound
equally in both ears or describes the sound as centered in the
middle of the head.. A person with resulting from damage to the
cochlear or vestibulocochlear nerve, hears the sound in the better-
hearing ear. The Weber test is useful for detecting unilateral
hearing loss
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14. • Otosclerosis is an excessive growth in the
bones of the middle ear which interferes
with the transmission of sound.

15. 15

16. a-Assess bone conduction by placing the base of
vibrating tuning fork on the mastoid process. Note
how many seconds pass before the client can no
longer hear the tone.
b-While the tuning fork is still vibrating, place the
tines near the ear canal. Note how many seconds
the client can hear the tone. This part of the test
assesses air conduction. Normally, air conduction is
twice as long as bone conduction (2:1).
Rinne test:

17. Rinne’s test

18. A person with a conductive
hearing loss hears bone-
conducted sound as long as
or longer than air-conducted
sound. A person with a
sensorineural hearing loss
hears air-conducted sound
longer than bone-conducted
sound.
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19. Otoscope
Holding the Otoscope

20. Otoscopic examination needs to be done bilaterally.
•You should always be visualizing the opening to the ear canal before and
• while advancing the speculum. (This will avoid causing undue pain.)
•In adults, the auricle is pulled posteriorly, superiorly and away from the patient to
straighten out the canal.
•This will help facilitate visualization of tympanic membrane.

21. (note the line of myringotomy is not an anatomical structure, it is where the surgeon makes the
incision to place a tube in the ear)
Anatomy of the tympanic membrane

23. Preventions
• Be caution while removing your wax
• Using ear plug

25. Eardrum perforation
• Otalgia
• Bleeding
• Fullness
• Hearing loss: conductive HL
or mixed HL
• Tinnitus
• Shape of perforation is split

26. Nose and paranasal
structures:
1-Inspect and palpate the nose for general
appearance and symmetry.
2-Test the Olfactory nerve for intactness.

27. 3-Inspect the internal nasal cavity for patency.

28. 4-Inspect the internal nasal structures with
nasoscope and small normally appear pink.
flashlight. The nasal mucosa and middle and inferior
turbinate

30. 5-Inspect the frontal and maxillary sinuses for
swelling
6-Palpate and percuss the frontal and maxillary
sinuses for tenderness and bogginess.
7-Palpate the frontal sinuses by applying light
pressure with the thumbs below the eyebrow.
Normally, palpation detects no tenderness or
swelling.

31. 8-Palpate the maxillary sinuses by applying light
pressure with the thumbs over the cheek bone.
Normally, palpation detects no tenderness.

32. 9-Use direct percussion to assess the frontal sinuses. Light
tapping above the eyebrow should elicit no tenderness.

33. Mouth and oropharynx
.
1-Inspects the lips for color ,symmetry , moisture, and texture.
2-Inspect the teeth for alignment ,color, number, surface
characteristics and stability
3-Note the odor of the breath.

34. 4-Inspect and palpate the inner lips and
gums.
5-Inspect buccal for color and symmetry.

35. 7-Inspect the tongue for movement ,color, surface, and ulceration.
8-Palpate the tongue for irregularities and lesions.
9-Palpate the tongue with gauze pad and palpate it to
assess consistency, mobility ,and muscle tone .The tongue
should slightly rough ,move freely , and have good muscle
tone.

36. 9-Inspect the posterior wall of the pharynx for color and
surface characteristics.
10-Inspect the palate and uvula for texture , color , and
surface characteristics.
11-Inspect the tonsils for texture and color