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Chapter 12
Ears, Nose, Mouth, and Throat
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy and Physiology
• Ear
– Sensory organ of hearing
• Nose
– Sensory organ of smell
• Mouth and throat
– Sensory organ of taste
– First part of digestive system
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Anatomy and Physiology
The Ear
The Outer Structures
The Internal Structures
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Anatomy and Physiology
The Ear (cont’d)
The Right Eardrum
Conduction Pathways
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The Health History
The Ear
• Common or concerning symptoms
– Hearing loss
– Earache
– Discharge
– Tinnitus
– Vertigo
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The Health History
(cont’d)
• Ear history
– Hearing loss?
• Conduction vs. sensorineural
– Earaches?
• Frequency, sharp, dull
– Discharge or drainage?
• Ear wax, pus, smell
– Tinnitus?
– Vertigo?
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The Health History
(cont’d)
• Past history
– Hearing loss
– Removal of cerumen
– Surgery
– Trauma
– Infection
– Noise exposure
– History of disease
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The Health History
(cont’d)
• Family history
– Hearing loss
– Otitis media
– Allergies
– Smoking or exposure to cigarette smoke
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Lumps On or Near the Ear
Keloid
Chondrodermatitis Helicis
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Lumps On or Near the Ear
(cont’d)
Tophi
Basal Cell Carcinoma
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Lumps On or Near the Ear
(cont’d)
Cutaneous Cyst
Rheumatoid Nodules
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Eardrum
Normal Right Eardrum
Perforation
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Eardrum
(cont’d)
Tympanosclerosis
Serous Effusion
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Eardrum
(cont’d)
Acute Otitis Media With
Purulent Effusion
Bullous Myringitis
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The Health History
(cont’d)
• Lifestyle habits
– Exposure to loud noises
– Protective devices
– Use of hearing aids
– Use of medications or drugs that interfere with
hearing or cause dizziness
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Hearing Loss
Conductive Loss
Sensorineural Loss
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Question
• The ossicles consist of all of the following except:
A. Incus
B. Malleus
C. Stapes
D. Mastoid
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Answer
• The ossicles consist of all of the following except:
• D. Mastoid
– The mastoid bone is a part of the cranium. The three
ossicles are the malleus, incus, and stapes.
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Anatomy and Physiology
The Nose
Outer Structures
Internal Structures
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Anatomy and Physiology
The Paranasal Cavities
Lateral Wall: Nasal Cavity
Cross Section of Nasal
Cavity, Anterior View
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Anatomy and Physiology
The Paranasal Cavities (cont’d)
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The Health History
The Nose and Sinuses
• Rhinorrhea
– Type of discharge
• Congestion
– Medications, infections
• Epistaxis
– May indicate bleeding disorder
• Change in sense of smell
• Pain
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The Health History
The Nose and Sinuses (cont’d)
• Past history
– Sinus infections
– Upper respiratory infections
– Allergies
– Trauma or injury
– Nasal or sinus surgery
– Polyps
– Dental history
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The Health History
The Nose and Sinuses (cont’d)
• Family history
– Allergies
– Asthma
– Cancer of nose or sinus
• Lifestyle habits
– Air quality
– Pets
– Alcohol, tobacco, recreational drugs
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Anatomy and Physiology
Mouth and Throat
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Anatomy and Physiology
Mouth and Pharynx (cont’d)
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Anatomy and Physiology
Mouth and Throat (cont’d)
A Tooth
The Upper Teeth
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Anatomy and Physiology
Mouth and Throat (cont’d)
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Anatomy and Physiology
Mouth and Throat (cont’d)
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Abnormalities of the Lips
Angular Cheilitis
Actinic Cheilitis
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Abnormalities of the Lips
(cont’d)
Herpes Simplex
Angioedema
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Abnormalities of the Lips
(cont’d)
Hereditary Hemorrhagic
Telangiectasia
Peutz-Jeghers Syndrome
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Abnormalities of the Lips
(cont’d)
Chancre of Syphilis
Carcinoma of the Lip
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The Health History
The Mouth and Throat
• Common or concerning symptoms
– Sore throat
• Upper respiratory infection
– Hoarseness
• Smoking, allergies, voice abuse, hypothyroidism,
tuberculosis, tumors
– Lesions
• Aphthous ulcers, nutritional deficiency
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The Health History
The Mouth and Throat (cont’d)
• Common or concerning symptoms (cont’d)
– Sore tongue
• Nutritional deficiency
– Bleeding gums
• Gingivitis
– Toothache
– Dysphagia
• Any particular foods
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The Health History
The Mouth and Throat (cont’d)
• Past history
– Sore throat
– Loss of voice
– Dental, mouth, or throat surgery
– Trauma or injury
– History of infections
– Oral cancer
– Sexually transmitted disease
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The Health History
The Mouth and Throat (cont’d)
• Family history
– Allergies
– Smoking or exposure to cigarette smoke
– Stroke
– Tuberculosis
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The Health History
The Mouth and Throat (cont’d)
• Lifestyle habits
– Brush teeth?
– Use tobacco products?
– Smoke recreational drugs?
– Drink alcohol?
– Past and present occupations?
– Past and present active sports?
– Use of dental dams?
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Question
• Patients should be encouraged to maintain good dental
hygiene, that would include which of the following?
(Choose all that apply.)
A. Daily brushing
B. Flossing
C. Routine dental visits
D. Good nutrition
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Answer
• Patients should be encouraged to maintain good dental
hygiene, that would include which of the following?
(Choose all that apply.)
• A. Daily brushing
• B. Flossing
• C. Routine dental visits
• D. Good nutrition
• All of these steps will help maintain good dental
hygiene and should be encouraged.
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Physical Examination
The Ear
• Equipment
– Tuning fork
– Otoscope
– Speculum
– Tongue blade
– Gloves
– Penlight
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Physical Examination
The Ear (cont’d)
• Auricle
– Inspect tissues for deformities, lumps, or skin
lesions.
– Pain, discharge, inflammation
• Movement painful in otitis externa
• Tenderness behind ear may be present with otitis
media.
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Physical Examination
The Ear (cont’d)
Ear Canal and Drum
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Physical Examination
The Ear (cont’d)
Ear Canal and Drum (cont’d)
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Physical Examination
The Ear (cont’d)
Right Eardrum
Acute Otitis Externa
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Physical Examination
The Ear (cont’d)
• Auditory acuity
– Test one ear at a time.
– Occlude nontested ear.
– Speak numbers or words with two equal syllables.
– Do not let patient read your lips.
– Ask them to repeat what they hear.
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Physical Examination
The Ear (cont’d)
Air and Bone Conduction
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Physical Examination
The Nose
• Equipment for examination
– Penlight
– Otoscope
– Nasal speculum or largest speculum available
– Gloves
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Physical Examination
The Nose (cont’d)
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Physical Examination
The Nose (cont’d)
• Inspect anterior and inferior surfaces.
• Test for nasal obstruction.
• Inspect inside of nose.
• Observe nasal mucosa, septum, and any abnormalities.
• Palpate for sinus tenderness.
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Physical Examination
The Nose (cont’d)
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Physical Examination
Mouth and Throat
• Equipment
– Penlight
– Tongue blade
– Gloves
– Gauze pad
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Physical Examination
Mouth and Throat (cont’d)
• Lips
– Color, moisture, lumps, ulcers, cracking, scaliness
• Oral mucosa
– Color, ulcers, white patches, nodules
• Gums and teeth
– Color, swelling, ulcerations
– Teeth alignment, caries, looseness
– Dentures
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Physical Examination
Mouth and Throat (cont’d)
Oral Mucosa
Tongue
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Physical Examination
Mouth and Throat (cont’d)
Findings in or Under the Tongue
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Physical Examination
Mouth and Throat (cont’d)
• Roof of mouth
– Color
– Architecture of hard palate
• Tongue and floor of mouth
– Symmetry of CN XII
– Color, texture
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Physical Examination
Mouth and Throat (cont’d)
• Throat
– Ask patient to say “ah.”
– Use tongue depressor as needed.
– Inspect soft palate, anterior and posterior pillars,
uvula, tonsils, and pharynx.
– Note color and symmetry.
– Note exudates, swelling, ulceration, and tonsillar
enlargement.
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Physical Examination
Mouth and Throat (cont’d)
• Tonsils graded by size
– +1: visible
– +2: between tonsillar pillars and
uvula
– +3: touching uvula
– +4: touching each other
• CN X paralysis
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Question
• Oral sex is a safe technique to use when practicing safe
sex.
A. True
B. False
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Answer
• Oral sex is a safe technique to use when practicing safe
sex.
• B. False
– This is a myth among adolescents and young adults.
STDs are readily contracted via oral sex with the
organisms then infected the mouth and pharynx.
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Findings in the Pharynx, Palate, and Oral
Mucosa
Large Normal Tonsils
Exudative Tonsillitis
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Findings in the Pharynx, Palate, and Oral
Mucosa (cont’d)
Pharyngitis
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Findings in the Pharynx, Palate, and Oral
Mucosa (cont’d)
Diphtheria
Thrush on the Palate
(Candidiasis)
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Findings in the Pharynx, Palate, and Oral
Mucosa (cont’d)
Kaposi Sarcoma in AIDS
Torus Palatinus
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Findings in the Pharynx, Palate, and Oral
Mucosa (cont’d)
Fordyce Spots (Fordyce
Granules)
Koplik Spots
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Findings in the Pharynx, Palate, and Oral
Mucosa (cont’d)
Petechiae
Leukoplakia
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Findings in Gums and Teeth
Marginal Gingivitis
Acute Necrotizing Ulcerative
Gingivitis
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Findings in Gums and Teeth
(cont’d)
Gingival Hyperplasia
Pregnancy Tumor (Epulis,
Pyogenic Granuloma)
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Findings in Gums and Teeth
(cont’d)
Attrition of Teeth; Recession
of Gums
Erosion of Teeth
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Findings in Gums and Teeth
(cont’d)
Abrasion of Teeth With
Notching
Hutchinson Teeth
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Findings in or Under the Tongue
Geographic Tongue
Hairy Tongue
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Findings in or Under the Tongue
(cont’d)
Fissured Tongue
Smooth Tongue (Atrophic
Glossitis)
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Findings in or Under the Tongue
(cont’d)
Candidiasis
Hairy Leukoplakia
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Findings in or Under the Tongue
(cont’d)
Varicose Veins
Aphthous Ulcer (Canker
Sore)
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Findings in or Under the Tongue
(cont’d)
Mucous Patch of Syphilis
Leukoplakia
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Findings in or Under the Tongue
(cont’d)
Tori Mandibulares
Carcinoma, Floor of the
Mouth
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Record Your Findings
• Ears
– Acuity
– Structures
• Nose
– Structures
• Mouth
– Color
– Structures
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Health Promotion, Disease Prevention,
and Education
The Ears
• Hearing screening
– Important to catch hearing deficits early
– Language development delay
– Increased potential for loss due to overexposure to
high levels of noise (work, play, home)
• Hearing loss prevention
– Use appropriate ear protective devices.
– Limit overexposure to high levels of noise.
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Health Promotion, Disease Prevention,
and Education
The Mouth and Throat
• Dental issues
• Diet
• Tobacco products
• Alcohol use
• Proper fit and use of dentures
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Question
• Use of tobacco products and excessive alcohol
consumption are principal risk factors for oral carcinoma.
A. True
B. False
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Answer
• Use of tobacco products and excessive alcohol
consumption are principal risk factors for oral carcinoma.
• A. True
– Research has shown that the use of tobacco products
and excessive alcohol consumption are principal risk
factors for developing oral carcinoma.
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