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Chapter 13
Ears, Nose, Mouth, and
Throat
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Identify the structures of the ears,
nose, mouth, and throat.
Discuss the system-specific history
for the ears, nose, mouth, and
throat.
Describe normal findings in the
physical assessment of the ears,
nose, mouth, and throat.
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Describe common abnormalities
found in the physical assessment of
the ears, nose, mouth, and throat.
Explain the pathophysiology of
common abnormalities of the ears,
nose, mouth, and throat.
Perform the physical assessment of
the ears, nose, mouth, and throat.
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Ear
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Frequency range of 20 to 20,000 Hz
Decibel range 0 to 140
External ear
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Auricle or pinna
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Ear
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Middle ear
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Ossicles
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Malleus (hammer)
Incus (anvil)
Stapes (stirrup)
Eustachian tube
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Ear
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Inner ear
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Labyrinth
Vestibule
Semicircular canals
Cochlea
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Nose
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Turbinates
Nasal mucosa
Olfactory receptor cells
Paranasal sinuses
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and Physiology
of the Mouth and Throat
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Mouth and throat
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Lips
Cheeks
Buccal mucosa
Hard palate
Soft palate
Teeth
Copyright 2002, Delmar, A division of Thomson Learning
Health History
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Ears
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Nose
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Hearing loss
Excessive cerumen
Deviated septum
Mouth and throat
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Tooth loss
Gum disease
Decreased taste
Copyright 2002, Delmar, A division of Thomson Learning
Common Chief
Complaints
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Hearing loss
Tinnitus
Nasal blockage or congestion
Halitosis
Oral lesions
Copyright 2002, Delmar, A division of Thomson Learning
Evaluation of Chief
Complaint
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Quality
Associated manifestations
Aggravating factors
Alleviating factors
Timing
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Medical
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Otitis media or externa
Nasal polyps, sinusitis, allergic rhinitis
Tonsillitis, dental caries, upper
respiratory infections
Chronic diseases, such as diabetes
mellitus, renal disease, hypertension,
immunosuppression
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Dental pathology
Nutritional disturbances
Surgical
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Oral surgery
Cosmetic surgery of head or neck
Repair of deviated septum
Tympanostomy tubes
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Medications
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Antibiotics, antihistamines,
decongestants, steroids, chemotherapy,
immunosuppressive drugs
Allergies
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Severity of signs and symptoms
Seasonal or environmental
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Accidents/injuries
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Special needs
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Foreign bodies
Trauma
Sports injuries
Use of assistive devices (hearing aids)
Speech disorders
Childhood illnesses
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Frequent tonsillitis or ear infections
Copyright 2002, Delmar, A division of Thomson Learning
Social History
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Alcohol use
Tobacco use
Drug use
Sexual practices
Work/home environment
Hobbies/leisure activities
Stress
Copyright 2002, Delmar, A division of Thomson Learning
Health Maintenance
Activities
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Sleep
Diet
Use of safety devices
Healthy checkups
Copyright 2002, Delmar, A division of Thomson Learning
General Approach to
Assessment
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Greet the patient
Explain assessment techniques
Quiet, well-lit environment
Sitting position
Compare right to left
Systematic approach
Copyright 2002, Delmar, A division of Thomson Learning
Equipment
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Otoscope
Nasal speculum
Penlight
Tuning fork
Cotton-tipped applicators
Tongue blade
Watch
Gauze square
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
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External ear
Inspection
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Note position, size, color, and shape
Palpation
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Auricle
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
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Normal findings
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Flesh color
Positioned centrally and in proportion
to the head
No foreign bodies, redness, drainage,
deformities, nodules, or lesions
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
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Abnormal findings
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Small- or large-size ears
Pale, red, cyanotic
Purulent drainage
Clear or bloody drainage
Pain or tenderness on palpation
Tumor
Hematoma behind ear over mastoid
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Auditory Screening
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Voice-whisper test
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Weber test
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Normal finding: able to repeat words
whispered at a distance of 2 feet
Normal finding: able to hear sound
equally in both ears
Rinne test
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Normal finding: air conduction > bone
conduction
Copyright 2002, Delmar, A division of Thomson Learning
Otoscopic Assessment
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Inspect both ears
Normal findings
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No redness, swelling, tenderness,
lesions, drainage, foreign bodies
Tympanic membrane is pearly gray
with well-defined landmarks
Light reflex present at 5 o’clock in
right ear and 7 o’clock in left ear
Tympanic membrane moves when the
patient blows against resistance
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Otoscopic Assessment
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Abnormal findings
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Redness, swelling, narrowing, pain
Drainage
Hard, dry, very dark yellow cerumen
Reddened tympanic membrane
Severe pain
Chalk patches on tympanic membrane
Copyright 2002, Delmar, A division of Thomson Learning
Risk Factors for Otitis
Media
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Less than 2 years of age
Frequent upper respiratory
infections
Cold weather
Males
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Risk Factors for Otitis
Media
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Caucasians, Native Americans,
Alaskan natives
Family history
Smoky environment
Bottle fed
Down syndrome
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
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Inspection of external nose
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Patency
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Location, symmetry, bleeding, masses,
swelling, lesions
Nostrils
Inspection of internal nose
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Otoscope with nasal speculum
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
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Normal findings
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Located in midline of face
No swelling, bleeding, lesions, or
masses
Both nostrils patent
Septum midline
Nasal mucosa is pink or dull red
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
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Abnormal findings
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Broken, misshapen, swollen nose
Occluded nasal passages
Septum is deviated
Nasal mucosa is red and swollen
Purulent drainage
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Sinuses
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Inspection
Palpation and percussion
Normal findings
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No evidence of swelling
Resonance heard on percussion
No discomfort during palpation or
percussion
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Mouth
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Inspection
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Lips, tongue
Gums, buccal mucosa
Teeth
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Mouth
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Normal findings
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Pink, moist lips
Tongue midline, adequate movement
No lesions
Tongue, gums, buccal mucosa are
pink, moist, smooth
No bleeding
Smooth, white teeth, no dental caries
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Mouth
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Abnormal findings
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Lesions, growths
Dry, cracked lips
Vesicles or blisters
Red, tender, inflamed tongue, gums,
buccal mucosa
Thrush
Coating on tongue
Bleeding gums
Copyright 2002, Delmar, A division of Thomson Learning
Inspection of the
Throat
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Gag reflex
Posterior pharynx
Uvula
Color of oropharynx
Presence of swelling, exudate,
lesions
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Inspection of the
Throat
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Normal findings
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Soft palate and uvula rise when patient
says, “ah”
Uvula is midline
No swelling, exudate, or lesions
Gag reflex is present
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Inspection of the
Throat
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Abnormal findings
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Posterior pharynx is red with white
patches
Tonsils and uvula are red and swollen
Hoarse voice
Grayish membrane covering tonsils,
uvula, soft palate
Copyright 2002, Delmar, A division of Thomson Learning
Gerontological
Variations
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Presbycusis
Diminished sense of smell and taste
Periodontal disease
Oral alterations due to disease or
side effects of medications
Tooth loss
Copyright 2002, Delmar, A division of Thomson Learning