Physical assessment

1. Physical assessment Ear, Nose, Mouth, and Throat

2. Anatomy and Physiology Review • Internal and external ear • Nose and sinuses • Oral cavity • Pharynx or throat

3. Ear • Sensory organ that functions in hearing and equilibrium • External ear • Auricle or pinna • Helix • Tragus • Lobule • External auditory canal • Lined with yellow-brown cerumen (wax)

4. Ear • Middle ear • Tympanic membrane • Separates external and middle ear • Ossicles • Malleus • Incus • Stapes • Eustachian tube • Connects middle ear and nasopharynx

5. Ear • Inner ear • Controls equilibrium • Hearing sensors

6. Figure 16.1 External ear.

7. Figure 16.2 The three parts of the ear.

8. Nose and Sinuses • External and internal structures of nose • Bridge and tip of nose • Septum and turbinates • Function to clean, warm, moisten air • Nasal mucosa • Paranasal sinuses • Mucus-lined, air-filled cavities that surround the nasal cavity

9. Nose and Sinuses • Paranasal sinuses • Function to clean, warm, moisten air • Olfactory cells connect to the olfactory nerve (cranial nerve I) and are responsible for the sense of smell • Another function to provide resonance for voice

10. The nose

11. Nasal sinuses

12. Mouth • Maxilla • Mouth • Teeth • Tongue • Gums • Uvula

13. Mouth • Lips • Inside of the cheeks • Palate • Hard palate • Soft palate • Mandible

14. Oral cavity

15. Innervation of the tongue

16. Throat • Known as pharynx • Leads to esophagus and trachea • Sections • Nasopharynx • Oropharynx • Laryngopharynx • Epiglottis • Tonsils

17. Special Considerations • Age • Developmental level • Race • Ethnicity • Work history • Living conditions • Socioeconomics • Emotional well-being

18. Lifespan Considerations • Infants and children • Shorter auditory canal • Increased incidence of otitis media • Beginning of salivation in infants • Development of deciduous and permanent teeth in children • Slightly enlarged, noninfected tonsils common in children ages 4 to 8

19. Lifespan Considerations • The pregnant female • Fullness or earaches • Rhinitis • Epistaxis • Heightened sense of smell • Edema of vocal cords

20. Lifespan Considerations • The older adult • Loss of high-frequency hearing • Gradual hearing loss (presbycusis) • Decreased sense of taste and smell • Decreased production of saliva • Receding gums • Tooth loss

21. Psychosocial Considerations • Mouth ulcers • Lip biting • Involuntary muscle spasms (tics) • Relaxation techniques may help relieve stress-related behaviors.

22. Cultural and Environmental Considerations • Variances among ethnic ancestry • Cleft uvula, lip, and palate • Occupational risk for hearing loss • Financial constraints • Lower socioeconomic status places children at risk for otitis media.

23. Focused Interview • Observe patient and be active listener • Consider in relation to normative parameters and expectations of function as well as other factors • Follow-up questions may be necessary.

24. Table 16.2 Potential Secondary Sources for Patient Data Related to the Ears, Nose, Mouth, and Throat

25. Focused Interview • Focused interview questions • General • Illness or infection • Symptoms, pain, and behaviors • Environment • Internal • External continued on next slide

26. Assessment Techniques • Inspection • Palpation • Percussion • Transillumination

27. Table 16.6 (continued) Overview of Disorders of the Mouth and Throat continued on next slide

28. Assessment Techniques • Inspection of the external ear • Palpation of the auricle and tragus • Palpation of the mastoid process • Inspection of the auditory canal using the otoscope • Examination of the tympanic membrane using the otoscope

29. Assessment Techniques • Administration of the whisper test • Administration of the Rinne and Weber tests using the tuning fork • Administration of the Romberg test

30. Palpating the tragus.

31. Palpating the mastoid process.

32. Pulling the pinna to straighten the canal.

33. Assessment Techniques • Otoscope • Auditory canal • Inserting the otoscope • Handle up or down • Straightening the ear canal • Tympanic membrane

34. Two techniques for holding and inserting an otoscope. Otoscopic examination with otoscope handle in downward position. continued on next slide

35. Two techniques for holding and inserting an otoscope. Otoscopic examination with otoscope handle in upward position.

36. Performing the whisper test.

37. Activating the tuning fork.

38. Rinne test. Bone conduction. continued on next slide

39. Rinne test. Air conduction.

40. Weber test.

41. Romberg test.

42. Assessment Techniques • Nose and sinuses • Inspection of the nose and patency testing • Palpation of the external nose • Inspection of the nasal cavity using a nasal speculum • Palpation of the sinuses • Percussion of the sinuses • Transillumination of the sinuses

43. Inspection of the nose.

44. Using the otoscope for nasal inspection.

45. Palpating the frontal sinuses. continued on next slide

46. Palpating the maxillary sinuses.

47. Percussion of frontal sinuses. continued on next slide

48. Percussion of maxillary sinuses.

49. Transillumination of the frontal sinuses. continued on next slide

50. Observing transillumination of the frontal sinuses.