Ears Nose and Mouth Flashcards
Physical Exam
Assess gross hearing Rinne and Weber test Inspect auricle Palpate mastoid process Press tragus Inspect canal Inspect tympanic membrane
Gross Hearing
Whispered voice test
Conversational speech
Rubbed fingers
if abnormal, asses Weber and Rinne test
Weber Test
place fork on midline of head
ask if sound is louder in one ear than other
should be equal
lateralization
hearing on both sides equally
Rinne Test
normal air > bone conduction
if blocked, bone > air
Conductive loss
blocking vibrations
external or middle disorder impairs conduction
Weber: sound will lateralize to impaired ear
Rine: bone > air
Foreign body, impacted cerumen, otitis externa
Tympanosclerosis
Otosclerosis
Tympanosclerosis
scar tissue on tympanic membrane
Sensorineural loss
-impaired vestibulocochlear nerve CN VIII or neuronal impulse
-higher tones lost
-hearing worse in noisy environment
-voice gets louder
-weber sound lateralizes to good ear
Rinne AC >BC
causes: aging, exposure to loud, inner ear infection, trauma, acoustic neuroma
acoustic neuroma
tumor growing inside ear, impedes CN VIII
Inspect external ear
- changes in skin, common for skin cancer
- symmetry
- piercings, scars, keloids
- palpate tragus and mastoid
- inspect behind for eczema and fissures
Otoscopic exam
evaluate external canal
assess tympanic membrane
asses for foreign body, cholesteatoma, fluid
Lift up and pull back
cholesteatoma
An abnormal skin growth in the middle ear behind the eardrum is called cholesteatoma. Repeated infections and/or a tear or pulling inward of the eardrum can allow skin into the middle ear.
Cone of light
indicates TM is soft, no pressure or fluid
R at 5:00
L at 7:00
Otitis External
external canal inflammation exuduate my block TM usually from swimming, trauma, dermatologic condition P aeruginosa and staph epidermidis Treatment antibx drops
Exostosis
nontender outgrowths of bone covered by normal skin deep in ear canals
nonmalignant, may obscure ear drum
seen in swimmers
serous otitis
common with viral upper respiratory infections
common reason for otalgia
can occur from flying
otalgia
ear pain
acute otitis media
middle ear infection
- whitish discoloration
- marked erythema
- bulging TM
Bullous Myringitis
painful vesicles appear on TM
common organism mycoplasm, viral, or bacterial otitis media
treat with macrolide
Cholesteatoma
- accumulation of squamous epithelium (skin)
- usually result of chronic otitis media or congenital
- unchecked may cause hearing loss
- refer to ENT, surgical removal
Perforated TM
holes in eardrum, usually result of purulent infections if middle ear
-central perforations, do not extend to margin of drum
marginal perforations involve margin, harder to heal
no drops, emergency/ENT
Tympanosclerosis
healed perforation
large chalky white patch with irregular margins
deposition of hyaline material develops after several episodes of OM
Tympanostomy tubes
- used for ventilation of middle ear
- young children usually age 2 after many otitis media infections
- water precautions
- fall out as child grows
Nose physical exam
Inspect and palpate:
-external nose
-nasal vacity (nasal septum, turbinates, mucosa)
test patency of nostril
palpate sinus areas
frontal and maxillary sinus transillumination
External nose
normal
deviated septum
Nasal patency
tests ability to breath through nostril, one at time
CN I usually not tested unless complaint
Nasal cavity
middle turbinate, inferior turbinate, vestibule, septum
turbinates healthy or red/swollen
viral rhinitis
mucosa reddened and swollen
allergic rhinitis
pale, bluish, or red response to environmental allergens assoc with sneezing, rhinorrhea, nasal obstruction, itchy eyes, nose and palate seasonal fall and spring cough r/t post nasal drip turbinates pale and boggy (swollen)
allergic signs
Allergic salute (nose tilts up due to swelling) allergic shiners (black eyes)
Nasal polyps
-polyps are pale, semitransluscent masses that usually come from middle meatus
-often associated with chronic allergic rhinitis
(come back if removed)
Septal perforation
caused by trauma, surgery, and intranasal use of cocaine or ampthetamines (drugs that dec blood flow)
Transillumination
normal = glows red, air abnormal = no glowing, full of fluid (sinusitis)
Mouth and throat physical exam
Inspect: lips, dentition, gums, buccal mucosa, tongue, palate, pharynx (uvula, pillars, tonsils, laryngeal wall), tongue, sublingual, eval Stenson and Wharton’s ducts, CN XII, CN IX, CN X
Angular Cheilitis
fissures in angles, nutritional defect or poor dentition
Herpes Simplex
vesicular lesions, contagious sores, fluid filled and painful
Angioedema
usually resolved but may be life threatening
*can be caused by ace inhibitors
Carcinoma of the lip
usually lower lip, associated with tobacco use
Gums
caries and periodontitis
Geographic tongue
map like texture of tongue, normal
candidiasis
yeast infection
white lesions on tongue or inner cheek
can be caused be inhaled steroids (teach to rinse mouth)
“oral thrush”
smooth tongue
atrophic glossitis - tender, painful, depapillation
atrophy of tongue
B12/niacin deficiency
CN IX, X, XII
CN IX: glossopharyngeal
CN X: Vagus
CN XII: hypoglossal
Cryptic tonsils
develop small pockets or pits called crypts. These crypts can trap food and form small growths called tonsilliths or tonsil stones
Grading Tonsils
1+ = visible
2+ = halfway between pillars nad uvula
3+ = touching uvula
4+ touching each other
Normal 1+ and 2+
not visible: retracted or removed
Pharyngitis
inflammation causing sore throat
common caused by strep, 85% viral, also mononucleosis
Karposi Sarcoma
hard/soft palate
deep purple lesions, raised or flat
oral cancer assoc. with AIDS
Herpangina (coxsackie)
viral with ulcers and lesions inside mouth
sore throat and fever
supportive therapy, rest pain relief
