Ears, Nose, Mouth, and Throat Flashcards
Otorrhea
ear drainage
Otalgia
ear pain
Tinnitus
ringing in the ear
Dysphagia
difficulty swallowing
General Approach to examiniation
Sitting position
Compare right to left
Systematic approach
Examination of the Ear
Auditory screening
Inspection and palpation of external ear
Otoscopic examination
Test CN III (auditory)
voice-whisper test, Weber’s Test, Rinne’s Test
Voice-Whisper Test
Patient to occlude one ear with finger (ear not being tested)
Stand 2 feet behind ear being tested and whisper a two- syllable word or phrase
Patient to repeat the word
Repeat test for other ear
Normal findings of Voice-Whisper Test
Able to repeat words whispered at a distance of 2 feet
Weber’s Test
Place vibrating tuning fork on midline of head
Check for lateralization of sound
Normal findings of Weber’s Test
Sound heard equally in both ears (no lateralization)
Weber’s Conductive hearing loss
Tested via Weber’s. Sound lateralizes to affected ear
Sound is conducted directly through the bone to the ear
Weber’s Sensorineural hearing loss
Tested via Weber’s. Sound lateralizes to unaffected ear. Related to nerve damage in affected ear.
Cause of Sensorineural hearing loss
disorder of the inner ear, auditory nerve, or brain
Cause of Conductive Hearing Loss
Due to blocked auditory canal, perforated tympanic membrane, fluid in middle ear, fusion of ossicles
Rinne’s Test
put fork on mastoid process and instruct patient to say when sound stops= bone conduction
Note the time interval and immediately move still-vibrating fork in front of the auditory meatus
Instruct patient to say when sound stops= air conduction
Note the time interval
Determine AC to BC ratio
Repeat on opposite ear
Normal Findings of Rinne’s Test
Air conduction > bone conduction (2:1 ratio)= positive test
AC is twice as long as BC
Rinne’s test for Conductive Hearing loss
Bone conduction equal to or greater than air conduction
AC<BC
Rinne’s test for Sensorineural Hearing loss
Air conduction and bone conduction are equally depreciated so 2:1 ratio of AC to BC is maintained AC>BC Air conduction > bone conduction but less than 2:1
Ear Inspection
Position Size Color Shape and symmetry Deformities, inflammation, lesions, or nodules
Inspect distal external auditory canal
Discharge and odor
Ear postition
Top of ear should be level with lower lid
Palpate Auricle
Tenderness or pain Swelling Nodules or lesions Move auricle up and down to assess for pain of auditory canal Palpate over tragus area
Palpate Mastoid process
tenderness
Inspection of ear Normal Findings
Flesh color
Positioned appropriately and in proportion to the head
No foreign bodies, redness, drainage, deformities, nodules, or lesions
No mastoid tenderness
Abnormal findings for color
pale, red, or cyanotic
Abnormal findings of external ear
Deformed (ex. cauliflower ear)
Tumor, lesions, nodules
Abnormal ear drainage
Purulent drainage
Clear or bloody drainage
Abnormal ear tenderness
Edema, inflammation
Hematoma behind ear (Battle’s sign)
Using otoscope to inspect ear
Adults pull up and back
Children pull down
Normal findings with Otoscope
No redness or inflammation No drainage No foreign bodies No lesions Presence of cerumen
Inspect Tympanic membrane
Landmarks, Color, Contour, Perforation
Normal Tympanic Membrane findings
Tympanic membrane is pearly gray, translucent
Slightly concave
Landmarks well-defined and in appropriate locations
Light Reflex
At 5 o’clock in right ear and 7 o’clock in left ear
Abnormal Tympanic membrane findings
Chalky patches on tympanic membrane Reddened tympanic membrane Bulging or retractions of membrane Indistinct or absent landmarks Perforation
Otitis Media Risk Factors
Less than 2 years of age Frequent upper respiratory infections Cold weather Male gender Caucasians, Native Americans, Alaska natives
Inspect nose and nares
Nose for shape, size, symmetry, lesions, swelling and color
Nares for flaring, narrowing, or discharge
Palpate Nose
Displacement of bone or cartilage
Tenderness
Masses
Evaluate Nostril Patency
Occlude one nostril and have patient breathe in
Inspect nasal mucosa
Color
Discharge
Masses, lesions, polyps
Swelling and color of turbinate
Inspect Nasal Septum
Alignment
Perforations, bleeding, lesions
Normal external nose findings
Located in midline of face
No swelling, bleeding, lesions
Both nostrils patent
Normal internal nose findings
Septum midline, no perforation or bleeding
Nasal mucosa is pink or dull red with no lesions, polyps, discharge
Abnormal External Nose Findings
Broken, misshapen, swollen nose
Occluded nasal passages
Abnormal Internal Nose Findings
Septum is deviated or perforated
Nasal mucosa is red, swollen
Purulent drainage
Bleeding
Sinuses
Inspect- swelling and inflammation
Palpate- tenderness
Percuss- sound, tenderness
Normal Sinus findings
No discomfort during palpation or percussion
Resonance heard on percussion
Transillumination
Observe for glow over frontal sinuses
Observe for glow on hard palate behind top molars
Examination of mouth
breath, lips, tongue
Examination of lips
Symmetry
Color
Edema
Lesions, cracks
Test CN XII (hypoglossal)
ROM and strength of tongue
Inspection of tongue’s dorsal surface
Swelling, size, color, variations, coating, fissures, ulceration, lesion
Inspection of tongue’s ventral surface
Hydration, lesions, inflammation, vasculature, Wharton’s ducts
Palpate tongue
only if Lumps, nodules, or ulceration seen on inspection
Buccal mucousa
Color and moisture
Ulcers and lesions
Stenson’s ducts
Inspect gums and gingiva
Color, moisture, retraction, hypertrophy, swelling, bleeding
Inspect Teeth
Occlusion and alignment
Color and stains
Missing teeth
Wear, notches, caries, dental repair
Inspect hard and soft palate
Shape, color, lesions, malformations
Normal findings of external mouth
Breath is fresh
Pink, moist lips
Tongue midline, symmetrical, with adequate movement
Normal findings of Internal mouth
Tongue has no lesions
Tongue, gums, buccal mucosa are pink, moist, smooth
Color of buccal mucosa and gums may vary by race
Normal findings of gums and teeth
No pockets between gums and teeth
No bleeding
Smooth, white teeth; proper alignment, no dental caries
Inspection of Throat
Position, size, color, and general appearance/size of tonsils and uvula
Color of oropharynx
Swelling, exudate, lesions
Test CN IX and CN X (glossopharyngeal and vagus)
say “ah” and inspect for Symmetrical elevation of soft palate and uvula
Gag Reflex
Normal findings of throat
Soft palate and uvula rise symmetrically when patient says “ah” Uvula is midline Throat is pink and vascular No swelling, exudate, or lesions Gag reflex is present
Abnormal throat findings
Posterior pharynx is red with white patches, Tonsils and uvula are red and swollen (on 4 pt. scale)
Hoarse voice
Grayish membrane covering tonsils, uvula, soft palate