EARS, NOSE, MOUTH/THROAT, HEAD, NECK FACE Flashcards
eyes should be
symmetrical
eyelids
Assess if eyelids approximate completely when eyes are closed
- If eyelids do not close completely = risk for corneal damage
- Should be no swelling, discharge, or lesions
- Ptosis = drooping of upper lid
eyeballs
- Should be aligned normally, no protrusion or sunken appearance
- Exophthalmos = protruding eyes
sclera
Have patient look up, using thumbs, slide lower lids along the bony orbital rim
* Should be “china white”
- Dark skinned patients
- May have small brown macules (like freckles) or yellow deposits
- Color may also appear gray-blue or “muddy”Look for:
- Redness
- Scleral icterus (yellowing)
- Tenderness
- Foreign body
- discharge
Lacrimal Apparatus
Check by pressing index
finger against the sac
- Just inside lower orbital rim
- Be careful not assess side of
nose
Abnormal response =
* Red
* Swollen
* Tender to pressure
* Regurgitation of fluid
* May indicate blocked duct
eye movement
Diagnostic Positions (6 cardinal
positions of gaze)
- Will reveal any muscle weakness during
movement - Have patient hold head steady, follow
your finger with only the eyes - Your finger should be about 12 inches
away from face - Progress with clockwise movements,
coming back to center after each
movement - Expected response = parallel tracking of
finger with both eyes
Abnormal response = eye movement not
parallel
Could indicate weakness of eye muscle or
dysfunction of cranial nerve
also assess for nystagmus = fine,
oscillating movements
eye assessment
Pupillary Light Reflex
* Darken Room * Ask patient to gaze into distance * Advance light from the side and
note response
Expected Response:
* Direct light reflex
* Consensual light reflex
* Abnormal Response
* Dilated pupils
* Dilated and fixed
* Unequal or no response
measurement
-gauge pupil size in diameter
-before and after light reflex
expected size= 3,4,5 mm
-increases in response to light
external ear
auricle or pinna
Consists of movable cartilage and skin
Characteristic shape serves to funnel sound waves into its
opening, which is called the external auditory canal.
auditory canal
–A cul-de-sac 2.5 to 3 cm long in adults that terminates at
eardrum, or tympanic membrane
–Lined with glands that secrete cerumen, a yellow waxy material
that lubricates and protects ear
–Lymphatic drainage of external ear flows to parotid, mastoid,
and superficial cervical nodes
tympanic membrane
eardrum, separates the external and middle ear
–translucent membrane with pearly gray color
parts of the malleus show through translucent drum
Pars flaccida: small, slack, superior section of TM
- Pars tensa: remainder of TM, thicker, and more taut
- Annulus: outer fibrous rim of the TM
middle ear
Tiny air-filled cavity inside temporal bone
- Contains tiny ear bones, or auditory ossicles:
malleus, incus, and stapes - Several openings are present.
- To the outer ear and inner ear eustachian tube: opening that connects middle ear with nasopharynx
and allows passage of air - Normally closed, but opens with swallowing or yawning
Three functions 1) Conducts sound vibrations from outer ear to central hearing apparatus in inner ear
2)Protects inner ear by reducing amplitude of loud sounds
3) Eustachian tube allows equalization of air pressure on each side of TM so that it does not rupture.
inner ear
Contains the bony labyrinth, which holds sensory organs for equilibrium and hearing.
Vestibule and semicircular canals within bony labyrinth compose the vestibular apparatus.
Cochlea contains central hearing apparatus.
Although the inner ear is not accessible to direct examination, its functions can be assessed.
inspection and palpation of the external ear
–size & shape
ears are equal and bilateral with no swelling or thickening
ears of unusual size and shape may be normal familiar trait with no clinical significance
skin condition
–skin color consistent with the person’s facial skin color
–skin intact with no lumps or lesions
DARWINS TUBERCLE: a small painless nodule at the helix: congenital variation and not significant
tenderness
–move pinna and push on tragus; should feel firm with mvmt– no pain
–palpating mastoid process should not produce any pain
note any: redness, swelling, lesions, foreign bodies, or discharge
tympanic membrane
Color and characteristics
- Systematically explore landmarks
- Normal TM shiny and translucent, with a pearl-gray color
- Cone-shaped light reflex prominent in anterior-inferior quadrant, a reflection of
the otoscope light - Sections of malleus are visible through translucent drum: the umbo, manubrium, and short process.
- At periphery annulus looks whiter and dense
test for hearing acuity
Screening for hearing deficit begins during history; how well does a person hear conversational speech?
- Ask the person directly if there is a hearing difficulty.
- If answer is yes, perform audiometric testing or refer for audiometric testing.
- If the answer is no, screen using the whispered voice test.
- Useful to document presence of hearing loss
- Refer any abnormal findings for more accurate measures with pure tone audiometry.
whispered voice test
Test one ear at a time while masking hearing in other ear by placing one finger on tragus and rapidly pushing it in and out of auditory meatus.
- Shield your lips so the person cannot compensate for a hearing loss (consciously
or unconsciously) by lip reading or using the “good” ear. - With your head 30 to 60 cm (1 to 2 ft.) from the person’s ear, exhale and whisper slowly some two-syllable words.
- Normally, the person repeats each word correctly after you say it.
nasal cavity
First segment of respiratory system
Upper third made up of bone; rest is
cartilage
Nasal cavity divided medially by septum
into two slit-like air passages
Anterior part of septum holds a rich
vascular network, Kiesselbach’s plexus, most common site of nosebleeds.
Lateral walls of each nasal cavity contain
three parallel bony projections: superior,
middle, and inferior turbinates.
Underlying each turbinate is a cleft, the
meatus, which is named for turbinate
above.
Sinuses drain into middle meatus, and
tears from nasolacrimal duct drain into
inferior meatus.
structure and function: Nose
Two pairs of sinuses are accessible to
examine.
Ø Frontal sinuses in frontal bone
above and medial to orbits
Ø Maxillary sinuses in maxilla
(cheekbone) along side walls of
nasal cavity
Ø Other two sets are smaller and
deeper.
– Ethmoid sinuses between the
orbits
–Sphenoid sinuses deep within
skull in the sphenoid bone
Only maxillary and ethmoid sinuses
are present at birth
inspection and palpation: nose
External nose
Ø Normally nose is symmetric, in midline, and in proportion to other facial features.
Ø Inspect for any deformity, asymmetry, inflammation, or skin lesions.
- If an injury is reported or suspected, palpate gently for any pain or break in contour.
Test patency of nostrils.
Nasal cavity Ø Use your pen light to assess nasal cavity Ø View each nasal cavity with the person’s head erect and then with head tilted back.
- Inspect nasal mucosa, noting its normal red color and smooth moist surface.
- Note any swelling, discharge, bleeding, or foreign body.
Nasal septum Ø Observe nasal septum for deviation. Ø Note any perforation or bleeding in septum.
structure and function: Mouth
First segment of digestive system and an
airway for the respiratory system
Oral cavity: short passage bordered by lips,
palate, cheeks, and tongue
Lips: anterior border of oral cavity, transition
zone from outer skin to inner mucous
membrane lining the oral cavity
Ø Palate: arching roof of mouth divided into
two parts
Ø Hard palate: anterior part made up of bone
Ø Soft palate: posterior part, an arch of muscle
that is mobile
Ø Uvula: free projection hanging down from
middle of soft palate
Ø Cheeks are the side walls of oral cavity.
inspection of the mouth
Begin with anterior structures and move posteriorly; use tongue blade to retract structures and bright light for optimal visualization.
Inspect lips: Ø For color, moisture, cracking, or lesions; retract lips and note inner surface.
Ø African Americans normally may have bluish lips and a dark line on gingival margin.
Inspect Teeth * Condition of teeth is an index of the person’s general health. * Note any diseased, absent, loose, or abnormally positioned teeth.
Inspect Tongue * Check tongue for color, surface characteristics, and moisture.
inspection of buccal muscosa
Observe uvula
–Normally looks like fleshy pendant hanging in midline; ask a person to say “ahhh” and note soft palate and uvula rise in midline
— Tests one function of cranial nerve X, the vagus nerve
structure and function of the mouth:
Mouth contains three pairs of salivary glands.
–Parotid gland lies within cheeks in front of ear.
–Submandibular gland lies beneath mandible at
angle of jaw.
Sublingual gland, the smallest, almond-shaped, lies within floor of mouth under tongue and has many small openings along sublingual fold under tongue.
Glands secrete saliva, the clear fluid that
moistens and lubricates the food bolus,
starts digestion, and cleans and protects the mucosa.
Adults have 32 permanent teeth; 16 in each
arch.
Each tooth has three parts: crown, neck, and root.
structure and function of the throat// pharynx
Area behind mouth and nose
Oropharynx: separated from mouth by a fold of tissue on each side, the anterior tonsillar pillar
Tonsils: behind folds, each is a mass of lymphoid tissue look more granular, and surface shows deep crypts
Tonsillar tissue enlarges during childhood until puberty.
Posterior pharyngeal wall is seen behind these structures.
Nasopharynx: continuous with oropharynx above oropharynx and behind nasal cavity
Pharyngeal tonsils (adenoids) and eustachian tube openings are located here
