Nose, Mouth, Throat, Eye and Ear Flashcards
Nose (structures)
a. Superior, middle and inferior turbinate
- bone structure to increase space
b. Olfactory nerve (CN1)
c. Mucous membrane
- helps to warm and filter out the air via rich vascular supply
d. Sinuses
- frontal, ethmoid, sphenoid and maxillary
Mouth and Throat (structures)
a. Tongue
b. Soft and hard palate
c. Tonsils
d. Uvula
e. Salivary glands (parotid, submandibular, sublingual)
Dev Considerations (nose, mouth, throat) - Infants and Children
- salivation doesn’t start until 3 months of age
- deciduous teeth (6mos - 2yo)
- permanent teeth (6yo-12yo)
Dev Considerations (nose, mouth, throat) - Pregnancy
- nasal stuffiness and epistaxis (nose bleed), increase vascularity in URT
- bleeding of gum
Dev Considerations (nose, mouth, throat) - Aging adult
- decreased sense of smell
- loss of taste sensation
- receding gums and tooth loss
Subjective Assessment: Nose
a. discharge Rhinorrhea (nasal discharge) b. cold c. sinus pain d. trauma e. epistaxis (nose bleed) f. allergies g. altered sense of smell
Subjective Assessment: Mouth and Throat
a. sores and lesions
b. sore throat
c. bleeding gums
d. toothache
e. hoarseness
f. dysphagia
g. altered sense of taste
h. sleep apnea
i. smoking and alcohol
j. self-care behaviours
Objective Assessment: Nose
Inspect and Palpate
a. symmetry
b. inflammation
c. lesions
d. test for patency
e. inspect nasal cavity (nares)
- swelling, discharge, bleeding, foreign body
- turbinates
- polyps
- septum deviation
f. palpate sinuses
- frontal and maxillary
Objective Assessment: Mouth
Inspect - lips - teeth - alignment of jaw - gums (pink, no swelling) - tongue (pink, inspect sides) - buccal mucosa (side of cheek) Stensen's duct: dimple by second molar, opening of parotid ducts Fordyce's granules: small yellow dots, benign sebaceous cysts
Palpate Torus palatinus (nodular bony ridge down middle of hard palate, normal variation)
Uvula and throat Bifid uvula: uvula split in two Tonsils (pitted) - grade 1-2: health - grade 3-4: swollen, might interfere with air flow
External Ear (structures)
Pinna (external ear) Tragus Lobule External Auditory canal - cerumen (ear wax) Tympanic membrane (ear drum) - translucent, pearly grey, oval slightly concave - cone of light
Middle Ear (structures)
Auditory ossicles (tiny ear bones)
- malleus
- incus
- stapes
Functions:
- conducts sound
- protects inner ear
- equalizes air pressure (eustachian tube, to the nasopharynx)
Inner Ear (structures)
Vestibule
Semicircular canals (equilibrium)
Cochlea (snail)
Hearing
Peripheral:
- sound waves > external auditory canal > vibrations on tympanic membrane
- middle ear ossicles > oval window
- semicircular canals, vestibule and cochlea > round window
- stimulated basilar membrane > receptor hair cells (organ of corti, sensory organ)
CN VIII - receive electrical impulse
Brainstem:
binaural interaction
Cerebral cortex:
interpret the meaning of the sound
Conductive Hearing Loss
Mechanical dysfunction of the external or middle ear
i.e. perforated ear drum
Sensorineural Hearing Loss
Dysfunction of the inner ear, cranial nerve VIII or auditory areas of the cerebral cortex
- unable to process auditory input
Equilibrium
Labyrinth in the inner ear provides information to the brain about the body’s position in space
- cerebellum
Vertigo
Inflamed labyrinth
- feeds wrong info to the brain causing staggering gait and a strong spinning, whirling sensation
Dev Considerations (Ears) - Infant and Children
Rubella
- during 1st trimester, can damage organ or corti and impair hearing
Shorter eustachian tube
- greater risk of middle ear infections
Dev Considerations (Ears) - adults
Otosclerosis
- conductive hearing loss caused by gradual hardening that cause stapes to become fixed in oval window
- onset ages 20-40
Dev Considerations (Ears) - Aging adults
- cilia in external canal become coarse and stiff
- impacted cerumen
- presbycusis: gradual sensorineural loss caused by nerve degeneration in the inner ear and auditory nerve
Subjective Assessment of Ears
a. earache (otalgia)
b. infections
c. discharge (otorrhea)
d. hearing loss
e. environmental noise exposure
f. tinnitus (ringing or buzzing)
g. vertigo
h. self-care behaviours
Objective Assessment of Ears
Inspect and palpate the external ear a. size and shape b. skin condition Darwin's tubercle: small painless nodule at the helix c. tenderness d. external auditory canal - swelling, redness, discharge
Inspect with otoscope
a. tympanic membrane (no perforations)
Objective Assessment of Ears (hearing acuity and vestibular apparatus)
a. Whispered voice test
b. Romberg Test
- maintain balance with eyes closed
External Eye (structures)
- palpebral fissures
- canthus (corner of the eye)
- caruncle (small fleshy mass containing sebaceous glands)
- conjunctiva (transparent protect covering)
- sclera (whites of eye)
- cornea (translucent layer)
- limbus (border between cornea and sclera)
- iris
- lacrimal gland (upper eye lids, moisture and tears)
- puncta (opening where tears drain)
- lacrimal sac (drainage)
Extraocular muscles
Six muscles for movement
- stimulated by cranial nerves III, IV and VI
Internal Eye
Outer layer
- sclera
Middle layer
- choroid (deliver blood and prevent light from refracting)
- lens (biconvex disc just behind pupil)
- Anterior and posterior chambers (contains watery aqueous humour, delivers nutrients and removes waste)
Inner layer
- vitreous body
- retina (visual receptive layer, lightwave to nerve impulse)
Retina
- optic disc
- optice nerve
- retinal vessels
- macula
- fovea centralis
Visual Reflexes
a. pupillary light reflex
- direct light reflect
- consensual light reflect (simultaneous constriction of other pupil)
b. fixation (ability to fix an imagine in centre of visual field - impaired by drugs, alcohol, fatigue and inattention)
c. accommodation
Dev Considerations (Eyes) - Infants
Macula not fully formed until 4 month and not mature until 8 months
Eyes mature at age 8
Dev Considerations (Eyes) - Older adults
- decreased tear production
- arcus senilis (infiltration of degenerative lipid material around limbus)
- presbyopia (lens loses elasticity)
- floaters
- macular degeneration (breakdown of cells in retina)
- cataract (clumping of proteins)
- glaucoma (increased intraocular pressure, decreased peripheral vision)
- diabetic retinopathy (damage to tiny blood vessels in the retina, leakage, cloudy vision)
Subjective Assessment of Eyes
a. vision difficulty
b. pain
c. strabismus (crossed eye)
d. diplopia (double vision)
e. redness/swelling
f. watering/discharge
g. hx of ocular problems
h. glaucoma
i. use of corrective lenses
j. self-care behaviours
k. medications
Objective Assessment of Eyes
a. Visual acuity
- snellen chart
- jaeger card
b. Visual fields
- confrontation
- corneal light reflexes
- cover-uncover test (muscle weakness)
- diagnostic positions test (six cardinal positions of gaze)
c. external ocular structures
- general
- eyebrows
- eyelids and lashes
d. anterior eyeball structures
- cornea and lens (abrasions)
- iris and pupil
PERRLA
e. ocular fundus
- red reflex
- optic disc
- retinal vessels
- genearl background
- macula
ptosis
drooping of upper eyelid
periorbital edema
swelling, fluid back up
styes
caused by staph infection
- painful, pustule, swelling
- antibiotic or warm compress
exophthalmos
endophthalmos
protruding eyes
sunken eyes
