Ear, Nose and Throat Flashcards
Inspection of ears
Inspect the auricles and mastoid area for size, shape, symmetry, landmarks, color, position, and deformities or lesions.
Palpate the auricles and mastoid area for tenderness, swelling, and nodules.
Inspect the auditory canal with an otoscope, noting cerumen, color, lesions, discharge, or foreign bodies.
Inspect the tympanic membrane for landmarks, color, contour, perforations, and mobility.
Assess hearing through the following:
Response to questions during history
Response to a whispered voice
Response to tuning fork for air and bone conduction
Inspection of Nose and Sinuses
Inspect the external nose for shape, size, color, and nares.
Palpate the ridge and soft tissues of the nose for tenderness, displacement of cartilage and bone, and masses.
Evaluate the patency of the nares.
Inspect the nasal mucosa and nasal septum for color, alignment, discharge, turbinates, and perforation.
Inspect the frontal and maxillary sinus area for swelling.
Palpate the frontal and maxillary sinuses for tenderness or pain, and swelling.
Inspection of Mouth
Inspect and palpate the lips for symmetry, color, and edema.
Inspect the teeth for occlusion, caries, loose or missing teeth, and surface abnormalities.
Inspect and palpate the gingivae for color, lesions, and tenderness.
Inspect the tongue and buccal mucosa for color, symmetry, swelling, and ulcerations.
Assess the function of cranial nerve XII (hypoglossal).
Palpate the tongue.
Inspection of the mouth CONT
Inspect the palate and uvula.
Inspect the oropharyngeal characteristics of the tonsils and posterior wall of pharynx.
Elicit gag reflex (cranial nerves IX and X).
External ear structures
Auricle
External auditory canal
External ear function
Protective
Helps gather and channel sound
Middle ear structure
Ossicles: malleolus, incus, stapes
Tympanic membrane
Middle ear function
Ossicles transmit sound from tympanic membrane to inner ear.
Tympanic membrane separates middle from external ear.
Inner ear structure
Vestibule
Semicircular canals
Cochlea
Inner ear function
Cochlea transmits sound to CN VIII.
Semicircular canals are involved in vestibular function
Function of nose, nasopharynx and sinuses
Odor identification
Passage of inspired and expired air
Humidification, filtration, and warmth of inspired air
Resonance of laryngeal sounds
External nose structure
Bone and cartilage
Nares
Internal nose structure
Septum Choanae Turbinates Cribriform plates Kiesselbach plexus Convergence of small fragile arteries and veins
Structure of sinuses
Sinuses
Maxillary
Frontal
Ethmoid
Sphenoid
Only the maxillary and frontal sinuses are accessible for physical examination.
Nasal floor is formed by the hard and soft palate.
Roof is formed by the frontal and sphenoid bone.
The adenoids lie on the posterior wall of the nasopharynx.
Function of mouth and oropharynx
Emission of air for vocalization and non-nasal expiration
Passage for food, liquids, saliva
Initiation of digestion by mastication and salivary secretion
Identify taste.
Structure of mouth
The oral cavity is divided into the mouth and the vestibule (space between the buccal mucosa and the outer surface of the teeth and gums).
The mouth, housing the tongue, teeth, and gums, is the anterior opening of the oropharynx.
The bony arch of the hard palate and the fibrous soft palate form the roof of the mouth.
Loose, mobile tissue covering the mandibular bone forms the floor of the mouth.
Structure of tongue, teeth and gums
The tongue is anchored to the back of the oral cavity at its base and to the floor of the mouth by the frenulum.
The gingivae, fibrous tissue covered by mucous membrane, are attached directly to the teeth and the maxilla and mandible.
The roots of the teeth are anchored to the alveolar ridges of the maxilla and mandible.
Structure of glands and tonsils
The parotid, submandibular, and sublingual salivary glands are located in tissues surrounding the oral cavity.
The oropharynx, continuous with but inferior to the nasopharynx, is separated from the mouth by bilateral anterior and posterior tonsillar pillars.
The tonsils lie in the cavity between these pillars.
Swallowing is initiated when food is forced by the tongue toward the pharynx.
Infants and children
Inner ear development in first trimester
External auditory canal in infants shorter than in adults
Eustachian tube in infants wider, shorter, more horizontal than in adults
Salivation increased by 3 months
Development of sinuses in children
Maxillary and ethmoid sinuses are present at birth but are very small.
Frontal and sphenoid sinuses begin to develop at about 3 years of age and complete development in late adolescence.
Teeth formation in children
Twenty deciduous teeth usually erupt between 6 and 24 months of age.
Permanent teeth begin forming in the jaw by 6 months of age.
Eruption of the permanent teeth begins about 6 years of age and is completed around 14 or 15 years of age in most races.
Pregnancy women
Elevated levels of estrogen cause increased vascularity of upper respiratory tract. Capillaries in nose, pharynx, and ears engorge. Nasal stuffiness and fullness in ears Decreased smell and impaired hearing Epistaxis Laryngeal changes Hoarseness and cough Vocal changes
Older Adults
Nearly a third of adults older than 65 years have hearing loss
Age-related hearing loss is associated with:
Degeneration of hair cells in the organ of Corti
Loss of cortical and organ of Corti auditory neurons
Degeneration of the cochlear conductive membrane
Decreased vascularization of the cochlea
Hearing loss in older adults
Sensorineural hearing loss first occurs with high-frequency sounds and then progresses to tones of lower frequency.
Conductive hearing loss may result from:
Excess deposition of bone cells along the ossicle chain, causing fixation of the stapes in the oval window
Cerumen impaction
Sclerotic tympanic membrane
taste and smell in older adults
Deterioration of the sense of smell results from loss of olfactory sensory neurons beginning at about 60 years of age.
The sense of taste begins deteriorating at about 50 years of age as the number of papillae on the tongue and salivary gland secretion decreases.
Mouth and ear structural changes in older
Continuing cartilage formation in ear and nose:
Ears and nose larger and more prominent
Mouth soft tissue changes:
Cheeks more prominent
Gingival tissue less elastic and more vulnerable to trauma
Teeth and tongue changes in older
Teeth are lost.
Difficulty chewing
Altered motor function of tongue
Difficulty swallowing
HPI: Vertigo
Time of onset, duration of attacks Description of attack Associated symptoms Unsteadiness, loss of balance, falling Medications: ototoxic, salt retaining
HPI: Epistaxis
Frequency and amount of bleeding
Predisposing factors
Site of bleeding
Medications
