NCM 216 LEC: EENT
PRELIMS – LECTURE 4
2nd SEMESTER | A.Y. 2022 – 2023
NOSE & THROAT
OUTLINE
I. Nose, Sinuses, Pharynx & Larynx
II. Disorder of the Throat
III. Disorder of the Larynx
NOSE, SINUSES, PHARYNX & LARYNX
 Nose – consists of bone and cartilage; air
enters through 2 openings/nostrils (nares)
Functions:
1. Olfaction – smelling (CRANIAL
NERVE I)
2. Air-conditioning – controlling air temp.
and humidity; removing particles
before air enters into the trachea,
bronchi and lungs.
 Paranasal sinuses (frontal, sphenoid,
maxillary, ethmoid) - air-filled cavities lined
with mucous membranes
Functions:
1. Reduce the weight of the skull To
produce mucus
2. To influence voice quality (resonating
chambers)
 Pharynx – commonly called the throat; divided
into 3 regions: nasopharynx, oropharynx,
laryngopharynx
Functions:
1. Respiratory fxn – receives air from the
nasal cavity
2. Digestive fxn – receives air, food and
fluids from the oral cavity
 UVULA – if going to swallow, it will block the
nasopharynx. If going to breathe, the uvula will
open to facilitate the air going in
 Larynx – commonly called the voice
box/glottis; passageway for air bet. The
pharynx above and the trachea below
Function:
1. essential in human speech
BSN 3D
DISORDERS OF NOSE
RHINITIS
 Inflammation of the nasal mucosa
Types:
1. Acute viral rhinitis or common colds
(rhinovirus, parainfluenza virus, coronavirus,
respiratory syncytial virus (RSV), influenza
virus, and adenovirus)
2. Allergic rhinitis or hay fever - is the most
common form of respiratory allergy presumed
to be mediated by an immediate immunologic
reaction
- Signs and symptoms of allergic
rhinitis: Watery eyes (body tries to
wash of the allergens), runny nose,
itchy throat
- Maybe: seasonal (pollens from grass,
trees, flowers) or perennial (domestic
animal hair, wool, house dust, foods,
newspaper,tobacco)
Manifestations:
 Edema
 Headache
 Swelling of the nasal mucosa
 congestion
 Fever sneezing
 Rhinorrhea- primary symptom of rhinitis
 Cough
 Itching
 Mucus production
 Sinus headache
Management:
 Antihistamine eg.: loratadine (claritin),
cetirizine (zyrtec), fexofenadine (allegra),
diphenhydramine (benadryl)
 Antipyretics
 Nasal decongestants eg.:
pseudoephedrine hydrochloride (sudafed)
 Rest & rehydration
 Desensitization-is a preventive treatment
for allergies -purified extract of the allergen
is injected for a prolonged period in
frequent interval (administered once or
twice a week) -allergy shots may have to
be continued for 3-5 years or longer to
provide the maximal effect
SINUSITIS
 Inflammation of the mucous membrane of 1
or more sinuses
  May accompany or follow rhinitis 
Anterior - easier to treat; keisselbach is
 Caused by Diplococcus, Strep, H. influenzae present in this area; pag pinch magstop
Signs and Symptoms:  Posterior - more severe bleeding; heavy
 Nasal swelling bleeding; di mag stops
 Congestion Management:

 Purulent nasal discharge

 Initial treatment: apply direct pressure
(Kiesselbach’s area)
 Headache
 Cautery
 Fever
 Nasal packing
 Cough
 Cottonball w/ epinephrine
 Facial pain
Nursing Management
 Ear pain  Monitor vital signs and assist with control
 Fatigue of bleeding.
 A decreased sense of ell (anosmia)  Provides tissues and an emesis basin to
 Sinus Headache allow the patient to expectorate any
 Otitis media could be a result of sinusitis excess blood.
and rhinitis as well  Review ways to prevent epistaxis:
Classification of Sinusitis avoiding forceful nose blowing, straining,
1. ACUTE – less than 4 weeks high altitudes
2. SUBACUTE – 4 weeks to 12 weeks  Adequate humidification.
3. CHRONIC – more than 12 weeks  Instruct the patient how to apply direct
Management: pressure to the nose in the case of a
 Antibiotics – eg.: amoxicillin (Amoxil), recurrent nosebleed.
sulfamethoxazole (Bactrim, Septra),  If recurrent bleeding cannot be stopped,
azithromycin (Zithromax), clarithromycin the patient is instructed to seek additional
(Biaxin), ciprofloxacin (Cipro) medical attention.
 Decongestants NASAL POLYPS

 Antihistamines  Most often seen in patients w/ allergic rhinitis

Antral irrigation: Caldwell-Luc procedure  Forms gradually from recurrent swelling of the
– permanent opening for drainage nasal mucosa
Caldwell-Luc procedure  Complication: airway obstruction
Nursing Management: Signs and Symptoms:
1. Methods to promote drainage:  Nose feeling blocked
 Inhaling steam - when this is  Anosmia
done, heat is already applied; try  Runny nose
to breathe on the nose so that  Headache or pain
congestion is removed  Rhinoscopy shows a grayish grape-like
 Increase fluid intake - usually mass in the nasal cavity
done so that inflammation is  CT scan of the sinuses will show opaque
removed (cloudy) spots where the polyps are.
 Applying local heat - heat is put Management:
on the area but usually not 1. Cortisone therapy
practiced 2. Polypectomy
2. Stress the importance of following the NOTE: Nasal polyps may recur
recommended antibiotic regimen
3. Discourage swimming and diving while DISORDER OF THE THROAT
patient has URTI
4. Avoid people who has URTI TONSILITIS
5. Maintain strict hand-washing habits
EPISTAXIS  inflammation & infection of the tonsils
 Nose bleeding  d/t Staph, H. influenzae
Types of Epistaxis:

BSN 3D
  Prone to Rheumatic fever cause by group a 2. Dry cough
betahemolytic streptococcus 3. Dysphagia
Types of Tonsilitis: 4. Aphonia (voice loss)
1. Bacterial – strep and staph; come to the 5. Fever
health center; If tonsils have whitish Management:
discoloration  Voice rest
2. Nonbacterial or viral – h. Influenza;  Steam inhalation - especially when the
monitor at home, gargle with salt and mouth is opened
water; if tonsils are just reddened
 Hydration
 Lozenges - if sweet, it can cause rebound
effect (undesirable) especially if bacterial
 Antibiotics

Signs and Symptoms:

 Difficulty swallowing
 Ear pain
 Fever,
 chills
 Headache
 Sore throat
 Tenderness of the jaw and throat

Voice changes/ Loss of voice
Management:
 Antibiotic therapy; warm saline gargles;
analgesics; antipyretics
 Apply ice collar to severe sore throat
 Oral care
 Soft/liquid diet; hydration
 Discourage spicy/sweet foods
 Encourage bed rest with increased fluid
intake during fever
 Tonsillectomy – for recurrent tonsilitis

DISORDER OF THE LARYNX

LARYNGITIS
 Inflammation of the mucous membrane of the
larynx
 caused by exposure to irritating inhalants,
pollutants, chemical agents, alcohol, smoke,
overuse of voice
 Inflammation of membrane of vocal cords so
there will be no modulation of air that is
coming out that leads to loss of voice
Signs and Symptoms:
1. Acute hoarseness

BSN 3D