Pemeriksaan Mata,

Telinga, Hidung dan

Tenggorokan
Oleh:
Ns. Gst. Kade Adi Widyas Pranata, S.Kep., M.S.
1. Pemeriksaan Mata
Developmental Competence
• Infants and Children :
At birth eyes function is limited, but it matures fully during the
early years.
• The Aging Adult :
• Changes in eyes structure cause distinct facial changes of
the aging person.
• Loss of skin elasticity causes wrinkling and drooping; fat
tissue and muscle athropy, feeling dryness and burning

Culture and Genetics

• Racial difference are evidence in the palpebral
fissures.
• Culturally based variability exist in the colour of the
iris and retinal pigmentation
Subjective Data
Vision difficulty
• Any difficulty of seeing or bluring? Any blind spot? Come on
suddenly or progressly?
Pain
• Any eyes pain? Come suddenly? Do you feel burning or iching?
Pain with bright light?
Strabismus, diplopia
• Any history of crossed eyes? Does this occur with eyes fatigue?
ever seen double? Constant, or does it come and go?
Redness, swelling
• Any redness or swelling in the eyes? Any infection? Now or past?
When do these occur? Anyone else in home with same condition
Watering, dischange
• Any dischange? What color is the dischange? Any matter in the
eyes? Is hard to open your eyes in the morning?
Subjective Data
History of ocular problem
• Any history of injury of surgery to eyes? or any history of
allergy?
Glaucoma
• Ever been tested for glaucoma? Result? Any family history of
glaucoma?
Use glasses or contact lenses
• Do you wear glasses or contact lenses? How do they work for
you? If you wear contact lenses, are there any problem such as
pain, photophobia, watering, or swelling?
Self-care behaviour
• Last vision test? Ever tested for color vision? Any environmental
condition at home or at work that may affect your eyes? Which
medication are you taking?
Additional History of Infant and Children

1. Any vaginal infection in the mother at time of

delivery?
2. Considering age of child, which developmental
milestones of vision have you (parent) noted?
3. Does the children have routine vision testing in the
school?
4. Are you (parent) aware of safety measure to protect
child's eyes from trauma?
Additional History for The Aging Adult

1. Have you noticed any visual difficulty with climbing

stairs or driving? Any problem with night vision?
2. When were last time you tested for glaucoma?
3. Any aching pain around eyes? any loss of peripheral
vision?
4. If you have glaucoma, how do you manage your
eyedrops?
5. Is there a history of the cataract?
6. Do you ever feel dry? burning? What do you do for
this?
7. Any decrease in usual acivities such as reading or
sewing? driving?
Objective Data
• Preparation
• Position person standing for vision
screening; then sitting up with head at your
eye level

• Equipment needed
• Snellen eye chart
• Handheld visual screener
• Opaque card or occluder
• Penlight
Objective Data
Test Central Visual Activity
• Snellen Eye Chart
1. Place the Snellen alphabet chart
in a well-lit spot at eye level
2. Position the person on a mark
exactly 6 meter or 20 feet from
the chart
3. Use opaque card to shiled the
eyes
4. If the person wears glasses or
contact lense, leave them on.
remove only reading glasses
5. Ask the person to read through
the chart to smallest line of letter
possible
Snellen Eye Chart
• Normal visus: 20/20 (dalam kaki/ feet) atau 6/6 (dalam meter) 
pasien bisa melihat optotip Snellen pada jarak 6 meter, orang
normal juga bisa melihat optotip Snellen pada jarak 6 meter).
• Nilai visus ditentukan oleh seberapa banyak klien dapat
membaca huruf pada baris yang ditunjuk. Klien dikatakan
memiliki visus pada baris yang ditunjuk jika mampu membaca >
50% huruf tersebut.

Contoh:
• Pada baris ke-6 yang terdiri dari 6 huruf, jika klien mampu
membaca semua huruf pada baris tersebut maka visusnya
adalah 6/9.
• Namun jika klien hanya mampu membaca 3 huruf (50%) maka
klien dianggap belum lolos pada baris tersebut dan otomatis nilai
visus yang digunakan adalah nilai visus sebelumnya (nilai visus
pada baris ke 5, yaitu 6/12).
• Finger test
Jika huruf paling atas pada Snellen Chart tidak
bisa dibaca penderita, lakukan test jari tangan
(finger test)
 Acungkan satu atau lebih jari tangan kanan/
kiri di depan klien dari jarak 3 meter, 2 meter,
atau 1 meter.
 Minta klien untuk menebak berapa jumlah jari
yang diacungkan.
 Jika pada jarak 3 meter klien bisa menebak/
melihat jari yang diacungkan maka visusnya
3/60, yang berarti orang normal bisa melihat
acungan jari pada jarak 60 meter, sedangkan
klien hanya bisa melihat pada jarak 3 meter.
• Waving hand test
Jika klien tidak bisa menebak/ melihat acungan jari
pada jarak 1 meter lakukan tes goyangan tangan
(waving hand test)
 Goyangkan kedua tangan di depan klien dari
jarak 3 meter, 2 meter atau 1 meter
 Tanyakan apakah klien dapat melihat goyangan
tangan di depannya atau terlihat buram
 Apabila pada jarak 3 meter klien bisa melihat
goyangan/ lambaian tangan di depannya maka
visusnya 3/300, yang berarti orang normal bisa
melihat goyangan tangan pada jarak 300 meter,
sedangkan klien hanya bisa melihat pada jarak
3 meter.
• Dark-light test
Jika klien masih tidak bisa melihat goyangan/
lambaian tangan pada jarak 1 meter, maka
lakukan tes penyinaran dengan lampu senter
(dark-light test)
 Sorotkan cahaya lampu senter di depan
klien dari jarak 1 meter
 Tanyakan klien apakah dapat melihat
cahaya lampu senter di depannya.
 Apabila klien bisa melihat cahaya lampu
senter di depannya maka visusnya 1/-
(tidak terbatas), jika tidak maka visusnya 0
• Near Vision Test
The chart consists of STEP
short sections of 1. Hold the card in good light
different-sized text, about 35 cm (14 inches) from
ranging from J1 to J11 or the eyes. If the person
larger, with J2 being the regulary wear glasses to read,
equivalent of 20/20 vision then have the person wear
them during the test
2. Test the eye separately
3. Ask the person to read without
hesitancy and without moving
the card closer or farther away
4. When the card is not avaiable,
ask the person to read for a
magazine or newspaper
Test Visual Fields
• Confrontation Test:
test screen for loss
of peripheral vision.
STEP
1. Face the person, roughly 2 feet apart, noses at the same level
2. Close your right eye, while the person closes their left. Keep
other eyes open & look directly at one another
3. Hold pencil or your finger as target midline between you and
person, and slowly advance it in from periphery in several
directions
4. Ask person to say “now” as target is first seen; this should be
just as you see the object also
Objective Data
Inspect Extraocular Muscle Function
• Corneal Light Reflex (Hirschberg Test)
STEP
1. Direct person to stare straight ahead as you hold the light
about 30 cm (12 inches) away
2. Note reflection of light on corneas; should be in exactly same
spot on each eye
Objective Data

Inspect Extraocular Muscle Function (cont.)

• Cover test
1. Ask the person to stare straight ahead at you nose
even though the gaze may be interrupted
2. With an opaque card, cover one eye
3. Note the uncovered
4. A normal response is a steady fixed
Objective Data
Inspect Extraocular Muscle Function (cont.)
• Diagnostic positions test
1. Ask person to hold head steady and follow movement of
your finger, pen, or penlight only with hid or her eyes
2. Hold target back about 12 inches so person can focus
comfortably, and move it to each of six positions; hold
momentarily, then back to center
3. Progress clockwise; normal response is parallel tracking of
object with both eyes
Objective Data
• Inspect External Ocular Structures

1. Eyelids and lashes

2. Conjunctiva and Sclera
3. Eye ball
4. Lacrimal Apparatus
5. Cornea and Lens
6. Iris and Pupil
Objective Data (cont.)

Inspect external ocular structures

Pupillary Light Reflex Accommodation

• Dark the room and • Ask the person to focus

ask he person to on a distant object
gaze into the • Then gave the person
distance
shift the gaze to a near
• Advance a light in object, such as your
from the side and finger held about 7-8
note the response from the person’s nose
Objective Data (cont.)
• Inspect ocular fundus
Objective Data (cont.)
• Inspect ocular fundus (cont.)
1. Optic disc (color, shape, margins, cup-disc ratio)
2. Retina Vessel (number, color, artery-vein [A:V]
ratio, caliber, arteriovenous crossing, tortuosity,
pulsation)
3. General background of fundus (color, integrity)
4. Macula
 Abnormal Findings:
Extraocular Muscle Dysfunction

Pseudo strabismus Exophthalmos

 Abnormal Findings

Retinal damage—increasing
Monocular blindness intraocular pressure

Slide 14-24
 Abnormal Findings

Star-shaped opacity—
Conjunctivitis cortical cataract
2. Pemeriksaan Telinga
Pathway of Hearing
• Air conduction
• Bone conduction

Hearing loss  Anything that obstructs the

transmission of sound impairs hearing
 Conductive (external or middle ear)
Caused by impated cerumen, foreign bodies, a perforated
tympanic membrane, pus or serum in the midle ear, and
otosclerosis
 Sensorineural (inner ear)
Caused by presbycusis a gradual nerve degeneration, ototoxic
drugs
 Mixed loss
combination of conductive and sensorial types in the same ear
 EXAMINATION
SUBJECTIVE DATA
1. Earache
Any earache or other pain in ears?
Abnormal findings: Otalgia may be caused directly by ear disease or
may be refered pain from a problem in theeth or oropharynx
2. Infections
Any ear infection as a adult or in childhood?
Abnormal findings: A history of chronic ear problems suggests
possible sequelae
3. Discharge
Any discharge from your ears?
Abnormal findings: Otorrhea suggests infected canal or perforated
eadrum such as external otitis, acute OM with perforation,
cholesteatoma
 EXAMINATION
SUBJECTIVE DATA

4. Hearing loss
Do you have any trouble hearing?onset
Abnornal findings: Presbycusis is gradual onset over
years, symmetric, mostly high-frequency loss, worse in noisy
environment, whereas a trauma hearing loss is often sudden.
Refer any sudden loss in one or both ears not associiated
with URI
5. Enviromental noise
Are you regularly exposed to sounds so loud that you have
to make yourself heard by some one standing more than one
yard away? Regularly exposed to gunfire noise?
Abnormal findings: Old trauma to hearing initially goes
unnoticed but results in further decibel loss in later years
 EXAMINATION
SUBJECTIVE DATA
6. Tinnitus
Ever feel ringing, crackling, buzzing in your ears? When did this
occur?
Abnormal findings: Tinnitus is a “phantom sound” that occours with
cerumen impaction, middle ear infection, and other ear disorders. It
seems louder with no competition from enviromental noise.
7. Vertigo
Ever feel like the room spinning around or yourself spinning?
Abnormal findings: true rotational spinning occurs with dysfunction
of labyrinth.
8. Patien-centered care
How do you clean your ears?
Assess potential trauma from invasive instrument such cotton-tipped
which can impact cerumen instead
Additional history for infants and children
• Ear infections
At what age was the child’s first episode? how many ear infections
in the past 6 months? How many total? How were these treated?
Abnormal findings: A first episode that accours within 3 months of
life increases risk for recurrent OM. Recurrent OM is 3 episodes in
past 3 months or 4 within past year
• Does the child seem to be hearing well?
Abnormal findings: Children at risk for hearing deficit include
those exposed to maternal rubella or maternal ototoxic drugs in
utero; premature infants; low-birth-weight infants; trauma of hypoxia
at birth; and infants with conginetal liver or kidney disease
• Does the child tend to put objects in the ears?
Abnormal findings: These children are at increased risk for trauma
 OBJECTIVE DATA

Preparation
Patien Equipment Technique
• Position the adult sitting up 1. Otoscope with 1. Inspect and
straight with his or her bright light (fresh palpate the
head at your eye level. batteries give off external ear
• Occasionally the ear canal white-not yellow 2. Inspect with
is partially filled with light) the otoscope
cerumen which obstructs 2. Pneumatic bulb 3. Test hearing
your view of the TM.
• Inspect attachment,
and palpate the external ear acuity
• If the eardrum is intact and sometime used 4. Test vestibular
• Inspect
no current infectionwith
is the otoscope
with infant or apparatus
present,• aTest
prefered
hearing acuity young child.
methode of cleaning the 3. Tunning fork
• Test
adult canal is tovestibular
soften theapparatus
cerumen with a warmed
solution of mineral oil
 Normal range of finding Abnormal finding
Inspect and palpate the external ears
Size and shape
The ears are of equal size bilaterally • Microtia--- ears smaller than 4 cm vertically;
with no swelling or thickening. • Macrotia---ears larger than 10 cm.
• Edema with infection or trauma
Skin condition
• The skin color is consisten with the • Reddened, excessively warm skin with
person’s facial skin color. inflamation, external ear abdormalities.
• The skin is intact with no lumps or • Crust and scaring with otitis externa, eczema,
lession contact dermatitis, seborrhea
Tenderness
• Move the pinna and push on the • Pain with movement occurs with otitis externa
tragus  should feel firm and and furuncle.
movement should produce no pain. • Pain at the mastoid process may indicate
• Palpating the mastoid process mastoiditis or enlarge posterior auricular node
should also produce no pain
The external auditory meatus
• No swelling, redness, or discharge • A sticky, yellow discharge accompanies otiti
should be present externa or may indicate OM if the drumb has
• Cerumen is usually present ruptured
• Impacted cerumen is a common cause of
conductive hearing loss
 Inspect with the otoscope
- Choose the largest speculum
- Tilt the person’s head slightly away from you toward the opposite
shoulder
- Pull the pinna up and back on an adult or older child
- Hold the pinna gently but firmly
- Do not release the traction till you have finished the examination
- Hold the otoscope ‘upside down’ along your finger and have the
dorsa (back) of your hand along the person’s cheek braced to
steady the otoscope
- Insert the speculum slowly and carefully along the axis of the canal
- Put your eye up to the otoscope
- Avoid touching the inner bony section of the canal wall, sensitive to
pain
- If you can not anything but the canal wall, try to reposition the
person’s head apply more traction the pinna and re-angle the
otoscope
 Normal Finding
The external canal
• No redness and swelling,
lession, forign bodies,
discharge, irritation
The tympanic membrane
a. Color and characteristics.
Systematically explore its
landmark  shiny and
transculent with a pearl gray
color
b. Integrity of membrane
TM is intact. No perforation.
Scarring indicates the
sequela of repeated ear
infections.
c. Position
The eardrum is flat and
slightly pullled in at the center
Abnormal Finding
• Redness and swelling occur with otitis externa.
• Purulent otorrhea suggests otitis externa or
OM if the drum has ruptured.
• Foreign body, polyp, furuncle,exsostosis
• Yellow-amber drum color occurs with OM with
effusion (serous)
• Red color with acute OM
• Absent of distorted landmark
• Air/fluid level or air bubbles behind drum
indicate OM with effusion
Perforation shows as a Dark oval area or as a
larger opening on the drum
• Retract drum: vacuum in midlle ear with
obstructed eustachian tube
• Bulging drum : increased preasure in OM
Test hearing acuity (audiometric)
do you have dissiculty hearing
now?
a. Whisperred voice test
Normally the person can
repeat each number/letter
correctly after you say it
b. Tunning fork test
These test may help
distinguish coonductive loss
from sensorineural loss but not • Bulging drum : increased preasure in
from mixed
c. The vestibular apparatus
To assess the vestibular
apparatus, perform the
Romberg test, which
evaluates standing balance.
This single question in people over 50
years has an 83% to 90% agreement
with hearing loss documented by
audiometric
• The person is unable to hear
whispered items.
• A whisper is a high-frequency sound
and is used to detect high-tone loss
• Retract drum : vacuum in midlle ear
with obstructed eustachian tube
OM
• Fall while opening eye : decay on
cerebellum
• Fall while closing eye : decay on
vestibular apparatus
 Tunning Fork Test
Weber Test Rinne Test

Interpretation : Interpretation :
Conductive loss : Conductive loss : AC=BC /
lateralize to poor ear AC<BC
Sensorineural loss: lateralize Sensorineural loss : AC>BC
to better ear but it is reduced overall
 Developmental competence

• Based on the patient’s developmental stage,

adjust your assessment technique or expected
findings.
• For example, for a child, use different tests to
assess hearing acuity.
• In an older adult, expect the tympanic
membrane to appear whiter, more opaque,
and duller than in a younger adult
 ABNORMAL FINDING
External Ear Abnoramalities

Otitis Externa(Swimmer’s Ear)

Branchial Remnant and Ear Deformity Cellulitis

 ABNORMAL FINDING
Lumps and Lessions on the Ear

Sebaceous Cyst Tophi Battle Sign

Chondrodermatitis
Nodularis Helicus
Keloid Carcinoma
 ABNORMAL FINDING
Ear Canal Abnormalities

Excessive Cerumen Otitis Externa Foreign Body

Osteoma Exostosis Furuncle Polyp

 ABNORMAL FINDING
Abnormal Tympanic Membrane

Otitis Media with

Retracted Drum Acute Otitis Media Cholesteatoma
Effusion

Bullous Myringitis
Scarred Drum Blue Drum Fungal Infection
3. Pemeriksaan
Hidung, Mulut,
& Tenggorokan
A. Structure and Function
• Nose
• Mouth
• Throat
 B. Developmental Competence
Infants and Pregnant The Aging Adult
Children Woman
Nose Develops during Nasal stuffiness • Appear more prominent
adolescence, & epistaxis may • Nasal hairs grow coarser & stiffer
along with other occur during  may not filter the air as well
secondary sex pregnancy • Sense of smell may diminish after
characteristic age 60 years
Mouth Infant salivation Gums may be • Soft tissue athropy  ulcerate
starts at 3 hyperemic, easily  (↑) risk of infection and
months softened, & malignant oral lesions
Children have 20 bleed with • Epithelium thins
deciduous or normal • (↓) in salivary secretion
temporary teeth toothbrushing • Tooth surface abraded  tooth
hypersensitive
• Tooth loss  the remaining teeth
drift  malocclusion
• Diminished sense of teste & smell
 malnutrition
C. Culture & Genetics
Bifid uvula Cleft lip & cleft Torus Leukoedema
palate palatinus
2% of the Highest 20% to 35% of Commonly in
general incidence in the US African
population & up Asians, population American
to 10% in some intermediate in
American Indian Caucasians,
groups lowest in African
Americans
D. Subjective Data
Nose Mouth and throat
1. Discharge 1. Sores or lesions
2. Frequent colds (upper 2. Sore throat
respiratory infections)
3. Sinus pain 3. Bleeding gums
4. Trauma 4. Toothache
5. Epistaxis (nosebleeds) 5. Hoarseness
6. Allergies 6. Dysphagia
7. Altered smell 7. Altered taste
8. Smoking, alcohol consumption
9. Patient-centered care, dental care
pattern, dentures or appliances

*Additional history for :

a. Infants and children
b. Aging adult
E. Objective Data
• Preparation
• Position the person sitting up straight with his or her head
at your eye level.
• If the person wears dentures, offer a paper towel and ask
the person to remove them.

• Equipment needed
• Otoscope with short, wide-tipped nasal speculum
attachment
• Penlight
• Two tongue blades
• Cotton gauze pad (4 x 4 inches)
• Gloves
E. Objective Data (cont’.......)
Step by step to do examination :
1. Nose
a.Inspect and palpate the nose
• External nose
• Nasal cavity
b.Palpate the sinus areas
2. Mouth
a.Inspect the mouth
• Lips
• Teeth and gums
• Tongue
• Buccal mucosa
• Palate
3. Throat
a.Inspect the throat
1. Nose
a.Inspect and palpate the nose
1) External Nose
Step by step to do examination :
• Inspect for any deformity, asymmetry,
inflamation, or skin lesions.
• Injury
 Palpate gently for any pain or break
in contour.
• Test the patency of the nostrils
 Pushing each nasal wing shut with
your finger while asking the person
to sniff inward through the other
naris.
• The sense of smell (mediated by
cranial nerve I)  not tested in a
routine examination.
2) Nasal cavity
Step by step to do examination :
• Attach the short, wide-tipped speculum to the
otoscope head, and insert this combined
apparatus into the nasal vestibule.
• Gently lift up the tip of the nose with your finger
before inserting.
• View each nasal cavity with the person’s head
erect and then with the head tilted back.
a.Inspect the nasal mucosa
 Note any swelling, discharge, bleeding, or
foreign body.
b. Observe the nasal septum
 Note any deviation, perforation or bleeding
c. Inspect the turbinates
 Note any swelling, any polyps and
distinguish them from the normal
turbinates.
b. Palpate the sinus areas
Step by step to do examination :
• Press the frontal sinuses by pressing using your thumbs
firmly up and under the eyebrows (Fig. A).
• Over your pressing to the maxillary sinuses below the
cheekbones (Fig. B).
• Take care not to press directly on the eyeballs

Transillumination
• Suspect sinus inflamation  no evidence to support the
practice of the frontal or maxillary sinuses
• Chronic sinusitis  the technique would not held
• Acute sinusitis  the asymmetry of light illumination still
is not valid
 Abnormal findings

Choanal Atresia Epistaxis Sinusitis Hay Fever

Furuncle Acute Rhinitis Foreign Body Perforated Septum Nasal Polyps

2. Mouth
a. Inspect the mouth
1) Lips

Step by step to do
examination :
• Inspect the lips for color,
moisture, cracking, or
lesions.

• Retract the lips and note

their inner surface as well.
 Abnormal Findings

Angular Cheilitis
Cleft Lip (Stomatitis, Perleche)

Herpes Simplex 1
2) Teeth and gums
Step by step to do examination :
a.Teeth
• Note any diseased, absent, loose, or
abnormally positioned teeth.
• Compare the number of teeth with the
number expected for the person’s age.
• Ask the person to bite as if chewing
something and note alignment of upper
and lower jaw.

b.Gums
• Check for swelling, retraction of
gingival margins, spongy, bleeding, or
discolored gums
 Abnormal Findings

Baby Bottle Tooth Decay Malocclusion Dental Caries Epulis

Gingival Hyperplasia Gingivitis Meth Mouth

3) Tongue
Step by step to do examination :
• Check the tongue for color, surface characteristics,
and moisture (Fig. A).
• Ask the person to touch the roof of the mouth (Fig.
B).
• With a glove, hold the tongue with a cotton gauze
pad for traction and swing it out and to each side
 Inspect for any white patches or lesions  if any
occur, palpate them for induration (Fig. C)
• Inspect the entire U-shaped area under the tongue
behind the teeth.
 Note any white pathces, nodules, or ulcerations.
 If lesions are present, or for any person older than
50 years or with a positive history of smoking or
alcohol use  use gloved hand to palpate the
area
 Place your other hand under the jaw to stabilize
the tissue and to capture any abnormality. Note
any induration (Fig. D)
 Abnormal Findings

Ankyloglossia Geografic Tongue Atrophic Glossitis Black Hairy Tongue

Carcinoma Fissured Tongue Macroglossia

4) Buccal mucosa
Step by step to do
examination :

• Hold the cheek open with a

wooden tongue blade and
check the buccal mucosa
for color, nodules, or lesions

Fordyce granules
 Abnormal Findings

Aphthous Ulcers Koplik Spots Leukoplakia

Candidiasis Herpes Simplex 1

5) Palate
Step by step to do examination
• Shine your light up to the roof
of the mouth.
• Observe the uvula.
Torus palatinus
• Ask the person to say “ahhh,”
and note the soft palate and
uvula rise in the midline  test
one function of cranial nerve X
(vagus nerve).
 Abnormal Findings

Bifid Uvula Oral Kaposi Sarcoma Cleft Palate

3. Throat
a. Inspect the throat
Step by step to do examination :
• Observe the oval, rough-surfaced tonsils behind
the anterior tonsillar pillar with your light (Fig. A)
• Tonsils are graded in size as follows :
 1+ visible
 2+ halfway between tonsillar pillars and uvula
 3+ touching the uvula
 4+ touching one another
• Depresing the tongue with a tongue blade to
enlarge view of the posterior pharyngeal wall
(Fig. B).
 Push down halfway back on the tongue; if you
push on its tip, the tongue humps up in back.
 Press slightly off center to avoid eliciting the
gag reflex.
 Scan the posterior wall of color, exudate, and
lesions.
3. Throat (cont’.......)
a. Inspect the throat
Step by step to do examination :
• Touching the posterior wall with the tongue blade elicits the gag
reflex
 Test cranial nerves IX and X, the glossopharyngeal and
vagus.

• Asking the person to stick out the tongue. It should protrude in

the midline.
 Note any tremor, loss of movement, or deviation to the side
 Test cranial nerve XII, the hypoglossal nerve

• During the examination notice any breath odor, halitosis.

 Abnormal Findings

Acute tonsillitis and Peritonsillar

Pharyngitis Abscess
4. Developmental Competence
A. Infants and children
Technique and position :
• Along with the ear examination, if crying  seize opportunity the
open mouth and oropharynk
• Infants
Place the infant supine on the examining table with the
arms restrained.
• Older infant and toddler
May be held on the parent’s lap with one of the
parent’s hands holding the arms down and the other
hand securing the child’s head against the parent’s
chest.
• Preschool child :
Encourage to use a tongue blade or place a mirror
• School-age child :
 Cooperative and loves to show off missing or new teeth  avoid the
tongue blade
 Uncooperative  slide the tongue blade along the buccal mucosa and
turn it between the back teeth  push down to depress the tongue 
stimulate gag reflex, the child opens the mouth wide
• Nose :
Newborn May have milia across the nose, determine the patency of the nares
Infant and Avoid the nasal speculum when examining the  instead gently push up
young child the tip of the nose with your thumb while using other hand to shine the
light into the naris
Children older Need to palpate the sinus areas
than 8 years of
age

• Mouth :
Lip Sucking tubercle
Teeth Lift the upper lip  number of teeth, pattern of
eruption, position, condition, and hygiene
Saliva Present or not
Buccal Bruising or laceration
mucosa or
gums
Palate Sucking reflex (insert gloved finger into the baby’s
mouth and palpate the hard and soft palate), Epstein
pearls, Bednar aphthae Epstein pearls
Tonsils Not visible in the newborn, gradually enlarge during
childhood
B. The Pregnant Woman
• Gum hypertrophy  pregnancy gingivitis

Early gingivitis Receded gums

C. The Aging
The nose Adult
may appear more prominent
The teeth may look slightly yellowed, show vertical
cracks, look longer as the gum margins recede,
look abraded, loosen
The tongue looks smoother
Buccal mucosa thinned and may look shinier