Chapter 13

Ears, Nose, Mouth, and

Throat

Copyright 2002, Delmar, A division of Thomson Learning

Competencies
 Identify the structures of the ears,
nose, mouth, and throat.
 Discuss the system-specific history
for the ears, nose, mouth, and
throat.
 Describe normal findings in the
physical assessment of the ears,
nose, mouth, and throat.
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
 Describe common abnormalities
found in the physical assessment of
the ears, nose, mouth, and throat.
 Explain the pathophysiology of
common abnormalities of the ears,
nose, mouth, and throat.
 Perform the physical assessment of
the ears, nose, mouth, and throat.
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Ear
 Frequency range of 20 to 20,000 Hz
 Decibel range 0 to 140
 External ear
 Auricle or pinna

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Ear
 Middle ear
 Ossicles
 Malleus (hammer)
 Incus (anvil)
 Stapes (stirrup)
 Eustachian tube

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
of the Ear
 Inner ear
 Labyrinth
 Vestibule
 Semicircular canals
 Cochlea

Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and
Physiology
of the Nose
 Turbinates
 Nasal mucosa
 Olfactory receptor cells
 Paranasal sinuses

Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology
of the Mouth and Throat
 Mouth and throat
 Lips
 Cheeks
 Buccal mucosa
 Hard palate
 Soft palate
 Teeth
Copyright 2002, Delmar, A division of Thomson Learning
Health History
 Ears
 Hearing loss
 Excessive cerumen
 Nose
 Deviated septum
 Mouth and throat
 Tooth loss
 Gum disease
 Decreased taste

Copyright 2002, Delmar, A division of Thomson Learning

Common Chief
Complaints
 Hearing loss
 Tinnitus
 Nasal blockage or congestion
 Halitosis
 Oral lesions

Copyright 2002, Delmar, A division of Thomson Learning

Evaluation of Chief
Complaint
 Quality
 Associated manifestations
 Aggravating factors
 Alleviating factors
 Timing

Copyright 2002, Delmar, A division of Thomson Learning

Past Health History
 Medical
 Otitis media or externa
 Nasal polyps, sinusitis, allergic rhinitis
 Tonsillitis, dental caries, upper
respiratory infections
 Chronic diseases, such as diabetes
mellitus, renal disease, hypertension,
immunosuppression
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
 Dental pathology
 Nutritional disturbances
 Surgical
 Oral surgery
 Cosmetic surgery of head or neck
 Repair of deviated septum
 Tympanostomy tubes

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
 Medications
 Antibiotics, antihistamines,
decongestants, steroids, chemotherapy,
immunosuppressive drugs
 Allergies
 Severity of signs and symptoms
 Seasonal or environmental

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
 Accidents/injuries
 Foreign bodies
 Trauma
 Sports injuries
 Special needs
 Use of assistive devices (hearing aids)
 Speech disorders
 Childhood illnesses
 Frequent tonsillitis or ear infections

Copyright 2002, Delmar, A division of Thomson Learning

Social History
 Alcohol use
 Tobacco use
 Drug use
 Sexual practices
 Work/home environment
 Hobbies/leisure activities
 Stress
Copyright 2002, Delmar, A division of Thomson Learning
Health Maintenance
Activities
 Sleep
 Diet
 Use of safety devices
 Healthy checkups

Copyright 2002, Delmar, A division of Thomson Learning

General Approach to
Assessment
 Greet the patient
 Explain assessment techniques
 Quiet, well-lit environment
 Sitting position
 Compare right to left
 Systematic approach

Copyright 2002, Delmar, A division of Thomson Learning

Equipment
 Otoscope
 Nasal speculum
 Penlight
 Tuning fork
 Cotton-tipped applicators
 Tongue blade
 Watch
 Gauze square
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
 External ear
 Inspection
 Note position, size, color, and shape
 Palpation
 Auricle

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Ear
 Normal findings
 Flesh color
 Positioned centrally and in proportion
to the head
 No foreign bodies, redness, drainage,
deformities, nodules, or lesions

Copyright 2002, Delmar, A division of Thomson Learning

Assessment of the Ear
 Abnormal findings
 Small- or large-size ears
 Pale, red, cyanotic
 Purulent drainage
 Clear or bloody drainage
 Pain or tenderness on palpation
 Tumor
 Hematoma behind ear over mastoid
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Auditory Screening
 Voice-whisper test
 Normal finding: able to repeat words
whispered at a distance of 2 feet
 Weber test
 Normal finding: able to hear sound equally
in both ears
 Rinne test
 Normal finding: air conduction > bone
conduction

Copyright 2002, Delmar, A division of Thomson Learning

Otoscopic Assessment
 Inspect both ears
 Normal findings
 No redness, swelling, tenderness, lesions,
drainage, foreign bodies
 Tympanic membrane is pearly gray with
well-defined landmarks
 Light reflex present at 5 o’clock in right
ear and 7 o’clock in left ear
 Tympanic membrane moves when the
patient blows against resistance
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Otoscopic Assessment
 Abnormal findings
 Redness, swelling, narrowing, pain
 Drainage
 Hard, dry, very dark yellow cerumen
 Reddened tympanic membrane
 Severe pain
 Chalk patches on tympanic membrane

Copyright 2002, Delmar, A division of Thomson Learning

Risk Factors for Otitis
Media
 Less than 2 years of age
 Frequent upper respiratory
infections
 Cold weather
 Males

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Risk Factors for Otitis
Media
 Caucasians, Native Americans,
Alaskan natives
 Family history
 Smoky environment
 Bottle fed
 Down syndrome

Copyright 2002, Delmar, A division of Thomson Learning

Assessment of the Nose
 Inspection of external nose
 Location, symmetry, bleeding, masses,
swelling, lesions
 Patency
 Nostrils
 Inspection of internal nose
 Otoscope with nasal speculum
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
 Normal findings
 Located in midline of face
 No swelling, bleeding, lesions, or
masses
 Both nostrils patent
 Septum midline
 Nasal mucosa is pink or dull red

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the Nose
 Abnormal findings
 Broken, misshapen, swollen nose
 Occluded nasal passages
 Septum is deviated
 Nasal mucosa is red and swollen
 Purulent drainage

Copyright 2002, Delmar, A division of Thomson Learning

Assessment of the
Sinuses
 Inspection
 Palpation and percussion
 Normal findings
 No evidence of swelling
 Resonance heard on percussion
 No discomfort during palpation or
percussion

Copyright 2002, Delmar, A division of Thomson Learning

Assessment of the
Mouth
 Inspection
 Lips, tongue
 Gums, buccal mucosa
 Teeth

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Mouth
 Normal findings
 Pink, moist lips
 Tongue midline, adequate movement
 No lesions
 Tongue, gums, buccal mucosa are
pink, moist, smooth
 No bleeding
 Smooth, white teeth, no dental caries
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Mouth
 Abnormal findings
 Lesions, growths
 Dry, cracked lips
 Vesicles or blisters
 Red, tender, inflamed tongue, gums,
buccal mucosa
 Thrush
 Coating on tongue
 Bleeding gums

Copyright 2002, Delmar, A division of Thomson Learning

Inspection of the Throat
 Gag reflex
 Posterior pharynx
 Uvula
 Color of oropharynx
 Presence of swelling, exudate,
lesions

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Inspection of the Throat
 Normal findings
 Soft palate and uvula rise when patient
says, “ah”
 Uvula is midline
 No swelling, exudate, or lesions
 Gag reflex is present

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Inspection of the Throat
 Abnormal findings
 Posterior pharynx is red with white
patches
 Tonsils and uvula are red and swollen
 Hoarse voice
 Grayish membrane covering tonsils,
uvula, soft palate

Copyright 2002, Delmar, A division of Thomson Learning

Gerontological
Variations
 Presbycusis
 Diminished sense of smell and taste
 Periodontal disease
 Oral alterations due to disease or
side effects of medications
 Tooth loss

Copyright 2002, Delmar, A division of Thomson Learning