Chapter 12

Chapter 12
Ears, Nose, Mouth, and Throat
Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
v Ear
o Sensory organ of hearing
v Nose
o Sensory organ of smell
v Mouth and throat
o Sensory organ of taste
o First part of digestive system

The Ear #1

The Ear #2

The Ear #3
v Middle Ear v Inner Ear
o Tympanic membrane o Hearing Pathway
o Ossicles § Cochlea
§ Malleus § Semicircular canals
§ Incus § Auditory nerve
§ Stapes § CN VIII
(Vestibulocochlear
nerve)
o Equilibrium

The Ear #4

The Health History
The Ear #1
v Common or concerning symptoms
o Hearing loss
o Earache
o Discharge
o Tinnitus
o Vertigo

The Health History
The Ear #2
v Ear history
o Hearing loss?
§ Conduction versus sensorineural
o Earaches?
§ Frequency, sharp, dull
o Discharge?
§ Ear wax, pus, smell

The Health History
The Ear #3
v Ear history
o Tinnitus?
§ Which ear, frequency, other symptoms
o Vertigo?
§ Clarify patient’s definition/understanding
§ Frequency, other symptoms, effect on daily life

The Health History
The Ear #4
v Past history
o Hearing loss
o Removal of cerumen
o “Swimmer’s ear”
o Surgery
o Trauma
o Infection
o Noise exposure
o History of disease

The Health History
The Ear #5
v Family history
o Hearing loss
o Allergies
o Smoking or exposure to cigarette smoke

The Health History
The Ear #6
v Lifestyle Habits
o Occupation/hobbies/activities
o Use of listening devices
o Use of loud tools
o Use of ear plugs/ear protection
o Use of hearing aids
o Medication and/or drug use that interfere with
hearing or cause dizziness

Lumps On or Near the Ear #1



Eardrum #1

Eardrum #2

Eardrum #3

Hearing Loss

Question #1
v The ossicles consist of all of the following except:
A. Incus
B. Malleus
C. Stapes
D. Mastoid

Answer to Question #1
v The ossicles consist of all of the following except:
v D. Mastoid
v The mastoid bone is a part of the cranium. The three
ossicles are the malleus, incus, and stapes.

The Nose and Paranasal Sinuses #1
v Function
o Inspiration and expiration
o Filtration, warmth, and moisturization of the air
exchanged
o Sensation of smell
o Resonance of speech





The Paranasal Sinuses #6

The Health History
v Rhinorrhea
o Type of discharge
v Congestion
o Medications, infections
v Epistaxis
o May indicate bleeding disorder
v Change in sense of smell

The Health History
v Past history
o Sinus infections
o Upper respiratory infections
o Allergies
o Trauma or injury
o Nasal or sinus surgery
o Polyps
o Dental history

The Health History
v Family history
o Allergies
o Asthma
v Lifestyle habits
o Air quality
o Pets
o Alcohol, tobacco, recreational drugs

Mouth and Pharynx #1





The Health History
The Mouth and Pharynx #1
v Common or concerning symptoms
o Sore throat
§ Upper respiratory infection
o Hoarseness
§ Smoking, allergies, voice abuse, hypothyroidism,
tuberculosis, tumors
o Lesions
§ Aphthous ulcers, nutritional deficiency

The Health History
v Common or concerning symptoms (cont.)
o Sore tongue
§ Nutritional deficiency
o Bleeding gums
§ Gingivitis
o Toothache
o Dysphagia
§ Any particular foods

The Health History
v Past history
o Sore throat
o Loss of voice
o Dental, mouth, or throat surgery
o Trauma or injury
o History of infections
o Oral cancer
o Sexually transmitted infection (STI)

The Health History
v Family history
o Allergies
o Smoking or exposure to cigarette smoke
o Stroke
o Tuberculosis

The Health History
v Lifestyle habits
o Brush and/or floss teeth?
o Use tobacco products?
o Smoke recreational drugs?
o Drink alcohol?
o Past and present occupations?
o Use of dental dams?

Abnormalities of the Lips #1




Question #2
v Patients should be encouraged to maintain good dental
hygiene, that would include which of the following?
(Choose all that apply.)
A. Daily brushing
B. Flossing
C. Routine dental visits
D. Good nutrition

v Patients should be encouraged to maintain good dental
hygiene, that would include which of the following?
(Choose all that apply.)
v A. Daily brushing
v B. Flossing
v C. Routine dental visits
• D. Good nutrition
• All of these steps will help maintain good dental hygiene
and should be encouraged.

Physical Examination
The Ear #1
v Equipment
o Tuning fork
o Otoscope
o Speculum
o Tongue blade
o Gloves
o Penlight

The Ear #2
v Pinna (Auricle)
o Inspect tissues for deformities, lumps, or skin
lesions.
o Pain, discharge, inflammation
§ Movement painful in otitis externa
§ Tenderness behind ear may be present with otitis
media

The Ear #3

The Ear #4

The Ear #5

The Ear #6
v Auditory acuity
o Test one ear at a time
o Occlude nontested ear
o Speak numbers or words with two equal syllables
o Do not let patient read your lips
o Ask them to repeat what they hear

The Ear #7

The Ear #8

The Ear #9
v Rinne test
o Compare air conduction (AC) and bone conduction
(BC)
o Conductive hearing loss
§ BC = AC or BC > AC
o Sensorineural hearing loss
§ AC > BC

The Nose #1
v Equipment for examination
o Penlight
o Otoscope
o Nasal speculum or largest speculum available
o Gloves

The Nose #2

The Nose #3
v Inspect anterior and inferior surfaces
v Test for nasal obstruction
v Inspect inside of nose
v Observe nasal mucosa, septum, and any abnormalities
v Palpate for sinus tenderness

The Nose #4

v Equipment
o Penlight
o Tongue blade
o Gloves
o Gauze pad

v Lips
o Color, moisture, lumps, ulcers, cracking, scaliness
v Oral mucosa
o Color, ulcers, white patches, nodules
v Gums and teeth
o Color, swelling, ulcerations
o Teeth alignment, caries, looseness
o Dentures



v Roof of mouth
o Color
o Architecture of hard
palate
v Tongue and floor of mouth
o Symmetry of CN XII
o Color, texture


v Pharynx
o Ask patient to say “ah.”
o Use tongue depressor as needed.
o Inspect soft palate, anterior and posterior pillars,
uvula, tonsils, and pharynx.
o Note color and symmetry.
o Note exudates, swelling, ulceration, and tonsillar
enlargement.

v Tonsils graded by size

o +1: visible
o +2: between tonsillar
pillars and uvula
o +3: touching uvula
o +4: touching each
other
v CN X paralysis

Question #3
v Oral sex is a safe technique to use when practicing safe
sex.
A. True
B. False

v Oral sex is a safe technique to use when practicing safe
sex.
v B. False
v This is a myth among adolescents and young adults. STIs
are readily contracted via oral sex, with the organisms
then infecting the mouth and pharynx.

Findings in Gums and Teeth #1




Findings in or Under the Tongue #1






Findings in the Pharynx, Palate, and Oral
Mucosa #1

Mucosa #2

Mucosa #3

Mucosa #4

Mucosa #5

Mucosa #6

Record Your Findings
v Ears
o Acuity
o Structures
v Nose
o Structures
v Mouth and Pharynx
o Color
o Structures

Health Promotion, Disease Prevention,
and Education
The Ears #1
v Hearing screening
o Important to catch hearing deficits early
o Language development delay
o Increased potential for loss due to overexposure to
high levels of noise (work, play, home)

and Education
The Ears #2
v Hearing loss
o Use appropriate ear protective devices
o Limit overexposure to high levels of noise
o Presbycusis
§ > 50 years 20% to 40%
§ > 80 years 80%

and Education
The Mouth and Pharynx
v Dental issues
v Diet
v Tobacco products
v Alcohol use
v Medication use—xerostomia
v Proper fit and use of dentures

Question #4
v Use of tobacco products and excessive alcohol
consumption are principal risk factors for oral carcinoma.
A. True
B. False

v Use of tobacco products and excessive alcohol
consumption are principal risk factors for oral carcinoma.
v A. True
v Research has shown that the use of tobacco products
and excessive alcohol consumption are principal risk
factors for developing oral carcinoma.

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Chapter 12

Ears, Nose, Mouth, and Throat

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

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Copyright © 2018 Wolters Kluwer · All Rights Reserved