Throat

Assessing the Mouth,

Throat, Nose and
Sinuses

REVIEW OF ANATOMY AND PHYSIOLOGY

Mouth
 oral cavity

 From lips,cheeks, hard and soft palate, uvula,

tongue and its muscles

Sinuses

Mouth
Nose

1. Inspection of the lips

Normal:

moist, smooth, no lessions, no swelling

Abnormal

1. Dehydration - dry, cracked lips

2. Viral Infection - lesions, ulcers

3. Pallor (circumoral) - shock, anemia Cyanotic (bluish)

cold_hypoxia

5. Reddish - ketoacidosis, CO poisoning; COPD with

polycythemia
6. Edema- local/systemic allergic or anaphylactic
reaction

7. Lip cancer-squamous cell carcinoma; lower lip

2. Inspect the teeth
Normal

: 32 pearly whitish teeth, smooth surfaces,

4. Inspect Stensen ducts (parotid)
edges; 28 (4 wisdom tooth do not erupt); no Normal:
decay, no missing;jaws aligned; gums are
visible with flow of saliva; no redness, swelling, pain;
smooth, moist and no lesions
Fordyce spots(normal)
Abnormal
Abnormal
1. Yellow or Brownish teeth - smoke; drink large Reddened opening of Stensen ducts -mumps
amount or tea, caffeine or excessive intake of flouride

2. Tooth decay 5. Inspect and palpate the tongue

Normal:
3. Malocclussion

pink, moist, moderate size, with papillae; no lesions or

4. Brown or Yellow strains or White
ulcers
spots - antibiotic therapy or tooth trauma
Abnormal
5.Red, swollen gums- gingvitis., scrvy , leukemia
1. Dry, nodules, ulcers, absent papillae or fissures
6.Periodontitis-Receding red gums with loss pf teeth
are seen 2. Deep longitudinal fissures - dehydration

7.Hyperplasia ( enlarged,reddened gums) -Pregnancy, 3. Black hairy tongue - hyposalivation, heavy smoking,
pberty, leukemia use of phenytoin alcohol intake, use of mouthwash antibiotics

8. Bluish-black or gray-white line along gum - lead 4. Smooth, red, shiny tongue - Niacin or Vit.B12
poisoning deficiency

5. Enlarged tongue - hypothyroidism, acromegalyDown

3. Inspect buccal mucosa syndrome, anaphylaxis

Normal 6. Atrophied or Fasciculations - CN 12 damage

pink,moist, no lesions, ulcers, swelling

6.Assess ventral surface of tongue and

Abnormal
palpate the area.
1. Leukoplakia - chalky white raised patches; chronic
Normal:
irritation, heavy smoking,alcohol use
smooth, shiny, pink, slightly pale, with visible veins; no
2. Thrush - "Candida albicans infection whitish curd -
lesions
like patehes that scrape off over reddened mucosa and
bleed Abnormal
3. Koplik spots - measles 1. Leukoplakia, persistent lesions, ulcers, nodules -
cancer
4. Canker sores
Most common site of oral cancer nderneath the
5. Brown patches - Addison Disease
tongue
7. Inspect Wharton Ducts and observe the
sides of the tongue
Normal: frenulum is midline; wharton ducts are visible
with salivary flow
Abnormal: canker sores (chemotherapy)
8. Check the strength of the tongue
Normal: strong resistance
Abnormal
1. Decreased strength - CN XIl
9. Check anterior tonaue's ability to taste
Normal: can distinguish salt and sweet
Abnormal: loss of taste
10. Inspect the hard (anterior) and soft
(posterior) palates and uvula
Normal:
 ‣ hard palate - pale or whitish. firm, transverse
rugae
 ‣ soft palate - pinkish, spongy, smooth palatine
tissues - intact
Abnormal
1. Thick white plaques on hard palate'- Candidlasis
2. Deep purple, raised or flat lesion - Kaposi sarcoma
3. Yellow tint - Jaundice
4. Cleft palate - opening in the hard palate
11. Note the odor
Normal: no unusual or foul odor
Abnormal
1. Fruity or acetone breathe - Diabetic Ketoacidosis
2. Ammonia odor - Kidney disease
3. Fecal breath - bowel obstruction/ dental caris
4. Sulfur odor (fetor hepaticus) - End-Stage Liver
Disease
12. Assess the uvula
Normal: fleshy, solid and hangs freely in midline
Abnormal
1. asymmetrical or loss of movement - stroke/CVA
2. palate fails to rise and uvula deviates - CN X
paralysis
13. Inspect the tonsils.
Normal: Present or absent; pink, symmetric, 1+
enlarged
Abnormal Red, enlarged (2,3,4+);exudates
 1+ - visible
 2+ - midway between tonsillar pillars and uvula
 3+- tonsils touch uvula
 4+- tonslls touch each other
14. Inspect posterior pharyngeal wall.
Normal: throat is pink, no lesions and exudates
AbnomaI bright red throat with whiteor yellow
exudates - pharyngitis
Nose
1. Inspect and palpate external nose.
Normal: color same with face; smooth, symmetric; no
tenderness
Abnormal: tenderness
2 Check patency of air flow through
nostrils:
Normal: able to sniff
Abnormal: swelling, rhinitis,obstruction
3. Inspect internal nose.

Normal:
 nasal mucosa - dark pink, moist, free of
exudates

 nasal septum - intact turbinates - dark pink,

moist, no lesions

Abnormal

1. Nasal mucosa is swollen, bluishnand pale - allergies,

URTI

2. Epistaxis(nosebleed)

3. UIcers or perforated septum - use of cocaine, trauma,

infection,

4.Polyps

Sinuses

1. Palpate sinuses
Normal: non-tender; no crepitus

1. Tender - acute bacterial rhinosinusitis

2. (+) crepitus, exudates - Viral URI

2. Percuss sinuses
Normal: non-tender

Abnormal
1. Tender - infection or allergies