EARS AND HEARING

NORMAL ANATOMY OF EAR

ABNORMAL FINDINGS
FOREIGN BODY

• Most frequently seen in

children
• Sense of fullness
• Decreased hearing
• Hearing movement of the
insect
• Severe pain
INFECTION
• Acute otitis Media
• group of inflammatory diseases of the
middle ear. The two main types are
acute otitis media (AOM) and otitis
media with effusion (OME). AOM is an
infection of abrupt onset that usually
presents with ear pain
• Otitis externa
• also called swimmer's ear, is
inflammation of the ear canal. It often
presents with ear pain, swelling of the
ear canal, and occasionally decreased
hearing. Typically there is pain with
movement of the outer ear.
HEARING LOSS
• Conductive hearing loss
• occurs when there is a problem conducting
sound waves anywhere along the route
through the outer ear, tympanic membrane
(eardrum), or middle ear (ossicles)
• Sensorineural hearing loss
• is a type of hearing loss, or deafness, in which
the root cause lies in the inner ear or sensory
organ (cochlea and associated structures) or
the vestibulocochlear nerve (cranial nerve
VIII)
TEST USED TO EVALUATE AUDITORY
FUNCTION
• WEBER’S TEST
• The tuning fork is placed on the midline of the skul
• Conduction loss- sound lateralizes to the defective ear
• Sensorineural loss- sound lateralizes to unaffected ear
• RINNE TEST
• The tuning fork is placed on the mastoid bone for bone conduction and
placed in front of the ear for air conduction
• Conduction loss- will hear bone conduction longer than air conduction
• Sensorineural loss- will hear air conduction longer than bone conduction
MOUTH
ABNORMAL FINDINGS
• Plaque
• Invisible soft film that adheres to the
enamel surface of teeth which
consist of bacteria, molecules of
saliva and remnants of epithelial cells
and leukocytes
• Tartar
• Visible hard deposit of plaque and
bacteria that forms at the gum lines
INFLAMMATION/
INFECTION
• Herpes simplex type 1(cold
sore)
• Prodromal burning, tingling
or pain sensation before the
outbreak of the lesion
• Gingivitis
• Inflammation of the gingiva
• Hyperplasia of the gums,
erythema and bleeding with
manipulation
• Tonsilitis
• Infection of the tonsils
• Sore throat, odynophagia,
fever, chills and tender
cervical lymph nodes
• Parotitis
• Inflammation of the parotid
salivary gland
• Glossitis
• Inflammation of the
tongue

• Candidiasis (oral thrush)

• Caused by candida
albicans
• Appears as soft white
plaques on the tongue,
buccal mucosa or
posterior pharynx
NOSE AND SINUSES
ABNORMAL FINDINGS

• Epistaxis
• Bleeding from the nose
 INFLAMMATIONS
• Allergic rhinitis
• Inflammation of the nasal
mucosa
• Rhinophyma
• Hypertrophy of the nose caused
by rosacea
• Pronounced flushing reactions
especially in response to heat,
emotional stimuli, alcohol, hot
drinks or spicy food
• Acute sinusitis
• Infection of sinuses that
typically occurs as a result of
pooling of secretions within the
sinuses
• Throbbing pain- affected sinus,
tender to palpate, thick
purulent discharge, edematous,
erythematous nasal mucosa
Nasal speculum
 ASSESSMENT SKILL RATING

1. Perform hand-washing.
2.Gather equipment

(gloves, cotton gauze pads, penlight speculum otoscope, tongue

blade)
3. Explain the procedure to client.
MOUTH

1. Inspect the lips. Observe lip consistency and color

Scor Equivalent Description
2.Inspect the teeth and mouth. Ask the client to open the
mouth. Scor Equivalent
e e
Note number of teeth, color, and condition. Note any repairs
such as crowns and any cosmetics.
3. Ask the client to bite down as though chewing on something
and note 10
84 1 Very Satisfactory
alignment of the lower and upper jaws.
4. Put on gloves and retract the client's lips and cheeks to check
gums for color and consistency.
47-50 3.25
5. Inspect the buccal mucosa. Use a penlight and tongue
depressor to retract the lips and cheeks to check color and
consistency. Also note for Stenson's ducts.
6. Inspect and palpate tongue. Ask the client to stick out the
tongue.
80- 1.25  Inspect for color, moisture, size and
texture. Observe for fasciculations and 43-46 3.5
83 
check for midline protrusion.
Palpate any lesion
7. Assess the ventral surface of the tongue.
 Ask the client to touch the tongue to the
roof of the mouth, and use a penlight to
inspect the ventral surface of the tongue,
76- 1.5 
frenulum and area under the tongue.
Palpate the area if you see lesions.
38-42 3.75
79 8. Inspect for Wharton's ducts.

9. Observe the sides of the tongue. Use a square gauze pad to

hold the client's tongue to each side. Palpate any lesions, ulcers
or any nodules for induration.
72- 1.75 Good
Rating Scale
10. Check for strength of the tongue. Place your fingers on the 34-37 4
\ 75
College of Nursing Document Code CON- CODE
external surface of the client's cheek. Ask the client to press
the tongue's tip against the inside of the cheek to resist
pressure from your fingers. Repeat on the opposite cheek.

11. Check the anterior tongue's ability to taste.

0-Not observed
EVALUATION TOOL 4.25 Revision No. 1 P
12. Inspect the hard and soft palates and uvula. Observe for
color and integrity.

68- 2 13. Note the odor of the mouth 30-33

71
1-Needs Improvement a
14. Assess the uvula. Note the characteristics and positioning of
the uvula.

15. Inspect the tonsils. Inspect the tonsils for color, size and

g
presence of exudates or lesions. Grade the tonsils

16. Inspect the posterior pharyngeal wall. Observe the color of

the throat
2-Satisfactory
63- 2.25 26-29 4.5
e
note any exudate or lesions.

17. Before inspecting the nose, discard gloves and perform

67 hand hygiene.

3-Very Satisfactory
Total
NOSE

1. Inspect and palpate the external nose. (note for color, shape
consistency
tenderness).
Effectivity Date January 2020
59- 2.5 2.Check Needs
patency of the air flow through the nostrils
(occlude one nostril at a time and asking client to sniff)
21-25 4.75
62 3. Inspect the internal noseImprovement
(use an otoscope or nasal speculum
and pers?
use your non dominant hand to stabilized and gently tilt the
client's head back.

55- 2.75 SINUSES

20 and
58 1.Palpate the frontal sinuses by using your thumbs to press up below
on the brow on each side of the nose.

2. Palpate the maxillary sinuses by pressing with thumbs up on

the maxillary
5
sinuses.

51- 3 3.Percuss the sinuses. Lightly tap over the frontal sinuses and
over the
maxillary sinuses for tenderness
54 4. Trans illuminate the frontal sinuses by holding a strong,
narrow light source snugly under the eyebrows (the room
should be dark).
Repeat for the other sinus

5.Transilluminate the maxillary sinuses by holding a strong,

narrow light source over the maxillary sinus and asking the
client to open his mouth. Repeat for the other maxillary sinus.

Total
Grand Total