ear

Physical Examination

Ear, Nose, Mouth and Throat

COMPETENCIES

* 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.

*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.

General Approach to Ears, Nose, Mouth, and Throat

1. Greet the patient and explain the assessment techniques

that using.

2. Use a quiet room that will be free from interruptions.

3. Ensured that the light in the room provides sufficient

brightness adequate observation of the patient.

4. Place the patient in an upright sitting position or for patients who cannot tolerated he sitting position assess head so that it can be rotated from side to side

5. Visualize the underlying structures during the assessment allow adequate description of findings.

6. Always compare right and left ears, as well as right and left nose, sinuses, mouth, and throat..

Equipment

Otoscope with earpieces of different

sizes and pneumatic attachment

Nasal speculum

Penlight

Tuning fork (512)Hz

Tongue blade

Watch

Gauze square

Clean gloves

Transilluminator

Cotton-tipped applicator

Sings & Symptoms:

-History of hearing problem

-Family history

-Medication history

-Ringing in ears hearing difficulty ,onset ,factors contributing to it, and how it interferes with living activities of daily , corrective hearing device

-Pain ,discharge , and lesion

AURICLES

Inspect the auricle for colors, symmetry of size and position 'To inspect position . Note the level at which the superior aspect of the auricle attach to the head in relation to the eye

Normal :

-Color same as facial skin

-Symmetrical

-Auricle aligned with outer canthus of eye, about 10" from vertical.

Abnormal:

-Bluish color of earlobes(cyanosis) pallor( cold weather)excessive

redness (inflammation or fever)

-Asymmetry

-Low-set( associate with congenital abnormality as Downs syndrome

Palpate the auricles for texture' lasticity,

and tenderness'

- Gent pull he auricles up-down and back war '

- Fold the Pinna forward (it should recoil).

- apply pressure on the mastoid

Normal

Mobile, firm , and not tender pinna recoils after it is folded

Abnormal

Lesions , scaly skin ,tenderness (infection of external ear)

External Ear Canal :

Using anotoscop inspect the external ear canal for cerumen, skin lesion ,pus or blood

Normal: pink in color , dry , hairy , dry yellow or brow cerumen , free of discharge blood and lesion

Abnormal :Redness , discharge excessive cerumen or lesion

Inspect tympanic membrane :

Color: gray , shinny ,semitransparent

Abnormal :Pink or red ,blue bleeding , yellow infection with dull surface

Hearing acuity :

1- Assess client responses to normal voice :

audible

Abnormal: request for repeat , lean, cups ear

2- Watch tick test : able to hear ticking in both ear

Abnormal: unable to hear

3- Tuning fork test :

Weber’s test

Rinne test

Romberg test

Mouth & Oropharynx

Equipmen t Needed

1. Penlight

2. Tongue blade

3. Small gauze (2*2)

4. Clean gloves

Preparation:

1. Position the client sitting up straight with his \her head

at your eye level.

2. Remove client's dentures if available

Subjective data:

I. Sores & Lesions

2.Sore Throat

3. Bleeding gum.

4. Toothache

5. Hoarseness

6. Dysphagia

7. Altered taste

8. Smoking, Alcohol

consumption

9. Self-care behaviors,

dental care pattern,

dentures or appliances

Inspection & palpationlips

Normal Findings

Color: in white skin Pink , in dark skin: may have bluish hue or freckle like pigmentation.

Movement: symmetrical during smile , open and close . No lesions, swelling, drooping , its moist and smooth Wearing gloves, 
inspect & palpate lips for the following:

The patient's teeth should be clean with no decay, appear white and shiny smooth surfaces and edges. Adults should have a total of 32 teeth with 16 teeth in each arch. Children by the age of 2 1/2 have a total of 20 teeth with 10 in each arch.

Abnormal findings

Missing teeth, loose or broken teeth and misaligned teeth. 

Wearing gloves,
inspect & palpate buccal mucosa for the following:

Color: Pink (increased pigmentation often noted in dark-skinned client

Consistency : Smooth, moist, without lesions

Landmarks : Parotid duct openings are seen small papilla located near upper second molar Retract client's lips to inspect & palpate gums for the following:

Color : pink

Consistency : Moist, free of lesion and ulcer ,pale or yellow defined in gingivitis

Inspect protruded tongue for the following:

Symmetry & texture and color moist; papillae present;

symmetrical appearance; midline fissure present ,pink ,smooth Inspect ventral surface of the tongue & mouth floor for

the following:

Color: pink slightly pale

Landmarks: Submandibular duct openings are located on both sides of the frenulum , tongue is free of lesions or increased redness; frenulum is centered.

Palpate inspected the site of tongue: pink , moist ,free of lesion and ulcer

Inspect hard & soft palate for the following:

Color & consistency : hard palate is pale irregular while soft palate is pink and soft , spongy

Inspect oropharynx for the following:

Color : pink

Landmarks : Tonsillar pillars symmetrical;

tonsils present (unless urgically removed) &

without exudates; uvula at midline & rises on phonation.

Grading of Tonsils :

0 : tonsils not visible

1+ tonsils are visible,

2+ tonsils are between the pillars

and uvula

3+ tonsils are touching the uvula

4 + tonsils extend to the midline of

the oropharynx.