Physical assessment

Ear, Nose, Mouth, and Throat

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Anatomy and Physiology
Review
• Internal and external ear
• Nose and sinuses
• Oral cavity
• Pharynx or throat

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Ear
• Sensory organ that functions in hearing and
equilibrium
• External ear
• Auricle or pinna
• Helix
• Tragus
• Lobule
• External auditory canal
• Lined with yellow-brown cerumen (wax)

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Ear
• Middle ear
• Tympanic membrane
• Separates external and middle ear
• Ossicles
• Malleus
• Incus
• Stapes
• Eustachian tube
• Connects middle ear and nasopharynx

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Ear
• Inner ear
• Controls equilibrium
• Hearing sensors

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Figure 16.1 External
ear.

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Figure 16.2 The three
parts of the ear.

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Nose and Sinuses
• External and internal structures of nose
• Bridge and tip of nose
• Septum and turbinates
• Function to clean, warm, moisten air
• Nasal mucosa
• Paranasal sinuses
• Mucus-lined, air-filled cavities that surround the
nasal cavity

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Nose and Sinuses
• Paranasal sinuses
• Function to clean, warm, moisten air
• Olfactory cells connect to the olfactory nerve
(cranial nerve I) and are responsible for the sense
of smell
• Another function to provide resonance for voice

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The nose

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Nasal sinuses

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Mouth
• Maxilla
• Mouth
• Teeth
• Tongue
• Gums
• Uvula

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Mouth
• Lips
• Inside of the cheeks
• Palate
• Hard palate
• Soft palate
• Mandible

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Oral cavity

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Innervation of the tongue

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Throat
• Known as pharynx
• Leads to esophagus and trachea
• Sections
• Nasopharynx
• Oropharynx
• Laryngopharynx
• Epiglottis
• Tonsils

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Special Considerations
• Age
• Developmental level
• Race
• Ethnicity
• Work history
• Living conditions
• Socioeconomics
• Emotional well-being

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Lifespan Considerations
• Infants and children
• Shorter auditory canal
• Increased incidence of otitis media
• Beginning of salivation in infants
• Development of deciduous and permanent teeth in
children
• Slightly enlarged, noninfected tonsils common in
children ages 4 to 8

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Lifespan Considerations
• The pregnant female
• Fullness or earaches
• Rhinitis
• Epistaxis
• Heightened sense of smell
• Edema of vocal cords

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Lifespan Considerations
• The older adult
• Loss of high-frequency hearing
• Gradual hearing loss (presbycusis)
• Decreased sense of taste and smell
• Decreased production of saliva
• Receding gums
• Tooth loss

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Psychosocial
Considerations
• Mouth ulcers
• Lip biting
• Involuntary muscle spasms (tics)
• Relaxation techniques may help relieve stress-
related behaviors.

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Cultural and Environmental
Considerations
• Variances among ethnic ancestry
• Cleft uvula, lip, and palate
• Occupational risk for hearing loss
• Financial constraints
• Lower socioeconomic status places children at risk
for otitis media.

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Focused Interview
• Observe patient and be active listener
• Consider in relation to normative parameters and
expectations of function as well as other factors
• Follow-up questions may be necessary.

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Secondary Sources for
Patient Data Related to the
Ears, Nose, Mouth, and
Throat

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Focused Interview
• Focused interview questions
• General
• Illness or infection
• Symptoms, pain, and behaviors
• Environment
• Internal
• External

continued on next slide

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Assessment Techniques
• Inspection
• Palpation
• Percussion
• Transillumination

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Table 16.6 (continued)
Overview of Disorders of
the Mouth and Throat

continued on next slide

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Assessment Techniques
• Inspection of the external ear
• Palpation of the auricle and tragus
• Palpation of the mastoid process
• Inspection of the auditory canal using the
otoscope
• Examination of the tympanic membrane using the
otoscope

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Assessment Techniques
• Administration of the whisper test
• Administration of the Rinne and Weber tests using
the tuning fork
• Administration of the Romberg test

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Palpating the tragus.

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 Palpating the mastoid
process.

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Pulling the pinna to
straighten the canal.

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Assessment Techniques
• Otoscope
• Auditory canal
• Inserting the otoscope
• Handle up or down
• Straightening the ear canal
• Tympanic membrane

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 Two techniques for holding and inserting an
otoscope. Otoscopic examination with otoscope
handle in downward position.

continued on next slide

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Two techniques for holding and inserting an
otoscope. Otoscopic examination with otoscope
handle in upward position.

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 Performing the whisper
test.

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Activating the tuning
fork.

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Rinne test. Bone
conduction.

continued on next slide

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Rinne test. Air conduction.

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Weber test.

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Romberg test.

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Assessment Techniques
• Nose and sinuses
• Inspection of the nose and patency testing
• Palpation of the external nose
• Inspection of the nasal cavity using a nasal
speculum
• Palpation of the sinuses
• Percussion of the sinuses
• Transillumination of the sinuses

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Inspection of the nose.

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Using the otoscope for
nasal inspection.

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 Palpating the frontal
sinuses.

continued on next slide

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Palpating the maxillary
sinuses.

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Percussion of frontal
sinuses.

continued on next slide

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Percussion of maxillary
sinuses.

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 Transillumination of the
frontal sinuses.

continued on next slide

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 Observing transillumination
of the frontal sinuses.

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 Transillumination of the
maxillary sinuses.

continued on next slide

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 Transillumination of the maxillary
sinuses using alternate technique.

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Assessment Techniques
• Mouth and throat
• Inspection and palpation of the lips
• Inspection of the teeth
• Inspection and palpation of the buccal mucosa,
gums, and tongue
• Inspection of the salivary glands
• Inspection of the throat

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Inspecting the teeth.

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Palpating the tongue.

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Inspecting the throat.

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Abnormal Findings
• Lesions
• Deformities
• Infectious processes
• Dental problems

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Table 16.6 (continued)
Overview of Disorders of
the Mouth and Throat

continued on next slide

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Table 16.6 (continued)
Overview of Disorders of
the Mouth and Throat

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