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106 Cards in this Set
- Front
- Back
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Anatomy and Physiology: Ears: Function
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Sensory organ - identifies, locates, and interprets sound; maintains equilibrium
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Anatomy and Physiology: Ears: Three parts
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External
Middle Inner |
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Anatomy and Physiology: Ears: External structures
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Auricle
External auditory canal |
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Anatomy and Physiology: Ears: External functions
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Protective
Helps gather/channel sound |
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Anatomy and Physiology: Ears: Inner ear structures
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Semicircular canals
Cochlea |
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Anatomy and Physiology: Ears: Inner ear functions
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Cochlea transmits sound to eighth CN
Semicircular canals involved in vestibular function |
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Hearing is interpretation of ________ that travel through the ear to the brain
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Hearing is interpretation of SOUND WAVES that travel through the ear to the brain
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Sound also transmitted by _____ directly to inner ear
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Sound also transmitted by BONE directly to inner ear
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Anatomy and Physiology: Nose/Nasopharynx Functions
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Odor identification
Passage of inspired and expired air Humidification/filtration/warmth of inspired air Resonance of laryngeal sounds |
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Anatomy and Physiology: Nose/Nasopharynx Structures: External Nose
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External nose
Bone Cartilage Nares |
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Anatomy and Physiology: Nose/Nasopharynx Structures:SInuses
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Maxillary
Frontal Ethmoid Sphenoid |
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Anatomy and Physiology: Nose/Nasopharynx Structures: Internal nose
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Internal nose
Septum Turbinates Cribriform plates Kiesselbach plexus Adenoids |
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Cribiform plate
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superior wall of the nose, seperates the nose from the brain.
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Anatomy and Physiology: Mouth/Oropharynx Functions
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Emission of air for vocalization/non-nasal expiration
Passage for food, liquids, saliva Initiation of digestion by mastication and salivary secretion Taste |
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Anatomy and Physiology: Mouth/Oropharynx Structures: Mouth
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Tongue
Teeth Gums Uvula Hard/soft palates |
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Anatomy and Physiology: Mouth/Oropharynx Structures: Vestibule
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XXX
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Anatomy and Physiology: Mouth/Oropharynx Structures: Salivary Glands
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Parotid
Submandibular Sublingual |
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Anatomy and Physiology: Mouth/Oropharynx Structures: Oropharynx
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Tonsils
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Anatomy and Physiology: Infants/Children
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Inner ear development in first trimester
Infants external auditory canal shorter than adults Infants eustachian tube wider, shorter, more horizontal than adults Salivation increases by 3 months Maxillary/ethmoid sinuses present at birth Sphenoid sinus not fully developed until puberty Frontal sinus develops by 7-8 years Deciduous teeth appear between 6-24 months Permanent teeth appear between 6-15 years Third molars appear about age 18 |
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Anatomy and Physiology: Pregnant Women
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Capillaries nose, pharynx, ears engorge
Nasal stuffiness/fullness in ears Decreased smell/impaired hearing Epistaxis Increased Vascularity/overgrowth of gums Laryngeal changes Hoarseness/cough Vocal changes |
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Anatomy and Physiology: Older Adults: Ears
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Hair cells degenerate, stapes ossify
Hearing deteriorates Striae vascularis atrophy Sensorineural hearing loss Striae vascularis is a part of the cochlea, genetically becomes atrophied. TM becomes sclerotic Conductive hearing loss Cerumen becomes dry Obstructs ear canal |
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Anatomy and Physiology: Older Adults: Nose
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Continuing cartilage formation in ear/nose
Ears and nose larger/more prominent |
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Anatomy and Physiology: Older Adults: Mouth
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Mouth soft tissue changes
Cheeks more prominent Gingival tissue less elastic/more vulnerable to trauma Altered motor function of tongue Difficulty swallowing Saliva production decreases Lost teeth Difficulty chewing Sensitivity to odors declines Decreases taste |
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Related History: Present Problem: Dizziness or Vertigo
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Time of onset, duration of attacks
Description of attack Associated symptoms Unsteadiness, loss of balance, falling Syncopal/presyncopal Vertigo Light headedness Medications |
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Related History: Present Problem: Earache
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Onset, duration, pain, fever, discharge
Concurrent URI, frequent swimming, trauma to head Related complaints Medications |
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Related History: Present Problem: Hearing Loss
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Risk factors
Onset Cerumen impaction Environment for best hearing Word discrimination/garbled sounds Speech Management Medications |
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Related History: Present Problem: Nasal Discharge
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Character
Associated symptoms Seasonality of symptoms Tenderness over sinuses/face pain/headache Postnasal drip/daytime cough Medications |
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Related History: Present Problem: Snoring
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Change in snoring pattern
Complaints of snoring loudness by partner Obstructive apnea Medications |
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Related History: Present Problem: Nosebleed
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Frequency/amount of bleeding
Nasal obstruction Treatment/difficulty stopping the bleeding Predisposing factors Site of bleeding Medications |
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Related History: Present Problem: Dental Problems
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Pain
Tooth grinding Temporomandibular joint problems Swollen/bleeding gums/mouth ulcers/tooth loss Dentures/dental appliances Malocclusion Medications |
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Related History: Present Problem: Mouth lesions
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Timing/duration
Pain Dryness of mouth/halitosis Associated factors Tongue character Medications |
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Related History: Present Problem: Sore throat
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Pain with swallowing
Associated with URI symptoms Postnasal drip Mouth breathing Exposure to dry heat/smoke/fumes Hoarseness Medications |
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Related History: Present Problem: Difficulty swallowing
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Solids/liquids
Tightness/substernal fullness Vomiting Drooling Aspiration when swallowing Swallowed liquids coming out of nose Dysphagia |
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Related History: Past Medical History: Systemic disease
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XX
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Related History: Past Medical History: Ear
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Childhood problems
Surgery Labyrinthitis Antibiotic use |
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Related History: Past Medical History: Nose
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Trauma/surgery
Chronic nosebleeds |
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Related History: Past Medical History: Sinuses
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Chronic postnasal drip
Repeated sinusitis/allergies |
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Related History: Past Medical History: Throat
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Frequent strep infections
Tonsils and adenoids |
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Related History: Family History
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Hearing problems or hearing loss
Ménière’s disease Allergies Hereditary renal disease |
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Ménière's disease
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is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. It is named after the French physician Prosper Ménière, who, in an article published in 1861, first reported that vertigo was caused by inner ear disorders. The condition affects people differently; it can range in intensity from being a mild annoyance to a chronic, lifelong disability.[2]
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Related History: Personal/Social History
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Environmental hazards
Nutrition Oral care patterns Tobacco use Alcohol use Intranasal use of cocaine |
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Related History: Infants/Children
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Prenatal history
Prematurity Erythroblastosis fetalis Infection Breast feeding Secondary tobacco smoke exposure Child care Congenital defect Playing with small objects Behaviors indicating hearing loss Dental care/# teeth Thumb sucking/pacifier use |
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Hemolytic disease of the newborn
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also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis fetalis,[1] is an alloimmune condition that develops in a fetus, when the IgG molecules (one of the five main types of antibodies) produced by the mother pass through the placenta. Among these antibodies are some which attack the red blood cells in the fetal circulation; the red cells are broken down and the fetus can develop reticulocytosis and anemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis)
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Related History: Pregnant Women
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Weeks gestation/postpartum
Presence of symptoms before pregnancy Symptoms suggestive of pathology Pattern of dental care |
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Related History: Older Adults
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Hearing loss/hearing aid
Physical disability Deterioration of teeth/difficulty chewing/dentures Dry mouth Medications that decrease salivation |
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Exam & Findings: Equipment
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Otoscope with pneumatic attachment
Nasal speculum Tongue blades Gauze Gloves Penlight/sinus transilluminator/light from otoscope Vials with different odors (e.g., mint, banana, coffee) |
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Exam & Findings: Ears External Exam: Inspect auricles
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Size/shape/symmetry
Landmarks/position on head Color Presence of deformities/lesions/nodules |
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Exam & Findings: Ears External Exam:Inspect external auditory canal
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Discharge/odor
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Exam & Findings: Ears External Exam:Palpate auricles/mastoid area
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Palpate for
Tenderness/pain Swelling Nodules Consistency of auricle should be firm and mobile, without nodules |
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Exam & Findings: Ears Otoscopic Exam
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Used to inspect external auditory canal and middle ear
Inspect auditory canal from meatus to TM Discharge Redness Scaling Lesions Foreign bodies Cerumen Inspect TM Landmarks Color Contour Perforation Use pneumatic attachment and evaluate Mobility/compliance of TM |
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Exam & Findings: Ears Hearing Evaluation
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Evaluate auditory function
Response to questions/directions Whispered voice test Compare air to bone conduction Weber test Rinne test Distinguish type of hearing loss Sensorineural Conductive Refer patients with loss for thorough auditory exam |
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Whispered Voice Test
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XX
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Weber Test
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XX
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Rinne Test
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XX
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Sensorneural
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XXX
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Conductive
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XXX
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Exam & Findings: Nose/Nasopharynx External Exam: Inspect nose/nares
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Nose for shape/size/color
Nares for flaring/narrowing/discharge |
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Exam & Findings: Nose/Nasopharynx External Exam: Palpate nose
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Displacement of bone/cartilage
Tenderness Masses |
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Exam & Findings: Nose/Nasopharynx External Exam: Evaluate patency of nares
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ZXXX
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Exam & Findings: Nose/Nasopharynx Speculum Exam: Inspect nasal mucosa
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Color
Discharge Masses/lesions Swelling of turbinates |
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Nose/Nasopharynx Speculum Exam: Inspect nasal septum
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Position/straightness/thickness
Perforations/bleeding/crusting |
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Exam & Findings: Nose/Nasopharynx
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Test sense of smell by recognition of different odors
Palpate frontal/maxillary sinuses for swelling Percuss sinuses for tenderness |
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Exam & Findings: Mouth/Oropharynx: Inspect/palpate lips
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Symmetry
Color Edema Surface abnormalities |
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Exam & Findings: Mouth/Oropharynx: Inspect teeth
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Alignment
Color/stains Numbers/missing teeth Wear/notches/caries |
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Exam & Findings: Mouth/Oropharynx: Inspect buccal mucosa
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Color
Moisture Ulcers Fordyce spots Plaque Leukoplakia |
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Exam & Findings: Mouth/Oropharynx: Inspect gums/gingiva
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Color
Moisture Swelling/bleeding |
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Exam & Findings: Mouth/Oropharynx: Palpate gums
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Lesions
Induration Thickening/masses Tenderness |
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Exam & Findings: Mouth/Oropharynx: Inspect tongue
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Swelling
Size/color Variations/Symmetry Coating Ulceration Movement |
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Exam & Findings: Mouth/Oropharynx: Inspect floor of mouth/ventral surface of tongue
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Swelling/varicosities
Frenulum Sublingual ridge Wharton ducts |
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Exam & Findings: Mouth/Oropharynx: Palpate tongue
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Lumps/nodules
Ulceration |
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Exam & Findings: Mouth/Oropharynx: uvula, oropharynx
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Inspect palate/uvula
Evaluate movement of soft palate (CN X) Inspect oropharynx with tongue blade Tonsillar pillars Retropharyngeal wall Elicit gag reflex (CN IX) |
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Wharton ducts
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empty salivary glands
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CN X
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vagus;
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CN IX
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Glossopharyngeal
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Exam & Findings: Additional Procedures: Rhomberg test
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Evaluate equilibrium
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Exam & Findings: Additional Procedures: Barany test
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If imbalance detected
Nylen-Baranys Test: full baranys with evaluation of nystagmus. Modified baranys for labrynthitis. |
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Exam & Findings: Additional Procedures: transillumination of sinuses
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Perform transillumination of sinuses if tenderness present
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Exam & Findings: Infants: Ears
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Inspect auricle for full formation/flexibility
Auditory canals should be examined first few weeks of life TM becomes conical after 1st months Evaluate infant hearing using sound stimuli |
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Exam & Findings: Infants: Nose and Sinuses
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Inspect for symmetry/positioning
Determine nasal patency Exam of sinuses unnecessary |
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Exam & Findings: Infants: Mouth
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Inspect lip shape and irregularities
Inspect buccal mucosa color/moisture Observe for drooling Inspect gums/teeth/tongue Inspect palatal arch/soft palate Evaluate suck reflex |
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Exam & Findings: Children: when to perform the otoscopic/oral exam
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Perform otoscopic/oral exam at end of PE
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Exam & Findings: Children: Ears
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Pull auricle down to view TM on exam
Evaluate toddler’s hearing by observing response to whispering, noisemakers Evaluate speech development Do Weber, Rhinne after age 3 Audiometry should be performed on all newborns |
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Exam & Findings: Children: Noses and Sinues
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Sinuses may be palpated but sinuses are developing
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Exam & Findings: Children: Mouth
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Inspect teeth for grinding/decay/brown spots
Check gag reflex Inspect tonsils/epiglottis |
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Exam & Findings: Pregnant Women
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Inspect nose/pharynx for edema/erythema
Inspect TMs for retraction/bulging Inspect gums for hypertrophy Inspect for nasal congestion and sinusitis |
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Exam & Findings: Older Adults: Ears and Hearing
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If hearing aid is worn, inspect auditory canal for irritation
Inspect for coarse hair on auricle Inspect TM for sclerotic changes Note presence of presbycusis/conductive hearing loss Inspect for cerumen impaction |
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Exam & Findings: Older Adults: Nose
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Look for dry mucosa
Inspect for increased hairs in vestibule in men |
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Exam & Findings: Older Adults: Mouth
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Look for reduced salivary flow
Check for thinning buccal mucosa Examine tongue for fissures, varicose veins Examine dentures for occlusion |
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Presbycusis
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sensironeural hearing loss of aging. Most pronounced in a room with a lot of background noise. Consider this during your evaluation. Difficulty hearing consonants.
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Common Abnormalities: Ear: Otitis externa
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XXX
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Common Abnormalities: Ear: Acute otitis media
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XXX
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Common Abnormalities: Ear: Middle ear effusion
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XXX
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Common Abnormalities: Ear: Cholesteatoma
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XXX
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Common Abnormalities: Ear: Otosclerosis
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XXX
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Common Abnormalities: Ear: Ménière’s disease
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XXX
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Common Abnormalities: Ear: Labyrinthitis
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XXX
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Common Abnormalities: Nose/Sinuses: Sinusitis
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Discuss differences between allergic, bacterial and viral sinusitis
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Common Abnormalities: Nose/Sinuses: Cocaine abuse
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Cocaine abuse look for ulceration to the septum. Explain mechanism, vasoconstriction.
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Common Abnormalities: Mouth/Oropharynx: Tonsillitis
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XXX
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Common Abnormalities: Mouth/Oropharynx: Peritonsillar abscess
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XXX
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Common Abnormalities: Mouth/Oropharynx: Sleep apnea
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XXX
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Common Abnormalities: Infants/Children: Cleft lip/palate
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XXX
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Common Abnormalities: Older Adults: Presbycusis
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Age related hearing loss
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Common Abnormalities: Older Adults: Xerostomia
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Dry Mouth
Medication related Arthritis Scleoderma Sjogren syndrome Xerostomia: dry mouth, can be medication related (anticholinergics/antidepressants), rheumatiod arthritis, and other systemic diseases. |
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Weber
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Lateralization
Which ear can they hear it better on Conductive to the effected ear Conductive: effusion, cerumen impaction Sensorineural to the uneffected ear Sensorineural: defect in the inner ear or interpretation of sounds. |
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Rinne
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Air vs Bone Conduction
2:1 normal Conductive Bone greater then Air Sensorineural Air greater then bone less then 2:1 Normal if bone heard for 15 seconds then air should be for an additional 15 seconds. |
