Hpa Ears, Nose, Mouth, Throat

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Physical assessment of the ears, nose, sinuses, mouth, and throat provide info about...

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neuro
resp
endocrine
GI
msk
cardio

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Sections of the ear

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external (auricle, pinna)
middle
internal

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External ear
-components
-purpose

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-components: auditory canal to TM
-purpose: receives sound waves and funnels them through the auditory canal to produce vibrations on the TM

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length and composition of external auditory canal

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2.5cm
outer third cartilage, remainder is bone covered by thin layer of skin

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purpose of tiny hairs and modified sweat glands lining external auditory canal

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produce cerumen

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normal colour of cerumen

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light skin: pale, honey colour
dark skin: dark-brown or black

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components of middle ear

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TM
ossicles
tympanic cavity

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diameter of TM

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2.5cm

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ossicles components

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malleus (hammer)
incus (anvil)
stapes (stirrup)

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purpose of ossicles

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transmit sound waves to inner ear by rapid movement

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muscles involved in movement of the ossicles

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tensor tympani - maintains tension of the TM and pulls the malleus inward when in contracts
stapedius - works in opposition by pulling stapes outward

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why are the middle ear muscles important?

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reduces intensity of sound which might otherwise result in serious damage to hearing receptors in the inner ear

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connection of middle ear to nasopharynx

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eustachian tube - where air pressure can be equalized to maintain normal hearing - aided by yawning and swallowing

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components of inner ear

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cochlea, semi-circular canals, vestibule

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vestibule

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important in hearing and balance

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semicircular canals

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3 at right angles to each other
provide equilibrium for the body

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cochlea

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small, snail shaped
3 compartments: first 2 contain perilymph and the 3rd contains endolymph
-perilymph and endolymph vibrate stimulating the hearing-receptor cells of the Corti and nerve impulses are sent to the brain

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normal hearing range

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20-20 000 Hz
1-140 dB

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safe range for loudness

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<140 dB

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components of the outer nose

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bone and cartilage
divided into 2 nasal fossae internally by septum and externally by columella
anterior openings are the nostrils

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nasal turbinates

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superior, middle, inferior
covered by mucous membranes and greatly increase the SA of muscous membrane in the nose

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Kiesselbach's plexus

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vascular area on the nasal septum which is the most common site of nosebleeds

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functions of fossae

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olfactory
respiratory - clean, filter, humidify, and control the temperature of inspired air to protect the lungs

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olfactory receptor cells

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located in upper nasal cavity superior nasal conchae, parts of nasal septum
bind odours causing nerve impulses to be transmitted to the olfactory cortex located in base of frontal lobe

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Paranasal sinuses

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air-filled cavities lined with mucous membranes
lighten the weight of the skull and and add resonance to the quality of the voice
-frontal, maxillary, ethmoid, sphenoid

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labial tubercle

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small projected area in the midline of the upper lip

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labial commissure

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area where the upper and lower lips meet

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vermillion zone

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reddish area of the lips

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philtrum

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median groove superior to the upper lips

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linear raphe

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linear ridge in the middle of the hard palate that is formed by 2 palatine bones and part of the superior maxillary bone

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frenulum

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connects tongue to floor of mouth anteriorly

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function of tongue

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helps with mastication, swallowing, speech, mechanical cleansing of teeth

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papillae

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assist in handling food
contain taste buds

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4 qualities of taste and where they are located

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sour - sides
sweet - near tip
salty - near tip
bitter - base

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sulcus terminalis

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midline depression that separates the anterior 2 thirds of the tongue from the posterior one-third

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Which glands secrete through Wharton's ducts?

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submaxillary

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Which glands secrete through Stenson's ducts?

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parotid

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amount of saliva produced/day

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1000-1500 mL

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purpose of saliva

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prevents dental caries and bacterial damage of healthy oral tissue by washing away bacteria and destroying it with antibodies and proteolytic enzymes

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Tooth composition in adults

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32 permanent teeth
4 incisors
2 canines
4 premolars
6 molars in each half of mouth

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composition of palatine tonsils

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lymphoid tissue

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Assessment of the ear

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Auditory screening
inspection and palpation of external ear
otoscopic assessment

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voice-whisper test: normal findings

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can hear from 0.6, (2 feet)

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purpose of weber and rinne tests

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to determine if the type of hearing loss the patient is experiencing is conductive or sensorineural

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what does sound lateralizing to affected ear in weber test indicate?

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unilateral conductive hearing loss - being conducted directly through bone to the ear
conductive hearing loss occurs when there are external or middle ear disorders such as impacted cerumen, perforation of the TM, serum or pus in middle ear, fusion of the ossicles

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what does sound lateralizing to unaffected ear in weber test indicate?

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sensorineural loss related to nerve damage in the impaired ear
sensorineural hearing loss occurs when there is a disorder in the inner ear, the auditory nerve, or the brain. disorders include congenital defects, effects of ototoxic drugs, and repeated or prolonged exposure to loud noise

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normal findings: Rinne Test

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air conduction is heard twice as long as bone conduction when the patient hears the sound through the external auditory ear canal after it is no longer heard at the mastoid process (AC>BC)

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Rinne test: bone conduction heard equal to or longer than air

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conductive hearing loss resulting from disease, obstruction, or damage to the outer or middle ear

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Rinne test: sensorineural loss - AC>BC but not 2:1

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conductive part in tact, cochlear nerve less able to transmit impulses regardless of how vibrations reach the cochlea - correlate with history

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Normal otoscopic findings

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no redness, swelling, tenderness, lesions, drainage, foreign bodies
tympanic membrane is pearly grey with well-defined landmarks
light reflex is 5 o'clock in R ear and 7 o'clock in L ear
tympanic membrane moves when patient blows against resistance

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abnormal otoscopic findings

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chalky patches on tympanic membrane
severe pain
redness, swelling, narrowing, pain
drainage
hard, dry, very dark yellow cerumen
reddened tympanic membrane

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risk factors for otitis media

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less than 2 years of age
frequent URIs
cold weather
male gender
Caucasians, Native Americans, Alaska natives
family history
smoky environment
bottle fed
Down Syndrome
craniofacial disorders

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hearing loss risk factors

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noise exposure
smoking
ototoxic drugs
congenital or heredity
CVD
aging
tumours
trauma
chronic infection
systemic disease
TM perforation
Meniere's disease
barotrauma

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abnormal finding: nostril not patent

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deviated septum
foreign body
URI
allergies
nasal polyps

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absence of glow in transillumination of sinuses

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congestion or congenital absence of sinus

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extremely bright glow in transillumination of sinuses

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decreased subcutaneous fat in elderly person

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mouth assessment

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breath
lips
tongue
buccal mucosa
gums
teeth
palate

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abnormal mouth findings

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lesions, growths
dry, cracked lips
vesicles or blisters
red, tender, inflamed tongue, gums, buccal mucosa
thrush
coating on tongue
red, tender, swollen gingiva
bleeding gums

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halitosis

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symptom of tooth decay, poor oral hygiene, diseases of the gums, tonsils, or sinuses

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breath smells of acetone

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malnourished
diabetic ketoacidosis
low carb diet

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breath smells musty

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fector hepaticas - liver failure - break down of nitrogen compounds

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breath smells of ammonia

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end-stage renal failure because of inability to eliminate urea

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normal colour of oral mucosa

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blacks - bluish
whites - pink

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grading of tonsils

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1+ visible
2+ between pillars and uvula
3+ touching uvula
4+ one or both tonsils extend to midline of oropharynx

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abnormal throat findings

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posterior pharynx is red with white patches
tonsils and uvula are red and swollen
hoarse voice
grayish membrane covering tonsils, uvula, soft palate

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gerontological variations

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presbycusis
diminished sense of smell and taste
lesions
periodontal disease
oral alterations due to disease or side effects of medications
tooth loss