Ears nose mouth throat
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Ears, Nose, Mouth, Throat. Ears. Summary of any symptom should include PQRSTU. P= provocative or palliative Q= quality or quantity R= region or radiation S= severity scale T= timing (onset, duration, frequency) U= understand client’s perception. Anatomy.

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Ears, Nose, Mouth, Throat

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Ears nose mouth throat

Ears, Nose, Mouth, Throat


Ears nose mouth throat

Ears


Summary of any symptom should include pqrstu

Summary of any symptom should include PQRSTU

  • P= provocative or palliative

  • Q= quality or quantity

  • R= region or radiation

  • S= severity scale

  • T= timing (onset, duration, frequency)

  • U= understand client’s perception


Anatomy

Anatomy

The ear is responsible for hearing and balance

Consists of 3 regions

External ear

Middle ear

Inner ear


Structure and function

Structure and Function

  • External Ear – auricle/pinna

    movable cartilage and skin

    Mastoid process= important Landmark

  • External Auditory Canal – the opening in the external ear; cul-de-sac 2.5 to 3 cm. Long in adult and ends at the eardrum.

    • Lined with glands that secrete cerumen


External ear

External Ear

2 types of cerumen

Whites and blacks – wet, sticky, and honey colored

Asians and Native Americans – dry and flaky

Lubricates & protects

Moves to meatus with chewing & talking

Outer 1/3 of canal is cartilage, inner 2/3 consists of bone covered with skin


External ear1

External Ear

  • Tympanic membrane (eardrum) separates external and middle ear.

    • Translucent membrane

    • Pearly, gray color

    • Cone of light reflection when using otoscope

    • Oval and slightly concave shape, pulled in at center by malleus


External ear2

External Ear

  • Malleus (hammer) – one of the middle ear ossicles

    • 3 parts

      • Umbo, manubrium short process, may show through the drum

    • Lymphatic drainage of the external ear flows into

      • Parotid, mastoid, superficial cervical nodes


Middle ear

Middle ear

  • Tiny air–filled cavity in the temporal bone contains:

    • Auditory ossicles (bones)

      • Malleus

      • Incus

      • Stapes

    • Openings to

      • Outer ear covered by tympanic membrane

      • Inner ear = oval and round windows

      • Eustachian tube connects middle ear to the nasopharnyx for air passage (normally closed, opens with swallowing/yawning)


Middle ear has 3 functions

Middle ear has 3 functions

  • Conducts sound vibration from outer ear to inner ear

  • Protects the inner ear by reducing the amplitude of loud sounds

  • Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes)


Inner ear

Inner Ear

  • Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium

    • Vestibule

    • Semicircular canals

    • Cochlea (contains the central hearing apparatus)


Function of hearing

Function of hearing

  • 3 levels

    • Peripheral – ear transmits sound and converts its vibrations into electrical impulses that can be analyzed by the brain. The electrical impulses are conducted by the auditory process of cranial nerve VIII (Acoustic) to the brain stem

      • Amplitude=loudness

      • Frequency=pitch


Ears nose mouth throat

  • Sound waves cause the eardrum to vibrate

  • Vibrations travel via the ossicles thru the oval window, the cochlea and are scattered against the round window

  • The basilar membrane of the cochlea contain the organ of Corti receptor hair cells that translate the vibrations to electric impulses

  • The impulses go to the brainstem via Acoustic nerve (VIII)


Ears nose mouth throat

  • Brain stem – function is binaural interaction – permits identification of sound and locating the direction of a sound in space. The acoustic nerve (Cranial nerve VIII) sends signals from each ear to both sides of the brain stem. Brainstem is sensitive to intensity & timing from the ears depending on head position


Ears nose mouth throat

  • Cerebral cortex – interprets the meaning of the sound and begins the appropriate response


Pathways of hearing

Pathways of hearing

  • Air conduction (AC)– normal pathway of hearing, the most efficient

  • Bone conduction (BC)– bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve


Hearing loss

Hearing loss

  • Conductive – mechanical dysfunction of the external or middle ear resulting in partial hearing loss (if ↑ amplitude to reach nerve elements in inner ear, person can hear)

    • Causes= impacted cerumen, FB, perforated eardrum, pus/bld in the middle ear, otosclerosis


Hearing loss1

Hearing loss

  • Sensorineural ( perceptive) – pathology of the inner ear, acoustic nerve or auditory areas of the cerebral cortex. ↑ amplitude may not help

    • Causes= Presbycusis, a nerve degeneration due to aging (50yrs) or ototoxic drugs

  • Equilibrium – labyrinth feeds info to the brain about the body’s position in space, inflammation causes vertigo.


Subjective data

Subjective data

  • Earaches

  • Infections- otitis media

  • Discharge

  • Hearing loss

  • Environmental noise

  • Tinnitus- ototoxic: ASA, Aminoglycosides (gentamicin) etc.

  • Vertigo

  • Self care behaviors


Objective data

Objective data

  • External ear = Inspect and Palpate

    • Size and shape

    • Skin condition

    • Tenderness- pinna & tragus; mastoid process

    • External auditory meatus- cerumen


Inspect using otoscope

Inspect using Otoscope

  • Pull pinna up & back for adult/older child

  • Pinna down for infant & ↓ 3yrs. Maintain hold on pinna until exam is complete.

  • Avoid inner, bony section of canal= sensitive to pain

  • Can angle otoscope towards nose


Inspect using otoscope1

Inspect using Otoscope

  • External canal

    • Color

    • Swelling

    • Lesions

    • Discharge ; color and odor. Clean or change speculum before examining other ear.


Ears nose mouth throat

  • Perform the otoscope exam prior to hearing tests.


Ears nose mouth throat

  • The following slide show a furuncle which is an infected hair follicle


Tympanic membrane

Tympanic membrane

  • Color – normal is shiny, translucent, pearl-grey

  • Characteristics – landmarks; umbro, manubrium, and short process

  • Position – flat, slightly pulled in at the center and flutters when person holds nose and swallows

  • Integrity of membrane – intact? Scarring = dense white patch


Hearing tests

Hearing tests

  • Begins with the history-Conversational tone

  • The following tests may indicate the presence of hearing loss but not the degree.


Hearing tests1

Hearing tests

  • Voice– place a finger on the tragus of one ear and while rapidly pushing it in and out of the meatus, place your head 1 –2 feet from your client’s other ear, shield your lips and whisper a 2 syllable word. Repeat on the opposite ear using another word, have the client identify the words (Used to detect high-tone loss)


Ears nose mouth throat

  • Normal Response to Voice test

    • Correct identification of whispered words bilaterally


Ears nose mouth throat

  • Tuning fork tests- measure hearing by AC and BC

    • To activate the tuning fork, hold it by the stem and strike the tines softly on the back of the hand

  • Weber test – used when hearing is reported as better in one ear than other (bone conduction)


Ears nose mouth throat

  • Normal finding for the Weber test is

    • Tone heard = loud bilaterally

      If sound lateralizes to one ear it indicates conductive or sensorineural loss.


Ears nose mouth throat

  • Rinne test – compares bone conduction and air conduction

    • Normally sound is heard 2X as long by air conduction as by bone conduction

    • Normal response ; positive Rinne Test = AC>BC Bilaterally

      Sound is heard longer by BC with a conductive loss.


Ears nose mouth throat

Weber test

Rinne test


Nose throat and mouth

Nose, Throat and Mouth


Ears nose mouth throat

Nose

  • First segment of the respiratory system

  • Warms, moistens and filters inhaled air

  • Sensory organ for smell


External parts

External parts

  • Bridge

  • Tip

  • Nares

  • Vestibule -nares widen in to vestibule

  • Columella divides the nares

  • Ala –lateral outside wing of the nose bilaterally

  • Upper 1/3 nose is bone; rest is cartilage


Internal

Internal

  • Nasal cavity, extends back over the roof of the mouth

  • Nasal hair, ciliated mucous membrane – red due to ↑ bld supply

  • Septum-divides cavity into 2 passages


Internal1

Internal

  • Superior, middle, inferior turbinates- 3 parallel bony projections on lateral walls of each cavity

  • Meatus- cleft underlying each turbinate. The sinuses drain into the middle, tears from the nasolacrimal duct drain into the inferior


Internal2

Internal

  • Olfactory receptors- in roof of the nasal cavity & upper part of septum. Merge into the olfactory nerve (I) goes to the temporal lobe of the brain


Ears nose mouth throat

Foreign Body


Ears nose mouth throat

  • Paranasal sinuses- air- filled pockets in the cranium

  • Purpose

    • ↓ wt. of the skull

    • Serve as resonators for sound

    • Provide mucous for the nasal cavity

      Sinus openings are narrow = susceptible to occlusion resulting in inflammation/sinusitis


Ears nose mouth throat

  • Frontal sinuses

  • Maxillary sinuses

  • Ethnoid sinuses

  • Sphenoid sinuses

    Frontal & Maxillary sinuses are accessible to examination


Mouth

Mouth

  • First segment of the digestive system

  • Airway for the respiratory system

  • ORAL CAVITY

    • Lips

    • Palate

      • Hard

      • Soft

      • Uvula – hangs down from the soft palate


Ears nose mouth throat

  • Cheeks- side walls of cavity

  • Tongue

    • Papillae- rough, bumpy elevations on dorsal

    • Frenulum

    • Taste buds

  • Teeth – 32 permanent


Ears nose mouth throat

  • Salivary glands

    • Parotid- largest of the glands, located in the cheeks, front of the ear. Stenson’s duct opens in buccal mucosa

    • Submandibular- walnut size, beneath the mandible at the angle of the jaw. Wharton’s duct either side of the frenulum

    • Sublingual –smallest, almond shape, under tongue


Throat

Throat

  • Area behind the mouth & nose

  • Oropharynx – separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars

  • Tonsils – lymphoid tissue behind pillars


Ears nose mouth throat

Posterior pharyngeal wall located behind the tonsils

Nasopharynx continues from the oropharynx but it is above it and behind the nasal cavity. It holds the adenoids and the eustachian tube openings.


Subjective data nose

Subjective data Nose

  • Discharge

  • Frequent colds

  • Sinus pain

  • Trauma

  • Epistaxis

  • Allergies

  • Altered smell


Subjective data mouth and nose

Subjective data Mouth and Nose

  • Sores, lesions

  • Sore throat

  • Bleeding gums

  • Toothache

  • Hoarseness

  • Dysphagia

  • Altered taste


Ears nose mouth throat

  • Smoking

  • Alcohol intake

  • Self care behaviors


Objective behavior

Objective behavior

  • Nose – Inspect and palpate

  • INSPECT for:

    • Symmetry, deformity

    • Inflammation

    • Skin lesions

    • Color

  • If injury – palpate gently


Ears nose mouth throat

  • Test for Patency

  • Test for Sense of Smell – Cranial nerve I (olfactory)


Ears nose mouth throat

  • Inspect nasal cavity/ septum

    • Deviated septum?

    • Can see middle & inferior turbinates


Ears nose mouth throat

  • Inspect and palpate Paranasal Sinuses

    • Press thumbs over frontal & maxillary sinuses

  • Transillumination for sinus inflammation

    • Frontal & Maxillary sinuses

    • Darken room


Mouth inspect

Mouth - Inspect

Use gloves, tongue depressor, light

  • Lips

  • Teeth

  • Gums

  • Tongue

  • Buccal mucosa –Stenson’s duct (parotid)

  • Palate


Throat inspect

Throat - Inspect

  • Tonsils

    • Grade size 1+ visible

    • …………….2+ ½ way b/t tonsillar pillars and uvula

    • …………….3+ touching the uvula

    • …………….4+ touching each other

  • Posterior pharyngeal wall

  • Gag reflex cranial nerves IX = glossopharyngeal and X = Vagus

  • Cranial nerve XII = hypoglossal- stick out tongue

  • Halitosis – Due to ????


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