Ear, nose, and throat - ati notes PDF

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eATI: Ear, nose, and throat examination • • • • • • •

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Inspect the ears for shape, placement, discharge and tenderness Check hearing Examine the ear canal and the tympanic membrane Inspect the nose and test cranial nerve l (olfactory) Inspect the lips and the oral cavity Test cranial nerves Xll (hypoglossal), lX (glossopharyngeal), and X (vagus) Inspect the ears for shape, placement, discharge, and tenderness o Inspects your patients ears for shape, placement, and any discharge. Then check for tenderness by palpating the pinna, or helix, of the ear and the tragus, the projection in front of the external opening of the ear, and by percussing over the mastoid process Check hearing o Test hearing by rubbing your fingers together inches from each ear, or by standing behind the patient, having him plug one ear, and then test ability to hear a few whispered words. The ability to hear either of these tests indicates that cranial nerve Vll is intact Examine the ear canal and the tympanic membrane o Use an otoscope to inspect your patients ear canals and tympanic membranes o Adult: attach a 4 mm speculum to the otoscope, twisting it on securely o Turn light on, the straighten the patients ear canal by grasping his ear and pulling upward and back o Young children: straighten the canal by pulling downward and back o Handling the scope safely and under direct visualization of the speculum tip, insert the tip about halfway into your patients ear canal. At that point, look through the viewfinder and inspect the ear canal as you advance the otoscope o Look for redness, open areas or foreign bodies o Small amount of ear wax or cermen is normal. Cerumen is moist and tan in white people or African Americans but is dry, flaky and gray in Asians and American Indians o Cerumen is more common in whites and african americans and can prevent you from seeing the tympanic membrane o Normal tympanic membrane: shiny and pearly gray with a cone of reflected light on the nasal aspect o Cone of light should be visible at 7 oclock in the left ear ad 5 oclock in the righ tear o May be able to see landmarks created by the tiiny bones behind the tympanic membrane as well o Take care to withdraw the otoscope as carefully as you inserted it to avoid damaging the delicate ear canal o Patients who have otitis externa or swimmers ear: manipulation of the external ear is usually painful o With middle ear infections, the tympanic membrane may be red and bulge into the ear canal, with obliteration of the cone of light o You may even see a perforation or tear in the tympanic membrane Inspect the nose and test cranial nerve l (olfactory)

Assess nose, look for alignment and check the nostrils to see if septum is midline and whether or not any discharge is present o Penlight: see a bit of the nasal mucosa o Check it for pallor, inflammation, swelling, or discharge o Note whether discharge is thin and clear, thick and purulent, or bloody o Difficulty breathing: may see flaring of the nostrils with inspiration o Ask patient to occlude each naris, one at a time, and sniff, noting whether or not the nares are open, or patent. o Check cranial nerve l by asking patient to identify a scent such as mint or coffee o Do not use a noxious odor such as an alcohol wipe o Pations with anasomia or impaired sense of smell, can detect noxious odors, which can also stimulate cranial nerve V Inspect the lips and mouth o Appearance of lips and oral mucosa reveal important info about overall health of patient o Assess mouth and lips looking for color, symmetry, dryness, cracking of lips o Use penlight and a tonged blade inspect oral mucosa for moistness, inflammation, ulcers, lesions, or white patches o Assess color of mucosa o Pallor, cyanosis, and jaundice are found here especially in dark skinned patients o Inspect gums or gingiva, looking for inflammation and examine teeth for obvious fractures or missing fillings o Check tongue, throat, or pharynx, and tonsils for redness, lesions, or exudate o Ask patient to say aah and look for the uvula to rise in the midline Test cranial nerves lX (glossopharyngeal, X (vagus) and Xll (hypoglossal o If uvula rises and patient can swallow, then cranial nerves lX and X are intact o When uvula rises, posterior pharyngeal wall is often exposed o If tongue obscures view of throat its best to moisten the tongue depressor before using it to apply tongue pressure o Look for redness or any exudated on the tonsils or trickling into the throat from the sinuses above o If uvula rises in midline with phonation, you do not need to test gag reflex o Unresponsive patient, touch posterior part of throat near the tonsils to check for gag reflex, which again demonstrates intact cranial Lx and X o To test cranial nerve Xll, ask patient to stick out his tongue while you look for midline protrusion o Ask patient to repeat light, tight, dynamite, indicates that nerve is intact. Ati video o o

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