Ear Nasal Throat quick Assessment.ppt

brief assessment of ENT organs

1. ASSESSMENT OF EARS, NOSE, MOUTH AND THROAT DR. CHIKONDE

2. Health History Ears Hearing loss Excessive cerumen Nose Decreased ability to smell (elderly) Mouth and throat Tooth loss Gum disease Decreased taste Tonsillitis Sore throat/infection

3. Common Chief Complaints Ear Hearing loss Otorrhea Otalgia Tinnitus

4. Nose Pain Drainage Blockage or congestion Bleeding (Epistaxis)

5. Mouth and throat Halitosis Oral lesions Swelling Oral thrush Ulceration Pain Difficulty in swallowing Hoarseness of voice

6. Evaluation of Chief Complaint Quality Associated manifestations Aggravating factors Alleviating factors Frequency Timing

7. Past Health History Medical Otitis media or externa Nasal polyps, sinusitis, allergic rhinitis Tonsillitis, caries, upper respiratory infections Chronic diseases such as diabetes mellitus, renal disease, hypertension, immuno-suppression Dental pathology Nutritional disturbances

8. Surgical Cosmetic surgery of head or neck Repair of deviated septum Oral surgery Tympanostomy tubes

9. Medications Antibiotics Antihistamines Decongestants Steroids Chemotherapy Immunosuppressive drugs

10. Allergies Signs and symptoms Pollen, insect stings, animal dander Injuries and accidents Foreign bodies Trauma Sports injuries Special needs Use of assistive devices (hearing aids) Speech disorders Childhood illnesses Frequent tonsillitis or ear infections

11. Social History Alcohol use Drug use Tobacco use Sexual practices Work and home environment Hobbies and leisure activities Stress

12. Health Maintenance Activities Sleep Diet Use of safety devices Health check-ups

13. General Approach to Assessment Greet patient Explain assessment techniques Quiet, well-lit environment Sitting position Compare right to left Systematic approach

14. Equipment Otoscope Nasal speculum Penlight Tuning fork in 256 , 512 and 1024 Hz Tongue blade Watch Gauze square Cotton-tipped applicators

15. Assessment of the Ear Examination consists of three parts: Auditory screening Inspection and palpation of external ear Otoscopic assessment

16. Take history of: _ Ear aches Infections Discharge Hearing loss Environmental noise Tinnitus Vertigo Self care

17. OTOSCOPIC EXAMINATION It is a visual examination of the auditory canal and tympanic membrane using an otoscope. It is also part of normal physical examination. It examines infection or blockage due to presence of foreign object or buildup of wax, tympanic membrane of rupture.

18. Otoscopic Assessment Inspect both ears External ear canal: lesions, swelling, discharge, hairs, foreign body, cerenum Tympanic membrane Pull auricle upward and backward to straighten the auditory canal

19. Normal findings Tympanic membrane is pearly gray with well-defined landmarks Light reflex present at 5 o’clock in right ear and 7 o’clock in left ear Tympanic membrane moves when patient blows against resistance No redness, swelling, tenderness, lesions, drainage, foreign bodies

20. Abnormal findings Chalky patches on tympanic membrane Severe pain Redness, swelling, narrowing, pain Drainage Hard, dry, very dark yellow cerumen Reddened tympanic membrane

21. Tympanic membrane in OM

22. WHISPERED SPEECH TEST It is a quick screening test for hearing. It is a bedside estimate of hearing impairment in which examiner stands 2 ft from one of the patient’s ear. Examiner whispers a number followed by a letter. An approximate 30 db hearing loss is suggested by inability to hear paired numbers and letters.

23. WHISPERED SPEECH TEST

24. AUDIOGRAPHY TESTS Rinne test Weber test

25. RINNE TEST It compares air and bone conduction hearing. Strike a 512 Hz tuning fork softly. Place the vibrating tunic fork in the base of mastoid bone. Ask client to tell you when the sound is no longer heard. Place the tunic fork to auditory meatus. Ask the client to tell you when the sound is no longer heard. Note time interval and findings

26. WEBER TESTS It distinguishes between conductive and sensorineural hearing loss. Strike a 512 Hz tuning fork softly. Place the vibrating fork on the middle of the client’s head . Ask client if the sound is heard better in one ear or same in both ears.

27. Normal findings Weber test Normal finding: able to hear sound equally in both ears Rinne test Normal finding: air conduction > bone conduction

28. TYMPANOGRAM It is test for middle ear functioning. In this a probe will be placed in the ear and cause air pressure. It is a graphical representation of the relationship between the air pressure in the ear canal and movement of the eardrum or tympanic membrane.

29. AUDITORY BRAINSTEM RESPONSE (ABR) TESTING It is a neurological test detects sensorineural hearing loss. It measures auditory nerve reactions in response to sounds. It can be used to detect hearing loss in infants and very young children. Audiologist will place electrodes on child’s forehead and ears, which send EEG readings to a computer.

30. ABR TESTING

31. PURE TONE AUDIOMETRY It is a behavioral hearing test that is designed to measure the severity and balance(unilateral or bilateral) of a person’s hearing loss. It utilizes a series of pure tones presented at selected frequencies within the range if hearing .

32. PURE TONE AUDIOMETRY

33. ELECTRONYSTAGMOGRAPHY(ENG) It is a diagnostic test to record involuntary eye movements (Nystagmus). It can also be used to diagnose the cause of vertigo, dizziness, balance dysfunction by testing the vestibular system.

34. ENG

35. MIDDLE EAR ENDOSCOPY

36. ARTERIOGRAPHY It is used to assess vascular abnormalities in temporal bone.

37. ROTARY CHAIR ASSESSMENT It is used to assess Vestibular function. Rotation of the client in a chair in darkness provides information about vestibular dysfunction and the level of central dysfunction.

38. POSTUROGRAPHY It helps to identify, localize the source of balance disorders. The client stands in a tall box like device while the floor moves. No visual cues are provided and response to correcting balance is recorded. Most people correct posture changes with adjustments in muscles.

39. POSTUROGRAPHY

40. ROMBERG TESTS The Romberg test is a test of the body's sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord. The Romberg test is used to investigate the cause of loss of motor coordination (ataxia).

41. MRI & CT It is the test of choice for tumors of the temporal bone. For certain Diagnostic assessment , both MRI and CT scans are obtained.

42. EQUIPMENT FOR EXAMINATION OF NOSE, MOUTH AND THROAT Otoscope with short, wide-tipped nasal speculum Pen light Two tongue blades Cotton gauze pad Gloves

43. Assessment of the Nose Take history of: Discharge Frequent colds Sinus pain Trauma Epistaxis Allergies Altered smell

44. Inspection and palpation of nose External nose Tenderness, discharge ,trauma, bleeding, lesions, masses, swelling, asymmetry Test patency of nostril Inspection of internal nose Speculum or otoscope with nasal speculum Nasal cavity Nasal septum Turbinates Sinus Areas- Palpate Frontal and maxillary sinuses Transillumination

45. Normal findings Located in midline of face No swelling, bleeding, lesions, or masses Both nostrils patent Septum midline Nasal mucosa is pink or dull red

46. Abnormal findings Broken, misshapen, swollen nose Occluded nasal passages Septum is deviated Nasal mucosa is red and swollen Purulent drainage

47. Assessment of the Sinuses Inspection ( Sinus Transillumination ) Palpation and percussion Normal findings No discomfort during palpation or percussion Resonance heard on percussion

48. (continues) Assessment of the Mouth Inspect Mouth Lips Teeth and gums Tongue U-shaped areas under the tongue Buccal mucosa Uvula Hard and soft palate

49. Mouth inspection and palpation LIPS inspect for color, moisture, cracking, or lesions. Palpate lips, and face for mass and tenderness TEETH/gums note any diseased absent, loose teeth gums should be pink or coral, check for swelling, retraction of gum margins spongy, bleeding discolored gums. TONGUE color pink and even dorsal side roughened, ventral smooth, glistening, shows veins Inspect under tongue for nodules, lesions, ulcerations

50. Cont… Buccal mucosa looks pink, smooth, moist, dark skinned people may have patchy hyperpigmentation Uvula fleshy pendant midline uvula and soft palate rise with “ahhh” sound. anterior hard palate is white with irregular transverse rugae the posterior soft palate is pinker smooth, and upwardly movable.

51. Normal findings of Mouth Breath is fresh Pink, moist lips Tongue midline, symmetrical, with adequate movement No pockets between gums and teeth No bleeding Smooth, white teeth; proper alignment, no dental caries

52. Abnormal findings of Mouth 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

53. (continues) Inspection of the Throat Position, size, color,and general appearance of tonsils and uvula Gag reflex Color of oropharynx Presence of swelling, exudate, lesions

54. Assessment of tonsils Enlarged tonsils are graded Grade 1 – wnl Grade 2 – tonsils b/w pillars and uvula Grade 3 – tonsils touching uvula Grade 4 – tonsils touching each other (kissing tonsils)

55. Neck assessment usually done with Thorax

56. Normal findings Soft palate and uvula rise when patient says “ah” Uvula is midline Throat is pink and vascular No swelling, exudate, or lesions Gag reflex is present

57. Abnormal findings Posterior pharynx is red with white patches Tonsils and uvula are red and swollen Hoarse voice Grayish membrane covering tonsils, uvula, soft palate

58. Gerontological Variations Presbycusis Diminished sense of smell and taste Lesions Periodontal disease Oral alterations due to disease or side effects of medications Tooth loss

59. Thank You