ASSESSMENT OF

THE EARS
 EARS
• The sense organ of hearing and equilibrium
• Composed of 3 distinct parts:
- external ear
- middle ear
- inner ear
STRUCTURES OF THE EAR
 EXTERNAL EAR
• PINNA/ AURICLE
- composed of thin plate of yellow elastic cartilage
covered by tight-fitting skin and form an irregular funnel
to conduct sound waves into the external auditory canal
-visible without any tools
 EXTERNAL EAR
• EXTERNAL AUDITORY CANAL
-S shaped in the adult
-outerpart: curveds up and back
-innerpart: curves down and forward
-presence of modified sweat glands
*CERUMEN- a wax-like substance
- keeps tympanic membrane soft
- has bacteriostatic properties and sticky –defense
MIDDLE EAR / TYMPANIC CAVITY

• A small air-filled chamber in the temporal bone

• TYMPANIC MEMBRANE/ EARDRUM
- transluscent, pearly gray appearance
- Partition form inner canal and middle ear
DISTINCT LANDMARK OF THE
TYPANIC MEMBRANE
 THREE AUDITORY OSSICLES

• INCUS, STAPES
•  

- This tiny bones responsible for transmitting sound

waves from the eardrum to the inner ear through the oval
window.
• Air pressure is equalized on both sides of the
tympanic membrane by means of eustachian
tube, connects middle ear to the nasopharynx
INNER EAR/ LABYRINTH
 INNER EAR/ LABYRINTH

• Fluid filled, made up of the bony labyrinth and inner

membranous labyrinth
• BONY LABYRINTH: Cochlea, Vestibule, Semi-circular
canal
• INNER COCHLEAR DUCT: Spiral Organ of Corti
( Sensory Organ For Hearing )
• The inner ear is made up of two small parts – cochlea
and semicircular canals
• The cochlea is a coiled structure that resembles the
shell of the snail.
• The cochlea and the semicircular canals are
connected by a structure called the vestibule.
• The vestibule has two smaller structures called
the saccule and the utricle.
• SENSORY RECEPTORS located in the
vestibule and semicircular canal , sense
position and head movements to help
maintain both static and dynamic
equilibrium.
• Nerve fibers from this area from the
vestibular nerve which connects the
cochlear nerve to form the 8th CN---
vestibulocochlear nerve
Semicircular Canals - Dynamic Equilibrium
• The semicircular canals are responsible for maintaining the dynamic
equilibrium of the body.
• The semicircular canals are filled with a fluid called the endolymph. Each one
of the semicircular canals has an enlarged cup-like structure called
the cupula. The cupula has thin hair like cells.
• Whenever the head moves, the fluid in the canals move. When the fluid in the
canals moves, the hair cells move in the direction of the fluid.
• The hair cells transmit the information about the direction of bending to the
sensory neurons of the vestibulocochlear nerve (vestibular branch) which then
sends the information about the direction of the movement to the cerebellum.
Vestibule - Static Equilibrium
• The utricle and saccule are responsible to help maintain the
static equilibrium of the body.
• Static equilibrium helps us to detect the positioning of our
head relative to gravity, that is it helps us realize which way
the head is tilted.
• Hair cells have sensory hairs that project into an otolithic
membrane. Otolith crystals are embedded in the otolithic
membrane that is positioned just above the sensory hairs.
• When the head moves the otoliths are pulled in the direction of gravity or
opposite to the direction of the movement. The movement pulls the
gelatinous membrane which in turn bends the hairs of the hair cells. The
hair cells transmit the information about the position to the sensory
neurons and these sensory neurons send the signals through the cranial
nerve VIII of the vestibular branch to the cerebellum.
• The signals that are detected by the hair cells of both the semicircular
canals and the vestibule are converted into nerve impulses and sent to the
brain through the vestibular nerve. The brain also receives signals from
the visual and skeletal system of the body.
• The brain coordinates all three signals from the inner ear, visual system
and skeletal system to maintain balance and equilibrium of the body.
 HEARING
• s
Sound Eardrum a. ossicles
External ear
vibrations vibrates vibrates
Nerve
impulse Mov’t of
travel to the fluid Pass to the fluid
brain stimulates the in the inner ear
(acoustic hair cells of
nerve) organ of corti
CONDUCTIVE HEARING – transmission of sound
waves through the external and middle ears.
CONDUCTIVE HEARING LOSS- related to the
dysfunction of the external or middle ear
SENSORINEURAL HEARING- transmission of
sound waves in the inner ear
SENSORINEURAL hearing loss - dysfunction of the
inner ear (organ of corti, CNVIII, temporal lobe of the
brain )
 PATHWAYS OF HEARING

CONDUCTION PHASE
-AIR-CONDUCTION- the normal hearing mode
-BONE- CONDUCTION-  vibrations of the skull
cause the cochlear fluids to be stimulated directly.
 EQUIPMENT
• WATCH WITH SECOND HAND FOR ROMBERG TEST
• TUNING FORK – WEBER TEST
• OTOSCOPE – flashlight type viewer used to visualize eardrum and external ear
canal
 The external ear

• Begin with the pinna.

• Examine for any deformity or skin changes.
• Look for scars or pits in front of, or behind ear.
• Hearing aids should be noted then removed.
• Tug the pinna gently for any tenderness
 Congenital abnormalities

Skin tag / accessory auricle Preauricular pit

 ABNORMAL FINDINGS IN EXTERNAL
EAR STRUCTURE
• Ears smaller than 4cm or larger than 10cm
• Malaligned or low set ears – chromosomal defects
 MICROTIA
• Congenital deformity in which the external ear and
sometimes the ear canal are not fully develop.
 MACROTIA
• Congenital excessive enlargement of the external ear
ENLARGED PREAURICULAR AND
POSTAURICULAR LYMPH NODES
 TOPHI- gout
-Non tender, hard, cream colored nodules on the helix containing uric acid
cystals
Malignant lesions
 OTITIS EXTERNA

-also called swimmer's ear, is inflammation of the ear

canal. It often presents with ear pain, swelling of the ear
canal, and occasionally decreased hearing. Typically
there is pain with movement of the outer ear.
-Bacterial infection- pseudomonas aeruginosa/ staph.
Aureus
 Foreign body
• Most frequently seen in
children
• Sense of fullness
• Decreased hearing
• Hearing movement of the
insect
• Severe pain
Impacted cerumen
polyp
 EXOSTOSIS EAR
• Surfer's ear  or abnormal bone growth within the ear canal. ...
Irritation from cold wind and water exposure causes the bone
surrounding the ear canal to develop lumps of new bony
growth which constrict the ear canal.
 ABNORMAL FINDINGS IN TYMPANIC
MEMBRANE
• ACUTE OTITIS MEDIA – Red bulging
eardrum and distorted, diminished or absent
light reflex
Otorrhea
 SEROUS OTITIS MEDIA
• Yellowish, bulging membrane with bubbles behind
• Acute otitis Media
• group of inflammatory diseases of the
middle ear.
• The two main types are acute otitis
media (AOM) and otitis media with
effusion (OME). AOM is an infection
of abrupt onset that usually presents
with ear pain
 blue or dark red tympanic membrane
• d/t trauma
Perforated tympanic membrane – increased
pressure from untreated infection or trauma
 Scarred tympanic membrane
• Scarring from infection
 Retracted tympanic membrane
• Caused by negative pressure due to eustachian tube or chronic otitis media
 Hearing loss
• Conductive hearing loss
• occurs when there is a problem conducting
sound waves anywhere along the route
through the outer ear, tympanic membrane
(eardrum), or middle ear (ossicles)
• Sensorineural hearing loss
• is a type of hearing loss, or deafness, in
which the root cause lies in the inner ear or
sensory organ (cochlea and associated
structures) or the vestibulocochlear nerve
(cranial nerve VIII)
• Common type of permanent hearing loss
 TEST USED TO EVALUATE AUDITORY FUNCTION
• WEBER’S TEST- helps evaluate the conduction of soundwaves through
bone to help distinguish between conductive hearing.
• The tuning fork is placed on the midline of the skull
• Conduction loss- sound lateralizes to the defective ear
• Sensorineural loss- sound lateralizes to unaffected ear
RINNE TEST
• -compared air and bone conduction sound.
• The tuning fork is placed on the mastoid bone for bone conduction
and placed in front of the ear for air conduction
• Normally: air conduction heard longer than bone conduction
(AC>BC)
•Conduction loss- will hear bone conduction longer
than or equal to air conduction (BC>AC)
•Sensorineural loss- will hear air conduction longer
than bone conduction (AC>BC)
• Presbycusis- begin with loss of high-frequency
sounds ( woman’s voice) followed by loss of low-
frequency sounds
• Gradual sensory neural hearing loss
• Aging
 ROMBERG TEST
• TEST THE CLIENTS EQUILIBRIUM
• ASK THE CLENT TO STAND WITH FEET TOGETHER, ARMS AT
SIDE, AND EYES OPEM , THEN WITH THE EYES CLOSED.
• MAINTAIN FOR 20 SEC – W/O SWAYING – VESTIBULAR D/O IF
SWAYING
 ASSESSMENT OF MOUTH, THROAT,
NOSE AND SINUSES
• MOUTH AND THROAT- first part of digestive system and responsible
for receiving food
• -CN VII (facial), V ( trigeminal ), IX ( glossopharyngeal) and XII
( hypoglossal)
• NOSE AND PARANASAL SINUSES- first part of respiratory system
- receiving,filtering, warming and moistening air to lungs
MOUTH
mouth
SALIVARY GLANDS IN THE MOUTH
-secretes saliva into the mouth
 THROAT/ PHARYNX
• MUSCULAR PASSAGE OF THE FOOD AND AIR
NOSE
nose
• Nasal septum contains a rich supply of blood
vessels known as KIESSELBACH AREA
• -common site of nasal blessing
• CONCHAE- Superior, middle and inferior turbinates
- Increase the surface area that exposed to incoming air
- PERSON INHALE-NASAL HAIR FILTERS AIR
CILIARY MUCOSAL CELLS CAPTURE
AND PROPEL DEBRIS TOWARD THE
THROAT

MEATUS under the turbinates receives drainage from the

paranasal and nasolacrial duct
 SINUSES
-air-filled cavities decrease the weight of the skull and act as a resonance
chambers during speech
 Paranasal sinuses

• Lined with ciliated mucous membrane that traps debris

and propels outside.
• Primary site of infection –easily blocked
• Frontal and maxillary –accessible for examination
• Ethmoidal and sphenoidal –deeper , not accessible for
exam
 ASESSMENT OF THE MOUTH

LIPS – smooth and moist without lesion

PALLOR LIPS
– anemia or shock
• CYANOSIS LIPS – cold or hypoxia
 Cherry lips/ reddish lips
• Ketoacidosis, carbon monoxide poisoning, copd with polycythemia
Swollen lips –allergies
Herpes simplex type I (COLD SORES )
-Clear vesicles surrounded by red indurated base
 CHEILOSIS OF THE LIPS
-scaling painful fissured at the corner of the lips
 Carcinoma of lips –round indurated lesions
becomes crusted and ulcerated with elevated border
 Hairy Leukoplakia
- a thick raised patch does not scrape off on the side of the tongue
-seen in HIV infection and AIDS

--
VITAMIN B12 DEFICIENCY- smooth,
reddish, shiny tongue w/o papillae
 CANDIDA ALBICANS infection ( thrush)
- curdlike patches easily scraped off, leaving a reddened area
 BLACK HAIRY (papillae) TONGUE –used of antibiotic that
inhibit bacterial growth, hyposalivation, heavy smoking and alcohol
intake
Cyanosis
Carcinoma of tongue
ABNORMALITIES IN THE GUMS
Gingivitis- inflammation of the gums
BLUISH-BLACK GUMS OR GREY WHITE LINE ALONG THE GUM LINE
Burton’s line

• LEAD POISONING- occurs due to deposition of lead sulfide,

 GINGIVAL HYPERPLASIA
• Enlarged reddend gum that may cover some of the parts of the teeth
• Seen in pregnancy, puberty, leukemia, and use of some medications-
phenytoin
 RECEDING GUMS
• Gum tissue surrounding teeth pulls back exposing more of tooth or root of
tooth
 KOPLIK SPOT
• Early sign of measles
• Tiny white spots that lie over a reddened mucosa
Canker sores
• Glossitis
• Inflammation of the
tongue

• Candidiasis (oral
thrush)
• Caused by candida
albicans
• Appears as soft white
plaques on the tongue,
buccal mucosa or
posterior pharynx
 KAPOSI SARCOMA LESION
• Advanced lesions seen in HIV
Yellow palate- jaundice
CLEFT PALATE AND LIPS
Stain
 Abnormal findings
• Plaque
• Invisible soft film that adheres to the
enamel surface of teeth which consist
of bacteria, molecules of saliva and
remnants of epithelial cells and
leukocytes
• Tartar
• Visible hard deposit of plaque and
bacteria that forms at the gum lines
tartar./ plaque/ toothdecay
 MOUTH ODOR

• FRUITY OR ACETONE BREATH- Diabetic Ketoacedosis

• AMMONIA ODOR- Kidney dse
• FOUL ODOR – Oral, respiratory infection, tooth decay
• FECAL BREATH ODOR- Bowel obstruction,
• SULFUR ODOR- (FETOR HEPATICUS)- END STAGE
LIVER CANCER
 TONSILITIS
• Infection of the tonsils
• Sore throat, odynophagia, fever, chills and tender cervical lymph
nodes
ABNORMAL FINDING IN THE NOSE

• Nasal tenderness on palpation

• ALLERGIC RHINITIS
-Inflammation of the nasal mucosa
 Abnormal findings

• EPISTAXIS
• Bleeding from the nose
• RHINOPHYMA
• Hypertrophy of the nose
caused by rosacea
• Pronounced flushing
reactions especially in
response to heat, emotional
stimuli, alcohol, hot drinks or
spicy food
NORMAL NASAL MUCOSA
NASAL MUCOSA ABNORMAL FINDINGS

• SWOLLEN AND PALE PINK OR BLUISH GRAY – W/ ALLERGIES

• RED AND SWOLLEN- UPPER RESP. INFECTION
• THICK YELLOW-GREEN PURULENT DISCHARGE- INFECTION
 NASAL SEPTUM PERFORATION
- use of cocaine, trauma, chronic infection, chronic nose picking,
piercing
 POLYPS
-small, firm, pale, round, overgrowth or masses on mucosa
-chronic allergies
• Acute sinusitis
• Infection of sinuses that
typically occurs as a result of
pooling of secretions within the
sinuses
• Throbbing pain- affected sinus,
tender to palpate, thick purulent
discharge, edematous,
erythematous nasal mucosa
• Parotitis
• Inflammation of the parotid salivary gland
Thank you for listening !!