Eyes, Ears, Mouth, Nose, and Throat Anatomy Review

Exam 2 Review (Eyes, Ears, Mouth, Nose, and Throat)

• This review identifies anatomy, physiology, and function of the eyes, ears, nose, mouth, and throat.

Eye Anatomy

• Pupil: The black opening in the center of the eye that allows light to enter
• Iris: The colored part of the eye
• Sclera: The white part of the eye
• Palpebral fissure: The opening between the upper and lower eyelids, protecting the eye from dust and debris
• Lateral and medial canthus: Refers to the outer and inner corners where the eyelids meet
• Upper and lower eyelid: Covers the eye
• Palpebral fissure encloses the eye
• Anterior chamber: The fluid-filled space between the cornea and the iris
• Lens: Located behind the iris, focuses light onto the retina
• The eye: It is globular and filled with fluid
• Macula and optic disc: These are visible when looking into the eye
• Optic nerve: This runs behind the eye
• Lacrimal apparatus: Includes the tear ducts
• Lacrimal gland: This sits above the upper eyelid and produces tears to moisturize the eyes
• Lacrimal sac: Streams tears to the inferior meatus of the turbinate, causing a stuffy nose when crying
  • OD = right eye
  • OS = left eye

Brain Anatomy

• Hypothalamus: It regulates temperature
• Occipital lobe: This handles visual reception
• Wernicke's area: This is for speech comprehension
• Parietal lobe: Processes sensation
• Cerebellum: Responsible for motor coordination, balance, and equilibrium
• Temporal lobe: Involved in hearing, taste, and smell
• Broca's area: This controls motor speech
• Frontal lobe: This affects personality, behavior, emotion, and intellectual functions
• Precentral gyrus: Primary motor area
• Postcentral gyrus: Primary sensory area

Eye Function

• The eye: It reverses images and then reverses them again when they reach the brain

Cranial Nerves

• It is important to know cranial nerves & if they are sensory, motor, or both, plus the corresponding tests, and nerve pairings
• EOM/Cardinal direction of gaze: Knowing which muscle contracts to pull in a certain direction is necessary
• CN III: Stimulating this nerve moves the eye up, down, and medially, innervating the superior, inferior, medial rectus, and inferior oblique muscles
• CN IV: Stimulating this nerve moves the eye toward the nose, innervating the superior oblique muscle
• CN VI: Stimulating this nerve pulls the eye out, innervating the lateral rectus muscle

Ear Anatomy

• Pinna: The outer ear, includes the helix and antihelix
• Tragus: The meaty part of the cartilage leading to the external auditory meatus
• Lobule: The earlobe
• Mastoid process: The bony prominence behind the ear
• External ear: This gathers sound waves and funnels them down the ear canal to the tympanic membrane

Middle Ear

• The otoscope can be used to examine this
• Tympanic membrane: It serves as the “door” to the middle ear
• Bony landmarks: The malleus, incus, and stapes are visible
• Eustachian tube: This can get backed up

Inner Ear

• This is not directly visible, but it includes the vestibule, semicircular canal, and cranial nerve 8
• Semicircular canals: These constantly feed equilibrium information to the brain about the body's position

Brain Anatomy as it Pertains to the Ears

• Knowing the effects of damage to the cranial nerves and brain on ear function is important
• Tympanic membrane: You should check for color (pearly grey), cone of light position (pointing towards the nose to the anterior), and bony landmarks -When the eardrum is healthy, the umbo and part of the malleus are visible, with the malleus drumming behind the tympanic membrane

Nose Anatomy

• Bridge of the nose: The upper bony part
• Tip of the nose: The lower cartilaginous part
• Vestibules: Located in each nare (nostril hole)
• Maxillary and frontal sinuses: These are the only sinuses to be assessed
• Turbinates: The meaty portions of the inner nose
• CN I (olfactory nerve): This goes through the turbinates to provide the sense of smell
• Sinuses: They are open area cavities
• Ethmoid and sphenoid sinuses: These sinuses cannot be assessed

Throat/Mouth Anatomy

• Nasopharynx and hypopharynx: These are connected
  • This is why nasal drainage can cause sore throats

Salivary Glands

• Parotid glands: These are in the cheeks, with the Stensen ducts draining the glands (small hole)
• Frenulum: Under that tongue is under the tongue at the center
  • Smaller frenulum/tongue tie: This can cause speech problems in younger children

Other Components of the Mouth

• Submandibular glands: These drain into Wharton's duct on each side of the frenulum
• Sublingual glands: located under the tongue
• Hard and Soft palates: This is where one should observe the architecture, color, texture, and any lesions
• Uvula: The uvula should be midline

Tonsils

• Think of the tonsils as a theatre
• Tonsil grading scale:
  • 1+ Visible
  • 2+ Halfway between tonsillar pillars and uvula (normal for some)
  • 3+ Touching the uvula
  • 4+ Touching one another (kissing tonsils); Airway obstruction is a concern for Grades 3 or 4.

PERRLA

• Pupils are Equal, Round, and Reactive to Light, and Accommodation

Accommodation

• The ability of the eye to change focus from distant to near objects - Finger closer = constrict - Finger in the distance = dilate

Subjective Data-Eye

• Vision difficulty
• Pain
• Strabismus (eye misalignment) aka lazy eye seen in children
• Diplopia (double vision)
• Redness
• Swelling
• Ptosis (droopy eyelids)
• Watery discharge
• Hx of eye surgery or injury
• Glaucoma (been tested? Family hx?)
• Corrective lens
• Self-care behaviors (sports needing protective eye wear?, wear sunglasses?, welder?)

Subjective Ear Data

• Earaches (aka otalgia)
• Infections
• Discharge
• Hearing loss
• Tinnitus (ringing in the ears)
• Environmental noise
• Vertigo/dizziness
• Self-care behaviors: Consider hearing protection, loud noises, air pods, lawn mowing/weed whacking, and concerts.

Subjective Nose Data

• Discharge?
• Frequent colds?
• Sinus pain/pressure?
• Trauma
• Epistaxis (nose bleeds)
• Allergies
• Altered smell, e.g., from Covid

Subjective Mouth and Throat Data

• Sores or lesions
• Sore throat
• Bleeding gums
• Toothache
• Hoarseness (symptom)
• Dysphagia (Difficulty swallowing foods or liquids)
• Altered taste
• Smoking, alcohol consumption
• Dental care pattern
• Dentures or appliance
• Self-care behaviors, i.e., brushing and flossing

Health Promotion Practices

• Using protective eyewear in activities such as gardening and walking outside
• Wearing blue light glasses and sunglasses reduces macular degeneration and other vision problems
• Wearing goggles when welding and woodworking reduces flying debris in your eyes

Ear Care

• Consider hearing protection and loud noises from air pods, lawn mowing/weed whacking?, concerts?
• Q tips? How are we cleaning our ears? Earwax comes out on it's own

EENMT Assessment

• It involves pupillary response, using the Snellen eye chart, corneal light reflex testing, diagnostic positions test, cover-uncover test, inspection of the palpebral conjunctiva, and inspection of the anterior eyeball.

More Information on Assessment

• Pulling down on the palpebral conjunctiva to inspect the sclera and conjunctiva expect the sclera to be white
• Inspection of Anterior Eyeball: Looking for Red Light Reflex at 15-degree angle!! Using your right eye on their right eye and left eye on their left eye with the OPTHALAMSCOPE
• Behind red light reflex is the clearly shown optic disc and the macula

Hearing Assessment

• Rinne test: Use put tuning fork against mastoid process, which conducts bone conduction through the cochlea to the auditory nerve.
• Air conduction is greater than bone conduction, if bone conduction is not heard well, but pulling tuning fork out towards the ear, you can hear better
• Weber test: Tests for localization and lateralization, you should be able to hear midline
• Air conduction describes the normal first phase in the hearing pathway.

  • Bone conduction bypasses the external and middle ear. A fork placed on the head, sets the bone of the skull into vibration and stimulates the cochlea directly.
    

Air and Bone Conduction

• Compare air conduction (AC) and bone conduction (BC) (Rinne test). Place the base of a lightly vibrating tuning fork on the mastoid bone.
• Place the fork close to the ear canal when the patient no longer hears and ask if a viration can be heard
• Here the “U” faces forward, which maximizes sound transmission. Normally the sound is heard longer through air than through bone (AC > BC).
• Adult: pull ear up and back to straighten external canal and visualize the tympanic membrane
• Child: pull down and out because children are more lateral and have a wider bridge
• Use the speculum that's as large as can comfortably fit in a patient

More Physical Exam Notes:

• External ear looks for size, lesions on the tip of the ear is common
• Examination looks for otitis externa hurts.
• External canal should look for redness, foreign body, swelling, drainage
• Tympanic membrane: Look for color, the cone of light pointing towards the nose and the boney landmarks you can see through the TM
• Testing hearing acuity
  • Conversational speech
  • Whispered voice test (CN8)
  • Tuning fork tests
    • Weber test
    • Rinne test

Romberg test

• Assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance
• Assessor stands with person with arms at side, eyes closed, see If they sway for about 20 seconds
• Provider will stay close incase the patient sways

External nose:

• Occlude each nostril and note patency (inhale!)
  • cartilaginous portion is slightly mobile. Nontender, w/o masses, with patent nares

Mouth Exam

• Starts with the lips, buccal mucosa, then teeth, gums, and tongue (texture and color) then underneath, side-to-side Expected findings and variations related to gender, age, and race

• Strabismus (lazy eye) can be seen in children usually

• Darker pigmented eyes can have a bluer sclera tint

• The lenses' are round at birth and get flatter throughout life from soft to hard

• Preemies (babies born immaturely) have reduced vision (reduced visual acuity)

Aging Adult

• Pupil size decreases
• Presbyopia occurs because over time the lens loses elasticity
• Visual acuity diminishes at 40 and more at 70
• Increase chance additional problems such as thickening and yellowing are the forming of cataracts.
• Cataract formation, or lens resulting, from a clumping of proteins in lens
• Glaucoma, common type [loss of peripheral vision
• Macular degeneration, leads to cells which causes Loss of central vision

Infants and Children

• The Eustachian tube is shorter, wider, and horizontal than adult's which makes it easier for pathogens from nasopharynx to migrate to middle ear
• Otosclerosis: hearing loss between ages of 20 and 40 years
• Gradual hardening that causes stapes to impeding transmission of sound
• Presbycusis: hearing loss by nerve degeneration
• Impacted cerumen is reversible loss in older people
• Smaller frenulum = problems in speech in younger kids
• Nasal, epistaxis as a result of increased vascularity in the upper respiratory tract (nasal stuffiness or nose bleeds) in pregnant women
• Gums may be hyperemic and softened and may bleed with normal (let them know that it's hormones and to brush with a softer brush, increased vascularity!)

Teething - inflamed gums:

• Start erupting at 6 months through 2 ½ when

• They have all 20 teeth

• Nasal hairs grow coarser & stiffer diminished sense of taste and smell

• gradual loss of subcutaneous fat in the mouth for aging adults

• Natural tooth, trouble w/ gums with age;

• EENMT abnormalities

• Cornea= abnormal eye (pupil looking/converging inwards), outwards), (difference, these are caused by trauma inspect scelera for yellow or inspect mucous indicating jaundice Preemmies and adults- reduced vision Hordeolem, painful warm compress.

Exothalamos Bulging Eye

• Pseudoptosis: treat w/ lubricant: hypothyroidism
• Ptosis: hypo
• "flashes" from retina
• Canal wrong, vertigo