assessment of ear-nose (2).ppsx

Health assessment of ear and nose Prepared by Dr. seham Mohamed Anatomy of the ear Anatomy of the ear  Anatomy of the ear External ear The flexible external ear consists mainly of elastic cartilage. It contains the ear flap, also known as the auricle or pinna, and th...

Health assessment of ear and nose Prepared by Dr. seham Mohamed Anatomy of the ear Anatomy of the ear  Anatomy of the ear External ear The flexible external ear consists mainly of elastic cartilage. It contains the ear flap, also known as the auricle or pinna, and the auditory canal. This part of the ear collects and transmits sound to the middle ear. Middle ear The tympanic membrane separates the external and middle ear. The center, or umbo, is attached to the tip of the long process of the malleus. the malleus attatched to the lncus and stapes. On the other side of the tympanic membrane. The eustachian tube connects the middle ear with the nasopharynx, equalizing air pressure on either side of the tympanic membrane. The middle ear conducts sound vibrations to the inner ear. Inner ear The inner ear consists of closed, fluid-filled spaces within the temporal bone. It contains the bony labyrinth, which includes three connected structures: the vestibule, the semicircular canals, and the cochlea. The inner ear receives vibrations from the middle ear that stimulate nerve impulses. These impulses travel to the brain, and the cerebral cortex interprets the sound.  ASSESSMENT Subjective data Have you had any trouble hearing? If so, do you wear hearing aids? Have you had any symptoms like ringing in the ears, drainage from the ears, or ear pain? Do you ever feel dizzy, off-balance, or like the room is spinning? Are you currently using any medications, ear drops, or supplements for your ears? External observations Observe the ears for position and symmetry. The top of the ear should line up with the outer corner of the eye, and the ears should look symmetrical, Inspect the auricle for lesions, drainage, nodules, or redness. Pull the helix back and note if it’s tender, which may indicate otitis externa. Inspect and palpate the mastoid area behind each auricle, noting tenderness, redness, or warmth. Finally, inspect the opening of the ear canal, noting discharge, redness, odor, or the presence of nodules or cysts. Otoscopic examination (discussed in the clinical) Used to examine internal structure as the tympanic membrane, pars flaccida, and the bony structures, as shown. The tympanic membrane should be pearl, gray, glistening, and transparent. Inspect the membrane for bulging, retraction, bleeding, lesions, and perforations.  Abnormal Finding Of The Ear Earache Earaches usually result from disorders of the external and middle ear and are associated with infection, hearing loss, and otorrhea. Hearing loss Several factors can interfere with the ear’s ability to conduct sound waves. Cerumen (wax), a foreign body, or a polyp may obstruct the ear canal. Otitis media may thicken the fluid in the middle ear, which interferes with the vibrations that transmit sound. Otosclerosis (a hardening of the bones in the middle ear), also interferes with the transmission of sound vibrations. Trauma can disrupt the middle ear’s bony chain. 3.Otitis media Otitis media, inflammation of the middle ear, results from disruption of eustachian tube patency. It can be suppurative or secretory, acute (or chronic. In Acute otitis media there is Infected fluid in middle ear, Rapid onset and short duration  :S&S of otitis media Signs and symptoms Adults common in children include: Common signs Ear pain, especially when lying down, Tugging or and symptoms pulling at an ear, Trouble in adults include: sleeping, Crying more than usual ( Fussiness). Ear pain Trouble hearing or responding to sounds Drainage of fluid Loss of balance from the ear Fever of 100 F (38 C) or higher Trouble hearing Drainage of fluid from the ear Headache Loss of appetite  Nose Anatomy The lower two-thirds of the external nose consists of flexible cartilage, and the upper one-third is rigid bone. Posteriorly, the internal nose merges with the pharynx, which is divided into the nasopharynx, oropharynx, an laryngopharynx. Anteriorly, it merges with the external nose. Anatomy Anatomy  Parts of the nose 1- Bone: The hard bridge at the top of your nose is made of bone. 2- Hair and cilia: Hair and cilia (tiny, hair like structures) inside your nose trap dirt and particles. Then they move those particles toward your nostrils, where they can be sneezed out or wiped away. 3- Lateral walls (outer walls): The outer walls of your nose are made of cartilage and covered in skin. The walls form your nasal cavities and your nostrils  Parts of the nose 4- Nasal cavities: Your nose has two nasal cavities, hollow spaces where air flows in and out. They are lined with mucous membranes. 5- Nerve cells: These cells communicate with your brain to provide a sense of smell. 6-Nostrils (nares): These are the openings to the nasal cavities that are on the face. 7- Septum: The septum is made of bone and firm cartilage. It runs down the center of your nose and separates the two nasal cavities.  Parts of the nose 8- Sinuses: You have four pairs of sinuses. These air- filled pockets are connected to your nasal cavities. They produce the mucus that keeps your nose moist. 9-Turbinates (conchae): There are three pairs of turbinates located along the sides of both nasal cavities. These folds inside your nose help warm and moisten air after you breathe it in and help with nasal drainage.  ASSESSMENT: Health history: How long you've had the symptoms? What treatments you've used? what makes the symptoms get better and what makes them get worse? What are the other health problems you have? Ask if the patient take any medicines? Ask about signs of common problems of the sinuses. These can include: Signs of a sinus infection. These can include long-term (chronic) yellow or greenish drainage, decreased sense of smell, facial pain or pressure, runny nose, and headache. Signs of nasal allergies. These can include runny nose, sneezing, and red or itchy eyes or nose. Signs of nasal blockage (obstruction). This can include needing to breathe through your mouth or nose on 1 side only.  PHYSICAL EXAMINATION Inspection Observe the patient’s nose for position , Observe the size , shape, symmetry, and color. Note variations, such as discoloration, swelling, or deformity. Observe for nasal discharge or flaring. If discharge is present, note the color, quantity, and consistency. If you notice flaring, observe for other signs of respiratory distress.  inspect the nasal cavity: Check patency, examine the nostrils by direct inspection using a nasal speculum, or Nasal speculum an otoscope, check for exudate. The mucosa should be moist, pink to light red, and free from lesions and polyps otoscope palpation Palpate the patient’s nose with your thumb and forefinger, assessing for pain, tenderness and swelling, Examining the sinuses checking for swelling around the eyes, especially over the sinus area. Then palpate the sinuses, checking for tenderness and deformity.. NOSE ABNORMALITIES: