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Head-Ears-Nose-Throat : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College

: Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens

Slide 4 : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens

Thyroid : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4

Lymphatics : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas

Vasculature : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature

Head Exam : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries

Neck Exam : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated

Normal findings : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits

Nose : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose

Mouth and Throat : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat

Nasal – Oral Exam : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency

Tonsillar grading : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading

Cheilosis : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis

Herpes simplex : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex

Dental caries : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries

Apthous ulcer (cancer sore) : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries Apthous ulcer (cancer sore)

Oral leukoplakia (?HIV) : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries Apthous ulcer (cancer sore) Oral leukoplakia (?HIV)

Anatomy review : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries Apthous ulcer (cancer sore) Oral leukoplakia (?HIV) Anatomy review Ears Functions Identification, localization, and interpretation of sound and maintenance of equilibrium External ear - cartilage covered with skin Auditory canal leads to middle ear Protected with cerumen (wax) Middle ear - air filled cavity in temporal bone with ossicles that transmit sound to inner ear

External Ear : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries Apthous ulcer (cancer sore) Oral leukoplakia (?HIV) Anatomy review Ears Functions Identification, localization, and interpretation of sound and maintenance of equilibrium External ear - cartilage covered with skin Auditory canal leads to middle ear Protected with cerumen (wax) Middle ear - air filled cavity in temporal bone with ossicles that transmit sound to inner ear Anatomy review Ear Tympanic membrane separates external ear from middle ear - normally pearly grey in color The cochlea transmits sound to the brain by the eighth cranial nerve External Ear

Ear Cross section : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries Apthous ulcer (cancer sore) Oral leukoplakia (?HIV) Anatomy review Ears Functions Identification, localization, and interpretation of sound and maintenance of equilibrium External ear - cartilage covered with skin Auditory canal leads to middle ear Protected with cerumen (wax) Middle ear - air filled cavity in temporal bone with ossicles that transmit sound to inner ear Anatomy review Ear Tympanic membrane separates external ear from middle ear - normally pearly grey in color The cochlea transmits sound to the brain by the eighth cranial nerve External Ear Ear Cross section

Tympanic Membrane : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexus Sinuses Mucous membrane and cilia Mouth and Throat Mouth and Throat Mouth and Throat Functions Structure Nasal – Oral Exam External nose Inspect Deviation, shape, size, color, discharge, flaring, narrowing Palpate Displacement, tenderness, masses Patency Nasal – Oral Exam Nasal cavity Speculum exam Inspect Septum, turbinates, mucosa Abnormalities Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Sinuses Inspect, palpate, percuss Nasal – Oral Exam Nasal – Oral Exam Nasal – Oral Exam Lips Inspect/ palpate Symmetry, color, edema, and surface abnormalities Teeth/ gums/ buccal mucosa Inspect Occlusion (CN V trigeminal) Tongue blade and pen light to inspect Glove to palpate How many teeth? Condition? Nasal – Oral Exam Oral cavity Inspect tongue Swelling, size, color, ulcerations, coating CN XII – extend tongue Say “AHHHH” – CN IX and X Oropharynx Inspect with tongue blade and pen light Gag reflex – CN IX and X Tonsillar grading Cheilosis Herpes simplex Dental caries Apthous ulcer (cancer sore) Oral leukoplakia (?HIV) Anatomy review Ears Functions Identification, localization, and interpretation of sound and maintenance of equilibrium External ear - cartilage covered with skin Auditory canal leads to middle ear Protected with cerumen (wax) Middle ear - air filled cavity in temporal bone with ossicles that transmit sound to inner ear Anatomy review Ear Tympanic membrane separates external ear from middle ear - normally pearly grey in color The cochlea transmits sound to the brain by the eighth cranial nerve External Ear Ear Cross section Tympanic Membrane

The Exam : Head-Ears-Nose-Throat Michael Zychowicz, DNP, RNFA, NP-C Assistant Professor of Nursing Mount Saint Mary College Skull Bony vault protecting brain Attachment sites for muscles Neck Cervical vertebrae Vertebrae prominens Thyroid Largest endocrine gland in the body 2 lobes connected by isthmus Secretes T3/ T4 Lymphatics Filtering of pathogens and foreign substances Entire network works with CV system Fluid re-uptake at capillary areas Vasculature Vasculature Head Exam Inspect Head and facial features Size, shape, and symmetry Hair texture, color, and distribution Skull characteristics Enlargement of salivary glands Palpate Feel facial bones and skull from front to back Palpate arteries Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated Neck Exam Inspect Inspect symmetry of muscles Note any neck fullness Note jugular vein and carotid artery distribution Check for masses, skin folds, or asymmetry Evaluate range of motion and strength of muscles Palpation Evaluate trachea position Palpate thyroid Auscultate thyroid if indicated Normal findings Full range of motion CN XI intact (turn head/ shrug shoulders) Trachea is midline, smooth, nontender, and movable Thyroid lobes are small, smooth, and free of nodules Pregnant women may have larger thyroid palpable with bruits Normal findings Older adults may have a nodular thyroid Older adults may also have weakness or impaired balance which predisposes them for falling and head injuries Nose Nose Function Odors, air, sound Structure Bone/ skin/ cartilage Mucous membrane Septum/ cribiform plate/ kiesselbach plexu