advanced hent voice

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

: 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

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 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

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 Head Exam Percussion Percuss sinuses Auscultation Listen for vascular abnormalities over temporal region if indicated

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

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 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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 : 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

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 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 : 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 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM

Some problems of eardrum : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection

Normal TM : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM

Impacted cerumen : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen

Acute Otitis Media : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media

Perforation : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation

Healed Perforation : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation

Tympanostomy tubes : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes

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 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne

Rinne Test (part 1) : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne Rinne Test (part 1)

Rinne Test (part 2) : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne Rinne Test (part 1) Rinne Test (part 2)

Weber Test : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne Rinne Test (part 1) Rinne Test (part 2) Weber Test

Conductive hearing loss : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne Rinne Test (part 1) Rinne Test (part 2) Weber Test Conductive hearing loss Causes Plugged ear canal, otitis media, immobile or perforated TM, otosclerosis PE findings: Small difficulty understanding words Childhood and young adult TM may not be visible or have visible problem Weber’s test lateralizes to impaired ear Rinne test BC=AC or BC>AC

Sensorineural loss : 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne Rinne Test (part 1) Rinne Test (part 2) Weber Test Conductive hearing loss Causes Plugged ear canal, otitis media, immobile or perforated TM, otosclerosis PE findings: Small difficulty understanding words Childhood and young adult TM may not be visible or have visible problem Weber’s test lateralizes to impaired ear Rinne test BC=AC or BC>AC Sensorineural loss Causes: Sustained loud noise, drugs, inner ear infection, trauma, hereditary disorder, aging PE findings: Hard time understanding words Middle to old age Usually no problem with TM visible Weber test lateralizes to good ear Rinne test: AC>BC

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 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 Ears Inspect Auricles, mastoid areas, auditory meatus characteristics and alignment Palpate auricles, mastoid area, tragus, and auditory meatus Otoscopic exam Auditory canal and TM Some problems of eardrum Serous effusion Amber fluid behind TM w/ or w/o bubbles Viral URI or sudden air pressure changes (scuba) Acute otitis media Red bulging ear drum, loss of landmarks Usually bacterial infection Tympanosclerosis Chalky white patch on TM Scar from OM - usually no problems Perforation Hole in TM from trauma or infection Normal TM Impacted cerumen Acute Otitis Media Perforation Healed Perforation Tympanostomy tubes The Exam Hearing tests Whisper test Weber Rinne Rinne Test (part 1) Rinne Test (part 2) Weber Test Conductive hearing loss Causes Plugged ear canal, otitis media, immobile or perforated TM, otosclerosis PE findings: Small difficulty understanding words Childhood and young adult TM may not be visible or have visible problem Weber’s test lateralizes to impaired ear Rinne test BC=AC or BC>AC Sensorineural loss Causes: Sustained loud noise, drugs, inner ear infection, trauma, hereditary disorder, aging PE findings: Hard time understanding words Middle to old age Usually no problem with TM visible Weber test lateralizes to good ear Rinne test: AC>BC Normal findings Auricle of ear is same color as face TM is translucent with bony landmarks and cone of light present