Week 12 notes Eye, Ear, Nose, Throat, and Skin Conditions

Eye Anatomy

The eye globe

• made up of many individual structures

• some can be easily viewed by the naked eye

• others require an

ophthalmoscope to

view

Eye Anatomy

Eye globe (cont.)

• sclera

 “the white of the eye”

 forms the outer

protective layer of the

eye

• cornea

 located in the center

of the most anterior

portion of the eye

Eye globe (cont.)

• pupil

 located in center of iris

 often compared to the

aperture lens of a

camera

 controls the amount of

light allowed into the

eye

Orbits (eye sockets)

surround and protect the eyes

• formed by seven bones

 frontal

 zygomatic

 maxillary

 ethmoidal

 sphenoid

 lacrimal

 palatine

Extraocular muscles

controls movement of

eyes

• 4 rectus muscles

 adduct, abduct, elevate,

and depress the eye

globe

• 2 oblique muscles

 control circular

movements

Eye Anatomy

Lacrimal apparatus

• produce, distribute, and collect tears

• can be damaged with lacerations involving the

medial portion of the eye lids

Orbits (eye sockets) (cont.)

• orbital floor and medial walls

 weakest portion of bony socket

 often fractured

with external

periorbital forces

(blow-out

fractures)

Eye globe (cont.)

• optic nerve

 located at back of the eye

 transmits nerve impulses from eye to brain

• optic disc

 portion of optic nerve

 visible when viewed with ophthalmoscope

Eye Signs and Symptoms

Pain

• can occur periocular, ocular, or retrobulbar (behind

the globe)

• location of pain along with intensity, onset, and

duration provides clues to possible pathology

• severe eye pain accompanied by systemic symptoms

or significant changes in vision (ie, severe

photophobia, blurring, flashing, “floaters,” partial loss

of visual field) suggest serious pathology (ie, acute

glaucoma)

 risk of permanent loss of vision exists

 emergency medical care is indicated

Eye Signs and Symptoms

Discharge

• may occur due to allergies and infections

• can range from clear and watery to white or yellowish

pus

Double vision (diplopia)

• 2 images of the same object, one from each eye

• associated pathology

 head injury

 multiple sclerosis

 diabetes

 myasthenia gravis

• warrants referral to ophthalmologist

Eye Signs and Symptoms

Itching

• commonly associated with allergy

• also associated with some infections

Photophobia

• sensitivity to light

• common reported with corneal abrasions

Ptosis

• drooping of the eye lid

Eye Signs and Symptoms

Tearing

• increased tearing can occur due to irritation of

anterior eye

• lacrimal apparatus injury or illness can cause

increased or decreased tearing

Halos (around lights at night)

• associated pathology

 glaucoma

 corneal edema

 corneal scarring

 dislocated intraocular lens.

Eye Signs and Symptoms

Light flashes (photopsia)

• commonly reported with retinal tears or

detachment

Anisocoria

• unequal pupils

 differences < 0.5 mm are found normally in ≈ 20%

of population

 differences > 0.5 mm considered abnormal

– particularly when accompanied by abnormal pupillary

reactions and history of head or eye trauma

Eye Signs and Symptoms

Nystagmus

• rhythmic oscillation of the eyes

• occurs with neurological pathology (including

head injury)

Protruding eyes (exophthalmos)

• retraction of the eye lids cause appearance of

protruding eyes

• associated with Grave’s disease

Eye Signs and Symptoms

Curtain over vision

• sudden appearance of curtain blocking either

direct or peripheral vision

• associated with detached retina or detached

vitreous

• warrants immediate referral

Eye Physical Exam

Visual acuity

Pupillary shape and reaction

Eye movements

Peripheral vision

Fluorescein strips with cobalt blue light

Ophthalmoscope

Visual Acuity

On-the-field

• ability to see object at 20’

• ability to focus and read text at 14-16”

Clinically

• Snellen eye chart

Any loss of visual acuity secondary to an

eye injury warrants immediate referral

Pupillary Shape and Reaction

Pupils should be inspected

• size

 unequal pupil size following a head or ocular injury

suggests neurological involvement and warrants

immediate referral

• shape

 tear-drop shape or irregularly peaked pupil

suggests possible globe rupture and is considered

a medical emergency

Eye Movements

Assessment of extraocular muscles

• should be performed following any traumatic eye

injury

• using penlight or finger, instruct the patient to follow

the object with out moving the head

• test ability to look laterally, medially, upward,

downward, diagonally up and out, and diagonally

down and out

• inability to look up is associated with orbital blowout

fractures

• normal eye movement can also be affected by head

injuries or other neurological conditions.

Peripheral Vision

Instruct the patient to cover one eye with

his hand

Examiner also covers her eye (same as

the patient’s – right or left)

• allows examiner to compare patient’s

peripheral vision with her own

Eye Infections

Conjunctivitis

Stye

Stye

Clogging and infection of oil gland

Caused by Staphylococcal bacteria

Can occur on edge of lid or inside lid

Stye

Signs and symptoms

• pain

• redness

• excess tearing

• blurred vision

• granular sensation in the eye

• oozing pus, which can spread to other areas

around the eyes

Stye

Management

• warm compresses 10-15 min, 3-4 times/day

• most will resolve within a few days

• do NOT “pop” stye

• allow to come to head on it’s own

Conjunctivitis

Inflammation of the conjunctiva

• infectious (contagious)

 viral

 bacterial

• allergic

 commonly occurs with

hayfever and allergic rhinitis

• irritant

 wearing extended wear contacts beyond

recommended time frame

Conjunctivitis

Signs and symptoms

• somewhat dependent on the cause

• redness

• pain

• discharge

 thick and colored (bacterial)

 thin and clear (viral, allergic)

• possible swelling of eyelid

• feeling of sand in the eye

Eye Trauma

Subconjunctival hemorrhage

Corneal abrasions

Hyphema

Retinal detachment

Subconjunctival Hemorrhage

Bleeding under the conjunctiva

Caused by

• trauma

• forceful coughing

• high blood pressure

Typically benign and will

resolve on its own within

1-3 weeks

Corneal Abrasions

Caused by

• blow to eye

• foreign object in eye

Signs and symptoms

• sensation of something in eye

• photophobia

• pain

Corneal Abrasions

Evaluation

• history

• inspection

• fluorescein strips w/cobalt blue light

Ear Anatomy

3 main sections:

• external ear

• middle ear

• inner ear

Ear Anatomy

External ear

• auricle

• external auditory canal

 helps move sound waves

toward tympanic

membrane (ear drum)

Ear Anatomy

Middle ear

• tympanic membrane

 forms the outermost border of middle ear

 separates external canal

from the ossicle bones

 vibrates when sound

waves strike it

Ear Anatomy

Middle ear

• tympanic membrane

 initiates process of converting sound waves to

electrical nerve impulses

 damage to membrane can

result in some degree

of hearing loss

Ear Anatomy

Middle ear

• ossicle bones

 malleus

 incus

 stapes

Ear Anatomy

Inner ear

• cochlea

 continue the conversion

of sound waves to

nerve impulses for

the brain to interpret

• semicircular canals

 maintain balance

Ear Anatomy

Eustachian tube

• connects middle ear to

nasal passages

• regulates pressure

within middle ear

Ear Signs and Symptoms

Tinnitus

• sensation of ringing in the ears

• may be reported with ruptured tympanic

membrane

Ear Signs and Symptoms

Pain

• common with most ear infections

• pain with palpation of tragus and traction of

ear lobe associated with otitis externa

• sensation of pressure or pain behind

membrane associated with otitis media

• tooth disorders can refer pain to the ipsilateral

ear

Ear Signs and Symptoms

Loss of hearing

• degree of hearing loss related to severity of

injury or illness

 partial

 complete

Medical History

Family history

• very few, if any, ear conditions have a genetic

component

Personal history

• forceful blow to the ear?

• recent illness

 sinus infection

 cold

 allergies

Ear Physical Exam

Inspect auricle

• redness

• swelling

• drainage

• foreign object

• cuts, scrapes, bruises

Ear Physical Exam

Apply traction to ear lobe

and pinna

• pain associated with otitis

externa

Otitis Externa

Inflammation/infection of external auditory

canal

Typically caused by repeated exposure to

water (creates warm, moist environment)

Otitis Externa

Signs and symptoms

• tenderness within canal

• tenderness when auricle or lobule is pulled or

tragus palpated

• red, swollen canal (otoscopic exam)

• drainage may be present in

canal (otoscopic exam)

• itching within canal

• decreased hearing

Otitis Externa

Physical exam

• visual inspection of outer ear

• inspection of ear canal using otoscope

Otitis Externa

Management

• antibiotic or antifungal ear drops

• irrigation with sterile saline or hydrogen

peroxide

• discontinue swimming

Return-to-play guidelines

nonswimmers do not need to be withheld from

play

• swimmers can return to activity once

symptoms are reduced

(approximately 3 days)

Otitis Externa

Prevention

• wearing tight fitting swim cap or ear plugs

• using hair dryer to dry ear canal

• using drying agents (swimmer’s ear drops)

Perforated Tympanic Membrane

A hole or tear in the tympanic membrane

Can cause hearing loss

Provides opening for bacteria – can lead

to middle ear infection

Anatomy

Nasal complex

• nasal cavity

• paranasal sinuses

 frontal

 sphenoid

 ethmoidal

 maxillary

Function

Air enters the nose through the paired

nostrils, vestibule, and nasal cavity

Air is filtered, warmed, and humidified

Air then passes on to nasopharynx,

trachea, and lung

Nose Signs & Symptoms

Runny nose

• clear, watery drainage (coryza)

• caused by inflammation of mucous

membranes

Congestion and pressure

• caused by accumulation of mucous and

drainage within nasal cavity and sinuses

Referred pain to teeth

• sinus infections

Nose Pathology

Epistaxis (nose bleed)

Nasal fracture

Nasal allergies and infections

Epistaxis

Etiology

• trauma (nasal or facial fracture)

• infection

• dry nasal passages

• allergies

• hypertension

Epistaxis

Treatment

• instruct patient to lean forward slightly & pinch

nostrils

• applying an ice bag to the nose can also help

control

• in cases that do not respond to this treatment

or that involve a fracture, the nose can be

packed with rolled gauze or tampons cut into

small sections to control the bleeding

Nasal Fracture

Typically involve epistaxis

Once the bleeding is controlled, the nose

and surrounding facial bones should be

visually inspected and palpated for

deformity

Fractures involving a deviated septum can

impair breathing within one nostril

Nasal Fracture

Ice can be applied to the nose to reduce

the pain and swelling

Patient should be referred to a physician

for follow-up

Nasal Allergies

Allergic rhinitis

Sinusitis and sinus infections

Allergic Rhinitis

2 types

• seasonal

 occurs most often during particular seasons, such

as during the peak pollen season in the spring

• perennial

 occurs throughout the year

 common triggers

– animal dander

– dust

– cockroach droppings

– mold

Throat Anatomy

Tonsils

• located on both sides of back of mouth

• made up of lymphoid tissue to

help fight infection

Uvula

• hangs at back of throat between

the tonsils

Throat Anatomy

Adenoids

• located on back of nasal cavity

• made up of lymphoid tissue to help fight infection

Epiglottis

• lies between oropharynx

and laryngopharynx

• functions to prevent food

from entering larynx

Throat Anatomy

Larynx has 3 main functions

• prevent food and fluids from entering trachea

• produce sound vibrations

• assist in cough

mechanism

Throat Signs and Symptoms

Pain

• common with throat infections

Difficulty swallowing

• may occur secondary to pain

White or red spots

• can occur on either throat or soft palate

• associate with throat infections

Throat Infections

Laryngitis

Pharyngitis

Tonsillitis

Strep throat

Laryngitis

Signs and symptoms

• hoarseness or complete inability to speak

• sore throat

• difficulty swallowing

Laryngitis

Physical exam

• fever (may or may not be present)

• larynx not visibly seen without a laryngoscope

Laryngitis

Management

• rest

• analgesics

• hydration

Pharyngitis (sore throat)

Signs and symptoms

• difficulty swallowing

• possible pain in ears

Pharyngitis

Physical exam

• red throat with possible pus pockets

• fever (may or may not be present)

Anatomy

Oral cavity lined with mucous membranes

32 teeth

• 16 in the upper jaw

• 16 in the lower jaw

Anatomy

Crown

• visible portion of tooth

• made of enamel

Dentin

• layer just below enamel

• harder than

Anatomy

Each tooth fits into an individual socket in

jaw bone, surrounded at base by gums

Root of tooth

• sits below gum line in bony

socket

• contains blood vessels

and nerves that provide

circulation and sensation

to tooth

Signs and Symptoms

Pain

• most common symptoms of mouth disorders

• can be local and specific to the disorder

 cavity

 tooth fracture

 Infection

• can be referred from another area (sinuses)

or to another area (ear)

Signs and Symptoms

Swollen, red, or bleeding gums

• inflammation and infection from gingivitis

Sensitivity to hot and cold food or

beverages

• caused by demineralization of teeth

secondary to plaque or cavities

Mouth Pathology

Gingivitis

Periodontitis

Dental caries

Oral cancer

Gingivitis

Bacterial infection of the gums

Signs and symptoms

• swollen, red, and bleeding gums

• bad breath

Should be treated by a dentist to prevent

the progression of the infection

Gingivitis

Prevention

• maintaining good oral hygiene

 brushing and flossing teeth

 regular dental check-ups

Return to participation

• no restrictions for participation in athletics or

group exercise for individuals with gingivitis

Periodontitis

Periodontitis occurs when the

inflammation and infection from gingivitis

spreads to the ligaments and bones that

support the teeth.

Periodontitis

Signs and symptoms

• swollen, red, and bleeding gums

• infections or abscesses along the gums

• bad breath

• partially loose teeth