Ch 17. Nose, Mouth and Throat

What is a common physical change in aging adults related to subcutaneous fat?

Aging adults experience a gradual loss of subcutaneous fat.

How does aging affect teeth in adults?

Aging often leads to natural tooth loss.

What sensory changes may occur with aging?

Aging can lead to a diminished sense of taste and smell.

What difficulty might aging adults have related to eating?

Aging adults may experience trouble with mastication (chewing).

What is a bifid uvula?

A bifid uvula is a condition where the uvula is split either completely or partially.

Which population is most commonly affected by cleft lip and cleft palate?

Cleft lip and cleft palate are most common in the Asian population.

What is torus palatinus?

Torus palatinus is a bony ridge running down the middle of the hard palate, seen in 20% to 35% of the U.S. population.

What is leukoedema, and in which population is it more commonly seen?

Leukoedema is a benign lesion on the buccal mucosa, more often seen in the Black population.

Nose subjective data

• discharge

• frequent colds, upper respiratory infections

• sinus pain

• trauma

• epistaxis (nosebleeds)

• allergies

• altered smell

Mouth and throat subjective data

• sores or lesions

• sore throat

• bleeding gums

• toothache

• hoarseness

• dysphagia

• altered taste

• smoking, alcohol consumption

• self care behaviors

• dental care pattern

• dentures or appliances

Mouth and throat self care behavior questions

• How often do you use a toothbrush and floss?

• Last dental examination? Do dental problems affect which
  foods you eat?

• Do you have a dental appliance: braces, bridge, headgear?

• Do you wear dentures? All of the time? How long have you
  had this set? How do they fit?

• Any sores or irritation on the palate or gums?

• Any problems with talking; do dentures whistle or drop? Can
  you chew all foods? How do you clean them?

What is the proper position for a person during an oral examination?

The person should be sitting up straight with their head at your eye level.

What should you ask the person to do if they wear dentures?

If the person wears dentures, offer a paper towel and ask them to remove them.

What equipment is needed for an oral examination?

The required equipment includes a penlight, two tongue blades, a 4 × 4-inch cotton gauze pad, and gloves.

What are the characteristics of the external nose during an inspection?

The external nose should be symmetric, midline, and proportional.

How do you test nasal patency?

To test nasal patency, push each nasal wing shut with your finger while asking the person to sniff inward through the other naris.

How should the nasal mucosa and turbinates appear during inspection?

The nasal mucosa and turbinates should appear light red in color when viewed with a penlight.

What cranial nerve is tested when assessing the sense of smell?

The sense of smell is tested by evaluating cranial nerve I (olfactory nerve).

What should be used to retract structures during an oral inspection?

A tongue blade should be used to retract structures during an oral inspection.

What type of light is recommended for inspecting the mouth?

A bright light is recommended for inspecting the mouth.

What should you inspect the lips for during the examination?

Inspect the lips for color, moisture, cracking, and lesions.

What should you do after retracting the lips during an inspection?

After retracting the lips, note the inner surface.

What should you inspect when examining the teeth?

Inspect for diseased, absent, loose, or abnormally positioned teeth. Compare the number of teeth with the expected number for the person's age and assess the overall bite.

What should you inspect when examining the gums?

Inspect the gums for color and margin.

How do you hold the tongue during an inspection?

Use a glove to hold the tongue with a cotton gauze pad for traction and swing the tongue out and to each side to inspect for any white patches or lesions.

What should you ask the person to do to inspect the ventral surface of the tongue?

Ask the person to touch their tongue to the roof of the mouth and note if the ventral surface looks smooth, glistening, and shows veins.

What should you check the tongue for during an inspection?

Check the tongue for color, surface characteristics, and moisture.

How do you hold the cheek open during a buccal mucosa inspection?

Hold the cheek open with a wooden tongue blade.

What should you check the buccal mucosa for during an inspection?

Check for color, nodules, or lesions.

What is an expected finding during the inspection of the buccal mucosa?

Stensen's duct, the opening of the parotid salivary gland, is an expected finding.

What is leukoedema, and where is it commonly seen?

Leukoedema is a benign lesion often seen on the buccal mucosa.

What should you inspect on the anterior hard palate during a mouth examination?

Inspect for color, texture, and any abnormalities.

How do you test CN X (Vagus nerve) during the inspection of the palate?

Ask the person to say "ahhh" and check that the soft palate and uvula rise in the midline.

What should you observe about the tonsils during a throat inspection?

The tonsils should be oval, rough-surfaced, pink (same as oral mucosa), and have indentations or crypts without exudate.

How are tonsils graded in size during an examination?

Tonsils are graded as:

• 1+ Visible

• 2+ Halfway between tonsillar pillars and uvula

• 3+ Touching the uvula

• 4+ Touching each other

How do you test CN IX (Glossopharyngeal) and CN X (Vagus) during a throat inspection?

Depress the back of the tongue with a tongue blade to check the gag reflex. This is NOT routinely done on conscious patients.

How do you test CN XII (Hypoglossal) during a throat inspection?

Ask the person to stick out their tongue; it should protrude midline.

What should you check for in addition to cranial nerve function during a throat inspection?

Notice any breath odor (halitosis).

What happens to the teeth in aging adults?

Teeth may appear longer as gum margins recede.

What happens to the tongue in aging adults?

The tongue looks smoother due to papillary atrophy.

How does the buccal mucosa change in aging adults?

The buccal mucosa thins and may appear shinier, resembling a "varnished" appearance.

What should you inspect for in the external nose during the examination?

Symmetry, any deformity, or lesions.

What should you do during the palpation of the nose?

Test the patency of each nostril.

What areas should be inspected with a penlight during the mouth and throat examination?

Mouth, teeth and gums, buccal mucosa, palate and tonsils, and pharyngeal wall.

When should palpation be performed during the mouth and throat examination?

Palpate when indicated.

Abnormality of the nose- epistaxis

Nose bleed

Abnormality of the nose- acute rhinitis

Acute rhinitis is the inflammation of the nasal mucous membranes, often caused by viral infections (like the common cold) or allergens. It leads to symptoms like a runny nose, congestion, sneezing, and a sore throat.

Abnormality of the nose- allergic rhinitis

Allergic rhinitis is an immune reaction to allergens like pollen, dust, or pet dander, causing nasal inflammation. Symptoms include sneezing, runny or stuffy nose, itching, and watery eyes. It can be seasonal (hay fever) or perennial (year-round).

Abnormality of the lips- herpes simplex 1

table 17.2

Herpes simplex virus 1 (HSV-1) causes oral herpes, leading to cold sores or fever blisters on the lips. Symptoms include painful, fluid-filled blisters that crust over, tingling or burning sensations before outbreaks, and occasional flu-like symptoms. It spreads through direct contact with infected saliva or skin.

Abnormality of the lips- Carcinoma

Lip carcinoma is a malignant tumor, often a type of squamous cell carcinoma, that develops on the lips, usually the lower lip due to sun exposure. Symptoms include a persistent sore, lump, or ulcer that does not heal, bleeding, pain, or crusting. Risk factors include UV exposure, tobacco use, and alcohol consumption.

Abnormality of the buccal mucosa- koplik’s spots

Koplik’s spots are small, white or bluish-white spots with a red halo that appear on the buccal mucosa (inside the cheeks) in the early stages of measles. They are an early diagnostic sign of measles and typically appear 1–2 days before the measles rash develops.

Abnormality of the buccal mucosa- leukoplasia

Leukoplakia is a condition characterized by thick, white patches on the buccal mucosa (inner cheek) that cannot be wiped off. It is often caused by chronic irritation from tobacco use, alcohol, or rough teeth. While usually benign, it can be precancerous and requires monitoring.

Abnormality of the buccal mucosa- candidiasis or monilial infection

Oral candidiasis (monilial infection) is a fungal infection of the buccal mucosa caused by Candida species, commonly Candida albicans. It appears as white, creamy patches that can be scraped off, leaving a red, inflamed area. It is more common in immunocompromised individuals, infants, and those using antibiotics or corticosteroids.

Abnormality of the oropharynx- oral kaposi’s sarcoma

Oral Kaposi’s sarcoma is a vascular tumor associated with human herpesvirus 8 (HHV-8), commonly seen in immunocompromised individuals, especially those with AIDS. It appears as red, blue, or purple plaques or nodules on the oropharynx, hard palate, or gums. Lesions may bleed, ulcerate, or cause discomfort while eating or speaking.