nose mouth and throat

anatomy of nose

External nose

• Nasal septum

• Nasal cavity

• Lateral wall of nasal cavity

olfactory nerve 1

Responsible for the sense of smell.

turbinates

-bony projections on lateral walls

-warms, humidify and filters inhaled air

Superior

• Smallest; protects olfactory bulb

• Middle meatus

• Frontal sinuses drain into this meatus

• Inferior meatus

• Largest; nasolacrimal duct drains into this meatus

Paranasal Sinuses

-Air-filled pockets in the cranium around the nose

-communicates with nasal cavity

-produce mucus

Two pairs of sinuses are accessible to examine:

frontal and maxillary

Other two sets are smaller and deeper

ethmoid and sphenoid

mout structure

Lips• Teeth & gums• Tongue• Buccal mucosa• Salivary Glands• Palate & uvula• Throat

Nasopharynx

• Pharyngeal tonsils

• Adenoids

• Eustachian tube openings

• Oropharynx

Tonsils

• Hypopharynx

• Final path to larynx

Aging Adult Considerations:Physical feature changes

Decreased subcutaneous fat & lean muscle

Aging Adult Considerations: nasal changes

Stiff, coarse nasal hairs➔ Decreased olfactory nerve fibers ➔ decreased smell

equipment needed for assessment

-otoscope

-pen light

-two tongue blades

-cotton gauze pad

-gloves

nasal discharge consistency

watery, purulent, mucoid, bloody

color of nasal discharge

clear, white, yellow, green, red

amount of nasal discharge

scant, moderate, copious

associated factors with nasal discharge

Cough, headache, pharyngitis, ear ache, tearing, itchy eyes, SOB

nasal polyps

Overgrowth of mucosa

• Accompany chronic allergies

• Smooth

• Pale gray

teeth inspection

An index of overall general health

-note diseased, absent, loose, abnormal position

gum inspection

Pink or coral with stippled (dotted surface)

• Dark skinned- dark melanotic line along gingival margin

-note swelling or retraction of gingival margins

-note bleeding

leukoedema

Milky/bluish white patches

• May appear opaque

• Normal in dark skin individuals

fordyce granules

• Ectopic sebaceous glands• Small yellow raised lesions• Benign

CN IX

Glossopharyngeal (S - taste, gag; M - phonation)

CN X

Vagus (S - pharynx; Motor - pharynx and larynx)

CN XII

Hypoglossal (Motor - move tongue)

Tonsil grade sizing 1+

visible

Tonsil grade sizing 2+

halfway between tonsillar pillars and uvula

Tonsil grade sizing 3+

touching the uvula

Tonsil grade sizing 4+

touching eachother

Tonsil grade sizing 0

surgical removed or not visible

considering older adults Nose

• More prominent on face due to loss of subcutaneous fat

considering older adults teeth

-Yellow due to worn enamel

• Look longer as gums recede

• Decay, edentulous

considering older adults tongue

smoother due to papillary atrophy

considering older adults buccal mucosa

thinned shiny

rhinitis

initially, a clear, watery discharge, rhinorrhea, which later becomes purulent

-bright red and swollen

• Accompanied by sneezing and swollen mucosa,which causes nasal obstruction

Allergic rhinitis

- rhinorrhea, itching of nose and eyes, lacrimation, nasal congestion, and sneezing• Turbinates are usually pale, grey, smooth

sinusitis

Acute inflamed infected sinus/es following URI

• 90% viral

• Consider bacterial infection when S/S last >10 days

Maxillary sinusitis

• Dull, throbbing pain in cheek and teeth

• Pain with palpation and when bending over

Frontal sinusitis

• Pain above supraorbital ridge

Epistaxis causes

-trauma

-nose picking or scratching

-vigorous coughing or blowing nose

Herpes Simplex 1 (HSV-1)

common cold

-group of clear vesicles with red base

-highly contagious and spreads

aphthous ulcers

"canker sores"; small, painful, round ulcers in the oral mucosa of unknown cause

carcinoma

-Initial lesion is round and indurated

-becomes crusted and ulcerated

-lips gums tongue

-if unhealed after 2 weeks , should be referred

candidiasis

yeast infection

White, cheesy, curd-like patch on the buccal mucosa and tongue

thrush

an opportunistic infection that occurs after the use of antibiotics and corticosteroids and in immunosuppressed people

Acute Tonsillitis And Pharyngitis

viral or bacterial infection

enlarged, tender anterior cervical and tonsillar nodes

-severe sore throat, painful swallowing, fever