Module 3: Ears & Nose

When inspecting in the nose what structures are you looking for?

-nasal mucosa: note its color and any swelling, bleeding, or exudate. If exudate is present, note its character: clear, mucopurulent, or purulent. The nasal mucosa is normally somewhat redder than the oral mucosa. -nasal septum: note any deviation, inflammation, or perforation of the septum. The lower anterior portion of the septum (where the patient's finger can reach) is a common source of epistaxis (nosebleed). - any abnormalities such as ulcers or polyps.

What does lateralization mean when conducting the Weber Test?

Ask where the patient hears the sound: on one side or both sides? Normally, the vibration is heard in the midline or equally in both ears. If it does lateralize it does so to the impaired ear. If nothing is heard, try again, pressing the fork more firmly on the head. Restrict this test to patients with unilateral hearing loss since patients with normal hearing may lateralize, and patients with bilateral conductive or sensorineural deficits will not lateralize.

What external ear structures does the provider inspect?

Auricle and External Auditory Canal.

What are the 2 pathways of hearing?

Conductive Phase: first part of the hearing pathway, from the external ear through the middle ear. Sensorineural Phase: second part of the pathway, involving the cochlea and cochlear nerve.

When inspecting the canal what are possible findings?

Discharge, foreign bodies, redness of the skin, or swelling. Cerumen, which varies in color and consistency from yellow and flaky to brown and sticky or even to dark and hard, may wholly or partly obscure your view.

What 2 sinuses are palpated?

Frontal and Maxillary

What is the proper technique to straighten the external auditory canal prior to inserting otoscope?

Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head

What does the Rinne Test compare?

Normally, the sound is heard longer through the air than through bone (AC > BC). Place the base of a lightly vibrating tuning fork on the mastoid bone, behind the ear and level with the canal. When the patient can no longer hear the sound, quickly place the fork close to the ear canal and ask if the patient hears a vibration. Here, the "U" of the fork should face forward, which maximizes sound transmission for the patient.

What are the steps in performing the Whisper Test and interpreting the results?

Stand 2 feet behind the seated patient so that the patient cannot read your lips. Occlude the non-test ear with a finger and gently rub the tragus in a circular motion to prevent transfer of sound to the non-test ear.Exhale a full breath before whispering to ensure a quiet voice. Whisper a combination of three numbers and letters, such as 3-U-1. Use a different number/letter combination for the other ear. Interpretation: Normal: Patient repeats initial sequence correctly.Normal: Patient responds incorrectly, so test a second time with a different number/letter combination; patient repeats at least three out of the possible six numbers and letters correctly. Abnormal: Four of the six possible numbers and letters are incorrect. Conduct further testing

When inspecting the nose the provider finds the tip to be tender what does that suggest?

Suggests local infection such as a furuncle, particularly if there is a small erythematous and swollen area.

What type of tuning fork is best used to assessing hearing?

To conduct these tests, make sure the room is quiet, and use a tuning fork of 512 Hz. These frequencies fall within the range of conversational speech, namely 500 to 3,000 Hz and between 45 and 60 decibels.

If a patient reports that they have hearing loss what is an initial screening test that can be performed in the office?

Whisper Test

When inspecting the eardrum what is being assessed?

color and contour. The cone of light—usually easy to see—helps to orient.

What are the structures of the inner ear?

the cochlea, the semicircular canals, and the distal end of the auditory nerve, also known as the vestibulocochlear nerve, or CN VIII.

What are the 3 compartments of the ear?

the external ear, the middle ear, and the inner ear.

What are the structures in the middle ear?

the ossicles—the malleus, the incus, and the stapes—transform sound vibrations into mechanical waves for the inner ear. The proximal end of the eustachian tube connects the middle ear to the nasopharynx.