Eyes, Ears, Nose & Throat

PN 2

Summer Semester

Eyes

Infants and Children:• At birth eyes symmetrical; pupils equal and

respond to light• Iris is brown or slate gray-blue• By 3 months colour changes• Eyelids edematous; little or no tears which begin

a 4 weeks• Vision in both eyes begin at 6 weeks• Eyes fully grown at age 8• Red reflex at birth

Eyes

Pregnant Female:

• May c/o dry eyes (contact lenses)

• Visual changes d/t shifting fluid in cornea

• Blurriness or distortion of vision can occur because of temporary changes in shape of eye in last trimester and first 6 weeks post partum.

Eyes

Older Adults:• Age 45 lens looses elasticity; ciliary muscle

becomes weaker = near vision become a problem (presbyopia)

• Droopy eye lids d/t decrease fat• Decrease tear formation• Cornea cloudy• Light reflex slower• Cateracts; macular degeneration• Narrow blood vessels

Considerations

Cultural and environmental:

• Blindness in poorer countries

• Excessive sun exposure

• Vitamin A deficiency

• Discard makeup after 3 mos

• Trauma in the workplace

• Excessive sun may lead to cataracts

Doing the Eye Assessment

• General questions

• Questions r/t illness or infection

• Questions r/t symptoms or behaviours

• Questions r/t to pain

• Questions r/t to age

• Questions r/t occupations/environment

Physical Assessment

• Provide specific clear instructions

• If you ask someone to read something…make sure they can read.

• Place card over “closed” eye; do not actually close or apply pressure

• Lighting in room should be adjustable

• Need at least 20 feet of space

• Use standard precautions

Snellen Eye Chart

• Results recorded as fractions• Numerator=distance from chart• Denominator=distance where ct with normal

vision can read line• Normal 20/20• 20/30 = at 20 ft ct can read what normal person

reads at 30 ft. • If ct is unable to read ½ of line, record the

number of line above• Smaller the fraction=worse vision• 20/200 is legal blindness

Visual tests

• We will do these when we do cranial nerve assessment

• Visual fields

• 6 cardinal fields of gaze

• Corneal light reflex

• Cover test

• Pupillary response

Eye lids

• Conjunctiva• Sclera• Skin cancer• Eye lid inflammation • Cataract• Conjunctiva• Ectropian/entropion• Trauma

Ears, Nose and Throat

Infants and Children:

• Auditory canal is short with upward curve

• Children (age 3) have horizontal tube

• Nose of child is too small to really examine

• Salivation begins at 3 months

• Drooling occurs until baby learns to swallow

ENT

Pregnant Female:

• Estrogen levels cause increase vascularity

• Vessels change in middle ear

• Increase blood flow in sinuses

• Sense of smell increases

• Edema of vocal cords

• Sometimes over growth of gums

ENT

Older Adult• Hair in ears• Ears become more prominent• Tympanic membrane paler and thicker• Lips and buccal mucosa become thinner and

less vascular• More fissures on tongue; decreased taste, saliva• Gums recede and tooth decay

Psychosocial Considerations

• Stress = mouth ulcers and lip biting• Clenching or grinding of teeth

Cultural and Environmental Considerations

• Teeth size and decay• Occupation and hearing• Finances/health care insurance

Interview

General questionsQuestions r/t illness and infectionQuestions r/t to symptoms and behaviourQuestions r/t painQuestions r/t environmentQuestions r/t ageQuestions r/t nose and sinus; mouth and

throat

Physical Assessment

• Inspection; palpation; percussion; trans illumination of sinuses

• Tuning fork, otoscope and nasal speculum

Ear/hearing

• Binaural hearing• Ears symmetrical in size, shape, colour and

configuration• External auditory canal is patent and free of

drainage• External ear and mastoid process are free of

lesions and tragus is movable• When viewing through otoscope the external ear

is open, non tender, free of lesions, inflammation and F/O’s

• Cerumen is soft and small amt.

Ear/hearing

• Tympanic membrane is flat, gray and translucent

• Malleolar process and reflected light are visible on tympanic membrane

• TM flutters with Valsalva

• During hearing test, air conduction is longer than bone conduction

• Adults are able to maintain balance

Hearing loss

• Noise induced hearing loss from exposure to loud music or machinery common cause of hearing loss in adult aged 20 to 40

• Hearing loss in older adults common and is either senorineural or conductive loss

• Presbycosis: occurs around age 50 and gets worse

Nose/Sinuses

• Infants: obligatory nose breathers

• Nose is only external organ of the resp track

• Nasal mucosa is rich in blood supply and filters inspired air.

• Olfactory cells are in roof of nose

• Sinuses are mucous lined, air-filled cavities that warm, filter and moisten air

Mouth and Throat

• Teeth, lips, gums (buccal mucosa), cheeks, tongue, hard and soft palate, uvula, manibular arch and maxillary arch

• Tongue: check for adhesions; taste

• Palate: check for cleft

• Throat: tonsils