Eye and ENT Examination. Ear, Nose, and Throat Anatomy.

Eye and ENT Examination

Ear, Nose, and Throat Anatomy

Oral Cavity

Pharynx Uvula Tonsils

Lymph Nodes

1 - Anterior cervical

2 - Posterior cervical

3 - Preauricular1

3

2

Ears

Pinna

Ear Examination

3 steps• Outer ear• Canal• Inner ear

General inspection and palpation (outer ear)

Otoscopic examination (canal and inner ear)

Outer Ear Exam

Look for deformities, lumps, skin lesions (eg. Herpes lesions, hematomas)

Associated structures• Lymph nodes• Pharynx• Eustachian tube

Ear Canal and Inner Ear Exam

Use proper sized otoscope tip Turn on otoscope and check that light

works Pull ear up, back, and toward you Use pinky finger for support and to

prevent injury Place otoscope tip in ear canal, then

lean forward and start looking into the otoscope

Ear Canal Exam

Look for redness, swelling, discharge, foreign bodies, wax

Pain with tragus and pinna manipulation can indicate problem with canal, as opposed to inner ear

Examination of TM

The TM is clear (transparent) when light passes through the membrane

The TM is dull (opaque) when light does not pass through the membrane so that the bony landmarks can not be clearly seen

Bulging TM The bulging often

impairs the visibility of the landmarks

Lymph Nodes

1 - Anterior cervical (pharyngitis)

2 - Posterior cervical (mono)

3 – Preauricular (conjunctivitis)

1

3

2

Lymph Nodes

Roll the lymph node area under the pads of your fingers, compressing it against the underlying structures

Feel for size and tenderness Check for symmetry

• Is there an enlarged gland that just happens to be on the side of the earache or sinus pressure?

Sinuses Grasp head fairly

firmly, and push with thumbs on the frontal and maxillary areas

For ethmoid sinuses, squeeze firmly between eyes with thumb and index finger

Evaluate for tenderness

Fairly nonspecific

Eye Examination

4 components 1 - Visual acuity (Snellen eye chart) 2 - Visual fields (by confrontation) 3 - Extra ocular movements (“H”) 4 - Ophthalmoscopic examination

1- Visual Acuity Exam

Use a Snellen eye chart• 20 feet from chart• Read at least half of each line

Read posters, magazines, newspaper if nothing else is available

2 - Visual Fields Exam(by Confrontation)

Have patient cover one eye lightly and look at your nose

Stand facing patient (confronting them) holding hands out to sides

Check upper fields by wiggling fingers of one or both hands

Repeat for lower fields Repeat for other eye

3 - Eye Movements Exam(Extra ocular movements)

Ask patient to look at your fingers Keep head still. Stabilize chin if needed Make large “H” Convergence test (bring finger to their nose)

• Cross eyed

4 - Ophthalmoscopic Exam

Adjust proper settings on scope (light intensity, light shape, light color, focus)

Position patient and adjust ambient lighting

Start laterally from a distance and obtain red reflex, then approach steadily as if peering through a keyhole

If lots of glare, use a smaller diameter light setting

Find optic disc directly or by following a blood vessel from narrower aspect to wider aspect, which will lead you to the optic disc

Quiz Time

Generally speaking, you don’t have to worry about rupturing a patient’s

tympanic membrane with a typically placed otoscope tip because,

a. The tympanic membrane is tough like shoe leather

b. They still have another good ear anyway!

c. The canal is about 1 inch deep

c

Anterior cervical nodes only

Anterior and posterior cervical nodes

Preauricular nodes

Possible Diagnoses – Herpes infection on temple, mono, tonsillitis

Tonsillitis

Mono

Herpes

Match the Swollen Lymph Nodes!

If you were to tug on someone’s pinna or poke someone’s tragus you

would expect,

a. A slapb. Pain which could indicate an

acute otitis mediac. Pain which could indicate

otitis externa

c

To look in a person's ear, you would move the pinna in the following

direction.

a. Down and outb. Up, back, and toward youc. Straight upd. Consult your GPS, then proceed as

directed

b

If you were looking in a healthy right ear, you would expect to see which of

the following?

a. The cone of light to the leftb. Our new kitty from last yearc. Same cat this yeard. A shiny, somewhat

transparent-appearing tympanic membrane

d

Matching Game?

If you wanted to evaluate someone’s visual acuity, you would (choose either best, pretty good, bad, or stupid!),

Ignore their complaint of decreased vision altogether

Use a Snellen eye chart

Poke them in the eye with your ophthalmoscope

Have them read from a magazine

Stupid

Pretty good

Bad

Best

Which of the following is the single greatest scientific achievement of all

time?

Einstein’s theory of relativity.The concept of the number “0”.Darwin’s discovery of Evolution.Vaccination.

None of the above.

It’s the Mr. Clean

Magic Eraser.