NOSE, MOUTH AND THROAT

ASSESSMENT
Nose, Mouth, and Throat

 Structure and Function

 Subjective Data—Health
History Questions
 Objective Data—The Physical
Exam
 Abnormal Findings
NOSE - SENSORY ORGAN FOR SMELL
 Functions:
o The nose humidifies, filters
and warms air before it
enters the lungs.
o Conserves heat and
moisture during exhalation.
o Identifying odors
o Giving resonance to
laryngeal sounds

 External Parts:
- Bridge
- Tip
- Nares
- Columnella
- Ala
  Internal Structures:
 NASAL CAVITY-
 Vibrissae-The hairs growing in the vestibule of the nose.
 Cilia- Microscopic hair like projection from certain epithelial
cells.
 Membranes containing such cells are known as ciliated
membranes.
 Nasal Mucosa- appears redder than oral mucosa because of
the rich blood supply present to warm the inhaled air.
 SEPTUM- divide the nasal cavity medially into two slit like air
passages.
 KIESSELBACH”S PLEXUS- the anterior part of the septum hold
a rich vascular network. The most common site of
nosebleeds.
 Extends back over the roof of the mouth
- Increase the surface area, more blood vessels and mucous
membranes are available to humidify and filter inhaled air.
 TURBINATES
 Line the lateral walls of the nasal cavity, providing a
large surface area of nasal mucosa. For heat and
water exchange as air passes through the nose.
 Three Turbinates

 Inferior

 Middle

 Superior
 Middle meatus
 The space between the inferior and middle
turbinates
 Serves as an outlet for drainage from frontal,
maxillary and anterior ethmoid sinuses.
 The inferior meatus- just below the inferior
turbinates-outlet of drainage from the nasolacrimal
ducts.
 Middle and superior meatus- serves as an outlet of
drainage from posterior ethmoid sinuses
NASAL PARTS
 Olfactory receptors – responsible for smell
and merge into the olfactory nerve, cranial
nerve I.
 Paranasal sinuses- communicate with the
nasal cavity, lined with ciliated mucous
membrane.
- Provide mucous and serve as resonators for
sound production.
SINUSES

Frontal
Maxillary
Ethmoid
Sphenoid
Nose, Mouth, and Throat
STRUCTURE AND FUNCTION OF THE
MOUTH
Firstsegment of digestive
system
Airway for respiratory
STRUCTURES:
 Hard and soft palates
 Uvula

 Tongue

Slide 16-3
Three pairs of salivary glands
- Parotid
- Submandibular
- Sublingual
32 permanent teeth
THROAT ASSESSMENT

Oropharynx
Nasopharynx- continuous
with oropharynx
Pharyngeal tonsils and
eustaschian tube openings
located here
Rich in lymphatics
Nose, Mouth, and Throat

SUBJECTIVE DATA—
HEALTH HISTORY QUESTIONS
 Nose
 Discharge
 Frequent colds (upper respiratory infections)
 Sinus pain
 Trauma
 Epistaxis (nosebleeds)
 Allergies
 Altered smell

Slide 16-4
SUBJECTIVE DATA—
Nose, Mouth, and Throat
HEALTH HISTORY QUESTIONS
 Mouth and throat
 Sores or lesions
 Sore throat
 Bleeding gums
 Toothache
 Hoarseness
 Dysphagia
 Altered taste
 Smoking and/or alcohol consumption
 Self-care behaviors
 Dental care pattern
 Dentures or appliances
Slide 16-5
OBJECTIVE DATA—
Nose, Mouth, and Throat
THE PHYSICAL EXAM
 Preparation
 Positioning
 Position the person in sitting up straight with his or her had at
your eye level. if the person wears dentures, offer a paper towel
and ask the person to remove them
 Equipment needed
 Otoscope with short, wide-tipped nasal speculum attachment
 Pen light
 Two tongue blades
 Cotton gauze pad (4 x 4 inches)
 Gloves
 Long-stem light attachment for otoscope (occasionally)

Slide 16-6
Assessing The Nose And Sinuses
Nose NORMAL FINDINGS DEVIATION FROM
NORMAL
Inspect for any Symmetric and Straight; Asymmetric;
deviations in shape, No discharge or flaring; Discharge from nares;
size, or color and flaring Uniform color; Localized area of
or discharge from nares redness/skin lesions;

Lightly palpate the Not tender, no lesions Tenderness on palpation;

external nose to presence of lesions
determine any areas of
tenderness, masses, or
displacements of bone
and cartilage
Determine patency of Air moves freely as Air movement is
both nasal cavities client breathes through restricted to one or both
the nares nares
 Determine the patency of
both nasal cavities

Air moves freely as the

client breathes through the
nares
Assessing The Nose And Sinuses
Nose NORMAL FINDINGS DEVIATION FROM
NORMAL
Observe for the Mucosa pink Mucosa red, edematous
presence of redness, Clear, watery discharge Abnormal discharge
swelling, growths and No lesions Presence of lesions
discharge, using the
flashlight

Inspect the nasal Intact and in midline Deviated to the left or to

septum between nasal the right
chambers
Sinuses
Palpate the maxillary Not tender Tenderness in one or
and frontal more sinuses
sinuses for tenderness
CRANIAL NERVE 1- OLFACTORY NERVE
 Test the sense of smell in those who reports loss
of smell. Those with trauma, and those with
abnormal mental status. And when presence of
intracranial lesion is suspected.
1. Assess patency by occluding one nostrils at a
time and ask the person to sniff.
2. Then with the person’s eyes closed, occlude
one nostrils and present an aromatic substance.
3. Use familiar, conveniently obtainable, and non-
noxious smells such as coffee, toothpaste,
orange , vanilla, soap or peppermint
 One cannot test smell when passage are
occluded with upper respiratory infection or
with sinusitis
 Anosmia- decreases or loss of smell occurs
bilaterally with tobacco smoking, allergic
rhinitis, and cocaine users
ASSESSING THE NOSE
 Inspect the nasal
cavities using a
flashlight or a nasal
speculum

 Observe for the

presence of redness,
swelling, growths and
discharge
 View each nasal cavity with the person’s
head erect, then with the head tilted back..
Inspect the nasal mucosa. Noting each
normal red color and smooth moist surface.
Note any swelling, discharge, bleeding and
foreign bodies.
 RHINITIS- Nasal mucosa is swollen and bright
red with an Upper respiratory infection.
 PALPATION

FRONTAL MAXILLARY
The frontal sinuses
are palpated by
gently pressing
upward on the bony
prominences above
each eye.

The maxillary sinuses

are palpated by
applying gentle
pressure on the bony
prominences of the
upper cheek.
ASSESSING
THE MOUTH
Assessing The Mouth And Oropharynx
Lips NORMAL FINDINGS DEVIATION FROM
NORMAL
Inspect for symmetry Uniform pink color; Pallor; cyanosis
of contour, color, and Soft, moist, smooth Blisters; generalized or
texture texture; loc. Swelling; fissures,
Symmetry of contour; crusts or scales
Ability to purse lips Inability to purse lips

Buccal Mucosa
Inspect and palpate the Uniform pink color Pallor; white patches
inner lips and buccal Moist, smooth, soft, (Leukoplakia)
mucosa for color, glistening, and elastic Excessive dryness
moisture, texture and texture Mucosal cysts; irritations
presence of lesions. from dentures;
abrasions, ulcerations;
nodules
Assessing The Mouth And Oropharynx
NORMAL FINDINGS DEVIATION FROM
NORMAL
Teeth & Gums
Inspect the teeth and 32 adult teeth Missing teeth; ill-fitting
the gums while dentures
examining the inner Smooth, white, shiny Brown or black
lips and buccal tooth enamel discoloration of the enamel
mucosa. Pink gums (may indicate staining or
presence of caries)
Excessively red gums
Moist, firm texture to Spongy texture; bleeding;
gums tenderness (may indicate
No retraction of gums periodontal disease.
(pulling away from Receding; atrophied gums,
teeth) swelling that partially
covers the teeth

Inspect the dentures. Smooth intact dentures Ill-fitting dentures, irritated

and excoriated area under
dentures
 Tongue/Floor of the NORMAL FINDINGS DEVIATIONS FROM
Mouth NORMAL
Inspect the surface of Tongue in central position Deviated from center
the tongue for position, Pink color, moist, slightly Smooth red tongue
color, and texture. rough; thin whitish coating; Dry, furry tongue
Smooth, lateral margins, Nodes, ulcerations,
no lesions discolorations; areas of
Raised papillae (taste tenderness
buds)

Inspect tongue Move freely, no Restricted mobility

movement tenderness
Ask the client to protrude the
tongue and move it from side to
side

Inspect the base of the Smooth tongue base with Swelling, ulceration
tongue, the mouth prominent veins
floor, and the frenulum.
Ask client to place the tip of the
tongue against the roof of the
mouth
 Tongue/Floor of the NORMAL FINDINGS DEVIATIONS FROM
Mouth NORMAL

Palpate the tongue and Smooth with no palpable Swelling, nodules

floor of the mouth for nodules
any nodules, lumps or
excoriated areas

Palates and Uvula

Inspect the hard and soft Light pink, smooth, soft Discoloration
palate for color, shape, palate; Palates the same color
texture and the presence Lighter pink hard palate, Irritations
of bony prominences more irregular texture Bony growths (Exostoses)
growing from hard palate

Inspect the uvula for Positioned in midline of Deviation to one side from
position and mobility soft palate tumor or trauma;
while examining the immobility
palates
Oropharynx and Tonsils NORMAL FINDINGS DEVIATIONS FROM
NORMAL
Inspect the oropharynx Pink and smooth posterior Reddened or edematous;
for color, and texture wall presence of lesions,
(one side at a time to plaques, or drainage
avoid eliciting gag
reflex)

Inspect the tonsils for Pink and smooth Inflamed

color and discharge, and No discharge Presence of discharge
size. Of normal size or not Swollen
visible

Elicit the gag reflex by Present Absent – may indicate

pressing the posterior problems with
tongue with a tongue glossopharyngeal (9th CN)
blade. & vagus (10th CN)
 Grading System for Tonsilitis

 Grade 1 – The tonsils are behind the

tonsillar pillars (Normal)
 Grade 2 – between the pillars and the
uvula
 Grade 3 – tonsils touch the uvula

 Grade 4 – one or both tonsils extend to

the midline of the oropharynx
ASSESSMENT OF THE NOSE
 Normal findings
 Located in midline of face
 No swelling, bleeding, lesions, or masses
 Both nostrils patent
 Septum midline
 Nasal mucosa is pink or dull red
ASSESSMENT OF THE NOSE
 Abnormal findings
 Broken, misshapen, swollen nose
 Occluded nasal passages
 Septum is deviated
 Nasal mucosa is red and swollen
 Purulent drainage

Copyright 2002, Delmar, A division of Thomson Learning

ASSESSMENT OF THE SINUSES
 Inspection
 Palpation and percussion

 Normal findings
 No evidence of swelling
 Resonance heard on percussion
 No discomfort during palpation or percussion

Copyright 2002, Delmar, A division of Thomson Learning

ASSESSMENT OF THE MOUTH
 Inspection
• Lips- Inspect the lips for color, moisture, cracking
or lesions. Retract the lips and note the inner
surface as well
• Teeth and Gums ( The condition of the teeth is an
index of the persons general health. Note the any
diseased, absent ,loose, or abnormally positioned
teeth , The teeth normally look white, straight and
evenly spaced and clean and free from debris or
decay.
• Compare the number of teeth with the number
expected for the person’s age.
• Ask the persons to bite as if chewing something
and note the alignment of the upper and lower jaw.
 Normal occlusion in the back is the upper
teeth resting directly on the lower , infront ,
the upper incisors slightly override the lower
incisors
 TONGUE

 Check the tongue for color, surface

characteristics and moisture. The color is
pink and even. The dorsal surface is normally
roughened from the papillae. A thin white
coating maybe present. Ask the client to
touched the tongue to the roof of the mouth.
Its ventral surface looks smooth, glistening
and shows vein. Saliva is present
 With te gloves hold the tongue using cotton
gauze pad for traction and swing the tongue
out and to each side. Inspect for any white
patches or lesions- Normally none are
present. If any occur palpate these for
indurations
 Inspect carefully the entire U- shape area
under the tongue. Oral malignancies are
most likely to develop here.Note any white
patches, nodules, or ulcerations. If lesions
are present, or with any persons over 50 or
with a positive history of smoking of alcohol
use. Use your glove hands to palpate the
area.Place your other hand under the jaw to
stabilize the tissue and to capture any
abnormality.
ASSESSMENT OF THE MOUTH

 Abnormal findings
 Lesions, growths
 Dry, cracked lips
 Vesicles or blisters
 Red, tender, inflamed tongue, gums,
buccal mucosa
 Thrush- a disease associated with white
spots on the mucous membrane
 Coating on tongue
 Bleeding gums
INSPECTION OF THE THROAT
 Using your light, observe the oval, rough-
surfaced tonsils behind the anterior tonsillar
pillar. Their color is the same as the oral mucosa.
And their surfaced is peppered with
indentation.In some people the crypts collects
small plugs of whitish cellular debris. This does
not indicate infection. However, there should be
no exudates on the tonsils
 Gag reflex- touching the posterior wall with the
tongue blade elicits the gag reflex.. This test the
cranial nerve IX and X the glossopharyngeal and
vagus
 To test the Cranial nerve XII or the hypoglossal
nerve- by asking the person to stick out the
tongue. It should protrude in the midline
INSPECTION OF THE THROAT
 Normal findings
 Soft palate and uvula rise when patient says,
“ah”
 Uvula is midline
 No swelling, exudate, or lesions
 Gag reflex is present

(continues)
Copyright 2002, Delmar, A division of Thomson Learning
INSPECTION OF THE THROAT
 Abnormal findings
 Posterior pharynx is red with white patches
 Tonsils and uvula are red and swollen
 Hoarse voice
 Grayish membrane covering tonsils, uvula, soft
palate

Copyright 2002, Delmar, A division of Thomson Learning

GERONTOLOGICAL VARIATIONS
 Diminished sense of smell and taste
 Periodontal disease- a chronic inflammatory
condition that attacks the supporting
structures of the teeth, including the
ligaments , and destroys the bones.
 Oral alterations due to disease or side effects
of medications
 Tooth loss

Copyright 2002, Delmar, A division of Thomson Learning

AGING ADULT
Sense of smell and taste
diminishes
Soft tissue atrophies,
epithelium thins
Salivary secretion decreases
Dental changes- dentures,
malocclusion, absence of teeth
Medications cause dry mouth
ASSESSING THE NECK

Examination includes the muscles, lymph nodes,

trachea, thyroid gland, carotid arteries and jugular
veins
ANATOMY OF THE NECK
• Anterior Triangle
– Medial Border of
Sternocleidomastoid
Muscle and Mastoid
• Posterior Triangle
– Formed by Trapezius
and
Sternocleidomastoid
(SCM) Muscles and
Clavicle
ANATOMY OF THE NECK
Includes:
• Trachea
•Thyroid glands
ANATOMY OF THE NECK
ASSESSING THE NECK
 Inquire if the client has any history of the
following:
• Problems with neck lumps
• Neck pain or stiffness
• When and how any lumps occur
• Previous diagnosis of thyroid problems
• Other treatment provided
NECK MUSCLES
• Inspect the neck muscles for abnormal
swellings or masses
• Observe the head movement
• Move the chin to the chest
• Move the head back so that the chin points
upward
• Move the head so that the ear is moved toward
the shoulder on each side
• Turn the head to the right and to the left
 Assess the muscle strength.
LYMPH NODES
 Palpate the entire neck
for enlarged lymph
nodes 1) Preauricular
• Face the client, bend
the head slightly
forward, toward the
side being examined
• Palpate the nodes using
the pads of the fingers
in a gentle rotating
motion
2) Postauricular
LYMPH NODES

3) Submental
4) Submandibular
5) Tonsillar

6) Anterior
Cervical
7) Posterior
Cervical
8) Supraclavicular
TRACHEA
 Palpate the trachea for lateral deviation
• Place fingertip or thumb on the trachea in the
suprasternal notch
• Move finger laterally to the left and the right in
spaces bordered by the clavicle, the anterior
aspect of the sternocleidomastoid muscle, and
the trachea
THYROID GLAND
 Inspect the thyroid gland:

Posterior Approach Anterior Approach

Posterior approach
Anterior approach
 THYROID GLAND

 Palpation of Thyroid
 Size — R>L. Normally does not
Extend above Thyroid Cartilage
 Shape — Butterfly
 Consistency — Firm but not Hard
 Sensation — Non-Tender
 Surface — Normally Smooth.
Nodules may Occur with Age or
Cancer of Thyroid.
 Movement — Rises with
Swallowing
THYROID GLAND
 If enlargement of the gland is suspected:
• Auscultate over the thyroid area for bruit ( a soft
rushing sound created by turbulent blood flow)
• Use the bell of the stethoscope
LIFESPAN CONSIDERATIONS
 Examine the neck while the infant or child is
lying supine
 An infant’s neck is normally short,
lengthening by about age 3 years. This
makes the palpation of the trachea difficult