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Adult Health Assesment
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Class Notes Part 1 Ears, Nose, Mouth⭐
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Class Notes Part 1 Ears, Nose, Mouth⭐

👂 Ears

External Ear

  • Tympanic Membrane (eardrum):
    • Separates external & middle ear.
    • Normal: pearly gray, translucent, bones visible.
  • Skin smooth.
  • Some individuals develop keloids.

Structure & Function

  • Role: sound conduction & equilibrium.
  • Inner ear infection → dizziness & balance issues.

Hearing

  • Sound produced by vibration.
  • Air Conduction (AC) vs Bone Conduction (BC):
    • AC is normally 2x BC.
  • Tests:
    • Air conduction: tuning fork in front of ear.
    • Bone conduction: mastoid process.
    • Whisper test → CN VIII (Acoustic).

👂 Internal Ear (Inner Ear) — Simplified for Nursing

🧠 Main Function:

The inner ear is responsible for hearing and balance (equilibrium).

It converts sound waves into nerve signals and helps the body maintain position and movement awareness.

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🌀 Three Main Parts of the Internal Ear
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1. Cochlea (Hearing)

  • A spiral-shaped, snail-like structure filled with fluid.
  • Contains the Organ of Corti, which has hair cells (sensory receptors).
  • Sound vibrations move the fluid, bending the hair cells → converts sound into electrical impulses → sent to the auditory nerve → brain interprets as sound.

    • 🧠 Think: Cochlea = Hearing center.

2. Vestibule (Static Balance)

  • Central part of the inner ear that connects the cochlea and semicircular canals.

🧠 Think: Vestibule = Balance when still.

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3. Semicircular Canals (Dynamic Balance)

  • Three fluid-filled loops positioned in different directions (horizontal, anterior, posterior).

🧠 Think: Semicircular canals = Balance while moving.

cochlea - hearing semicircular canal - balance while moving vestibule - balance when still

⚡ Clinical Notes for Nurses

  • Vertigo: results from inner ear problems
  • Hearing loss: may occur if the cochlea or auditory nerve is damaged.

Aging & Ears

  • Otosclerosis → progressive hearing loss.
  • Cerumen: soft/sticky, may harden.
    • Do not remove manually; it migrates outward naturally.
  • Older adults: difficulty hearing in noisy areas.
  • Abnormal findings:
    • Ear discharge = infection.
    • Tinnitus, vertigo.

Ear Exam Techniques

  • Inspect size, shape, color (consider ethnicity).
  • Palpate tragus → pain = infection.
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  • Adults: pull ear up & back.
  • Tests:
    • Weber Test
    • Rinne Test
    • Romberg Sign (balance; swaying normal, falling abnormal).
  • Landmarks: tympanic membrane light reflex at 5 or 7 o’clock.

👃 Nose (Chapter 17)

  • Nasal cavity divided by septum → 2 passages.
  • CN I (Olfactory): smell.
    • Tested with coffee/alcohol, eyes closed.
    • Usually only tested if complaint or older adult (safety/fire risk).
  • Sinuses:
    • Frontal & maxillary → accessible.
    • Ethmoid → too deep.
  • Inspection:
    • Drainage, septum intact, discoloration.
  • Mouth breathers: may have dry mouth or cracked lips — check hydration.
  • Oxygen therapy: dries nasal mucosa → use humidifier or saline spray.

Anatomy Nose:

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Click to see Pictures:
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Click to Read

👃 Nose — Structure and Function (for Nursing)

🧠 Main Functions

  • Smell (Olfaction) 👃
  • Filtration, humidification, and warming of inspired air 🌬️
  • Resonance for speech 🗣️
  • Drainage for sinuses and tear ducts

🧩 Anatomy of the Nose

1. External Nose

  • Made of bone and cartilage, covered by skin.
  • Nostrils (nares): openings for air entry.
  • Nasal septum: divides nose into right and left passages.

🧠 Nursing note: Deviated septum can cause breathing difficulty or snoring.

2. Nasal Cavity

  • Inside space behind the nostrils, lined with mucous membrane and cilia (tiny hairs).
  • Warms, filters, and moistens air before it reaches the lungs.
  • Contains olfactory receptors in the upper part → detect smells.

🧠 Nursing note: Dryness or irritation (e.g., oxygen therapy, decongestants) can damage mucosa and cause nosebleeds (epistaxis).

3. Turbinates (Conchae)

  • Curved bony structures inside the nasal cavity.
  • Increase surface area to trap particles and warm the air.

🧠 Nursing note: Swollen turbinates = nasal congestion or obstruction.

4. Paranasal Sinuses

  • Air-filled spaces around the nose: frontal, maxillary, ethmoid, sphenoid.
  • Lighten skull weight, improve voice resonance, and produce mucus.

🧠 Nursing note: Sinusitis = infection or inflammation → facial pain, pressure, nasal drainage.

5. Olfactory Nerve (Cranial Nerve I)

  • Located at the roof of the nasal cavity.
  • Transmits smell signals to the brain.

🧠 Nursing note: Loss of smell (anosmia) can occur after head injury, infection, or aging.

👄 Mouth & Throat

  • Structures: lips, palate, cheeks, tongue.
    • Hard palate → anterior, immobile.
    • Soft palate → posterior, mobile (“Ahh”).
    • Cheeks → should be intact, no swelling or lesions.
    • Uvula → displaced if tonsils inflamed.
  • Tongue:
    • Structure: papillae rough surface.
    • Frenulum: short/tight = speech problems (may require cutting in child).
    • CN IX, X, XII involved.
    • In case of Damage to cranial nerve Tongue will deviate towards the damaged side.
  • Salivary Glands: 3 pairs.
    • two pairs of salivary glands accessible to examination on the face
      • Parotid gland: largest of salivary glands even though is not normally palpable. Located in the cheeks, over the mandible, anterior to and just below the ear.
      • Submandibular
    • Sublingual. Salivary glands accessible to examination on the mouth. Floor of the mouth, under the tongue.
      • image
  • Teeth & Gums:
    • Inspect for cavities, gum color, structure, lesions.
    • Gum striations can be normal.
  • Aging Changes:
    • Loss of subcutaneous fat → prominent jaw.
    • Tooth loss, dentures.
    • Decreased taste & smell.
    • Mastication problems.
  • Abnormalities:
    • Bleeding gums.
    • Dry mouth.
    • Septum deviation.
    • Oral lesions.
  • Throat Exam:
    • Tonsils graded → 2+ = normal. 3+ They are touching the Uvula. 4+ They are touching each other.
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Subjective Questions

  • Vision: “Any blurring or difficulty seeing?”
  • Smell, taste, hearing problems?
  • History of allergies, sinus pain, or sore throat?