Sponsors

You're browsing as an anonymous user. Join the community today to view notes at your university, edit pages, and share knowledge!

Nasal & Oral Examination

From Mediwikis

Nasal Examination

  • Introductions, explanation and consent
  • Wash hands

Inspection

  • Observe the skin of the nose for changes/deformity
  • Stand behind the patient and get them to tip their head back - look for deviation (has it been broken before?)
  • Lift the tip of the nose to inspect anterior nares (nostrils)
  • You need to visualize:
    • Nasal vestibule
    • Septum anterior end (is it in the midline)
    • Inferior turbinates anterior end
      • These are easier to see in children, in adults use a (clean) thudicom's (nasal) speculum/large bore speculum on auroscope


Thudicom's Speculum - hang it from you index finger and pinch it between your thumb and middle finger, use it carefully as it can be uncomfortable for patients.

Palpation

  • Feel the nasal bones and cartilage for deformity and tenderness
  • Ask the patient to close each nostril in turn and get them to breathe through the other to see whether it is blocked

Completion

  • Wash hands, thank patient
  • If necessary ENT can visualize the nose with a tiny thin endoscope

Mouth and Throat Examination

  • Wash hands, introductions, explanation and consent, ask the patient to remove any dentures (if present)
  • Examine the cervical lymph nodes
  • Get a good light source (e.g. pen torch) and pop on some gloves
  • Look at the lips, tongue, mucosa, gums and teeth for abnormalities (e.g. dental hygiene)
  • Use tongue depressor to look at the inner surface of the lips
  • Look at hard palate (e.g. for cleft, high arch)
  • Get the patient to stick their tongue out so you can see the sides, push it gently with a tongue depressor so you can see the sides right to the back
  • Get the patient to put their tongue on the top of their mouth so you can see the underneath
  • Get the patient to open wide and say "Ahh" (may need tongue depressor), visualize:
    • Uvula (?moves symmetrically)
    • Abnormality of the soft palate (e.g. cleft)
    • Tonsils (NB tonsils are the largest at age 8 and then begin to involute so they may be difficult to see in adults)
      • Size
      • Colour
      • Discharge
      • Membrane
      • Symmetry
  • If a lesion is found try to palpate it with a gloved hand (describe it as any other, i.e. size, shape, surface, consistency, colour etc.)
  • If a white plaque found then scrape it gently with the tongue depressor to see if it comes off (if it does ?candida, if it doesn't ?hairy leukoplakia)
  • Stimulate the gag reflex
  • Thank patient, dispose of equipment, wash hands