Ears, Nose, Ears, Nose, Mouth & Mouth &

OropharynxOropharynx

Ear Ear Sensory organ for Sensory organ for

hearing & maintaining hearing & maintaining equilibriumequilibrium

3 parts – external ear, 3 parts – external ear, middle ear, inner earmiddle ear, inner ear

External ear – auricle or External ear – auricle or pinna is movable pinna is movable cartilage & skin. Use cartilage & skin. Use these landmarks to these landmarks to describe findings. describe findings. Mastoid process (bony Mastoid process (bony prominence behind prominence behind lobule) not part of the lobule) not part of the ear but used to describe ear but used to describe findingsfindings

External EarExternal Ear Shape of auricle helps to funnel sound Shape of auricle helps to funnel sound

waves into the external auditory canal waves into the external auditory canal which is about 2 ½ to 3 cm long. Ends at which is about 2 ½ to 3 cm long. Ends at the ear drumthe ear drum

Glands in the canal secrete cerumen – Glands in the canal secrete cerumen – lubricates & protects the ear (a sticky lubricates & protects the ear (a sticky barrier that keeps foreign bodies from barrier that keeps foreign bodies from getting near the tympanic membrane). getting near the tympanic membrane). Cerumen migrates outward by chewing & Cerumen migrates outward by chewing & talking. May be honey colored & sticky or talking. May be honey colored & sticky or dark in color & flakydark in color & flaky

Slight S shape to canal – need to straighten Slight S shape to canal – need to straighten to visualize the tympanic membraneto visualize the tympanic membrane

Tympanic MembraneTympanic Membrane Separates the external & Separates the external &

middle earmiddle ear Translucent, pearly grey color, Translucent, pearly grey color,

with a cone of light (reflection with a cone of light (reflection of the otoscope light)of the otoscope light)

Vibrates in response to soundVibrates in response to sound Can visualize the malleus, a Can visualize the malleus, a

middle ear ossicle. Can see middle ear ossicle. Can see the umbo, manubrium (or the umbo, manubrium (or handle) & short process. Pars handle) & short process. Pars flaccida is slack superior flaccida is slack superior portion, pars tensa is thickerportion, pars tensa is thicker & more taut. Annulus is outer, & more taut. Annulus is outer, fibrous rimfibrous rim

Middle EarMiddle Ear Tiny cavity inside the temporal bone. Tiny cavity inside the temporal bone.

Contains auditory ossicles – malleus, incus, Contains auditory ossicles – malleus, incus, & stapes& stapes

Eustachin tube connects the middle ear to Eustachin tube connects the middle ear to nasopharynx. Normally closed but opens nasopharynx. Normally closed but opens when swallowing or yawningwhen swallowing or yawning

3 functions – conduct sound vibrations 3 functions – conduct sound vibrations from outer to inner ear; protect inner ear from outer to inner ear; protect inner ear by decreasing amplitude of loud sounds; by decreasing amplitude of loud sounds; eustachian tube allows equalization of eustachian tube allows equalization of pressure on each side of ear drum so pressure on each side of ear drum so membrane doesn’t rupture membrane doesn’t rupture

Inner EarInner Ear Bony labyrinth that holds the sensory organ for Bony labyrinth that holds the sensory organ for

equilibrium & hearing.equilibrium & hearing. Vestibular apparatus contains vestibule & Vestibular apparatus contains vestibule &

semicircular canals for balancesemicircular canals for balance Cochlea contains the hearing apparatusCochlea contains the hearing apparatus Romberg test (p. 674)Romberg test (p. 674)

HearingHearing Ear transmits sound & converts Ear transmits sound & converts

vibrations into electrical impulses vibrations into electrical impulses that can be analyzed by the brain.that can be analyzed by the brain.

Sound waves produce vibrations on Sound waves produce vibrations on tympanic membrane. These tympanic membrane. These vibrations are carried to middle ear vibrations are carried to middle ear ossicles to the oval window. Then ossicles to the oval window. Then sound waves travel to cochlea & are sound waves travel to cochlea & are dissipated against the round dissipated against the round window. window.

Numerous fibers along the basilar Numerous fibers along the basilar membrane are the receptor cells of the membrane are the receptor cells of the Organ of Corti (the sensory organ of Organ of Corti (the sensory organ of hearing). Basilar membrane vibrates at hearing). Basilar membrane vibrates at a point specific to the frequency of the a point specific to the frequency of the sound. sound.

As the hair cells bend, they mediate the As the hair cells bend, they mediate the vibrations into electrical impulses. vibrations into electrical impulses. Electrical impulses are conducted by Electrical impulses are conducted by cranial nerve 8 to the brainstemcranial nerve 8 to the brainstem

Finally the cortex interprets the sound Finally the cortex interprets the sound & begins an appropriate response.& begins an appropriate response.

AC – air AC – air conduction, normal conduction, normal pathway of hearing pathway of hearing & most efficient& most efficient

BC – bone BC – bone conduction, bones conduction, bones of skull vibrate & of skull vibrate & transmit directly to transmit directly to inner ear to nerveinner ear to nerve

Hearing LossHearing Loss Anything that obstructs the transmission of Anything that obstructs the transmission of

sound impairs hearing.sound impairs hearing. Conductive Conductive – mechanical dysfunction of – mechanical dysfunction of

external or middle ear (impacted cerumen, external or middle ear (impacted cerumen, foreign bodies, perforated tympanic foreign bodies, perforated tympanic membrane). A partial loss – can still hear if membrane). A partial loss – can still hear if amplitude is increasedamplitude is increased

SensorineuralSensorineural – pathology of inner ear, – pathology of inner ear, cranial nerve 8, or auditory area of cerebral cranial nerve 8, or auditory area of cerebral cortex. Caused by gradual nerve cortex. Caused by gradual nerve degeneration (aging, ototoxic drugs). An degeneration (aging, ototoxic drugs). An increase in amplitude may increase in amplitude may notnot allow the allow the person to hearperson to hear

EquilibriumEquilibrium

Labryinth feeds info to brain about Labryinth feeds info to brain about body’s position in space. If becomes body’s position in space. If becomes inflamed, it feeds the wrong inflamed, it feeds the wrong information to the brain & person information to the brain & person experiences a staggering gait & a experiences a staggering gait & a whirling, spinning sensation whirling, spinning sensation (vertigo)(vertigo)

Subjective DataSubjective Data

EaracheEarache InfectionsInfections DischargeDischarge Hearing lossHearing loss Environmental noiseEnvironmental noise Tinnitus (ringing)Tinnitus (ringing) Vertigo (spinning sensation)Vertigo (spinning sensation) How do you clean your ears?How do you clean your ears?

NoseNose

NoseNose Sensory organ for Sensory organ for

smellsmell Warms & moistens Warms & moistens

inhaled airinhaled air

External nose shaped External nose shaped like a triangle, superior like a triangle, superior part called bridge, part called bridge, comes down to the tipcomes down to the tip

Oval openings (nares) Oval openings (nares) & just inside the nares & just inside the nares is the vestibuleis the vestibule

Columella separates Columella separates the nares & continues the nares & continues inside as the septuminside as the septum

Upper 1/3 is bone, rest Upper 1/3 is bone, rest is cartilageis cartilage

Inner NoseInner Nose Nasal cavity extends back over roof of Nasal cavity extends back over roof of

mouthmouth Anterior is lined with coarse nasal hairs (to Anterior is lined with coarse nasal hairs (to

filter air). Rest is lined with ciliated filter air). Rest is lined with ciliated mucous membrane (to filter dust & mucous membrane (to filter dust & bacteria)bacteria)

Looks redder than oral mucosa b/c rich Looks redder than oral mucosa b/c rich blood supply to warm inhaled airblood supply to warm inhaled air

Septum holds rich vascular network, most Septum holds rich vascular network, most common site of nosebleedscommon site of nosebleeds

Septum may also deviate to the sideSeptum may also deviate to the side

Lateral walls each have 3 parallel bony Lateral walls each have 3 parallel bony projections – superior, middle, & inferior projections – superior, middle, & inferior turbinates. These increase the surface area so turbinates. These increase the surface area so more blood vessels to warm, humidify & filter more blood vessels to warm, humidify & filter air. Under each turbinate is a meatus. Sinuses air. Under each turbinate is a meatus. Sinuses drain into middle meatus, tears from drain into middle meatus, tears from nasolacrimal duct drain into inferior meatusnasolacrimal duct drain into inferior meatus

Olfactory receptors at the roof of the nasal Olfactory receptors at the roof of the nasal cavity merge with cranial nerve 1 (olfactory) cavity merge with cranial nerve 1 (olfactory) which transmits to temporal lobe of brainwhich transmits to temporal lobe of brain

SinusesSinuses Air filled pockets. Join Air filled pockets. Join

up with the nasal cavity up with the nasal cavity & are lined with same & are lined with same ciliated mucous ciliated mucous membrane. Provides membrane. Provides mucous which drains mucous which drains into nasal cavityinto nasal cavity

Openings are narrow & Openings are narrow & easily occludedeasily occluded

4 sets – can access 2 – 4 sets – can access 2 – frontal sinuses (frontal frontal sinuses (frontal bone, above & medial to bone, above & medial to orbits) & maxillary orbits) & maxillary sinuses (in maxilla or sinuses (in maxilla or cheekbones along sides cheekbones along sides of nasal cavity)of nasal cavity)

Other 2 are smaller & Other 2 are smaller & deeperdeeper

Subjective DataSubjective Data

DischargeDischarge Frequent coldsFrequent colds Sinus painSinus pain TraumaTrauma Epistaxis (nosebleeds)Epistaxis (nosebleeds) AllergiesAllergies Altered smellAltered smell

Mouth & Mouth & OropharynxOropharynx

MouthMouth

First part of digestive systemFirst part of digestive system Lips are the transition from outer skin Lips are the transition from outer skin

to inner mucous membraneto inner mucous membrane Palate at roof of mouth – anterior Palate at roof of mouth – anterior

hard palate is made up of bone & hard palate is made up of bone & whitish in color; posterior soft palate whitish in color; posterior soft palate is an arch of muscle, pink in color & is an arch of muscle, pink in color & mobilemobile

Uvula – projection hanging down from Uvula – projection hanging down from the middle of the soft palatethe middle of the soft palate

At the floor of the At the floor of the mouth…mouth…

Tongue – a striated Tongue – a striated muscle in a crosswise muscle in a crosswise pattern so it can pattern so it can change shape & change shape & positionposition

Papillae are rough Papillae are rough elevations on its elevations on its surfacesurface

Larger vallate Larger vallate papillae at base of papillae at base of tongue in an inverted tongue in an inverted V shapeV shape

Microscopic taste Microscopic taste buds in the papillaebuds in the papillae

Ventral surface Ventral surface is smooth, shiny is smooth, shiny with prominent with prominent veinsveins

Frenulum is a Frenulum is a fold of tissue fold of tissue that connects that connects tongue to floor tongue to floor of mouthof mouth

3 pairs of salivary glands 3 pairs of salivary glands – to secrete saliva, – to secrete saliva, moisten & lubricate moisten & lubricate food, & cleans & food, & cleans & protects mucosaprotects mucosa

ParotidParotid – largest, in the – largest, in the cheek. Duct opening is cheek. Duct opening is Stenson’s duct, opens Stenson’s duct, opens opposite 2opposite 2ndnd molar molar

SubmandibularSubmandibular - gland - gland size of a walnut beneath size of a walnut beneath mandible. Wharton’s mandible. Wharton’s duct opens on each side duct opens on each side of the frenulumof the frenulum

Sublingual Sublingual gland – gland – smallest, lies in floor of smallest, lies in floor of mouth, under the mouth, under the tongue. Many small tongue. Many small openings along the openings along the sublingual foldsublingual fold

32 teeth – 16 up & 16 down32 teeth – 16 up & 16 down Gums hold teeth in place – thick Gums hold teeth in place – thick

fibrous tissue covered with mucous fibrous tissue covered with mucous membrane. Different than rest of membrane. Different than rest of oral mucosa b/c lighter pink in color oral mucosa b/c lighter pink in color & stippled surface& stippled surface

Pharynx Pharynx Throat – area behind Throat – area behind

mouth & nosemouth & nose Separated by anterior Separated by anterior

tonsillar pillartonsillar pillar Tonsils – mass of Tonsils – mass of

lymphoid tissue, same lymphoid tissue, same color as surrounding color as surrounding mucous membrane, mucous membrane, looks more granular looks more granular with deep crypts. with deep crypts.

Posterior pillars – Posterior pillars – located behind tonsilslocated behind tonsils

Subjective DataSubjective Data

Sores or lesionsSores or lesions Sore throatSore throat Bleeding gumsBleeding gums ToothacheToothache HoarsenessHoarseness Dysphagia (difficulty swallowing)Dysphagia (difficulty swallowing) Altered tasteAltered taste Smoking, alcoholSmoking, alcohol