Ears, Nose, Mouth, Throat

Ears

Anatomy

• The ear is responsible for hearing and balance

• Consists of 3 regions–External ear–Middle ear–Inner ear

Structure and Function• External Ear

> auricle/pinna

- movable cartilage covered with skin

- Mastoid process= important Landmark

External Auditory Canal

- S-shaped pathway leading to the ME

- 2.5 to 3 cm. long in adult

- Its skeleton of bone and cartilage is covered with sensitive skin ( outer 1/3 is cartilage, inner 2/3 consists of bone)

- This canal lining is protected and lubricated with cerumen

- Lymphatic drainage of the external ear flows into parotid , mastoid, superficial cervical nodes

MIDDLE EAR

>air filled cavity in the temporal bone

- >It contains the ossicles ( malleus, incus,stapes) that transmit sound from the TM to the oval window of the inner ear

MIDDLE EAR>Tympanic membrane (eardrum)

separates external and middle ear.–Translucent membrane–Pearly, gray color–Cone of light reflection when using

otoscope–Oval and slightly concave shape,

pulled in at center by malleus

Middle ear

>Openings to Outer ear covered by tympanic membrane

Inner ear = oval and round windows

Eustachian tube connects middle ear to the nasopharnyx for air passage (normally closed, opens with swallowing/yawning)

Middle ear has 3 functions1. Conducts sound vibration from

outer ear to inner ear

2. Protects the inner ear by reducing the amplitude of loud sounds

3. Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes)

Inner Ear

• Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium

1. Vestibule

2. Semicircular canals

3. Cochlea (contains the central hearing apparatus)

Function of hearing• 3 levels

1. Peripheral

> ear transmits sound and converts its vibrations into electrical impulses

> The electrical impulses are conducted by the auditory process of cranial nerve VIII (Acoustic) to the brain stem 1. Amplitude=loudness

2. Frequency=pitch

Sound waves cause the eardrum to vibrate

> Vibrations travel via the ossicles thru the oval window > the cochlea > to the round window where they are dissipated

Vibrations in the basilar membrane of the cochlea that contain the organ of Corti receptor hair cells > translate the vibrations to electric impulses

> The stimulated impulses go to the brainstem via Acoustic nerve (VIII)

2. Brain stem- permits identification of sound

and locating the direction of a sound in space.

- Sensitive to intensity and timing from the ears

depending on head position3. Cerebral cortex- Intreprets the meaning of the

sound and begins the appropriate response

Pathways of hearing

1. Air conduction (AC)– normal pathway of hearing, the most efficient

2. Bone conduction (BC)– bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve

Physical Examination• The Auricle 1) inspect each auricle for size ,

shape, symmetry, color, position on the head, deformities, nodules and lesions

2) If ear pain, discharge or inflammation is

present, move the auricle up and down

3) Note tenderness of pinna and mastoid area. Press the tragus and press firmly behind the ear

Physical Examination

• Auricle

-Extends slightly outward from the skull

- Positioned in a nearly vertical plane

- The origin of the helix should be on a horizontal line with corner of the eye

- It should have the same color as the facial skin w/o moles, cysts & other lesions

Otoscopic Exam1) Tip the patient’s head to the opposite

side

2)Grasp the auricle firmly but gently, while pulling it upward, backward and slightly outward

3)Insert into the canal, sl down and forward, the largest ear speculum that the canal will accommodate

4) Observe the ff:

- patency of the ear canal

- describe the walls of the ear canal. Note

any redness or swelling

- identify any discharge, presence of cerumen or FB in the ear canal

- tympanic membrane

Inspect using Otoscope

• External canal–Color

–Swelling

–Lesions

–Discharge ; color and odor. Clean or change speculum before examining other ear.

Tympanic membrane• Color – normal is shiny,

translucent, pearl-grey• Landmarks ( umbo, handle of

malleus, light reflex)• Position – flat, slightly pulled in at

the center and flutters when person holds nose and swallows

• Integrity of membrane – intact

•Perform the otoscope exam prior to hearing tests.

Hearing Evaluation

1.Rough quantitative test for hearing loss

2.Whisper test3.Tuning fork

• Rough quantitative test for hearing loss

- begins when the patient responds to your questions and directions. The patient responds without excessive requests for repetition

- Speech with a monotonous tone and erratic volume may indicate hearing loss

WHISPER TEST

• Begins with the history-Conversational tone

• The following tests may indicate the presence of hearing loss but not the degree.

• Place your mouth at the side of the patient’s head ( 2 ft.) from her ear with the far ear covered

• Whisper test questions that can’t be answered by yes or no

• Test consistently with loud, medium and soft tones

• Repeat on the opposite ear using another word, have the client identify the words (Used to detect high-tone loss)

• Normal Response to Voice test–Correct identification of

whispered words bilaterally

TUNING FORK TESTS• Measure hearing by air conduction

and bone conduction

• Frequency of fork is 256-1024 cycles/sec.

• To activate the tuning fork, hold it by the stem and strike the tines softly on the back of the hand

TUNING FORK TEST• Weber test > used when hearing is reported as

better in one ear than the other ( bone conduction)

> with normal neurosensory hearing and no conductive loss, the sounds are equal in both ears

> lateralization of the sound to one ear indicates a conductive loss on the same

side or a perceptive loss/sensorineural loss on the other side

• Weber Test

• Rinne test – compares bone conduction and air conduction

1. Normally sound is heard 2X as long by air conduction as by bone conduction

2. Normal response ; positive Rinne Test = AC>BC Bilaterally

Sound is heard longer by BC with a conductive loss.

• Rinne Test

Weber test Rinne test

Summary of any symptom should include PQRSTU

• P= provocative or palliative

• Q= quality or quantity

• R= region or radiation

• S= severity scale

• T= timing (onset, duration, frequency)

Subjective data

• Earaches

• Tinnitus

• Vertigo

• Dizziness

• Discharge

• Hearing loss

HISTORY Always ask the following:

• Tinnitus –ringing in the ears

causes:

a.Outer ear- cerumen, foreign body,polyp

in the external auditory canal

b. Middle ear – inflammation ,otosclerosis

c. Internal ear- fever, suppuration of the

labyrinth, SY,acoustic nerve tumor

internal ear – fracture at the base of the skull, meniere syndrome

d.Drugs quinine, salicylates,

aminoglycosides, gentamicin

• Ear pain ( Otalgia )

- pain may arise from inflammation of structure in the ear or be referred from other pharyngeal sites including the thyroid

Causes:Auricle-

trauma,hematoma,frostbite,burn,eczema,

lnsect bites, impetigo, herpes zoster

External auditory canal- otitis externa ,carbuncle, eczema,

hard cerumen, FB, herpes zoster

Middle ear-

acute otits media, acute mastoiditis

Referred pain- unerrupted lower third molar, carious

teeth, tonsillitis, carcinoma of pharynx, trigeminal neuralgia , subacute thyroiditis

• Dizziness

- patient has a sense of disturbed relation to space

- described as being unsteady, weak, light headed or having the feeling of turning

Causes:

Endocrine

hypothyroidism,pregnancy, hypoparathyroidism

Idiopathic multisystem atrophyInfectious tabes dorsalis, meningitis,

encephalitis, brain abscessMetabolic/ nutritional pellagra, Vit.B12 def.,fluid &

electrolyte imbalance

Mechanical/trauma

skull fracture, otosclerosis, eye muscle imbalance glaucoma

Neoplastic

Brain tumors

Neurologic

migraine, peripheral neuropathy

Psychosocial

anxiety disorder

Vascular

hypertension, orthostatic hypotension

• Vertigo

- persistent stimulation of the semicircular

canals or vestibular nucleus when the

head is at rest

- It gives a hallucination of motion

- When the eyes open, the pts.surrounding

seems to be whirling or spinning

- When the eyes closed, the pt.continues to feel in motion

Causes:

Peripheral labyrinthine System

- otitis media with effusion, otosclerosis,

temporal bone fracture

Central labyrinthine system

- migraine, cerebellar hemorrhage, intracranial abscess

Cranial V111 infections

- Acute meningitis, tuberculous meningitis, tumors

Brainstem nuclei

- encephalitis, brain abscess, hemorrhage, multiple sclerosis

• Hearing loss a. Conductive- seen in people with

external or middle ear problem Causes:-obstruction of external auditory canal

(FB, impacted cerumen)- Disorder of the eardrum & middle ear

( perforated TM, pus/blood in the ME )- Overgrowth of bone with fixation of the

stapes ((Otosclerosis)

b. Sensorineural hearing loss ( Perceptive) - involves the inner ear Causes: - disorders of the cochlea or the acoustic

nerve (CN 8)- Aging ( Presbycusis ) due to nerve

degeneration- Trauma- Drug toxicity- Tumors- infections- Heredity/congenital deafness

EAR SIGNS• EXTERNAL EAR

a) Malformations of the Pinna

microtia – smaller than normal

macrotia – unusually large

lop or bat ear- pinna may protude at R angle

aztec or cagot ear – failure of

development of the lobule

Macrotia or large ear

Before Surgery

After Surgery

Before Surgery After surgery

Lop or Bat ear

- pinna may protrude at right angle

Lop or Bat Ears

satyr ear- pointed pinna cauliflower ear- untreated

hematomas heal as nodular and bulbous irregularities of the helix and and antihelix

- result of blunt trauma and necrosis of the underlying cartilage

Cauliflower Ears

b) Pinna nodule Darwin tubercle- harmless developmental eminence in the upper 3rd

of the posterior helix Gouty tophus – small, whitish uric acid crystals along the peripheral margins of the auricles, olecranon bursa,

tendon sheaths - nodules are painless hard,

and irregular

Gouty deposits

b)External acoustic meatus

Cerumen Impaction

- due to excessive production of wax or a narrowed meatus leads to partial or complete obstruction of the canal

- complete obstruction leads to partial deafness acc. by tinnitus or dizziness

Otorrhea( ear discharge) yellow discharge- melted cerumen serous discharge- eczema in the meatal wall, early ruptured acute OM bloody discharge- temporal bone fracture purulent discharge- chronic external otitis, chronic suppurative OM, cholesteatoma, TB, polyps

Foreign body

Insect invaders

PolypsFuruncle

• Tympanic membrane

Retracted Tympanic membrane :

- Seen in Serous Otitis media

- more concave TM

- accentuated bony landmarks

- distorted light reflex

Normal Tympanic Membrane Retracted Tympanic Membrane

Bulging Tympanic membrane:

- seen in Acute suppurative otitis media

- more conical

- loss of bony landmarks

- distorted light reflex

Normal Tympanic Membrane Bulging Tympanic Membrane

Perforated Tympanic membrane:

- previous suppurative middle ear infection has eroded thru the membrane producing

holes

- perforation appears as oval holes thru which the darkened middle ear cavity is seen

Perforated Tympanic Membrane

Perforated Tympanic Membrane

COMMON DISORDERS OF THE EAR

• Otitis Externa a) Acute external otitis -due to Ps.aeruginosa, staph, strep, proteus - pain maybe mild or severe accentuated by

movement of the pinna - swimmers’ ear - preauricular, postauricular , Ant cervical LN

b) Chronic external otitis

- commonly due to bacteria and fungal

- pruritus is the main complain instead of pain

- aural discharge maybe present

• Otitis Mediaa) Chronic suppurative otitis media - ass. with permanent perforation

of the eardrum -hearing is always impaired - painless aural discharge - pain and vertigo indicates

development of complications like brain abscess

b) Cholesteatoma

- collection of desquamated epithelial cells in the middle ear

- foul smelling discharge, marginal

perforation,hearing loss, pearly gray mass

superior part of tympanic membrane

- eustachian tube dysfunction causes

retraction of tympanic membrane

• Vertiginous disordera) Acute Labyrinthitis - most frequent cause of vertigo - patient gradually develop a sense of

whirling that reaches a climax in 24-48 hrs. disappear gradually in 3-6 wks.

- N/V may occur at the height of symptoms

- no accompanying tinnitus or hearing loss

b) Benign Paroxysmal positional Vertigo (BPPV)- Calcium deposits in the labyrinth

( otoliths) are dislodged and move in response

to gravity eliciting a feeling of motion- More common in older individuals- Sudden onset, often when rolling over

in bed or arising in the morning- No headaches/fever but with nausea

and inability to stand- Avoid any head motion to lessen

symptoms

Thank You

Nose, Throat and Mouth

Nose

• First segment of the respiratory system

• Warms, moistens and filters inhaled air

• Sensory organ for smell

• Resonance of laryngeal sound

External parts• Bridge – frontal and maxillary bones

• Tip

• Nares – anterior openings of the nos

• Columella - divides the nares

• Ala nasi –lateral outside wing of the nose bilaterally

• Upper 1/3 nose is bone; rest is cartilage

Internal • Nasal cavity -floor of the nose ( hard and soft

palate) - roof of the nose ( frontal and

sphenoid bone)• Nasal hair• Nasal Septum-divides cavity into 2

passages• Nasal turbinates

Internal • Superior, middle, inferior

turbinates- 3 parallel bony projections on lateral walls of each cavity

• Meatus- cleft/ groove underlying each turbinate.

• Inspired air enters thru the nares > passes thru the vestibule> to the choanae which are posterior openings > leading to the nasopharynx

Internal • Olfactory receptors

- roof of the nasal cavity & upper part of septum above the superior turbinate.

-merge into the olfactory nerve (I) > goes to the temporal lobe of the brain

• Kiesselbach plexus

- a vascular network located superficially on the anterior superior portion of the septum

- site of most anterior nosebleeds

SINUSES• Paranasal sinuses

- air-filled paired extensions of the nasal cavities within the bones of the skull

- lined with mucous membranes and cilia that move secretions along excretory pathways

- sinus openings are narrow, susceptible to occlusion> resulting in inflammation /sinusitis.

- drained into the medial meatus

• Purpose– Serve as resonators for sound– Provide mucous for the nasal

cavity

Types:1. Frontal sinuses2. Maxillary sinuses3. Ethmoid sinuses4. Sphenoid sinuses Frontal & Maxillary sinuses are

accessible to examination

Physical Examination

• Nose – Inspect and palpate

• INSPECT for:– Symmetry,

deformity– Inflammation– Skin lesions– Color – Nasal flaring– discharges

• Palpate

- ridge & soft tissues of the nose

- note any displacement of the bone,

cartilage

- note for tenderness & any mass

- The nasal structures should be firm and stable to palpation

- if with injury, palpate gently

• Test for sense of smell (CN 1)

• Evaluate the patency of the nose

- nasal breathing should be noiseless and easy thru the open nares

Nasal Cavity Use the nasal speculum and good

light source to inspect the nasal cavity

a) Nasal mucosa - inspect for color, discharge,

lesions, masses - it should appear deep pink ( pinker

than the buccal mucosa) & glistening

b) nasal septum - In normal adult, the nasal

septum is seldom precisely a midline structure

- No perforations, bleeding or crusting should be apparent

- a film of clear discharge is often apparent on the nasal septum

c) Nasal Turbinates - only the inferior and

middle turbinates will be visible

- it should be the same color as the surrounding area and have a firm consistency

• Paranasal Sinuses: Inspect and Palpate

–Press thumbs over frontal & maxillary sinuses ( palpate the cheeks and supraorbital ridges)

–No tenderness or swelling over the soft tissue should be present

• Transillumination test a) Frontal & Maxillary sinuses

b) nasal septum- Best perform in a dark room- Look for a bright light in the

supraorbital ridge and maxilla- Look for deviation, perforation,

masses in the transilluminated septum

SYMPTOMS• Loss of smell ( anosmia )

- lesion of CN 1 or nasal obstruction - commonly due to closed head

trauma - invariably accompanied by a

perceived change in taste of food ( bland & unpalatable)

• Abnormal smell/ taste (dysgeusia)

- this is a common complaint in patients who have loss of smell

- if it is paroxysmal and associated with behavioral symptoms, it suggests complex partial seizures

SIGNS

SKIN LESIONS

Basal Cell Carcinoma

SIGNS• Discharge - Describe discharge as to its

character ( watery, mucoid, purulent , bloody)

- color ( greenish, whitish, bloody)

- bilateral or unilateral

•

• Running Nose

. 1.Unilateral

- Choanal atresia

- Foreign body- foul purulent discharge

- neoplasm – bloody discharge

- Head injury or surgery – clear spinal fluid

2. Bilateral

- allergy

- infection ( upper respiratory)

Foreign Body

. Unilateral - Choanal atresia - Foreign body

- neoplasm - Head injury or surgery

. Unilateral - Choanal atresia - Foreign body

- neoplasm - Head injury or surgery

• Epistaxis ( nosebleed)

-Kiesselbach plexus – most common site of bleeding anteriorly

- Back 3rd of the Inferior Meatus – most common site posteriorly

Causes:

1. Local

- coughing

- sneezing

- nose pricking

- fracture

- foreign bodies

2. Generalized

- Congenital – hereditary telangiectasia

- inflammatory/immune – wegener

granulomatosis

- infectious – typhoid fever, dengue,

diphtheria

- Metabolic/toxic – aspirin, scurvy

- Mechanical – change in atmospheric

pressure ( mountain climbing, flying), exertion

- Neoplastic – nasopharyngeal Ca

leukemia

- vascular- hemophilia, thrombocytopeni

- trauma- nasal and maxillary fracture

- Elevated venous pressure- Cor pulmonale Congestive Heart failure

- Elevated arterial pressure – HPN,

coarctation of aorta

• Nasal septum

a) Deviation

- the cartilagenous and bony septum

may deviate as a hump, spur, shelf to

enroach on one nasal chamber

occlusion causing obstruction

b) Perforation - a hole in the nasal septum

(transillumination test) is commonly caused by chronic infection, nasal surgery,

repeated trauma in picking off crusts,

cocaine abuse - rarely due to SY, TB

Nasal Septum Perforation

Nasal Syndromes• Acute Rhinitis ( infectious) ( common

cold)- Rhinoviruses infect the mucous

membranes of the nose & sinuses causing inflammation and inc. nasal secretions

- Watery nasal discharge, sneezing, discharge becomes purulent acc. by fever and body malaise

- Symptoms 3-10 days

- Severe local pain suggest a complication-bacterial sinusitis

• Allergic rhinosinusitis - itching of the nose & eyes,

rhinorrhea, lacrimation, sneezing - headache is common - maybe seasonal or perennial - common allergens are pollens,

molds, house dust, mites, coachroach, animal danders

• Vasomotor Rhinitis - nonallergic mucosal edema and

rhinorrhea ass. with vasodilatation of the nasal vessels, mucosal edema & inc. mucous production

- due to chronic environmental irritants ( dust , smoke, strong odor, cold air), pregnancy, estrogens, progesterone

• Suppurative Paranasal Sinusitis

- due to Strep. pneumonia, H. influenza

- severe pain in the face occuring 7-14 days after signs & symptoms of an acute URTI

- pain & pressure without fever suggest sinus obstruction requiring decongestants

• Cavernous Sinus Thrombosis

-This is the most feared complication of nasal infections. It can cause blindness or death

- Infection spreads from the nose>angular veins> cavernous sinus> septic thrombosis

-patient complains of pain deep in the eyes

- Both eyes are involved, immobilization of the globes, periorbital edema, chemosis

- May involve CN 3,4, &6

- Sudden chills, high fever, prostated, comatose, death within 2-3 days

THANK YOU

THANK YOU

Mouth • First segment of the digestive

system• Airway for the respiratory system• ORAL CAVITY

– Lips– Palate

1. Hard2. Soft3. Uvula – hangs down from the soft palate

• Cheeks- side walls of cavity

• Tongue1. Papillae- rough, bumpy elevations

on dorsal 2. Frenulum3. Taste buds

• Teeth – 32 permanent

• Salivary glands1. Parotid- largest of the glands,

located in the cheeks, front of the ear. Stenson’s duct opens in buccal mucosa

2. Submandibular- walnut size, beneath the mandible at the angle of the jaw. Wharton’s duct either side of the frenulum

3. Sublingual –smallest, almond shape, under tongue

Throat Area behind the mouth & nose

Oropharynx – separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars

Tonsils – lymphoid tissue behind pillars

• Posterior pharyngeal wall located behind the tonsils

• Nasopharynx continues from the oropharynx but it is above it and behind the nasal cavity.

-It holds the adenoids and the eustachian tube openings.

Physical Examination

• Preparation for examination a) Face the patient with both of

you seated at the same level b) Remove any dentures to see

the mucosa underneath c) Hold the tongue blade in the left

hand and penlight in the right hand

d) A good light source is needed

INSPECT AND PALPATEUse gloves, tongue depressor, light

• Lips

• Teeth

• Gums

• Tongue

• Buccal mucosa

• Mouth ( roof and floor of the mouth)

• Lips - remove lipstick - should be pink , smooth surface,

free of lesions. - distinct border between the lips

and facial skin should not be interrupted by lesions

- Vertical and horizontal symmetry both at rest and with movements

rest

Rest Movement

- Inspect the inner surface of the lips by retracting them with a tongue blade

Retraction of the Upper Lip Retraction of the lower Lip

• Teeth - ask patient to clench his/her teeth

, smile and observe the occlusion of the teeth.

- facial nerve is also tested- Make sure teeth are firmly

anchored, probing each with a tongue blade

- Generally ivory white in color with 32 permanent teeth in adults

Proper Occlusion of Teeth

• Buccal mucosa - with mouth open, using a tongue

blade, inspect for color, pigmentation,

nodules, white patches - normally pinkish red, smooth, moist - orifice of the stensen duct should

appear as a whitish yellow or whitish pink protrusion in alignment with the 2nd upper molar

Retraction of the cheekto view the Buccal Mucosa

Buccal Mucosa with prominent Papilla of Stensen Duct

• Gums - using a tongue blade, gums should

have pink appearance with clearly defined tight margin at each tooth

- gum surface beneath dentures should be free of inflammation, swelling or bleeding

- Using gloves, palpate gums for tenderness, mass, induration, thickening

• Tongue

- should fit well in the floor of the mouth

- ask the patient to extend the tongue while you inspect for color, lesions, deviation, tremor, limitation of movement

- Ask the patient to touch the tongue tip to the hard palate area directly behind the upper central incisors. There should be no difficulty.

- Inspect the dorsum of the tongue it should appear dull red ,moist,

glistening note also for any swelling, coating,

ulcerations- Inspect the ventral surface of the

tongue it should be pink and smooth with

large veins bet. the frenulum and fimbriated folds

- Wharton ducts should be apparent on each side of the frenulum

Mouth>Roof of the mouth - hard and soft palateFloor of the mouth - tongueTake note of the smell coming

from the oral cavityAsk the patient to tilt his head to

inspect the palate and uvula

Uvula , soft palate, bilateral fauces

ThroatTonsils

- usually blend into the pink surface of the pharynx

- surface of the tonsils have crypts where cellular debris and food collect

- in normal adult, tonsils seldom protrude beyond the faucial pillars

Posterior wall of the pharynx- It should be smooth and

glistening pink mucosa with some irregular spots of lymphatic tissue and small blood vessels

- Test CN 9 and 10 touch the posterior wall of the

pharynx on each side (+) gag reflex

Larynx

- immediately behind and below the oral cavity

- it is on the anterior wall of the pharynx

- it is viewed in the laryngeal mirror held behind it

SIGNS

• Lips

Cyanotic Lips

Chapped dry lips

> Cheilitis

- dry cracked lips due to dehydration from wind chapping, dentures , braces, or excessive lip licking

- angular cheilitis due to candidiasis

Chapped Lips with Cheilitis

Cheilosis ( angular stomatitis)

- ulcerations of skin at the corners of the mouth due to crusting 2ndary to riboflavin deficiency or ill fitting dentures

Cheilosis (Angular Stomatitis)

Cleft lip

- due to incomplete fusion of the frontonasal process with the 2 maxillary processes

Cleft Lip

Retraction of the Lower Lip showing white scars Traumatized Lip (Green arrows)

• Hard palate

Maxillary Torus

Maxillary torus

- bony protuberance at the midline

- no clinical significance

Cleft palate

- a midline opening in the hard palate

- congenital failure of the fusion of the maxillary process

- usually ass. with cleft palate

Cleft Palate

• Tonsils

Enlarged tonsils

- Grading tonsillar enlargement–Grade size 1+ visible

–…………….2+ ½ way b/t tonsillar pillars and uvula

–…………….3+ touching the uvula

–…………….4+ touching each other

• Uvula

Deviation of the uvula

• Posterior pharyngeal wall

After tonsillectomy

Posterior Pharyngeal WallWith a yellow Pseudocyst

Posterior Pharyngeal Wall withWhite removable mass of mucus

Acute viral pharyngitis - mucosa of oropharynx shows lymphoid

tissue are elevated but noo edema - sore throat, rhinorrhea, malaise,

myalgiaStreptococal or staphylococcal

pharyngitis- Pharyngeal mucosa is bright red,

swollen, edematous studded with white or yellow follicles

- Tonsils maybe enlarged

Pharyngeal diptheria

- patch of white membrane in the tonsils.

- pharyngeal mucosa bleeds on surface, reddened , reddened, swollen ,edematous

Candidiasis

- shining raised white patches on posterior pharynx, buccal mucosa and tongue

• Tongue

Lingual Deviation

Tongue-tie or shortened frenulum

Folliate Papillae(Green)Circumvallate Papillae(blue)

Elongated filiform Papillae

Large reddened fungiform Papillae Circumvallate Papillae

Gingival Fibrous NoduleAt the mucogingival junction

• Gums

Bleeding gums

local causes:

traumatic – toothbrush, laceration, dental caries, tartar on the teeth

infection – pyorrhea alveolaris, stomatitis

neoplasm – epulis, papilloma of gums

General causes:

Scurvy, syphilis

Metal poisoning –phosporous, lead, mercury

Blood dyscrasia – hemophilia, leukemia, thrombocytopenia

Deep red or purple gums

- tender , swollen, spongy and easily bleeds

- due to scurvy ( ascorbic acid deficiency)

• Teeth

Malocclusion of teeth

Periodontitis ( Pyorrhea Alveolaris)

- lower teeth are involved

- with purulent and retracted gumsEpulis

- fibrous tumor arising from periosteum and emerges from between the teeth.

• Larynx

> hoarseness

acute laryngitis – most common cause of hoarseness

> laryngeal edema

signs of obstruction – hoarseness, dyspnea and stridor

Laryngeal spasm

- acute obstruction of the upper airways accompanied by hoarse brassy cough, dyspnea in children

- due to allergy, infection, FB, neoplasm

Laryngeal paralysis

- Due to immobile vocal cords

• Halitosis ( fetor Oris) bad breath- Poor hygiene- Dental or tonsillar infections- Atrophic rhinitis- Putrefaction of food in the

stomach from pyloric obstruction- Infected sputum form lung

abscess and bronchiectasis

THANK YOU