1. SENSORY DISORDERS
Nelia B. Perez RN, MSN
PCU – MJCN
Class 2015

2. CONTENTS
• Review Of Anatomy and Physiology
• Common Sensory Disorders

3. Ears

4. Anatomy
•The ear is responsible for
hearing and balance
•Consists of 3 regions
• External ear
• Middle ear
• Inner ear

5. 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

6. - 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

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

10. 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
>

11. 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

12. 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)

15. Middle ear has 3 functions
1. 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)

16. 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)

18. 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

19. 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

20. 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)

21. 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 position
3. Cerebral cortex
- Intreprets the meaning of the
sound and begins the
appropriate response

22. 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

25. 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

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

27. 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

28. Otoscopic Exam
1) 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

32. 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

33. Inspect using Otoscope
• External canal
• Color
• Swelling
• Lesions
• Discharge ; color and odor.
Clean or change speculum
before examining other ear.

34. 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

36. •Perform the
otoscope exam prior
to hearing tests.

37. Hearing Evaluation
1.Rough quantitative
test for hearing loss
2.Whisper test
3.Tuning fork

38. • 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

39. WHISPER TEST
•Begins with the historyConversational tone
•The following tests may
indicate the presence of
hearing loss but not the
degree.

40. • 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

41. • 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

42. 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

43. 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

44. > 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

45. • Weber Test

46. •
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.

47. • Rinne Test

48. Weber test
Rinne test

49. 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)

50. Subjective data
• Earaches
• Tinnitus
• Vertigo
• Dizziness
• Discharge
• Hearing loss

51. 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

52. internal ear – fracture at the
base of the skull, meniere
syndrome
d.Drugs
quinine, salicylates,
aminoglycosides, gentamicin

53. •Ear pain ( Otalgia )
- pain may arise from
inflammation of structure in
the ear or be referred from
other pharyngeal sites
including the thyroid

54. Causes:
Auricletrauma,hematoma,frostbite,burn,
eczema,
lnsect bites, impetigo, herpes
zoster
External auditory canalotitis externa ,carbuncle,
eczema, hard cerumen, FB,
herpes zoster

55. Middle earacute otits media, acute
mastoiditis
Referred pain- unerrupted lower
third molar, carious
teeth, tonsillitis, carcinoma of
pharynx, trigeminal neuralgia ,
subacute thyroiditis

56. • 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

57. Idiopathic
multisystem atrophy
Infectious
tabes dorsalis, meningitis,
encephalitis, brain abscess
Metabolic/ nutritional
pellagra, Vit.B12 def.,fluid &
electrolyte imbalance

58. Mechanical/trauma
skull fracture, otosclerosis, eye muscle imbalance
glaucoma
Neoplastic
Brain tumors
Neurologic
migraine, peripheral neuropathy
Psychosocial
anxiety disorder
Vascular
hypertension, orthostatic hypotension

59. • 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

60. Causes:
Peripheral labyrinthine System
- otitis media with effusion,
otosclerosis,
temporal bone fracture
Central labyrinthine system
- migraine, cerebellar
hemorrhage, intracranial abscess

61. Cranial V111 infections
- Acute meningitis,
tuberculous meningitis,
tumors
Brainstem nuclei
- encephalitis, brain abscess,
hemorrhage, multiple
sclerosis

62. • 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)

63. 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

64. 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

65. Macrotia or large ear
Before Surgery
After Surgery

66. Before Surgery
After surgery

67. Lop or Bat ear
- pinna may protrude
at right angle

68. Lop or Bat Ears

69. 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

70. Cauliflower Ears

71. 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

72. Gouty deposits

73. 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

74. 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

75. Foreign body
Insect invaders
Polyps
Furuncle

76. • Tympanic membrane
Retracted Tympanic membrane
:
- Seen in Serous Otitis media
- more concave TM
- accentuated bony landmarks
- distorted light reflex

77. Normal Tympanic Membrane
Retracted Tympanic Membrane

78. Bulging Tympanic membrane:
- seen in Acute suppurative
otitis media
- more conical
- loss of bony landmarks
- distorted light reflex

79. Normal Tympanic Membrane
Bulging Tympanic Membrane

80. 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

81. Perforated Tympanic Membrane

82. Perforated Tympanic Membrane

83. 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

84. b) Chronic external otitis
- commonly due to bacteria
and fungal
- pruritus is the main
complain instead of pain
- aural discharge maybe
present

85. • Otitis Media
a) 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

86. 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

87. • Vertiginous disorder
a) 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 36 wks.
- N/V may occur at the height of
symptoms
- no accompanying tinnitus or hearing
loss

88. 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

89. Thank You

90. Nose, Throat and Mouth

91. Nose
• First segment of the
respiratory system
• Warms, moistens and filters
inhaled air
• Sensory organ for smell
• Resonance of laryngeal sound

93. 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

94. 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

95. Internal
• Superior, middle, inferior
turbinates- 3 parallel bony
projections on lateral walls of
each cavity
• Meatus- cleft/ groove
underlying each turbinate.

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

97. 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

99. 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

100. • Purpose
• Serve as resonators for sound
• Provide mucous for the nasal
cavity
Types:
1. Frontal sinuses
2. Maxillary sinuses
3. Ethmoid sinuses
4. Sphenoid sinuses
Frontal & Maxillary sinuses are
accessible to examination

103. Physical Examination

104. • Nose – Inspect and
palpate
• INSPECT for:
•
•
•
•
•
•
Symmetry, deformity
Inflammation
Skin lesions
Color
Nasal flaring
discharges

105. • 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

106. •Test for sense of smell (CN
1)
•Evaluate the patency of the
nose
- nasal breathing should be
noiseless and easy thru the
open nares

107. 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

108. 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

109. 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

111. • 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

112. •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

117. 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)

118. • 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

119. SIGNS
SKIN
LESIONS

120. Basal Cell Carcinoma

121. SIGNS
• Discharge
- Describe discharge as to its
character
( watery, mucoid, purulent ,
bloody)
- color ( greenish, whitish, bloody)
- bilateral or unilateral

122. •
•
Running Nose

124. . 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)

125. Foreign Body

126. . Unilateral
- Choanal atresia
- Foreign body
- neoplasm
- Head injury or surgery

127. • Epistaxis ( nosebleed)
-Kiesselbach plexus – most
common site of bleeding
anteriorly
- Back 3rd of the Inferior
Meatus – most common site
posteriorly

128. Causes:
1. Local
- coughing
- sneezing
- nose pricking
- fracture
- foreign bodies

129. 2. Generalized
- Congenital – hereditary
telangiectasia
- inflammatory/immune – wegener
granulomatosis
- infectious – typhoid fever, dengue,
diphtheria
- Metabolic/toxic – aspirin, scurvy

130. - Mechanical – change in atmospheric
pressure ( mountain climbing, flying),
exertion
- Neoplastic – nasopharyngeal Ca
leukemia
- vascular- hemophilia,
thrombocytopeni

131. - trauma- nasal and maxillary fracture
- Elevated venous pressure- Cor
pulmonale
Congestive Heart failure
- Elevated arterial pressure – HPN,
coarctation of aorta

132. • 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

133. 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

134. Nasal Septum Perforation

135. 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

136. -Symptoms 3-10 days
-Severe local pain suggest a
complication-bacterial
sinusitis

137. • 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

138. • 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

139. • Suppurative Paranasal Sinusitis
- due to Strep. pneumonia, H.
influenza
- severe pain in the face occuring 714 days after signs & symptoms of an
acute URTI
- pain & pressure without fever
suggest sinus obstruction requiring
decongestants

140. • 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

141. -patient
eyes
complains of pain deep in the
- 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

142. THANK YOU

143. THANK YOU

144. Mouth
• First segment of the digestive
system
• Airway for the respiratory system
• ORAL CAVITY
• Lips
• Palate
1. Hard
2. Soft
3. Uvula – hangs down from the soft
palate

145. • Cheeks- side walls of cavity
• Tongue
1. Papillae- rough, bumpy elevations
on dorsal
2. Frenulum
3. Taste buds
• Teeth – 32 permanent

147. • Salivary glands
1. 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

149. 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

150. • 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.

152. Physical Examination

153. • 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

154. INSPECT AND PALPATE
Use gloves, tongue depressor, light
• Lips
• Teeth
• Gums
• Tongue
• Buccal mucosa
• Mouth ( roof and floor of the
mouth)

155. • 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

156. Rest
r
e
s
t
Movement

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

159. Retraction of the Upper Lip
Retraction of the lower Lip

160. • 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

161. Proper Occlusion of Teeth

162. • 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

163. Retraction of the cheek
to view the Buccal Mucosa
Buccal Mucosa with prominent
Papilla of Stensen Duct

164. • 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

165. • 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.

166. - 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

167. -
Wharton ducts should be
apparent on each side of
the frenulum

169. Mouth
>Roof of the mouth
- hard and soft palate
Floor of the mouth
- tongue
Take note of the smell coming
from the oral cavity
Ask the patient to tilt his head to
inspect the palate and uvula

171. Uvula , soft palate, bilateral fauces

172. Throat
Tonsils
- 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

174. 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

175. 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

176. SIGNS

177. • Lips

178. Cyanotic Lips

179. Chapped dry lips

180. > Cheilitis
- dry cracked lips due to
dehydration from wind
chapping, dentures , braces, or
excessive lip licking
- angular cheilitis due to
candidiasis

181. Chapped Lips with Cheilitis

182. Cheilosis ( angular
stomatitis)
- ulcerations of skin at the
corners of the mouth due to
crusting 2ndary to riboflavin
deficiency or ill fitting
dentures

183. Cheilosis (Angular Stomatitis)

184. Cleft lip
- due to incomplete fusion
of the frontonasal process
with the 2 maxillary
processes

185. Cleft Lip

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

187. • Hard palate
Maxillary Torus

188. Maxillary torus
- bony protuberance at the
midline
- no clinical significance

189. Cleft palate
- a midline opening in the hard
palate
- congenital failure of the
fusion of the maxillary process
- usually ass. with cleft palate

190. Cleft Palate

191. • Tonsils
Enlarged tonsils

192. - Grading tonsillar enlargement
• Grade size 1+ visible
• …………….2+ ½ way b/t tonsillar
pillars and uvula
• …………….3+ touching the uvula
• …………….4+ touching each
other

193. • Uvula
Deviation of the uvula

194. • Posterior pharyngeal wall
After tonsillectomy

195. Posterior Pharyngeal Wall
With a yellow Pseudocyst
Posterior Pharyngeal Wall with
White removable mass of mucus

196. Acute viral pharyngitis
- mucosa of oropharynx shows lymphoid
tissue are elevated but noo edema
- sore throat, rhinorrhea, malaise,
myalgia
Streptococal or staphylococcal
pharyngitis
- Pharyngeal mucosa is bright red,
swollen, edematous studded with white
or yellow follicles
- Tonsils maybe enlarged

197. 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

198. • Tongue
Lingual Deviation

199. Tongue-tie or shortened
frenulum

200. Folliate Papillae(Green)
Circumvallate Papillae(blue)
Elongated filiform Papillae

201. Large reddened fungiform Papillae
Circumvallate Papillae

202. • Gums
Gingival Fibrous Nodule
At the mucogingival junction

203. Bleeding gums
local causes:
traumatic – toothbrush,
laceration, dental caries, tartar
on the teeth
infection – pyorrhea alveolaris,
stomatitis
neoplasm – epulis, papilloma of
gums

204. General causes:
Scurvy, syphilis
Metal poisoning –phosporous, lead,
mercury
Blood dyscrasia – hemophilia,
leukemia,
thrombocytopenia

205. Deep red or purple gums
- tender , swollen, spongy
and easily bleeds
- due to scurvy ( ascorbic
acid deficiency)

206. • Teeth
Malocclusion of teeth

207. Periodontitis ( Pyorrhea
Alveolaris)
- lower teeth are involved
- with purulent and retracted
gums
Epulis
- fibrous tumor arising from
periosteum and emerges from
between the teeth.

208. • Larynx
> hoarseness
acute laryngitis – most common
cause of hoarseness
> laryngeal edema
signs of obstruction – hoarseness,
dyspnea and stridor

209. 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

210. • 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

211. THANK YOU