Skip to 0 minutes and 11 secondsThe third video section covers the examination of the ears, nose, mouth and throat. Whilst you are watching consider when you
Skip to 0 minutes and 19 secondswould need a specialised swallowing assessment. Right now I’m going to examine your ears OK, so first of all I’m just going to just touch them, tell me if it’s painful. Is there any pain here? No. I am examining the oracle and tragus for pain or any swelling. OK, lovely. Now I am going to look inside your ear. I am going to pull your ear back slightly and up and then just look inside. Assessing for otitis externa or discharge which could indicate infection or perforation to the tympanic membrane. The otoscope allows me to visualise the external canal, tympanic membrane, cone of light and possibly the head of the malleus.
Skip to 1 minute and 6 secondsThe cone of light should be in the 5’o’clock position in the right ear and the 7o’clock position in the left ear. They point towards the patient’s chin. And that’s lovely, nice and clear. Then we’ll do the same on the other side. So is there any pain here? No. Or here? No. Is there any pain before or in front of your ear? No. OK, so let’s look inside. That’s really good, lovely, nice and clear. So now I am just going to check your hearing I’m going to stand behind you, I want you to cover one ear for me. OK, and now I want you to repeat the number that I’m going to say, 438. 438. 47. 47.
Skip to 1 minute and 53 secondsThank you, now cover the other ear. The whisper test assesses for growth hearing deficient, cranial nerve 8. 259. 259. 75. 75. That’s excellent thank you. Now I want to have a look at your nose. OK, so could you just look up towards the ceiling for me? That’s lovely, I’m just going to look inside. I am looking for any signs of trauma to the nose, any deviation of the septum, any signs of polyps, checking that the mucosa and turbinates are pink and healthy. A change in the sense of smell would indicate a problem with cranial nerve 1. That’s lovely. OK bring your head back down and now could you cover one nostril for me and sniff.
Skip to 2 minutes and 41 secondsAnd the other side, and no problems there at all? OK, have you noticed a change in your sense of smell recently? No. I’m going to have you with your mouth open for a little while now this time so if it’s uncomfortable let me know. OK. Now I am going to examine your mouth, could you open your mouth wide for me? Say aah.
Skip to 3 minutes and 4 secondsAah. I am inspecting the lips, gums, hard and soft palates and the floor of the mouth for colour and surface characteristics, note any odour alliaceous, note the oropharynx and anterior posterior pillars, tonsils and uvula. Is it central on saying aah cranial nerve 9. Now show me your teeth. Assess the teeth for a colour, number and general hygiene. Could you stick your tongue out for me? Move it from side to side. Put your tongue into your cheek and don’t let me push it away. Assess the tongue and beneath it for colour and characteristics and symmetry of the tongue movements, cranial nerve 12. That’s excellent, thank you. Have you had any problems with your swallowing recently? No.
Skip to 3 minutes and 51 secondsIf the patient indicates swallowing problems then a formal swallowing test, cranial nerve 10 should be organised.
Head to toe (part 3)
Having covered examination of the head and face, including cranial nerves II, III, IV, V, VI and VII in the previous step, watch the third video, covering examination of the ears, nose, mouth and throat.
In what circumstances would you require a more specific swallowing assessment?