KANKIYA IRO SCHOOL OF HEALTH TECHNOLOGY KANKIA

DEPARTMENT OF COMMUNITY HEALTH

LECTURE NOTE ON:

PRIMARY EAR, NOSE AND THROAT CARE

JCHEW 132

COMPILED BY:

AMINU JAFARU IDRIS

OCTOBER 2018

1
 COMMUNITY EAR, NOSE AND THROAT CARE:

INTRODUCTION:

Community ear nose and throat care is one of miscellaneous national

component of Primary Health Care; it emphasis is on the care of ear,

nose and throat at the grass root level i.e Primary Health Care

operational levels.

Ear Nose and Throat diseases are of clinical important because it can

cause deafness or hardness of hearing in serious handicapping

condition.

Anatomically, there is a relationship between the ear, nose and throat,

due to this fact any disease that can affect one of the organ can easily

spread to the other if adequate care is no instituted.

The study of the disease of ear nose and throat is refers to as

otorhinolaryngology.

OBJECTIVES OF EAR NOSE AND THROAT CARE:

1. Early detection of the common ENT diseases.

2. Appropriate treatment of common diseases and injuries affecting

the ear, nose and throat.

3. To refer serious cases.

2
 4. To prevents common diseases and injuries of the ear nose and

throat at the grassroots levels.

5. To prevent deafness and hardness of hearing.

1.1 THE ANATOMY OF THE EAR

Introduction

The Ear is one of the sense organ, and its major function is hearing and

balancing. The ability of a Community Health Practitioner, to help and

render qualitative health services to Individuals in community with

Earproblems. The need to understand the anatomy and physiology of

the Ear is very important. Morphologically, the ear is divided into three

(3) segments namely; External Ear, Middle Ear and Inner Ear.

3
It is also important to know that the ear start its development during

the third to sixth week of the intra uterine life and by the end of the

seventh foetal month the ear has been fully formed.

Timing of Development of the Ear and Week of Gestation

S/ DEVELOPME PINNA MEATUS MIDDLE LABYRITH

NO NT VESTIBULA AND

R EAR COCHEAL

1 Begins 6th 8th 3rd 3rd

2 Complete 20th 28th 30th 20th

The different malformations associated with external and middle ear

depend upon the time the normal development was arrested in the

embryonic life.

As it has been said earlier, the ear is divided into three parts:

S/ PART OF THE COMPONENTS

NO EAR

1 External ear Pinna, external auditory canal, tympanic

membrane

2 Middle ear cleft Eustachian tube, tympanic cavity and its

contents like ossicle muscles, ligaments,

mucosal folds, meatus and air cell system.

4
3 Inner ear Cochlea, vestibule and semicircular canal.

THE EXTERNAL EAR:

This is the first part of the ear which consist of the pinna, the auditory

meatus, the auditory canal and the tympanic membrane (ear drum)

THE MIDDLE EAR:

This is a small air filled chamber in the scar. It start from the tympanic

membrance and end at the oval window, its made up of three tiny soft

bones called the auditory ossicles. The auditory ossicles are the

malleus, incus, and stapes. The malleus attached to the tympanic

5
membrane and joint the incus by its short process, the incus joint the

head of the stapes and the stapes attached to the oval window. The

ossicles function together in transmitting sound wave to the inner ear,

at each side of the middle ear there is an estachian tube which allowed

passage of air from the surrounding to enter or live the middle ear to

maintained constant air pressure at both side of the ear drum.

THE INNER EAR:

This is the complex of bony and membranous passage ways filled with

a fluid called perilymph and endolymph, this fluid filled passage way

form the cochlear and semi circular canals.

PHYSIOLOGY OF HEARING:

Sound wave from the external environment is collected by the pinna

which direct it to the auditory meatus to the tympanic membrane.

The sound wave vibrate the tympanic membrane to transmit the sound

energy on to the ossicles, the ossicle act together and transmit the

sound on to the oval window.

From the oval window vibration is send in to the inner ear where

vibrations are transmitted across the sensory nerves cells of the

auditory nerves (cranial nerves No VIII) which then transmit the

impulses to the brain for interpretation.

6
Equilibrium Function

The equilibrium of the body is maintained by co-ordination of three

systems:

(1) Vestibular apparatus

(2) Proprioceptors; and

(3) Vision (eye)

NOTE: Loss of functions of two leads to severe problems with posture

and balance.

PHYSIOLOGY OF BALANCE

The three semi-circular canals and the vestibule (utricle and saccule)

are concerned with balance. Any change of position of the head causes

movement in the perilymph and endolymph, which bends the hair cells

and stimulates the sensory nerve endings in the utricle, saccule and

ampullae. The resultant nerve impulses are transmitted by the

vestibular nerve which joins the cochlear nerve to form the

Vestibulocochlear nerve. The vestibular branch passes first to the

vestibular nucleus, then to the cerebellum. The cerebellum also

receives nerve impulses from the eyes and proprioceptors (sensory

receptors) in the skeletal muscles and joints. Impulses from these

three sources are coordinated and efferent nerve impulses pass to the

cerebrum and to skeletal muscles. This results in awareness of body

7
position, maintenance of upright posture and fixing of the eyes on the

same point, independently of head movements.

FUNCTIONS OF THE EAR:

1. Hearing.

2. Balance.

3. Diagnosis of disease.

4. Giving shape to the face.

5. Beautification (cosmetics purposes).

1.2 ANATOMY OF THE NOSE:

The nose is otherwise known as nasal cavity or olfactory organ, it is an

organ of respiration and sense of smelling. The nose is the first part of

the respiratory organ through which air mades its initial empty in to

the body it consist of a large irregular cavity divided in to two by a

septum, situated at the midline. The nasal cavity consists of two

opening; the anterior nares from the exterior to the nasal cavity and

the posterior nares from the nasal cavity to the pharynx.

8
 DIAGRAM OF THE NOSE

NASAL CAVITY COMMUNICATION:

Each nasal cavity communicates with:

1. Exterior through the anterior nares.

2. Nasopharynx through the posterior nares (choana)

3. Paranasal sinuses through the ostia.

4. Middle ear through the Eustachian tube.

PARTS OF THE NASAL CAVITY:

The nasal cavity consists of 4 parts:

1. Vestibule.

2. Atrium.

3. Olfactory region.

9
 4. Respiratory region.

Vestibule: is the anterior and inferior portion of the nasal cavity that

is lined by skin in contrast to the rest of nasal cavity. It bears

sebaceous glands and hair follicles. The hair are called vibrissae.

Atrium: is the part of the middle turbinate.

Olfactory region: the roof of the nasal cavity, the region above

superior turbinate and the adjoining septum. It is lined by the yellow

olfactory neuro-epithelium having bipolar sensory cells.

Respiratory region: the lower 2/3 of the nasal cavity is lined by

pseudo stratified ciliated columnar epithelium rich in goblet cells. The

mucosal here is very vascular and has erectile tissue. It is pink in

colour. It is continuous with the mucosa of the sinuses, nasopharynx

and Eustachian tubes. The ciliary movement propels the nasal

secretion backwards towards the posterior choanae.

PARANASAL SINUSES:

The paranasal sinuses are air filled spaces in certain bones of the skull

and they are in direct communication with the nasal cavity through

their opening called ostia. They can be divided in to two groups:

1. Anterior group- frontal, anterior ethmoidal and maxillary air

sinuses.

10
 2. Posterior group- posterior ethmoidal and sphenoidal air sinuses.

MECHANISM OF SMELLING:

The air entering the nose is warmed and carried in to the roof of nasal

cavity where the olfactory organs are stimulated and impulses pass

along the olfactory nerves to the olfactory region in the brain for

interpretation.

FUNCTION OF THE NOSE:

 Respiration.

 Olfaction (smelling).

 Protection (immunity)

 Humidification.

 Assist in phonation (production of sound).

 Diagnosis of certain diseases.

 Beautification (cosmetics purposes).

 Filtration.

 Given shape to the face.

 Draining excess tiers from the eye.

FUNCTIONS OF PARANASAL SINUSES:

The functions of the paranasal sinuses include the following:

1. Reduction of the weight of the skull.

11
 2. Vocal resonance.

3. Rapid growth of the face due to formation of the sinuses.

4. Protection of the orbit.

5. Air conditioning.

1.3 ANATOMY AND PHYSIOLOGY OF THROAT (PHARYNX):

The pharynx is a funnel shaped fibro-muscular tube that forms the

upper part of the digestive and respiratory tracts. It is lined by mucous

membrane. It extends from the base of the skull to the level of the

body of the sixth cervical vertebra. From above downwards, the nasal

cavity, oral cavity, laryngeal inlet open in to the pharynx. The

corresponding part of the pharynx is named as:

1. Nasopharynx: opening in to the nasal cavity.

2. Oro-pharynx: opening in to the oral cavity.

3. Laryngopharynx (hypopharynx).

The lower end of the pharynx is continuous with the oesophagus. This

is the narrowest part of the gastro-intestinal tract and it is called

cricopharynx which is situated behind the cricoids cartilage.

On each side of the throat there is a tube that connect the pharyngeal

cavity with the middle ear, the tube is known as the Eustachian tube.

12
FUNCTIONS OF THE THROAT:

1. Passage of air and food

2. Protection (immunity).

3. Assist in phonation.

4. Assist in hearing.

5. Taste humidification.

6. Filtration.

2.0 SIGNS AND SYMPTOMS OF EAR, NOSE AND THROAT

CONDITIONS

Introduction

Ear, Nose and Throat diseases are serious conditions seen so often in

our community, it is very important for a community health

practitioner to recognize this conditions early and provide immediate

13
solutions. Therefore, this lecture note will equip the student on these

common conditions of Ear, Nose and Throat.

IDENTIFY SYMPTOMATIC CONDITIONS OF THE EAR

Introduction

To understand treatment of Ear, Nose and Throat (ENT) diseases, you

should be able to recognize the symptoms and signs of ENT diseases.

This unit will help you to understand the symptoms and signs in ENT,

and also to know that problems in the ear can be as a result of the

diseases from the nose or throat and vice versa since the three areas

are closely related and contiguous with one another. Symptoms are

what the patient will complain of while the signs are what you will

observe or see in the patient. Treatment is the simple solution or

advice you offer the patient to get better from the condition.

COMMON SYMPTOMATIC CONDITIONS OF THE EAR

1. OTALGIA (Ear pain)

2. OTORRHEA (Ear discharge)

3. Deafness

4. Vertigo

5. Tinnitus

TREATMENT OF COMMON SYMPTOMATIC CONDITIONS OF EAR

EAR PAIN (OTALGIA)

14
The pain may be primarily in the ear or the pain may be referred from

other areas like the throat or nose. Pain may be referred to the ear

through the 5th, 7th, 9th or 10th cranial nerves or the upper two

cervical nerves. It is important to note the character of the pain, the

onset, its distribution, severity, periodicity and relieving factors.

CAUSES OF EAR PAIN

 Foreign body in the ear, -Impacted wax,

 Furuncle (boils) in the ear, -Acute Otitis Media,

 Keratosis obstrain

 Myringitis (inflammation of the tympanic membrane)

 Fungal, trauma and -Tumours are also causes of ear pain.

Common causes of referred pain to the ear are:

 Palate or salivary glands. - Tonsillitis,

 Peritonsillar abscess, - Impacted molar tooth.

 Dental caries, - Alveolar abscess,

 Infection in the mouth,

 Post-tonsillectomy pain and malignancy (tumour)in the oral

cavity.

DIAGNOSING OF EAR CONDITIONS

Besides the examination of the ear, other structures like nose,

paranasal sinuses, oral cavity, and pharynx should be examined.

15
INVESTIGATIONS

Beside routine investigations, the following investigations may be

required.

 Radiograph of nose and paranasal sinuses

 Radiograph of the cervical spine

 Radiograph of temporo-mandibular joints

TREATMENT/MANAGEMENT

 Specific treatment depends upon the cause.

 General treatment consists of drugs administration.

i. Analgesics

ii. Antibiotics

(See, Standing Orders for drugs dosages)

OTORRHEA

Otorrhea is a medical term referring to Ear discharge due to diseases

of the ear, but it may be due to a few other causes outside the ear.

CAUSES OF OTORRHEA IN THE EAR

 Otomycocis. This is a fungal infection of the external ear.

 Furunculosis. This is a bacterial infection of the external ear.

 Liquid wax may also be present as ear discharge.

16
  Acute suppurative otitis media. This is infection in the middle ear

with perforation of the tympanic membrane, duration less than

three weeks.

 Chronic suppurative otitis media. This is a long standing infection

in the middle ear with perforation of the tympanic membrane,

usually more than eight weeks.

 Suppurativelabyrinthitis. This is infection of the inner ear

labyrinth which produces discharge.

CAUSES OUTSIDE THE EAR

 Cerebrospinal fluid Otorrhea. Following road traffic accident,

cerebrospinal fluid may leak into the ear if there is a perforation

at the base of the skull.

 Parotid abscess. The abscess may track down through the

external auditory canal.

PRESENTATION/FEATURES

The discharge may be profuse or scanty, continuous or intermittent,

serous or mucoid or mucopurulent, may even be foul smelling or

odourless, the discharge may be watery.

EXAMINATION/INVESTIGATION

o Bacteriological examination for culture and sensitivity.

17
 o Otoscopy (examination of the ear).

o Test of hearing.

TREATMENT: DEPENDS ON THE CAUSE

 Ear drop

 Systemic antibiotic

 Aural toileting

OTITIS EXTERNA:

This is an acute septic infection of the skin of the outer ear, auditory

meatus or the auditory canal.

Causative Agent:

Staphyloccus aureus.

Signs and symptoms:

i. Pain in the ear.

ii. Slight discharge.

iii. Redness of the eardrum.

iv. Dullness.

Treatment:

According to standing orders.

18
OTITIS MEDIA:

This is an inflammation of the middle ear accompanied with discharge

from the ear usually the first sign is pus.

Types of Otitis Media:

i. Acute otitis media: this usually start suddenly with slight fever

and pain in the ear.

ii. Chronic otitis media: This is progression of acute otitis media for

more than two weeks.

Signs and symptoms:

i. Fever.

ii. Severe pain in the ear.

iii. Dullness.

iv. Redness of the eardrum.

v. Bulging of the eardrum.

vi. Pus discharge from the ear.

Predisposing factors:

These are some of the factors that lead to otitis media.

i. Measles.

ii. Mumps.

19
iii. Chicken pox.

iv. Common cold.

v. Tonsillitis.

Treatment:

According to standing orders.

Prevention:

i. Appropriate treatment of respiratory tract infection.

ii. Immunization.

Complication:

i. Hardness of hearing.

ii. Deafness.

iii. Meningitis.

iv. Mastoiditis.

v. Brain abscess.

DEAFNESS:

Is a condition of inability to hear or hearing impairment.

Classification/ types:

1. Congenital deafness

2. Adventitious deafness.

20
Congenital deafness: This is the deafness that a child is born with.

Risk factors:

i. Family history of heredity deafness.

ii. Maternal barred infection.

iii. Acute hypoxia at birth.(lack of oxygen in the body)

Adventitious deafness: This is the condition in which one is born

with normal hearing but the sense of hearing become non-functional

later in life due to certain factors.

Types of Adventitious deafness:

1. Conductive deafness: This occur due to impaired transmission

of sound wave from the pinna to the oval window due to the

following:

 Cerumen wax.

 Foreign body.

 Injuries to the tympanic membrane.

 Infection e.g measles, otitis media, mumps, etc.

 Fibrosis of the ossicles.

2. Neural deafness: This is as a result of the disease or injuries of

the cochlear nerves or hearing centre in the brain due to the

following:

21
  Injuries affecting the inner ear.

 Drug side effect e.g Aminoglycoside group such as

Gentamycin.

 Infection affecting the brain e.g Meningitis.

 Noise pollution.

 Presbycusis: degenerative changes in the sensory cell due to

ageing process.

Characteristics of deafness:

1. Lack of respond to spoken words.

2. General indifferent to sound (lack of interest to sound)

3. Respond to noise as oppose to words.

4. Screaming to express pleasure or annoyances.

5. Alertness to gesture or movement.

Prevention of deafness:

1. Good antenatal care.

2. Appropriate treatment of disease and injuries.

3. Immunization against major infectious diseases.

4. Prevention of accidents.

5. Regular visit to ENT clinic.

TINNITUS

22
DEFINITION

Tinnitus can be defined as a ringing sound or noise in the ear or head.

It is different from auditory hallucination which is hearing of voices and

sentences due to functional disturbances.

This is noise in the ear. It is very common and annoying symptom. It

may be mild and occur only at night; sometimes the tinnitus is

continuous and loud and interferes with hearing. Tinnitus is one of the

most difficult symptoms to treat.

CAUSES OF TINNITUS

The causes of Tinnitus are categories into local, general and functional

causes.

Local Causes

 Cerumen.

 Perforation of tympanic membrane

 Serous otitis media – causes muffling of voice with low pitched

tinnitus and intermittent character.

 Otosclerosis (harden part of the ear as a result of growth) – starts

with disease, ringing, roaring or whistling sound continuous type,

disappears as the disease progresses.

 Presbyacusis (impairment of hearing) and acoustic trauma

produces high pitch tinnitus, ringing in character.

23
  Exposure to loud noise.

 Meniere’s disease (accumulation of fluid in the ear) is

characterized by low pitched fluctuating tinnitus which becomes

louder during attacks.

 In summary, any disease of the ear which can cause deafness

may also produce tinnitus.

General Causes

 Drugs like aspirin, quinine, salicylates, streptomycin,

dihydrostreptomycin, neomycin, gentamicin are ototoxic drugs

causing high pitched tinnitus.

 Vascular causes like atherosclerosis, hypertension, etc. cause high

pitched tinnitus. In hypertension, tinnitus is fluctuating.

 Anaemia. Low BP causes low intensity tinnitus.

Functional causes

 Emotional factors may cause tinnitus but tinnitus itself may lead to

anxiety and depression.

 Idiopathic: No cause for tinnitus detected.

DIAGNOSIS/INVESTIGATION

Even when Tinnitus is the primary complaint, audiological evaluation is

usually preceded by examination by an ENT specialist to diagnose

treatable conditions like middle ear infection, concussion, otosclerosis,

24
TREATMENT OF TINNITUS

i. Treatment of the primary cause.

ii. Masking of tinnitus by a tinnitus masking device, alarm clock or

radio may be useful in a quiet place.

iii. Reassurance for difficult cases.

iv. Surgical treatment has little value. Labyrinthectomy, 8th Nerve

Section, stellate ganglion block, chorda tympani nerve section,

etc have been tried.

v. Drugs: like lidocaine eardrop, carbamazepine, clonazepam, etc.

have been tried.

PREVENTION OF TINNITUS

 Prolonged exposure to loud sound or noise levels can lead to

tinnitus. Ear plugs or other measures can help with prevention.

 Several medicines have ototoxic effects, and can have a

cumulative effect that can increase the damage done by noise. If

ototoxic medications must be administered, close attention by the

physician to prescription details, such as dose and dosage

interval, can reduce the damage done.

VERTIGO

DEFINITION

25
Vertigo or giddiness is a subjective sensation of imbalance, where the

patient feels that either his surroundings are going round him, or he

himself is rotating. It may be a mild to severe vertigo accompanied by

nausea, vomiting; palpitation, gastric upset and diarrhea due to vagal

stimulation. Vertigo differs from fainting spell where patient feels

sinking and blackout.

CAUSE OF VERTIGO

The causes of vertigo are also categories into local, traumatic, and

causes outside the ear.

Local Causes

 Wax causes - Furuncle

 Labyrinthitis - Meneirer’s disease

 Perilymph fistula - Syphilis

 Vestibular neuronitis - Ototoxic drugs

 Otitis media

Trauma to the Inner Ear

 Head Injury with fracture of temporal bone.

 Surgical trauma: e.g. mastoidectomy or stapedectomy, vestibule

may be damaged.

 Acoustic trauma. Very loud sound may occasionally cause vertigo

(Tullio phenomenon).

26
 Causes outside the Ear

 Hypertension with atherosclerosis.

 Hypotension.

 Cardiac problems: Arrhythmias, regurgitation.

 Disseminated sclerosis (abnormal growth and harden tisuues).

 Tumours or abscess in the cerebellum and brain stem.

 Increased intra-cranial tension

 Diabetes

 Anaemia

 Diplopia – perceives double images (double vision)

 Refractory errors – short sightedness and long sightedness

 Glaucoma – Ocular high pressure leading to blindness.

DIAGNOSIS/INVESTIGATION

i. Detailed history about the patient should be taken.

ii. Proper examination of the ear, nose and throat. Also, a general

examination of the body should be carried out.

iii. The patient should be investigated along the area of the possible

cause; treatment is directed to the cause.

SYMPTOMS OF VERTIGO

Vertigo is often triggered by a change in the position of your head.

People with vertigo typically describe it as feeling like they are:

27
 Spinning - Tilting

 Swaying - Unbalanced

 Pulled to one direction

 Other symptoms that may accompany vertigo include:

- Feeling nauseated

- Vomiting

- Abnormal or jerking eye movements (nystagmus)

- Headache

- Sweating

- Ringing in the ears or hearing loss

Symptoms can last a few minutes to a few hours or more and may

TREATMENT OF VERTIGO

i. Treatment for vertigo depends on what's causing it.

ii. In many cases, vertigo goes away without any treatment. This is

because your brain is able to adapt, at least in part, to the inner

ear changes, relying on other mechanisms to maintain balance.

iii. Referred complicated cases of vertigo to the ENT specialist.

EAR SYRINGING:

Is a means of injecting water in to the ear with forces by the use of an

ear syringe or robber bulb to remove wax, foreign body or pus from the

ear.

28
PROCEDURES FOR EAR SYRINGING:

1. Collect requirements needed.

2. Wash your hands thoroughly.

3. Explain the purpose and procedure to the patient.

4. Have the patient in a setting position.

5. Examine the ear with otoscope to confirm the abnormality. If

there is a foreign body in to the ear, take a great care do not

push it further.

6. Place the marckin tosh and towel over the patient shoulder.

7. Ask the patient to hold the receiver against his/her neck below

the ear.

8. If there is a pus in the outerear, wipe away with wet cotton wool.

9. Fill the syringes with warm irrigation solution and test the

temperature on your wrist it should be slightly warm.

10. Hold the lobe backward and upward to straighten the

auditory canal, hold backward downward for a child.

11. Expel the air from the syringe and place the tip in the

opening of the ear from canal, facing upward. Be sure to allow

room for the solution to return freely.

12. Now syringe the ear until foreign body or wax is remove or

until the solution become clear.

29
 13. Ask the patient to tip his head towards the receiver to

empty the ear canal.

14. Irrigate the outer ear in the same way if ordered.

15. Dry the outer ear and the neck with a towel.

16. Check result of the irrigation with auriscope.

CONTRA INDICATIONS ON EAR SYRINGING

The following patients should not be subjected into ear syringing

 Perforated tympanic membrane

 Vertigo

 Hygroscopic (vegetative) foreign bodies should not be syringed,

as they may swell and get impacted. Seeds like beans or maize

may even begin to germinate.

COMPLICATIONS OF SYRINGING

 Tympanic membrane perforation

 Trauma to the external auditory canal

 Burns if the liquid for syringing is hot

 Giddiness, vertigo, if hot or cold is used.

 Infection: use of unsterilized water may cause otitis externa.

NOTE: Analgesics can be prescribed if there is pain.

DISEASES AND CONDITIONS ASSOCIATED WITH THE NOSE:

30
EPITAXIS: Is a bleeding from the mucus membrane of the nasal

cavity.

Causes:

i. Foreign body.

ii. Trauma or injuries. E.g wound, fractures etc.

iii. Infection e.g typhoid fever.

iv. Diseases e.g hypertension, chronic liver disease.

v. Vitamin deficiency e.g vitamin K and C.

vi. Tumors.

Management:

i. Arrest bleeding.

ii. Identify the cause and treat according to standing orders.

iii. Refer serious cases.

COMMON COLD AND INFLUENZA:

These are the commonest and the most wide separate disease of the

respiratory organs, acute and highly infectious but usually mild.

Causative agents:

1. Cold virus.

2. Influenza virus.

31
Incubation period: 1 to 3 days.

Mode of transmission:

Air born through droplet.

Signs and symptoms:

i. Rhinitis.(inflammation of the nose)

ii. Coryza (nasal discharge).

iii. Sneezing.

iv. Mild fever.

v. Muscles pain and malaise.

vi. Headache and loss of appetite.

vii. Sore throat.

Treatments:

1. Usually symptomatic according to standing orders.

2. Antibacterial to prevent secondary infection.

Complications:

1. Secondary infection.

2. Otitis media.

RHINITIS:

32
This is an infection of the nasal mucosa characterized by inflammation

and nasal discharges.

Causes:

i. Bacteria e,g streptococcus.

ii. Viruses e.g Rhino virus.

iii. Allergies.

Signs and symptoms:

1. Itching.

2. Sneezing.

3. Watery discharge from the nose.

4. Fever and headache.

5. Nasal blockage.

Treatments:

1. Isolation may be necessary in cases of viral rhinitis

2. Absolute bed rest help quick recovery

3. Warm water bath and steam inhalation with tincture benzoic or

menitol are helpful

4. Adequate fluid intake should be encouraged

5. Analgesic and antipyretic to control constitutional symptoms.

6. Antihistamine such as Chlorampheniramine should be given

33
 7. Nasal decongestant drops may be helpful, given for few days (5 –

7 days) to prevent rhinitis if used for prolonged period

8. Antibiotics have no role except when there is secondary infection

SINUSITIS:

This is an inflammation of paranasal sinuses often follows common

cold, influenza, and other general infection.

Signs and symptoms:

i. Headache and fever.

ii. General body pain.

iii. Post nasal discharge

iv. Loss of appetite.

v. Loss of sense of smell.

vi. Sore throat.

Management:

1. Usually symptomatic according to standing orders.

2. Antibiotic to prevent secondary infection.

Complication:

 Otitis media.

NASAL POLYPS:

These are semi-transparent tumor like growth in the nasal cavity.

Causes:

 Not clearly known but are usually due to some allergy.

34
Signs and symptoms:

i. Headache.

ii. Nasal bleeding.

iii. Loss of sense of smell.

iv. Nasal obstruction.

Management:

 Refer

PREVENTION OF COMMON NOSE PROBLEMS:

1. Proper and adequate nutrition.

2. Proper personal hygiene.

3. Good environmental hygiene.

4. Prevention of accident.

5. Regular visit to ENT clinic.

DISEASES AND CONDITIONS AFFECTING THE THROAT

(PHARYNX)

PHARYNGITIS:

Is an acute inflammation of the pharynx usually accompanied common

cold, influenza and tonsillitis.

Causes:

1. Bacteria e.g streptococcus.

2. Virus e.g influenza virus.

Signs and symptoms:

35
 1. Fever and headache.

2. Sore throat.

3. Itching.

4. Cough.

Management:

i. Symptomatic according to standing orders.

ii. Antibiotic to prevent secondary infection.

Complication:

Otitis media.

TONSILITIS:

This is an acute or chronic inflammation of the palatine tonsil, palatine

arch and wall of the pharynx.

Causes:

 Streptococcus.

 Viruses.

Signs and symptoms:

i. Fever and chill.

ii. Headache.

iii. Body weakness.

iv. General body pain.

v. Sore throat.

36
 vi. Difficulty in swallowing (dysphagia)

vii. Swelling and redness of the tonsil.

viii. Cough.

Treatment:

1. Antibiotic.

2. Analgesic and antipyretic.

3. Hot saline gargles.

4. Extra fluid.

Complication:

1. Otitis media

2. Deafness.

3. Mostoiditis.

4. Rheumatic fever.

5. Glomerulonephritis.

SORE THROAT:

Is a condition when the back of the throat frequently becames inflamed

accompanied with burning sensation.

Causes:

i. Common cold.

ii. Influenza.

iii. Sinusitis.

iv. Tonsillitis.

37
v. Measles.

vi. Diphtheria.

Signs and symptoms:

1. Dryness of the throat.

2. Burning pain.

3. Fever and chills.

4. Hoarseness.

5. Difficulty swallowing.

Management:

i. Identify and treat the cause according to standing orders.

ii. Relief pain.

iii. Extra fluid.

Complication:

1. Rheumatic fever.

2. Glomerulonephritis.

DIPTHERIA:

Is a childhood highly infectious disease characterized by the formation

of fibroid pseudo membrane on the mucosa of the respiratory tract.

Causative agent:

 Corynebacterium diptheriae.

Incubation period:

 Two to three days.

38
Mode of transmission:

 Air borne through droplet.

Signs and symptoms:

1. Moderate fever.

2. Mild sore throat.

3. Enlargement of the cervical node.

4. Greysish pseudo membrane over the base of the throat.

Management:

 Refer.

Complication:

i. Blockage of the wind pipe causing strangulation.

ii. Rheumatic heart diseases.

iii. Heart failure.

Prevention:

 Active immunization.

PREVENTION OF THE COMMON THROAT PROBLEM:

1. Proper and adequate diet.

2. Appropriate treatment of diseases.

3. Proper personal hygiene.

4. Immunization against infectious diseases.

5. Regular visit to ENT clinic.

39
UNSAFE PRACTICES IN THE COMMUNITY ASSOCIATED WITH

EAR, NOSE AND THROAT DIOSRDER:

i. Removal of uvula.

ii. Ear piercing.

iii. Nose piercing.

iv. Clearing the cilia in the ear canal.

v. Removal of the cilia in the nose.

PROCEDURE IN EAR EXAMINATION OF THE PATEINT

 Create a good rapport with the patient

 Explain purpose and procedure to the patient

 Prepared an examination tray containing the following;

i. diagnostic set

ii. Tray

iii. Gallipot with wet swab

iv. Gallipot with dry swab

v. Kidney dish for waste receiver

 Assemble the instrument by connecting the light source and

check the functioning of the Otoscope.

 Sit the patient in a proper position if is an adult. If is a child

instruct the mother on how to hold the child for complete

convenience.

40
 Clean the ear piece with a wet cotton swab with alcohol or any

disinfectant.

 Use one of your hand to hold the instrument, and the other to

hold the pinna

 Pull the pinna softly backward and upward, so that you have

access to the auditory canal

 Light the otoscope and control the illumination

 Insert the ear piece of the otoscope into the auditory canal softly

and gently.

 Apply your eye on the magnifying lens of the otoscope

 Examine the ear carefully, by checking the auditory canal for:

i. Rashes

ii. Boils

iii. Obstruction

iv. Impacted wax

v. Colour of the Tympanic membrane

vi. Inflammation

vii. Perforated Tympanic membrane

viii. Discharge.

 Record all findings

 Interprets finding to the patient or client in a way they

understand

41
REFERENCES

1. Chan Y (2009). "Tinnitus: etiology, classification, characteristics,

and treatment". Discovery Medicine. 8 (42): 133–36. PMID

19833060

2. Schaette, R; McAlpine, D (21 September 2011). "Tinnitus with a

Normal Audiogram: Physiological Evidence for Hidden Hearing

Loss and Computational Model". The Journal of Neuroscience. 31

(38): 13452–57. doi:10.1523/JNEUROSCI.2156-11.2011. PMID

21940438.

3. Tinnitus". American Academy of Otolaryngology – Head and Neck

Surgery. 2012-04-03. Archived from the original on 2012-10-16.

Retrieved 2012-10-26.

4. Persaud RA, Hajioff D, Thevasagayam MS et-al. Keratosis

obturans and external ear canal cholesteatoma: how and why we

should distinguish between these conditions. ClinOtolaryngol

Allied Sci. 2004;29 (6): 577-81. doi:10.1111/j.1365-

2273.2004.00898.x - Pubmed citation

42