Assessment of Nose, Mouth, and Throat

Assessment of the nose, mouth, and throat should be completed as part of a comprehensive assessment or as a focused assessment if your patient is experiencing issues with their nose, mouth, or throat.

The methods of nose, mouth, and throat assessment include inspection and palpation. Alright, first, you’ll inspect the external nose.

The skin should be smooth, and the color should match the rest of the face. The nares, or nostrils, should be positioned symmetrically and appear relaxed.

Flaring could indicate respiratory distress, and narrowing can obstruct the airway. Nares should also be free from discharge.

Thick or purulent discharge may occur with an infection; and bloody drainage is typically related to trauma or injury. Next, using a nasal speculum and a penlight, gently push the tip of the nose up so you can inspect the internal nasal cavity.

The tissue is normally slightly red and covered with fine hairs. The nasal septum should be smooth, without perforation, and positioned at midline.

A lateral displacement of the septum, called a deviated septum, is often the result of an injury. Next, inspect the lips, which should be symmetrical, slightly moist, and smooth, with a distinct vermillion border between the lips and the skin of the face.

The overall color should be pink in patients who have lighter skin, and there’s often a bluish undertone in patients with darker skin, which can give a false impression of cyanosis.

Pale lips might be seen with anemia and cracked, or dry lips are associated with dehydration or exposure to wind and cold.

Angular cheilitis, or cracks and redness at the corners of the mouth, can occur with iron or a vitamin B deficiency. Lesions on or around the lips can be caused by herpes simplex virus, skin cancer, or trauma.

Lip swelling can be related to an allergic reaction or an injury. Following inspection of the lips, inspect the teeth and gums.

The teeth can range in color including white, yellow, or grayish; and they should be smooth without sharp edges. Missing teeth can occur due to trauma or extraction.

The gums should be slightly moist and have a distinct border at each tooth, and their color can vary depending on skin color.

Patients with lighter skin typically have pinkish gums, whereas patients with darker skin usually have a darker oral pigmentation and a brown or black line along the gingival margin.

Gum hyperplasia can be related to periodontal disease or due to side effects of medications like phenytoin. Red or bleeding gums are associated with gingivitis or hormonal abnormalities.

Then, inspect the tongue, which should move freely, appear midline in the mouth, and be pink and moist. A beefy red tongue can be associated with iron or a vitamin B deficiency.

Oral thrush appears as white patches on the tongue and oral mucosa, that, when wiped away, leaves behind a reddish area or bleeding.

Thrush is caused by an overgrowth of Candida and is commonly found in patients who are immunocompromised. On the other hand, a thickened white patch that can’t be wiped away could be caused by leukoplakia, which is a premalignant oral lesion associated with smoking or chewing tobacco.

The rest of the oral mucosa should be free from lesions and nodules; though you might visualize aphthous ulcers, or canker sores, which are small, painful, non-contagious lesions that can develop on the soft tissue of the mouth from irritation, as well as viral or bacterial infections.

Lastly, using a tongue blade and penlight, inspect the posterior pharynx, which should be free from nodules, masses, or exudate.

The uvula should be pink and dangle at the midline; and the tonsils, if present, should be pink with an irregular surface.

Bright red and swollen tonsils that contain exudate are an indication of an infection. Moving on to palpation, you’ll begin by palpating the nasal bridge and nares, which should be free from tenderness or masses.

To test for patency, gently occlude one naris at a time and ask your patient to breathe through the open naris. Normally, air should move freely through each naris.

Noisy or difficult breathing could be due to congestion, nasal polyps, or even a foreign body. You’ll also palpate the frontal and maxillary sinuses.

If tenderness is present, it’s usually related to an infection. Next, using your gloved hand, palpate the teeth, inner lips, and gums.

Assess the teeth for smoothness and firm attachment to the gums. Wiggling teeth can occur due to trauma or periodontal disease.

The gums should be nontender and firm. Gum tenderness is associated with trauma or infection.

Lastly, palpate the tongue, where a slightly rough texture on the dorsum of the tongue is expected. Alright, as a quick recap… Assessment of the nose, mouth, and throat should be done as part of a comprehensive assessment or as a focused assessment if your patient is experiencing issues with their nose, mouth, or throat.

The methods of nose, mouth, and throat assessment include inspection and palpation.