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.