Clinical Examination of Facial Injuries
Examination Map HISTORY
Location of Pain
Activity and Injury Mechanism
Inspection of the Ear
Inspection of the Nose
Septum and mucosa
Inspection of the Throat
Thyroid and cricoid cartilage
Inspection of the Face and Jaw
Inspection of the Oral Cavity
Palpation of the Anterior Structures
Palpation of the Lateral Structures
Buccinator FUNCTIONAL ASSESSMENT
Range of motion
Tracking NEUROLOGICAL EXAMINATION
Cranial Nerve Assessment REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUE TESTS
Tympanic membrane rupture
Temporomandibular Joint Dysfunction
Inspection Findings 16-1: Use of an Otoscope for Inspection of the Ear and Nose
(A) An otoscope with a speculum that fits snugly within the ear canal without causing pain is used to inspect the tympanic membrane. The speculum needs to be placed only slightly into the ear canal to view the structures. Visualization is improved when the pinna is pulled upward and backward (some clinicians prefer to pull the earlobe downward). (B) The use of an otoscope to view the nasal passage.
|Patient Position ||Seated or standing |
|Position of Examiner ||Positioned to easily access the patient's ear or nose |
|Evaluative Procedure || |
Select and fit a speculum on the otoscope that will fit snugly into the opening.
When inspecting the ear, open the auditory canal by gently pulling upward and backward on the pinna or downward on the earlobe. Gently insert the speculum into the ear. Deep penetration is not necessary.
|Positive Test || |
Ear: Reddened and/or bulging tympanic membrane; fluid buildup behind the tympanic membrane; fluid in the ear canal; ruptured tympanic membrane
Nose: Deviation or deformity of the nasal passage(s)
|Implications || |
Ear: A reddened and/or bulging tympanic membrane is indicative of middle ear infection (acute otitis media). Fluid behind the tympanic membrane (otitis media effusion) is not necessarily indicative of an infection. Fluid in the ear canal may represent otorrhea, or leakage of cerebrospinal fluid, and is associated with a skull fracture. A ruptured tympanic membrane may result from a blow to the ear.
Nose: Fracture, deviated septum
|Comments ||Cerumen may obscure the tympanic membrane. To clear cerumen, gently flush the ear with hydrogen peroxide or warm water. Do not do this if a tympanic membrane rupture is suspected. |
|Evidence ||Absent or inconclusive in the literature |
Laceration of the external ear. This injury requires suturing to prevent permanent deformity of the ear.