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Description : Check out this medical presentation on Ear, Nose, and Throat Facts, which is titled "Diseases of the Eyes, Ears, Nose, and Throat", to gain the knowledge of the anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of common or major diseases of the eyes, ears, nose, and throat, including nose bleed.

Tags : Ear, Nose, Throat Facts, Diseases, anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, management

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Slide 1-

Chapter 19 Diseases of the Eyes, Ears, Nose, and Throat
Slide 2-

National EMS Education Standard Competencies Medicine Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.
Slide 3-

National EMS Education Standard Competencies Diseases of the Eyes, Ears, Nose, and Throat Knowledge of the anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of Common or major diseases of the eyes, ears, nose, and throat, including nose bleed
Slide 4-

Introduction Calls may involve disorders of the eyes, ears, nose, and throat (EENT). Patients may need to be transported to an emergency department with access to a specialist.
Slide 5-

Anatomy and Physiology of the Eye The globe measures about 1 inch in diameter. Housed within the orbit Held in place by connective tissue and muscles Control eye movement
Slide 6-

Anatomy and Physiology of the Eye Oculomotor nerve (third cranial nerve) Cause motion of the eyeballs and upper eyelids Optic nerve (second cranial nerve) Provides the sense of vision
Slide 7-

Anatomy and Physiology of the Eye
Slide 8-

Anatomy and Physiology of the Eye Eye structures Sclera (“white of the eye”) Cornea Conjunctiva Iris Pupil Lens Retina Converts light impulses to nerve signals
Slide 9-

Anatomy and Physiology of the Eye Anterior chamber: between lens and cornea Filled with aqueous humor Posterior chamber: between iris and lens Filled with vitreous humor
Slide 10-

Anatomy and Physiology of the Eye Light rays enter the eyes through the pupil. Focused by the lens Image is cast on the retina The optic nerve transmits the image to the brain. The visual cortex coverts it into a conscious image.
Slide 11-

Anatomy and Physiology of the Eye Two types of vision Central vision Enables visualization of objects directly in front of you Peripheral vision Enables visualization of lateral objects while a person is looking forward
Slide 12-

Anatomy and Physiology of the Eye Lacrimal apparatus Secretes and drains tears from the eye Tears moisten the conjunctivae.
Slide 13-

Patient Assessment Ensure scene safety. Keep your patient calm. Form a general impression. Assess airway and breathing. Cover both eyes. Consider pain management. Cardiac monitoring is recommended.
Slide 14-

Patient Assessment Obtain chief complaint and history. OPQRST Diabetes is the leading cause of new cases of blindness in adults. Diabetic retinopathy
Slide 15-

Patient Assessment Symptoms that may indicate a serious ocular condition: Visual loss that does not improve with blinking Double vision Severe eye pain Foreign body sensation Perform a thorough examination.
Slide 16-

Patient Assessment Assess for: Pain/tenderness Swelling Abnormal or loss of movement Sensation changes Circulatory changes Deformity Visual changes Airway compromise
Slide 17-

Patient Assessment Assess structures: Orbital rim Ecchymosis, swelling, lacerations, and tenderness Eyelids Ecchymosis, swelling, lacerations, or any abnormalities Corneas Foreign bodies
Slide 18-

Patient Assessment Assess structures: Conjunctivae Redness, pus, inflammation, and foreign bodies Globes Redness, pigmentation, and lacerations Pupils Size, shape, equality, and reaction to light
Slide 19-

Patient Assessment When assessing ocular function, test: Visual acuity Ability to see large and small letters Peripheral vision Ability to recognize an object entering the visual field Ocular motility Ability to move the eyes in all directions
Slide 20-

Patient Assessment Obtain a full set of baseline vital signs. The patient may experience side effects if: Used more than one eye medication Used too much medication Ask how he or she administered the medication.
Slide 21-

Patient Assessment Eye drops and lubricants can be applied by: Gently squeezing the lower eyelid Applying the medication Have the patient close the eyes and roll them. Apply gentle pressure to the corner of the eyes to prevent drainage.
Slide 22-

Patient Assessment Irrigation may be necessary. Use sterile water or isotonic saline solution. Flush from the inside corner to the outside. Eye injuries should be seen in the emergency department.
Slide 23-

Burns of the Eye and Adnexa Can be caused by: Chemicals Heat Light rays Thermal burns Occur when a patient is burned in the face during a fire
Slide 24-

Burns of the Eye and Adnexa Retinal injuries caused by extremely bright light: Generally not painful May result in permanent damage Superficial burns of the eye: May not be painful initially Symptoms include: Conjunctivitis Redness Swelling Excessive tear production
Slide 25-

Burns of the Eye and Adnexa Assessment and management Assess for and treat life-threats. May be difficult if eyes are closed Open the eye and irrigate with sterile water or sterile saline solution. Pain may have to be managed before assessment.
Slide 26-

Burns of the Eye and Adnexa Assessment and management (cont’d) Assess positions of gaze. Cover an eye burned by ultraviolet light with: Sterile, moist pad Eye shield Transport in a supine position.
Slide 27-

Burns of the Eye and Adnexa Assessment and management (cont’d) Chemical burns require immediate irrigation. Direct as much fluid as possible. Use a device that will control the flow. Do not allow contaminated fluid to enter the eye. Irrigate for at least five minutes.
Slide 28-

Burns of the Eye and Adnexa
Slide 29-

Burns of the Eye and Adnexa
Slide 30-

Burns of the Eye and Adnexa Assessment and management (cont’d) Use of the Morgan lens (eye irrigation device) Administer a topical anesthetic. Connect the lens to the IV bag, and let it drip. Slide the Morgan lens under the eyelids. Run the fluid at the desired rate.
Slide 31-

Burns of the Eye and Adnexa Assessment and management (cont’d) Transport considerations for eye burn patients: Prevent one eye from draining into the other eye. Specialized treatment can be found at level-1 trauma centers.
Slide 32-

Burns of the Eye and Adnexa Assessment and management (cont’d) Contact lenses To remove a hard lens, use a small suction cup. To remove soft lens, pinch between thumb and index finger and lift off eye.
Slide 33-

Conjunctivitis Conjunctiva becomes inflamed and red. Often starts in one eye and spreads to the other eye Often caused by bacteria, viruses, allergies, or foreign bodies Courtesy of John T. Halgren, M.D., University of Nebraska Medical Center
Slide 34-

Conjunctivitis Assessment and management Rule out life threats or dangers to the crew. Perform general assessment of vision. Viral conjunctivitis resolves on its own Bacterial conjunctivitis: topical antibiotic Allergic conjunctivitis: topical antihistamine
Slide 35-

Corneal Abrasion Painful Due to superficial trauma to the cornea If discomfort does not resolve, patient should be seen in the emergency department.
Slide 36-

Corneal Abrasion Assessment and management Symptoms include: Pain Sensitivity to light Tearing Lubrication can alleviate some pain. Taping the eyelid closed can keep the eye from drying out.
Slide 37-

Corneal Abrasion Assessment and management (cont’d) Invert the eyelids to expose the source. Look for a foreign body in the eye. A topical anesthetic may relieve symptoms. If movement of the eye causes discomfort, cover both eyes.
Slide 38-

Foreign Body Can cause significant pain Commonly caused by machines such as: Grinders Sanders Nailers Weed whackers
Slide 39-

Foreign Body Assessment and management Evaluate the entire eye using a light. Examine the undersurface of the upper eyelid. If you spot a foreign object on the surface, attempt to remove it with a moist, cotton-tipped applicator.
Slide 40-

Foreign Body Assessment and management (cont’d) To assist with dislodging: Irrigate the eye with a sterile saline solution. Transport the patient to the hospital.
Slide 41-

Foreign Body Assessment and management (cont’d) Do not remove an impaled foreign body. Stabilize in place. Cover with a moist, sterile dressing. Place a protective barrier over the object. Cover unaffected eye. Transport promptly.
Slide 42-

Inflammation of the Eyelid (Chalazion and Hordeolum) Oil glands and oil ducts may become blocked, causing: Chalazion: swollen bump or pustule on the external eyelid Hordeolum (stye): red tender lump in the eyelid or the lid margin © Francoise Sauze/Photo Researchers, Inc.
Slide 43-

Inflammation of the Eyelid (Chalazion and Hordeolum) Assessment and management Often painful Can progress to become systemic Thorough assessment of vital signs and history Treat inflammation with a warm washcloth. Transport to the emergency department.
Slide 44-

Glaucoma Group of conditions that lead to increased intraocular pressure Usually treated with eye drops to reduce ocular pressures
Slide 45-

Glaucoma Assessment and management Perform a general eye assessment. Ask patients what medications they have taken. Treatment in the pre-hospital setting: Administer tetracaine for pain relief. Irrigate for the removal of an irritating substance.
Slide 46-

Hyphema Bleeding into the anterior chamber of the eye Obscures vision Blood clotting is a concern. Can cause a rise in intraocular pressure
Slide 47-

Hyphema Assessment and management Pain and blurred vision is likely. Blood may be visible. If rupture of the globe is suspected, take spinal motion restriction precautions.
Slide 48-

Hyphema Assessment and management (cont’d) If no contraindications, transport upright. Other medications with antiplatelet effects should be avoided. An anxiolytic may facilitate transport.
Slide 49-

Iritis Inflammation of the iris Acute causes include: Trauma Irritants Chronic causes include: Autoimmune diseases Arthritis Irritable bowel disease Crohn disease © Biophoto Associates/Photo Researchers, Inc.
Slide 50-

Iritis Assessment and management Red area surrounding the iris, cloudy vision, or an unusually shaped pupil Focus on history. Acute iritis may respond to topical corticosteroids. Chronic iritis should be referred to a specialist.
Slide 51-

Papilledema Swelling or inflammation of the optic nerve Patients experience: Headaches Nausea Temporary vision loss or narrowing vision fields A “graying” in the field of vision
Slide 52-

Papilledema Can be caused by: Abscess Tumor Inner ear infection Lung infection Dental infection Other causes: Meningitis Fever Hypertensive crisis Chronic high blood pressure Guillain-Barré syndrome
Slide 53-

Papilledema Assessment and management Prehospital management consists of: Treat symptoms. Transport. Assess ABCs and life threats. Administer analgesics or a mild sedative, if needed.
Slide 54-

Retinal Detachment and Defect Potential result of blunt eye trauma Assessment and management: Generally painless Produces: Flashing lights Specks “Floaters” Requires immediate medical attention
Slide 55-

Cellulitis of the Orbit Periorbital cellulitis Presents as a painful, red, swollen eyelid Risk factors: Insect bites Upper respiratory disorders Trauma Orbital cellulitis Medical emergency Risk factors: Sinusitis Tooth infections Ear infections Trauma Sinus infections
Slide 56-

Cellulitis of the Orbit Assessment and management Treatment includes antibiotics. Prehospital management includes: Ruling out life threats Obtaining a thorough history Transporting to the appropriate care
Slide 57-

The Ear The ear is the primary structure for hearing and balance. Disorders and injuries can leave a person unable to: Communicate React Maintain equilibrium
Slide 58-

Anatomy and Physiology of the Ear Divided into three anatomic parts
Slide 59-

Anatomy and Physiology of the Ear Sound waves enter the ear. Travel to the tympanic membrane. Sound waves set up vibration in the ossicles. Vibrations transmit to the cochlear duct. At organ of Corti, vibrations form impulses. Travel to the brain via the auditory nerve.
Slide 60-

Patient Assessment Observe the scene for hazards. As you approach, assess: Age and sex of the patient Environmental conditions Degree of distress Presence of hearing aid(s)
Slide 61-

Patient Assessment Ensure ABCs and manage life threats. Take a complete history. Observe ears for: Drainage Excess cerumen Inflammation Swelling
Slide 62-

Patient Assessment Have patient rate his or her pain. Ask about: Changes in hearing Tinnitus Dizziness Inspect for: Wounds Swelling Drainage Mastoid process Transport.
Slide 63-

Foreign Body Usually seen in pediatric patients Assessment and management Determine the nature of the object. Look for bleeding, redness, or inflammation. Stabilize impaled objects in place. Transport in a position of comfort.
Slide 64-

Impacted Cerumen Yellowish oily substance found in outer ear May present as: “Wet”: a sticky brown color “Dry”: a grayish flaky substance Can become impacted
Slide 65-

Impacted Cerumen Risk factors include: Abnormal ear canal shape Diseases that cause increased cerumen Improper use of cotton swabs
Slide 66-

Impacted Cerumen Assessment and management Symptoms may include: Pressure or fullness in the ears Ringing in the ears Loss of hearing
Slide 67-

Impacted Cerumen Assessment and management (cont’d) Prehospital treatment includes: Thorough history Visual inspection of the ear
Slide 68-

Labyrinthitis Feeling of vertigo or loss of balance after an ear infection or upper respiratory infection Other symptoms may include: Ringing in the ears Loss of hearing Vomiting
Slide 69-

Labyrinthitis Assessment and management Prehospital treatment is directed at: Reducing nausea and vomiting Transporting the patient in a position of comfort Serious disorders will need to be ruled out by a CT scan and an MRI.
Slide 70-

Meniere Disease Endolymphatic rupture creates increased pressure in the cochlear duct Damages organ of Corti and semicircular canal Patients will likely experience: Severe vertigo Tinnitus Sensorineuronal hearing loss
Slide 71-

Meniere Disease Assessment and management Prehospital care includes an antiemetic. Physician may treat with diuretics and an antiemetic.
Slide 72-

Otitis Externa and Media Infection resulting from bacterial growth in the ear canal Externa: outer ear Media: middle ear More common in children than adults
Slide 73-

Otitis Externa and Media Assessment and management Signs and symptoms may include: Edema and erythema Diminished hearing acuity Inflamed, bulging tympanic membrane Prehospital treatment: relieving unbearable symptoms
Slide 74-

Perforated Tympanic Membrane Ruptured eardrum Results from: Foreign bodies in the ear Pressure-related injuries Diving-related injuries
Slide 75-

Perforated Tympanic Membrane Assessment and management Signs and symptoms include: Loss of hearing Blood drainage from the ear Pain Assess and treat other injuries. Transport for evaluation.
Slide 76-

The Nose Susceptible to injury because of prominence Allergens, particles, and chemicals can cause inflammation, infection, and injury. Inside of the nose is extremely vascular. Excellent route for some medicines.
Slide 77-

The Nose Smelling disorders include: Anosmia: total loss of sense of smell Dysosmia: distorted sense of smell Hyperosmia: increased sensitivity to smell Presbyosmia: loss of smell from normal aging
Slide 78-

Anatomy and Physiology of the Nose One of two primary entry points for oxygen Nasal septum: separation between the nostrils Turbinates: layers of bone within each nasal chamber © Jones & Bartlett Learning
Slide 79-

Anatomy and Physiology of the Nose Frontal sinuses are above the nose. Paranasal sinuses Cavities within several bones associated with the nose
Slide 80-

Patient Assessment Look for environmental clues. Ensure scene safety. Assess airway and breathing. Determine level of distress.
Slide 81-

Patient Assessment Insert an airway adjunct as needed. Do not insert a nasopharyngeal airway or attempt nasotracheal intubation with: Suspected nasal fractures CSF or blood leakage from the nose Inquire about history of nose conditions.
Slide 82-

Epistaxis Nosebleed Anterior Bleed fairly slowly Self-limiting and resolve quickly Posterior More severe Often cause blood to drain into the throat, causing nausea and vomiting
Slide 83-

Epistaxis Assessment and management: Place a nontrauma patient in a sitting position, and pinch nostrils together. Direct the patient not to sniff or blow his or her nose.
Slide 84-

Foreign Body Most likely to be seen in pediatric patients Pressure in the nasal passage can cause: Tissue necrosis Inflammation Swelling
Slide 85-

Foreign Body Assessment and management Determine life threats. Any persistent, foul-smelling, purulent discharge should lead to suspicion. Let discharge drain. Transport the patient in a position of comfort.
Slide 86-

Rhinitis A nasal disorder that is most common during childhood and adolescence Generally caused by allergens
Slide 87-

Rhinitis Assessment and treatment Signs and symptoms may include: Nasal congestion Itchy runny nose and eyes Postnasal drip Keep the patient in the Fowler position.
Slide 88-

Sinusitis Patients experience thick nasal discharge, sinus and facial pressure, headache, and fever. Infection occurs when an obstruction or growth blocks the paranasal sinus.
Slide 89-

Sinusitis Assessment and management Condition can be chronic, acute, or recurrent Treatment: reduce inflammation and drain sinuses. Complications occur when the infection moves into the brain or bone.
Slide 90-

The Throat Disorders of the pharynx and larynx may include inflammation, infections, or abnormal growths.
Slide 91-

The Throat Esophageal disorders can affect the throat. Esophageal reflux: valve only partially closes or opens too much Symptoms include: Burning sensation in the chest Indigestion Change in voice tone
Slide 92-

Anatomy and Physiology of the Throat 32 teeth distributed about the maxillary and mandibular arches Each side of the arch form 4 quadrants One central incisor One lateral incisor One canine Two premolars Three molars
Slide 93-

Anatomy and Physiology of the Throat The top portion of the tooth is the crown. The pulp cavity fills the center of the tooth. Dentin forms the principal mass of the tooth. Alveoli are the bony sockets for the teeth. Alveolar ridges: ridges between the teeth that are covered by gums
Slide 94-

Anatomy and Physiology of the Throat
Slide 95-

The Mouth Digestion begins with mastication. Tongue: the primary organ of taste Attached at mandible and hyoid bone Covered by a mucous membrane
Slide 96-

The Mouth Nerves: Hypoglossal Provides motor function to the tongue Glossopharyngeal Provides taste sensation Trigeminal Provides motor innervation to the muscles of mastication Facial Supplies motor activity of facial expression Provides taste sensation Provides cutaneous sensations to the tongue and palate
Slide 97-

The Neck Anterior part of the neck include: Thyroid and cricoid cartilage Trachea Muscles and nerves Major blood vessels
Slide 98-

The Neck Other structures: Vagus nerves Thoracic duct Esophagus Thyroid and parathyroid glands Lower cranial nerves Brachial plexus Soft tissue and fascia Various muscles
Slide 99-

Patient Assessment Swallowing abnormalities require a position to allow drainage. Assessments should consider epiglottitis if: Sore throat Drooling Head that is hung forward
Slide 100-

Dentalgia and Dental Abscess Dentalgia: toothache Dental abscess Occurs when a bacteria growth spreads into the gums, facial tissue, bones, and/or neck © Dr. P. Marazzi/Photo Researchers, Inc.
Slide 101-

Dentalgia and Dental Abscess Assessment and management Infection may become systemic. An abscess in the throat, neck, or under the tongue can affect the ability to breathe. Prehospital treatment is aimed at relieving symptoms.
Slide 102-

Diseases of Oral Soft Tissue Can be the root cause to other health problems Include: Cold sores Canker sores Thrush Leukoplakia Gingivitis Bad breath
Slide 103-

Diseases of Oral Soft Tissue Assessment and management Rule out urticaria and allergic reactions.
Slide 104-

Oral Candidiasis (Thrush) Candida albicans accumulates on the lining of the mouth. Patient will have creamy white lesions. May be painful and may bleed © Biophoto Associates/Photo Researchers, Inc.
Slide 105-

Oral Candidiasis (Thrush) Assessment and management Most likely to be found in: Babies Patients with compromised immune systems Patients who wear dentures Patients who use inhaled corticosteroids
Slide 106-

Oral Candidiasis (Thrush) Assessment and management (cont’d) Additional symptoms may include: Cracking and redness at the corners of the mouth A “cottony” feeling in the mouth Sensation of food stuck in the throat
Slide 107-

Oral Candidiasis (Thrush) Assessment and management (cont’d) Patients at increased risk: HIV/AIDS Cancer Diabetes Vaginal yeast infections Treat higher priorities. Make the patient comfortable.
Slide 108-

Ludwig Angina Cellulitis caused by bacteria from an infected tooth root or mouth injury Physical exam may show redness and swelling of the neck or under the chin.
Slide 109-

Ludwig Angina Assessment and management Symptoms may include: Difficulty breathing Neck pain and swelling Altered speech sounds
Slide 110-

Ludwig Angina Assessment and management (cont’d) Prehospital treatment requires aggressive management of the airway in severe cases. Contact medical control physician early on. Attend to basic ABCs.
Slide 111-

Foreign Body in the Throat Assessment and management Keep the patient calm. Transport in a position where if the object becomes dislodged, gravity will allow it to fall out.
Slide 112-

Epiglottitis Inflammation of the epiglottis Blocks the trachea and obstructs the airway Often a result of the H. influenzae type b virus
Slide 113-

Epiglottitis Assessment and management Symptoms may include: Fever Painful swallowing Stridor Signs may include: Sick and anxious “Tripod” position or sniffing position Pallor or cyanosis
Slide 114-

Epiglottitis Assessment and management (cont’d) Transport to an appropriate hospital. Minimize scene time. Do not agitate the patient. Do not attempt to look in the mouth. Alert receiving personnel.
Slide 115-

Laryngitis Swelling and inflammation of the larynx Causes may include: Pneumonia Irritants and chemicals Bronchitis Allergies
Slide 116-

Laryngitis Assessment and management Symptoms include: Fever Hoarseness Swollen lymph nodes or glands Have the patient follow up with a physician.
Slide 117-

Tracheitis A bacterial infection of the trachea caused by Staphylococcus aureus Frequently occurs in children following URI Trachea is easily blocked by swelling Can be life-threatening
Slide 118-

Tracheitis Assessment and management Symptoms: “Croup-like” cough Difficulty breathing High fever Signs: Tripod positioning Intercostal retractions
Slide 119-

Tracheitis Assessment and management (cont’d) Minimize stress to the patient. Administer 100% oxygen. Use pulse oximetry. Monitor vital signs. Be prepared for difficult intubation. Transport promptly.
Slide 120-

Tonsillitis Swelling and inflammation of the tonsils Usually caused by viral infections Can also be caused by bacteria © Biophoto Associates/Photo Researchers, Inc.
Slide 121-

Tonsillitis Assessment and management Symptoms: Swollen tonsils Sore throat Difficulty swallowing Signs: White or yellow coating or patches Fever Sore throat
Slide 122-

Pharyngitis Inflammation of the pharynx Often due to a rapid onset of sore throat Without discomfort or pain with swallowing © BSIP/Photo Researchers, Inc.
Slide 123-

Pharyngitis Assessment and management Symptoms may include: Discomfort or pain on swallowing Pharyngeal erythema Purulent patchy yellow, gray, or white exudate Ulcers on the soft palate
Slide 124-

Peritonsillar Abscess Collection of infected material around the tonsils Complication of tonsillitis © Dr. P. Marazzi/Photo Researchers, Inc.
Slide 125-

Peritonsillar Abscess Assessment and management Symptoms may include: Facial swelling Inability to swallow Tender glands of jaw and throat
Slide 126-

Peritonsillar Abscess Assessment and management (cont’d) Treatment involves antibiotics and draining the abscess. Transport patient to the hospital.
Slide 127-

Temporomandibular Joint Disorders Causes include: Arthritis damage to the joint’s cartilage Jaw injury Jaw muscle fatigue from grinding or clenching of the teeth
Slide 128-

Temporomandibular Joint Disorders Assessment and management Symptoms may include: Jaw pain Difficulty chewing Locking of the joint
Slide 129-

Summary Paramedics may encounter emergencies related to disorders of the eye, ear, nose, or throat (EENT) or may discover these disorders while assessing an unrelated emergency. Assess the eye for pain, tenderness, swelling, abnormal or loss of movement, sensation changes, circulatory changes, deformity, and visual changes.
Slide 130-

Summary Early transport to an appropriate facility can improve outcomes. Provide emotional care to patients with eye conditions. Flush burns to the eye. Never use chemical antidotes when treating burn injuries to the eye.
Slide 131-

Summary Specific conditions of the eye include conjunctivitis, corneal abrasion, foreign body, inflammation, glaucoma, hyphema, iritis, papilledema, retinal detachment and defect, and cellulitis of the orbit. The ear is the primary structure for hearing and balance.
Slide 132-

Summary Adequate assessment of the external ear canal and middle ear cannot be performed in the field. Specific conditions of the ear include foreign body, impacted cerumen, labyrinthitis, Meniere disease, otitis, and perforated tympanic membrane.
Slide 133-

Summary The nose is a vascular structure and contains nasal mucosa that is a short route to the brain. Never insert a nasopharyngeal airway or attempt nasotracheal intubation in any patient with suspected nasal fractures or in patients with CSF or blood leakage from the nose.
Slide 134-

Summary Specific problems related to the nose include epistaxis, foreign body, rhinitis, and sinusitis. Disorders of the throat may represent acute inflammation and infections, chronic inflammation, or abnormal growths.
Slide 135-

Summary When assessing a patient with a throat complaint, note whether the patient is able to swallow. Specific disorders include dentalgia, dental abscess, Ludwig angina, foreign body, epiglottitis, laryngitis, tracheitis, oral candidiasis, peritonsillar abscess, pharyngitis/tonsillitis, and temporomandibular joint disorders.
Slide 136-

Credits Chapter opener: © Biophoto Associates/Photo Researchers, Inc. Backgrounds: Green—Jones & Bartlett Learning; Purple—Courtesy of Rhonda Beck; Red—© Margo Harrison/ShutterStock, Inc.; Orange—© Keith Brofsky/Photodisc/Getty Images. Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.