The examination steps are to check the oropharynx first, then the nasopharynx, and then the hypopharynx. During the examination, the person being examined should sit upright with a neutral attitude, and breathe naturally when opening the mouth. Do not exert force to avoid tension and congestion in the pharynx and change the original appearance of the pharynx. The inspection can be carried out in the following order.
1. Lips: Observe the shape and color of the lips and surrounding tissues to see if they are normal and whether there are dry scales, cracks, herpes, scars, etc.
2. Oral cavity: Use a tongue depressor to push the lips and cheeks, and observe the mucous membrane for congestion, ulcers, new organisms, spots, and the condition of the parotid duct orifice. Then observe the condition of the teeth and gums to see if there is gingivitis, bleeding, or streak lines. When examining the tongue, look at the tongue coating, tongue quality, tongue body and its motor function. Observe whether there is deviation of tongue extension, tongue coating thickness, dryness and wetness and color, red and white tongue texture, tongue body size, whether there are erosions, cracks, geographic tongue or white spots, whether there is granulation tissue, neoplasms or ulcers, etc. The shape of the tongue often reflects the overall physical condition and the status of the digestive system. Ask the patient to stick out his tongue and observe the floor of the mouth. Pay attention to whether the tongue tie is too tight, whether there is difficulty in extending the tongue, whether there are ulcers and cysts under the tongue, and whether the submandibular gland and sublingual gland duct openings are normal. Finally, ask the examinee to tilt his head back and observe the depth and narrowness of the hard palate and palatal arch to see if there are ulcers, neoplasms, perforations, collapse, or cleft palate, etc.
3. Soft palate and uvula: Use a tongue depressor to gently press the front 2/3 of the tongue toward the base of the tongue. The tongue depressor should not be inserted too deep to avoid nausea and vomiting. Observe the color of the soft palate, whether there are ulcers or new growths, whether it is red, swollen, or swollen and collapsed. Is the soft palate cleft? Is the uvula absent, divided, too long, or red and swollen? Instruct the person being examined to observe the movement of the soft palate and uvula when making the "ah" sound to see if they can be lifted up, or if one side cannot be lifted up: Failure to lift up indicates soft palate paralysis. When suffering from acute pharyngitis, the soft palate and uvula are obviously congested: chronic pharyngitis often causes the uvula to become congested, swollen, and can droop and touch the base of the tongue.
4. Tonsils (palatine tonsils): Move the tongue depressor to press the tongue side or ask the subject to tilt his head slightly to the left and right, and observe the lingual and pharyngeal palatine arches extending from both sides of the soft palate. There is no congestion, whether the color is bright red or dark red, and whether there are pseudomembranes, exudates, ulcers, scar adhesions and changes in appearance.
The tonsils are between the two palatal arches and generally do not exceed the palatal arches, but their size cannot be used as an indicator of the presence or severity of inflammation. During the examination, attention should be paid to the exposed volume and shape of the tonsils, whether the surface is moist and whether there are spots, keratins or exudates, whether the dimples are clear and whether there are scars, and whether both sides are symmetrical. Generally, the tonsils are divided into four degrees (or grades) based on the size of the exposed volume. Degree 0 is buried deep within the two palatal arches and cannot be seen. Degree I (+) is exposed between the two palatal arches. Degree II (++) covers the pharyngeal and palatine arches. , III degree (+++) protrudes beyond the pharyngeal and palatine arches toward the midline of the pharynx.
When suffering from acute tonsillitis, the tonsils are red and swollen, with yellowish-white dots or small flakes of exudate on the surface; in chronic tonsillitis, the surface of the tonsils is dark red, often scarred, and appears uneven, or There are yellow and white spots, and there may be small white cysts in the fossae. It is also necessary to use another tongue depressor to compress the lingual and palatine arches to see if there is any pus or okara (cheese)-like material squeezed out of the cavity. You can also squeeze and protrude the tonsils that are hidden and difficult to see. The lower pole of the tonsils and the triangular fold are difficult to see clearly. You can ask the person being examined to make an "ah" sound or take a deep breath to see them clearly.
5. Posterior pharyngeal wall: During the examination, the examinee is required to sit upright to prevent the head from being twisted and causing the transverse process of one cervical vertebra to protrude forward, which may be misdiagnosed as a lesion. When the subject's pronunciation raises the soft palate, sometimes the first cervical tuberosity appears as a protrusion on the posterior pharyngeal wall, which cannot be regarded as a pathological change.
Normally, the mucosa of the posterior pharyngeal wall is smooth, moist, and pink. Sometimes there are microscopic blood vessels or a few scattered small lymphoid follicles. Those suffering from acute inflammation are bright red, and those suffering from chronic inflammation are dark red. If mucus or pus is attached to the mucosal surface, it often indicates lesions in the nasal cavity and sinuses. The mucous membrane is dry, shiny or covered with pus, mostly due to sicca or atrophic pharyngitis. If there are too many lymphatic follicles in the posterior pharyngeal wall, or even merge into large pieces, it is a type of proliferative or hypertrophic pharyngitis. The mucosa of the posterior pharyngeal wall is tense and bulging, and retropharyngeal abscess or tumor should be ruled out. In addition, attention should be paid to pseudomembranes, ulcers, scarring, etc.