Clinical Examination of the Ear, Nose and Throat

Report
Clinical Examination of the
Ear, Nose and Throat
Dave Pothier
St Mary’s 2003
Important things to remember
• ABC is ALWAYS necessary
• See patient as a whole
• Look at patient from the time they enter
the room
• Systemic problems give valuable clues
• Look for health ‘props’
Practice is vital
ENT examination/equipment is not intuitive
Be familiar with gear
THE EAR
Position
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Good light
Headlight / reflected light from headmirror
Side on to patient
Inspect, Palpate, Use otoscope
NB look behind ear
External anatomy
Palpate
• Feel pinna
• Feel lymph nodes
• Palpate neck
Canal
• Inspect pinna and concha
• Otoscopic examination
• Pull upwards, outwards
and backwards
• Look for cavity,
Otitis externa
Osteomas
Mastoid cavity
TM
• Assess all quadrants
• Look for malleus,
incus
• Record abnormalities
Pars flaccida
Long process incus
Handle of malleus
Umbo
Pars tensa
Canal wall
Perforations
Central perforation
Marginal perforation
Don’t forget
• Tuning fork tests
• Simple free field tests
• Look at audiological investigations
THE NOSE
Inspection
• Good light
• Look at skin and scars
• Assess shape
• Look at vestibules by lifting tip
Palpation/inspection
• Occlude each nostril in turn and assess air
entry
• Look at misting of tongue depressor
Anterior rhinoscopy
• Use thuddicums speculum
hold it properly!
Nasendoscopy
• Rigid
• Flexible
Don’t forget
• Also examine neck and oral cavity
• Check postnasal space
• Ear disease may suggest pathology
THE THROAT
What does this area consist of?
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Mouth?
Pharynx?
Larynx?
Trachea?
Oesophagus?
Neck?
Best to view as much as
possible
Oral cavity
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Open wide!
Two tongue depressors
Examine every mucosal surface
Protrude tongue
Look at salivary orifices
Bimanual palpation
Percuss teeth
Larynx
• Indirect / direct laryngoscopy
To be learned in OPD
View of larynx
Tongue base
Vallecula
Epiglottis
False cord
Vocal cord
Piriform fossa
Arytenoid
cartilage
Neck
• Inspect
• Palpate
• Auscultate
Inspection
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Scars
Lumps
Sinuses
Asymmetry
Stoma
Ask patient to swallow and protrude tongue
Ask patient to breathe deeply
Ask patient to count to ten
Palpation
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Adequate exposure
Systematic
Develop system
From in front then mainly from behind
Submandibular area, both triangles
Supraclavicular area
Auscultation
• Listen for bruit
Thyroid and carotid
Summary
• See patient as a whole – don’t focus in on
one part of the body too soon
• Be systematic
• Adequate exposure
• Be familiar with toys
• Suggest further assessments

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