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 • 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

• Assess all quadrants • Look for malleus, incus • Record abnormalities TM

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!

• Rigid Nasendoscopy • 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?

• Mouth?

• Pharynx?

• Larynx?

• Trachea?

• Oesophagus?

• Neck?

Best to view as much as possible

Oral cavity • 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

Tongue base Vallecula Epiglottis False cord Vocal cord Piriform fossa Arytenoid cartilage View of larynx

• Inspect • Palpate • Auscultate Neck

Inspection • Scars • Lumps • Sinuses • Asymmetry • Stoma • Ask patient to swallow and protrude tongue • Ask patient to breathe deeply • Ask patient to count to ten

Palpation • 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