EXAMINATION OF ENT

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EXAMINATION OF ENT
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CONTENTS

• Equipments in the ENT OPD.
• Symptomatology examination of Ear.
• Symptomatology examination of Nose.
• Symptomatology examination of Throat.
• Examination of larynx.

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Symptomatology of ear

• Ear discharge
• a) side unilateral or
  bilateral
• b) duration
• -short ( ASOM, furunculosis)
• -intermittent ( CSOM)
• -long duration ( Atticoanyral
  CSOM, granulomatous, malignancy)

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• onset
• a) sudden ( upper respiratory
  infections, ASOM)
• b) insidous ( CSOM , malignancy)
• SEVERITY
• a) profuse ( tubotympanic CSOM)
• b) scanty ( atticoantral CSOM)

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• Characterstics of discharge
• a)
  watery ( CSF otorrhea, eczematous cause in otitis
  externa, viral myringitis)
• b) mucoid ( otitis media)
• c) purulent ( furunculosis, CSOM-
  atticoantral, malignant otitis externa)
• d) mucopurulrent ( tubotympanic
  CSOM, secondary infection in attico antral CSOM)

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• Progression
• a) continous ( AAD , granulomatous
  conditions)
  
  b) intermittent ( CSOM)
• Colour
• a) blood stained ( ASOM , CSOM, trauma,
  malignancy, slag burn injury)
• b) bloody discharge ( trauma, rupture of
  jugular bulb, malignancy of EAC middle ear)
  

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• d)Pulsatile discharge ( ASOM, ICA,
  aneurysm, glomus, jugulare, glomus tympanicum)
• e)Discharge with retro orbital pain (
  petrositis, patchy meningitis, brain abscess in
  petrous area)
• f)Foul smelling ( AAD, myiasis, chronic
  FB, malignancy)

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• Thick browny discharge due to wax
• Greenish pseudomonas infections
• IMPAIRED HEARING
• a) side ( unilateral/ bilateral
• b) duration
• c) onset- since birth ( TORCH
  group of infections)

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• Acquired due to causes in
• - EAC
• -tympanic membrane
• -middle ear
• -eustachian tube
• -nasopharynx
• -metabolic systemic
• Sudden acquired sensorineural hearing loss
• -- cochlear retrocochlear causes

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• Autophony
• Diplacusis
• Recruitment of loudness
• Fluctuation
• Progression
• Any H/O trauma, fever, drug abuse
• Familial history

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• EAR PAIN
• a) side
• b) duration
• -sudden onset (
  furuncolosis , trauma, ASOM)
• -gradual onset (
  CSOM , malignancy , granuloma tous conditions
• c) type pricking/ throbbing/ burning/
  stabbing
• d) severity

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• e) aggravating factors
• f) relieving factors
• g) referred pain
• TINNITUS
• a) side
• b)duration
• c) progression,
• d) character
• e) high/ low pitch
• f) H/O drug abuse

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• VERTIGO
• a) duration
• b) episodes- constant/ periodic
• c) frequency of attack
• d) relieving factor
• e) association with hearing loss, otorrhea,
  coughing, sneezing, exposure to loud sound
• f) accompanied by nausea vommiting

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• AURAL FULLNESS
• -patulous ET
• -eustachian tube dysfunction
• -menieres disease
• ITCHING IRRITATION OF EAR
• HYPERACCUSIS

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examination

• PHYSICAL EXAMINATION
• 1.pinna
• -Inspection
• -size -anotio
• -macrotio
• -microtio
• -shape-mozarts ear,wildmuths ear,stahls ear
  cauliflower ear,maccauss ear,loop ear,bat
  ear,ear in downs syndrome and poyyers syndrome

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• Position of pinna
• scar,swelling,keloids,scaling,erypelas,dermati
  ts,obliteration, fistula-malotia
• -synotia
• -Look for swelling,scaling,vesicles,scars,keloid
  ,ulceration,discolouration,sinuses,growth onset
• PREAURICULAR AREA
• swelling,scar
• POSTAURICULAR AREA

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Instruments for ear examination
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EXTERNAL AUDITORY CANAL

• -Incision scar
• -size of meatus
• -contents of lumen
• -swelling
• TYMPANIC MEMBRANE
• -color-normal tm-pearly white, semi translucent
• non lustrous, red congested, bluish, yellow TM,
  pink, blackish grey coated membrane white
  membrane chalky dark grey membrane
  

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PAIN

• -bulged/retracted
• -Surface of membrane
• -bullae,epithelial pearls,calcareous
  deposits,retraction pockets,
• -Perforations-types
• location
• size
• shape
• edge
• margins
• resiudual drum

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RETRO TYMPANIC MASS

• MIDDLE EAR MUCOSA
• -mucosa
• -edematous
• -discharge
• -granulations
• -tympanosceloritic patches

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EUSTACHIAN TUBE

• EXAMINATION OF FACIAL NERVE AND NECK
• -Functional examination
• -test for nystagmus
• -fistula test
• -tuning fork tests
• Rinnes
• webers
• absolute bone conduction

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• rinnes test webers test

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Audiometry
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INVESTIGATIONS

• -Hb
• -TCDC, DC, ESR
• -X-ray of mastoid
• -Biopsy
• -CT SCAN, MRI, gallium scan
• -Ear discharge for cuulture sensitivity
• -Hearing tests
• -audiometry

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SYMPTOMATOLOGY OF NOSE

• Nasal obstruction ( unilateral or bilateral)
• duration
• -intermittent- ( vasomotor rhinitis, allergic
  rhinitis,ethamoidal polyposis
• -progressive- (polyp,malignancies )
• Severity
• Associated with purulent discharge

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NASAL DISCHARGE

• -side- unilateral ( foreign bodies,
  sinusitis, rhinitis caseosa , fungal sinusitis,
  malignancy.
• -bilateral (chronic sinusitis, atrophic
  rhinitis, polyp).
• -Type- watery(common cold, rhinitis CSF
  rhinorrhea, eosiniphilic rhinopathy)
• -purulent (chronic sinusitis atrophic rhinitis,
  rhinitis caseosa, malignancy)

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BLOODY DISCHARGE

• -chronic sinusitis, fungal sinusitis
  baro sinus, TB, leprosy, lupus , syphillis,
  benign malignant conditions.
• Thick nasal discharge cystic fibrosis, allergic
  fungal sinusitis, kartageners syndrome.
• Colour
• foul smelling/ no
• crusting

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EPITAXIS

• -duration
• -Previous episode
• -Provoked or spontaneous
• -quantity
• -Aggrevating factors
• -bleeding factors
• -H/O drug intake, facial trauma, bleeding
  from other sites
• -Family history

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Disturbances of smell

• duration
• Foul smelling
• H/O nasal allergy, nasal surgery
• Post nasal drip
• Cough with/ without expectoration

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HEADACHE

• site frontal, bitemporal, vertex, occipital
• Side- unilateral or bilateral
• Duration
• Character
• Periodicity
• Aggrevating factors
• Relieving factors
• Association with nausea and vommiting
• Association with opthalmic changes, aura

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FACIAL PAIN

• Side
• Severity
• Continous or intermittent
• aggrevating relieving factors
• Change of voice- rhinolalia aperta/clausa
• External nasal deformity

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EXAMINATION

• face -dark circles seen in rhinitis
• external nose
• -skin- discolouration, vesicles
  scar, fistuala.
• -swelling, oedeme, signs of
  neoplasm, mobility
• -columella- fissure, ulcerations,
  destructions
• -vestibule- follicle, ulcer,
  swelling, scar, stenosis,
  dislocation, growth

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Nasal cavity

• anterior rhinoscopy
• a) mucosa- hypereremic (rhinitis, sinusitis,
  abscess)
• pale ( rhinitis)
• dry nose
• b) floor of nose- swelling, defects
• c)nasal septum- ulcer, perforation, swelling,
  epistaxis, DNS
• posterior rhinoscopy
• choanal patency
• hypertrophy of middle
  turbinate

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Discharging middle ear superior meatus

• Choanal polyp
• Enlargement of adenoids
• Growth in nasopharynx
• Eustachian opening
• Tubal elevation
• posterior end of septum
• Cold spatula test

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PARANASAL SINUSES

• Maxillary sinus- elicited by presssure on canine
  fossa
• Frontal sinus- elicited by pressure above medial
  eyebrow on the floor of frontal sinuls above
  the medial canthus
• Ethmoidal sinus- elicited by pressure on medial
  wall of orbit

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INVESTIGATIONS

• Hb TC DC ESR
• RBS, urea creatinine
• X-ray- PNS, nasopharyns , chest
• Nasal endoscopy
• Nasal cytology, cukture sensitivity, mantouex
  test
• CT scan, MRI
• Rhinomanometry, biopsy
• syphilis

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SYMPTOMATOLOGY OF ORAL CAVITY OROPHARYNX

• Pain- onset, duration, site,type, radiation,
  aggrevating relieving factors
• Ulceration- dental ulcers, syphillitic ,
  tuberculous, diptheric, angular stomatitis,
  malignancy
• Bleeding from gums- bleeding/ clotting
  disorders, scurvy, malignancy, trauma

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Disturbances of salivation

• Xerostomia- mouth breathing , drug induced,
  post radiation, sjogrenss syndrome
• Ptyalism- ulcerative lesions, iodine
  therapy, bad oral hygiene
• Odynophagis- apthous ulcer, tonsillitis,
  quinsy, pharungitis, epiglottitis,absces
  s

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Dryness of mouth

• - febrile state,
  dehydration, anxiety, drug induced,
  hemorrhage
• Hypothyroidism
• Trismus- dental causes, mandibular, maxillary
  fractures, quinsy, sub mucous fibrosis
• Swelling
• Disturbance of taste

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Altered speech

• Muffled voice- tonsilar hypertrophy, base of
  tongue malignancy
• Thick voice quinsy
• Dysarthrria- tongue lesions, facial plus
  hypoglosssal Nv. Palsy
• Mouth breathing
• Hearing loss- cleft palate, reccurent
  tonsillitis, chronic pharyngitis

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EXAMINATION

• Lips - inflammation deposits,
  discolouration, ulcerations, angular
  stomatitis, hyperplasia vesicles
• buccal mucosa- spots coloured patches
  appearance growth
• Gums - redness, hemorrhage, fistula,
  malignancy
• gingivolabial., gingivobuccal sulcus

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Buccal mucosa
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Teeth

• Tongue- tip dorsum oral part of tongue
• mucosal lesions, discolouration,
  crack ulceration, swelling
• Floor of mouth- whartons orrifice, oedema,
  redness, ulceration growth
• Retro molar trigone

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palate

• Tonsils, anterior pillars
• Soft palate uvula
• Posterir pharangeal wall
• Base of tongue
• Indirect laryngoscopy

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INVESTIGATIONS

• Hb TC DC ESR
• Throat swab- cukture sensitivty
• X-ray- nasopharynx, PNS chest,
• VDRL , mantoux test, CT SCAN
• Biopsy, paulbunnel test
• Wassermann,s test

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EXAMINATION OF LARYNX

• Epiglottis
• Ventricular bands
• Indirect laryngoscopy
• Rigid or flexible fibre optic endoscopy
• Examination of lymph nodes of neck

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Thank you