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Published byKiley Swingle
Modified over 4 years ago
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
Position Good light Headlight / reflected light from headmirror Side on to patient Inspect, Palpate, Use otoscope NB look behind ear
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
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
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
View of larynx Tongue base Vallecula Epiglottis False cord Vocal cord Piriform fossa Arytenoid cartilage
Neck Inspect Palpate Auscultate
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
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