1. Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003

2. 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’

3. Practice is vital ENT examination/equipment is not intuitive

4. Be familiar with gear

5. THE EAR

6. Position Good light Headlight / reflected light from headmirror Side on to patient Inspect, Palpate, Use otoscope NB look behind ear

7. External anatomy

8. Palpate Feel pinna Feel lymph nodes Palpate neck

9. Canal Inspect pinna and concha Otoscopic examination Pull upwards, outwards and backwards Look for cavity, Otitis externa Osteomas Mastoid cavity

10. TM Assess all quadrants Look for malleus, incus Record abnormalities

11. Pars flaccida Long process incus Handle of malleus Umbo Pars tensa Canal wall

12. Perforations Central perforation Marginal perforation

13. Don’t forget Tuning fork tests Simple free field tests Look at audiological investigations

14. THE NOSE

15. Inspection Good light Look at skin and scars Assess shape Look at vestibules by lifting tip

16. Palpation/inspection Occlude each nostril in turn and assess air entry Look at misting of tongue depressor

17. Anterior rhinoscopy Use thuddicums speculum hold it properly!

18. Nasendoscopy Rigid Flexible

19. Don’t forget Also examine neck and oral cavity Check postnasal space Ear disease may suggest pathology

20. THE THROAT

21. What does this area consist of? Mouth? Pharynx? Larynx? Trachea? Oesophagus? Neck? Best to view as much as possible

22. Oral cavity Open wide! Two tongue depressors Examine every mucosal surface Protrude tongue Look at salivary orifices Bimanual palpation Percuss teeth

23. Larynx Indirect / direct laryngoscopy To be learned in OPD

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

25. Neck Inspect Palpate Auscultate

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

27. Palpation Adequate exposure Systematic Develop system From in front then mainly from behind Submandibular area, both triangles Supraclavicular area

29. Auscultation Listen for bruit Thyroid and carotid

30. 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