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Clinical Examination of the Ear, Nose and Throat

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

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Clinical Examination of the Ear, Nose and Throat

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  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

  28. Auscultation • Listen for bruit Thyroid and carotid

  29. 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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