History taking and Physical exam in ENT

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HEARING abnormal or normal?

Onset sudden or gradual?

Unilateral or bilateral?

Which is the better ear?

What is the functional capacity of each ear? can one hear and understand? Does he

only hear loud noises? Is it worsened incrowds?

Is the loss constant or fluctuating?

Associated symptoms: vertigo, tinnitus,

drainage or fullness of the ears?



HEARING

Past history:

Systemic disease? vascular problemsPrevious surgery to the ear?

Hx of head trauma

Ear infections as a child



HEARING

Personal and Social:

Noise exposure? occupation?

Drug intake: aminoglycosides (injections, woundirrigations) diuretics, salicylates

Previous use of hearing aids?

Family history: congenital or familial





TINNITUS


Associated symptoms hearing loss, vertigo

High pitched or low pitched?

Continuous, intermittent, pulsatile?

Duration recent or long-standing?

Altered by head position or pressure onneck?

Drug intake aspirine and quinine?



EAR DISCHARGEWhich ear? Unilateral or bilateral?

Onset and duration?

Continuous or intermittent?Predisposing factors? Sinusitis, colds, allergy

Character: mucoid, mucopurulent, purulent, serous

Associated otalgia

Odor foul-smelling or non-foul?

Associated symptoms headache, hearing loss,dizziness, facial weakness

Past history of ear trauma or surgery



OTALGIA

Onset and duration?

Continuous or intermittent?

Location deep, superficial, circumaural

Nature sharp, dull, boring

Pain on manipulation of ear? points to

otitis externaAssociated symptoms ear discharge,hearing loss, tinnitus, headache, vertigo,sore throat



PINNA DEFORMITY

Acquired, traumatic

Congenital since birth?

Family history of similar lesions?Birth and maternal history

Is there hearing loss?



EPISTAXIS


Anterior, posterior, or diffuse?

Spontaneous or post-traumatic?

Duration and onset

Amount of blood loss

Associated problems: colds, strong blowingof nose, medical problems such ashypertension, use of anticoagulants, signs of blood dyscrasias, renal disease



OBSTRUCTION AND RHINORRHEAUnilateral or bilateral?

Duration and onset

Constant or seasonal?Change in character with change in position

Facial pain

Spontaneous or post-traumatic

Associated symptoms: frequent sneezing,headache, postnasal drip, nasal pruritus, sorethroat, earache, asthma

Drug use use of nasal drops; antihypertensives,cocaine sniffing, tranquilizers, hormones



NASAL DEFORMITY

Congenital or acquired

Recent acquired with trauma

Associated problems such as epistaxis, nasalobstruction

Alcohol intake

History of acne rosaceaHistory of trauma



ORAL ULCERATIONS

Duration and onset

Persistent or intermittent

Location and pattern are they in crops?

Painful or nonpainful?

Use of immunosuppressive drugs, sexual

habits and venereal diseaseAssociated problems fever, malaise, othermucosal ulcers (vaginal, anal, urethral)



INTRAORAL MASS LESIONS

Duration and onset

Location

Rapidity of growth

Painful or nonpainful

Odynophagia

Trismus

Presence of lymph nodes

Previous dental extractions or surgical

consult?



ALTERATIONS IN TASTE

Dysgeusia, hypogeusia, or ageusia

Onset and durationAssociated problems in smell,medications, head injury, headache, earsurgery (chorda tympani cut), facial painand visual disturbances



ODYNOPHAGIA

Onset and duration

Location referred to ear?

Constant or intermittent?

Is it progressive?

Occurs with solids or liquids?

Associated symptoms of hoarseness, stridor,odynophagia

History of foreign body ingestion

History of corrosive intake



DYSPHAGIA

Duration

LocalizationWith solids or liquids?

Associated symptoms



HOARSENESSDuration (congenital or acquired)

Intermittent or progressive

Pattern or time of day worsenedHistory of vocal abuse, occupation

Environment exposure to chemicals

Stridor

Pain

History of trauma, surgery under generalanesthesia, neck and chest surgery, thyroid status

Endotracheal intubation



AIRWAY OBSTRUCTION STRIDOR

Duration

Exercise intolerance

Nature stridor inspiratory or expiratory or both;history of foreign body

Exacerbation by exercise or sleep

Relieved by change in position, opening mouth,

protruding tongueAssociated with recent viral infection

History of trauma to neck; neck or chest surgerymedications



NECK MASSESLocation

Duration

Size: stable, growing, alternating

Single or multipleTender or nontender

Discrete, multiple, matted

Pulsatile

Erythematous

Associated problems such as weight loss,hyperthyroidism, nasal obstruction, dysphagia,hoarseness, intraoral lesions, pigmented skin

lesions, ear pain



DISCRETE SWELLING

Duration

Pain

Facial asymmetryConstant or intermittent



DIFFUSE SWELLING

Uniglandular or multiglandular

Duration

Painful or nonpainful

Exacerbation with eating

Previous history of mumps or vaccination

Associated problems: e.g. Xerostomia,alcohol intake, starvation, iodides, bromides,antihypertensives, tranquilizers, joint pains,fever, skin rashes



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History taking and Physical exam in ENT