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introduction to ENT History and Clinical ExaminationDr. ZAID AL-DAHWIConsultant ENT Head of ENT department KING SAUD MEDICAL CITY

ENT Undergraduate LecturePersonal historyNameAgeSexNationalityResidenceOccupationHabbits (smoking)Marital state

Evaluation of ENT PatientHistory of present illnessWe asked about:The present symptomsThe onset, The duration, Progression and severity

Any systemic disease e.g. diabetes, hypertension, coronary artery disease, liver or kidney disease, or a bleeding disorder. Treatment has taken.

Evaluation of ENT PatientHistory of past illnessHistory of Similar complaints in the past, Previous operationsAllergy to any drug.

Evaluation of ENT PatientFamily historyFamily history of same disorderSome diseases have a genetic basis, e.g. certain types of SNHL

Evaluation of ENT PatientTHE CLINICAL EXAMINATION Evaluation of ENT PatientEXAMINATIONofTHE EAR

Symptoms OF EAR A patient with ear disease presents with one or more of the following complaints: 1. Hearing loss. 2. Tinnitus. 3. Dizziness or vertigo. 5. Earache. 4. Ear discharge. 6. Itching in the ear. 7. Deformity of ear pinna. 8. Swelling around the ear.

Examination of Ear PinnaInspection Size microtia,

macrotia

Examination of Ear PinnaInspection size (microtia, macrotia)shape cauliflower ear

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position bat ear.

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). Redness Perichondritis

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). Redness (perichondritis); Swelling Auricular haematoma, or abcess

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). Redness (perichondritis); Swelling haematoma, or abcess Sebacious cyst

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). Redness (perichondritis); Swelling (haematoma, sebacious cyst); Vesicles (herpes zoster)

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). redness (PERICHONDRITIS); swelling (haematoma, SEBACIOUS CYST); vesicles (herpes zoster); sinus preauricular sinus.

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). redness (PERICHONDRITIS); swelling (haematoma, SEBACIOUS CYST); vesicles (herpes zoster); sinus (preauricular sinus.)

Ulceration or neoplasm.Basal cell carcinoma

Examination of Ear PinnaInspection size (microtia, macrotia); shape (cauliflower ear); position (bat ear). redness (PERICHONDRITIS); swelling (haematoma, SEBACIOUS CYST); vesicles in concha and retroauricular groove (herpes zoster); ulceration or neoplasm. sinus (preauricular sinus). Palpation ; Fluctuation (hematoma or abscess)Tenderness (furunculosis)

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide),

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swellingfuruncle,

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swellingfuruncle,Aural Polyp

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swellingfuruncle, Aural Polyp

Exostosis. Exostosis(cold water swimmers)

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swellingfuruncle, Aural PolypExostosis

Osteomas.

Osteomas (bening neoplasia)

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swellingfuruncle, Aural Polyp Exostosis Osteomas.neoplasm.

Squamous papilloma in EACExamination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swellingfuruncle, Aural PolypTumour

contents of lumenwax,

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swellingfuruncle, Aural PolypTumour

contents of lumenwax, Otitis ExternaNecrotizing

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swellingfuruncle, Aural PolypTumour

contents of lumenwax, Otitis ExternaFungal OtomycosisCandida albicans

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swellingfuruncle, Aural PolypTumour

contents of lumenwax, Otitis Externafungaldischarge

Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swellingfuruncle, Aural PolypTumour

contents of lumenwax, Otitis Externafungaldischarge FB

Examination of MastoidAcute Mastoiditis

Examination of tympanic membraneNormal tympanic membrane is pearly white in color and semitransparent

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparentA tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medi or haemotympanum. A chalky plaque is seen in tympanosclerosis.

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparentA tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis.

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparentA tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis.

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparent. A tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. retracting or bulging.

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparent. A tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. Retracting or Bulging.

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparent. A tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. Tympanic membrane may be retracting or bulging. (c) Surface of tympanic membrane. show bullae , orperforation

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparent. A tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. Tympanic membrane may be retracting or bulging. (c) Surface of tympanic membrane. show bullae , orperforation

Examination of tympanic membraneNormal tympanic membrane is pearly white in colour and semitransparent. A tympanic membrane is examined for: (a) Colour. Red and congested in acute otitis media, bluish in secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. Tympanic membrane may be retracting or bulging. (c) Surface of tympanic membrane. show bullae , orPerforationCholesteatoma

Examination of facial nerve.Paralysis of facial nerve may co-exist with disease of the ear,

Auditory and Vestibular function Tuning fork tests Rinne test

Auditory and Vestibular function Tuning fork tests Rinne test Weber test

Auditory and Vestibular function Tuning fork tests Rinne test Weber testPure tone audiogram (PTA)

Auditory and Vestibular function Tuning fork tests Rinne test Weber testPure tone audiogram (PTA)Tympanogram

Auditory and Vestibular function Tuning fork tests Rinne test Weber testPure tone audiogram (PTA)TympanogramNystagmus

Auditory and Vestibular function Tuning fork tests Rinne test Weber testPure tone audiogram (PTA)TympanogramSpontaneous nystagmus Fistula test

EXAMINATIONof THE NOSE

Symptoms of NOSE AND PARANASAL SINUSES A patient with nose disease presents with one or more of the following complaints: 1. Nasal obstruction. 2. Nasal discharge. 3. Post-nasal drip. 4. Epistaxis. 5. Sneezing. 6. Headache or facial pain. 7. Swelling or deformity. 8. Disturbances of smell. 9. Snoring. 10. Change in voice (hyper- or hyponasality).

EXAMINATION External Nose signs of inflammation (furuncle, abscess)

EXAMINATION External Nose signs of inflammation (furuncle, abscess)swelling Glioma

non-neoplastic lesion consisting of neuroglial tissue without the communication to the central nervous sytem

EXAMINATION External Nose signs of inflammation (furuncle, abscess)swelling Glioma Dermoid

congenital nasal dermoid.encephalocele.

EXAMINATION External Nose signs of inflammation (furuncle, abscess)swelling Glioma Dermoid Neoplasm basal cell carcinoma

EXAMINATION External Nose signs of inflammation (furuncle, septal abscess), swelling (dermoid or glioma) neoplasm (basal cell or squamous cell carcinoma). Nasal Deformity

EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards.

EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards. It is examined for a furuncle,

EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards. It is examined for a furuncle, a dislocated caudal end of the septum, and

EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards. It is examined for a furuncle, a dislocated caudal end of the septum, and TumoursSquamous cell carcinoma

Anterior Rhinoscopy Look for: Septum. Deviation or spur,

Anterior Rhinoscopy Look for: Septum. Deviation or spur, Perforation,

Anterior Rhinoscopy Look for: Septum. Deviation or spur,ulcer, perforation, swelling (haematoma or abscess).

Anterior Rhinoscopy Look for: Septum. Deviation or spur,ulcer, perforation, swelling (haematoma or abscess). Bleeding Point (Littles area)

Kiesselbach's plexusAnterior Rhinoscopy Look for: Septum. Deviation or spur,ulcer, perforation, Swelling (haematoma or abscess). Floor: FB

Anterior Rhinoscopy Look for: Septum. Deviation or spur,ulcer, perforation, Swelling (haematoma or abscess). Floor: FBLateral Wall (Turbinates):Pale, Hypertrophy

Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Floor of nose. swelling (dental cyst), neoplasm (haemangioma), or granulations (foreign body ) Lateral wall. Look at the turbinates and meatuses. Pale mucosa and HIT(allergy), rudimentary in atrophic rhinitis),

Para-Nasal-Sinuses Eye Examination Ethmoiditis and orbital cellulitis

Anterior Rhinoscopy Look: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Floor of nose. swelling (dental cyst), neoplasm (haemangioma), or granulations (foreign body ) Lateral wall. Look at the turbinates and meatuses. Pale mucosa and HIT(allergy), rudimentary in atrophic rhinitis), discharge in the middle meatus (infection of maxillary, frontal or anterior ethmoidal sinuses),

Anterior Rhinoscopy Look for the following points: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Floor of nose. swelling (dental cyst), neoplasm (haemangioma), or granulations (foreign body ) Lateral wall. Look at the turbinates and meatuses. Pale mucosa and HIT(allergy), rudimentary in atrophic rhinitis), discharge in the middle meatus (infection of maxillary, frontal or anterior ethmoidal sinuses), mass (polyp, or carcinoma).

Posterior Rhinoscopy INDIRECT

FIBEROPTIC FLEXIBLE

Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of inferior turbinates.

Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of inferior turbinates. Mass (adenoid or tumour)

Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of inferior turbinates. Mass (adenoid or tumour) Choanal atresia

EXAMINATION OF THE THROAT

AND LARYNX Symptoms of PHARYNX A patient presents with one or more of the following complaints:Sore throat. Odynophagia (painful swallowing), Dysphagia (difficulty in swallowing). Earache. Disorders of voice, e.g. hoarsenessHalitosis (bad smell from the mouth). Respiratory obstruction. Repeated ckaking of throat. Cough and expectoration. Mass in the neck .Disturbance of salivation. Xerostomia or Excessive salivation.Disturbance of tasteTrismus. Lesion on oral cavity.

EXAMINATION OF OROPHARYNXInspection : 1. Tonsils and pillars 2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall

EXAMINATION OF OROPHARYNXInspection : 1. Tonsils and pillars 2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall

ACUTE FOLLICULAR TONSILLITIS

EXAMINATION OF OROPHARYNXInspection : 1. Tonsils and pillars 2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall

PERITONSILLAR ABCESS

EXAMINATION OF LARYNX AND HYPOPHARYNXExternal Examination of LarynxinspectionPalpationIndirect Laryngoscopy

Flexible or Rigid Fibreoptic Endoscopy (a) Flexible endoscopy. (b) Rigid endoscopy.

LaryngoscpyLarynx Epiglottitis4 year old drooling toxic child

79LaryngoscpyLarynx CarcinomaDysphonia / Hoarseness for >3 weeks

80LaryngoscpyLarynx Reinkes OedemaSmoking

81LaryngoscpyVocal cord nodules

82NECK ExaminationPalpation

83Neck lumpBrachial cyst

84Neck lumpThyroglossal Duct Cyst

85Neck lumpParotid Salivary gland: Warthin's Tumors

86Neck lumpSubmandibular salivary gland NeoplasiaUsually inflammatory

87Neck lumpGoitre

88Neck lumpLudwig's angina

89Neck lump TBUsually multiple nodesCold abscess

90Neck lumpMetastatic Neck Lymph NodesPrimaryCarcinomaLymphoma (common)Secondary MouthPharynxLarynxInfraclavicular (lung, breast, stomach)

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