History taking & examination in ENT

COMPLETE DETAILS OF HISTORY TAKING AND EXAMINATION IN ENT

1. HISTORY TAKING AND EXAMINATION IN OTORHINOLARYNGOLOGY Dr. Ritesh Mahajan

2. HISTORY TAKING Name Age Sex Religion Occupation Address Today I am going to present the history of (age) year old, male/female (name) . He/she is a (religion) by religion and works at/as (occupation) in (city) and is a permanent resident of (address ) .

3. Chief complaints He/she presented in the out patient department of ENT with chief complaints of:- In chronological order : Disease which started first. Right ear discharge – 2 years. Difficulty in hearing – 1 year. Ringing sensation in ear – 6 months. Fever – 1 week .

4. PRESENT ILLNESS Patient was apparently alright 2 years back when he/ she started with (complaint). First describe the 1 st chief complaint then its associated symptoms and relevant negative history. Then go on 2 nd chief complaint and like wise. Then negative history of overall disease picture.

5. PAST HISTORY History of Tuberculosis / Syphilis/ Leprosy/epilepsy   History of infectious fever - Measles/Chicken pox/Typhoid   History of trauma or allergy   Any history of previous surgery   History of diabetes and hypertension   Diseases of CNS & Others.

6. FAMILY HISTORY Members of family. Similar complaints in any other member in the family   History of T.B./Diabetes/ Hypertension   Duration   Onset

7. PERSONAL HISTORY   Diet/Sleep/appetite   Micturation / bowel habits Habits : Smoking Pan chewing Alcohol intake Hygiene/Socio-economic Status Exposure to dusty atmosphere or chemical irritants or fumes

8. OTHERS Menstrual History. Socioeconomic history. Immunization history – in case of a child. Children : examiner should be told about the person from whom you have taken history, e.g. Mother in case of a child.

9. GENERAL PHYSICAL EXAMINATION Built Nourishment Orientation to time, place & person Vital data:   Pulse Respiratory rate Blood pressure Temperature Pallor/ Icterus /Cyanosis/Clubbing/Pedal oedema / Generalised Lymphadenopathy

10. SYSTEMIC EXAMINATION CV S – S1, S2 heard, no audible murmurs. RS – normal vesicular breath sounds heard, no crepts , no wheezing. CNS - Higher mental functions, Motor functions , Sensory functions - normal. Cranial nerves – facial nerve, olfactory, hypoglossal, vagus, gloss pharyngeal, trigeminal, auditory nerve. Per Abdomen - soft, non tender, no organomegaly .

11. EAR

12. EXAMINATION OF THE EAR Right and left ear Pre auricular region Pinna Post auricular region External auditory canal Tympanic membrane Fistula test Mastoid tenderness Facial nerve Tunning fork tests – Rinne’s Weber’s Air bone conduction

13. EAR Pinna – Shape, Size, Position. Post aural – Swelling, Scar, 3 point tenderness test, Battle’s sign, G riesinger’s sign. Pre auricular area – Sinus, Swelling, Cyst, Accessory tragus, Lymph nodes. External Auditory Canal – upwards, backwards & outwards. Without speculum and with speculum. Examine- roof, floor, anterior & posterior wall. Wax, Pus, Foreign body, Granulation, Fruncle , Osteoma , Laceration, Stenosis , Atresia .

14. EAR Tympanic Membrane – Describe and identify normal anatomical landmarks- C olour, cone of light, 4 quadrants, umbo , H andle of malleus , L ateral process of malleus, A nterior & posterior malleolar folds, P ars tensa, P ars flaccida , B ony annulus, I ncudostapedial joint.

15. EAR Colour – Pink (otosclerosis), Rising Sun (glomus jugular) , Red (acute otitis media, myringitis, baro-otitis media), Bluish (blood accumulation). Cone of light – ET block, Atelectasis, serous otitis media. Mobility – Siegalization and Valsalva maneuver.

16. ear Pars tensa - Retraction, Granulation, Blebs, Sclerotic patches or perforation. Perforation – Type, Margins, Location, Size, Shape, Edge, Residual drum, Structures seen through perforation, Granulation, Postero-Superior retraction with cholesteatoma, Polyps, & Tympano-Sclerotic Patches. Pars Flaccida – Attic or Sharpnell’s membrane. Central perforation is ‘SAFE’ while Marginal/attic perforation is usually ‘UNSAFE’.

17. TUNING FORK TESTS

18. NOSE

19. EXAMINATION OF THE NOSE Examination of external nose {skin and osteocartilaginous framework} Inflammation Scars Sinus Swelling Neoplasm Deformity Examination of vestibule Furuncle Fissure Crusting Dislocated caudal end of the septum Tumours

20. EXAMINATION OF THE NOSE Anterior Rhinoscopy Nasal passage Septum Floor of nose Lateral wall Nasal mucosa Turbinate hypertrophy Shape of turbinate Posterior Rhinoscopy Choana Posterior ends of inferior turbinates Posterior end of septum Discharge Openings of the Eustachian tubes Posterior end of middle turbinate Fossae of Rosenmuller

21. EXAMINATION OF THE NOSE Functional Examination of Nose Cold Spatula test Cotton-wool test Sense of smell Cottle’s test Paranasal sinus tenderness Maxillary Frontal Ethmoidal

22. ORAL CAVITY & OROPHARYNX

23. ORAL CAVITY & OROPHARYNX INSPECTION: Lips Teeth Gums Buccal mucosa Anterior 2/3 of tongue Floor of the mouth Hard palate

24. ORAL CAVITY & OROPHARYNX Soft palate Oro- antral fistula Anterior pillar Tonsil Posterior pillar Posterior pharyngeal wall

25. ORAL CAVITY & OROPHARYNX Tongue : Anterior 2/3 rd , & Posterior 1/3 rd . Size, Appearance, Swelling, Ulcer, Mobility, Dorsum and Floor of Tongue. Tonsils: Gr. 1 – medial surface of tonsil hidden behind anterior pillar. Gr. 2 – medial surface of tonsil just at level of anterior pillar. Gr. 3 – size in between Gr. 2 and Gr. 3 Gr. 4 – tonsil touching each other ( kissing tonsils).

26. ORAL CAVITY & OROPHARYNX Tonsil 0 : Tonsils fit within tonsillar fossa Tonsil 1+ : Tonsils <25% of space between pillars Tonsil 2+ : Tonsils <50% of space between pillars Tonsil 3+ : Tonsils <75% of space between pillars Tonsil 4+ : Tonsils >75% of space between pillars

27. ORAL CAVITY & OROPHARYNX PALPATION : Tongue Buccal mucosa Floor of mouth Tonsils and its bed. Base of tongue. Swelling in oral cavity.

28. EXAMINATION OF LARYNX Redness of skin (abscess, perichondritis ) Bulge or swelling (extension of growth or enlarged lymph nodes) Widening of larynx (growth of pyriform fossa) Surgical emphysema (accidental or surgical trauma) Palpate the hyoid bone, thyroid cartilage, thyroid notch, cricoid cartilage, and the tracheal rings. Movements of larynx (laryngeal crepitus ).

29. Structures seen on indirect laryngoscopy Larynx - Epiglottis, aryepiglottic folds, arytenoids, cuneiform and corniculate cartilages, ventricular bands, ventricles, true cords, anterior commissure, posterior commissure, subglottis and rings of trachea. Laryngopharynx - Both pyriform fossae , postcricoid region, posterior wall of laryngopharynx . Oropharynx - Base of tongue, lingual tonsils, valleculae, medial and lateral glossoepiglottic folds.

30. EXAMINATION OF LARYNX Indirect laryngoscopy:

31. THANK YOU