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

ENT examination/equipment is not intuitive

Be familiar with gear

THE EAR

Position

• Good light• Headlight / reflected light from headmirror• Side on to patient• Inspect, Palpate, Use otoscope

NB look behind ear

External anatomy

Palpate

• Feel pinna • Feel lymph nodes• Palpate neck

Canal

• Inspect pinna and concha• Otoscopic examination• Pull upwards, outwards

and backwards

• Look for cavity,

Otitis externa

Osteomas

Mastoid cavity

TM

• Assess all quadrants• Look for malleus,

incus• Record abnormalities

Pars flaccida

Long process incus

Handle of malleus

Umbo

Pars tensa

Canal wall

Perforations

Central perforation Marginal perforation

Don’t forget

• Tuning fork tests• Simple free field tests

• Look at audiological investigations

THE NOSE

Inspection

• Good light• Look at skin and scars• Assess shape

• Look at vestibules by lifting tip

Palpation/inspection

• Occlude each nostril in turn and assess air entry

• Look at misting of tongue depressor

Anterior rhinoscopy

• Use thuddicums speculum

hold it properly!

Nasendoscopy

• Rigid

• Flexible

Don’t forget

• Also examine neck and oral cavity

• Check postnasal space

• Ear disease may suggest pathology

THE THROAT

What does this area consist of?

• Mouth?• Pharynx?• Larynx?• Trachea?• Oesophagus?• Neck?

Best to view as much as possible

Oral cavity

• Open wide!• Two tongue depressors• Examine every mucosal surface• Protrude tongue• Look at salivary orifices• Bimanual palpation• Percuss teeth

Larynx

• Indirect / direct laryngoscopy

To be learned in OPD

View of larynx

Tongue base

Vallecula

Epiglottis

False cord

Vocal cord

Piriform fossa

Arytenoid cartilage

Neck

• Inspect• Palpate • Auscultate

Inspection

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

Palpation

• Adequate exposure• Systematic• Develop system• From in front then mainly from behind

Submandibular area, both triangles

Supraclavicular area

Auscultation

• Listen for bruit

Thyroid and carotid

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