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 in crowds? Is the loss constant or fluctuating? Associated symptoms: vertigo, tinnitus, drainage or fullness of the ears?

Past history:
Systemic disease? vascular problems Previous surgery to the ear? Hx of head trauma Ear infections as a child

Personal and Social:
Noise exposure? occupation? Drug intake: aminoglycosides (injections, wound irrigations) diuretics, salicylates

Previous use of hearing aids? Family history: congenital or familial

Unilateral or bilateral? Associated symptoms hearing loss, vertigo High pitched or low pitched? Continuous, intermittent, pulsatile? Duration recent or long-standing? Altered by head position or pressure on neck? Drug intake aspirine and quinine?

Which 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 externa Associated symptoms ear discharge, hearing loss, tinnitus, headache, vertigo, sore throat

Acquired, traumatic Congenital since birth? Family history of similar lesions? Birth and maternal history Is there hearing loss?

Unilateral or bilateral? Anterior, posterior, or diffuse? Spontaneous or post-traumatic? Duration and onset Amount of blood loss Associated problems: colds, strong blowing of nose, medical problems such as hypertension, use of anticoagulants, signs of blood dyscrasias, renal disease

Unilateral 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, sore throat, earache, asthma Drug use use of nasal drops; antihypertensives, cocaine sniffing, tranquilizers, hormones

Congenital or acquired Recent acquired with trauma Associated problems such as epistaxis, nasal obstruction Alcohol intake History of acne rosacea History of trauma

Duration and onset Persistent or intermittent Location and pattern are they in crops? Painful or nonpainful? Use of immunosuppressive drugs, sexual habits and venereal disease Associated problems fever, malaise, other mucosal ulcers (vaginal, anal, urethral)

Duration and onset Location Rapidity of growth Painful or nonpainful Odynophagia Trismus Presence of lymph nodes Previous dental extractions or surgical consult?

Dysgeusia, hypogeusia, or ageusia Onset and duration Associated problems in smell, medications, head injury, headache, ear surgery (chorda tympani cut), facial pain and visual disturbances

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

Duration Localization With solids or liquids? Associated symptoms

Duration (congenital or acquired) Intermittent or progressive Pattern or time of day worsened History of vocal abuse, occupation Environment exposure to chemicals Stridor Pain History of trauma, surgery under general anesthesia, neck and chest surgery, thyroid status Endotracheal intubation

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 tongue Associated with recent viral infection History of trauma to neck; neck or chest surgery medications

Location Duration Size: stable, growing, alternating Single or multiple Tender 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

Duration Pain Facial asymmetry Constant or intermittent

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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