Professional Documents
Culture Documents
EAR EXAMINATION
Introduction: -Good morning Sir / Madam
- My name is Dr……………….
-May I examine your ear
-Is there any pain in or around your ear?
Inspection:
[Inspect the pre-auricular, pinna and post-auricular region]
- On inspection of the ear, there is no abnormality noted, pinna appears to be normal, there is no
Scar, no sinus noted. (Tag, deformity, low set ears)
Palpation:
[Palpate the tragus, pinna, mastoid]
- There is no pain on manipulation of the tragus, pinna and no mastoid tenderness
- On otoscopic examination, the external canal is patent, skin appears to be normal, no scar seen
(endaural), no discharge, no mass or granulation tissue seen.
(Wax, pus discharge, bleeding, swollen EAC, anterior hump, polyp, granulation tissue, keratin, widen
EAC, any meatoplasty)
If there is mastoid cavity: the mastoid cavity is present, facial ridge is high or low, the cavity is well
epithelized, no pus discharge, no keratin or granulation seen.
- The tympanic membrane appears intact, normal colour, not retracted, handle of malleus is in
normal position and cone of light is present.
(Attic retraction, scutum erosion, keratin)
I would like to assess the hearing with Tuning fork and free field voice test.
- Perform Rinne’s test first: Strike the tuning fork {be gentle should not be so loud that examiner
also hears} and hear myself first then put in front (1.) of the ear then mastoid (2.). {Please support
patient’s head} Ask patient which one (1. or 2.) louder.
- Then Weber test: Place on forehead and support head at the back. Ask right/ left or loud at centre.
- Explain to patient, tragal rub for masking and brany’s noise box (90-110) for shout,
And to complete my examination, I would like to do fistula test, examine for nystagmus and all the
cranial nerves especially facial nerve.
Siegelisation
Dr JALAL H
NOSE EXAMINATION:
From front, right and left side: no obvious swelling, scar, deformity or deviation seen.
From up: please lift hair and check for bicoronal flap
Look nose from up – no scar, deformity (look for light reflection on nose)
Look for proptosis
Look for maxillary prominence
Please check for sinus tenderness (Frontal, ethmoidal, maxillary (on canine fossa is thinnest)
On lifting the nasal tip: check for any collumella scar, comment on vestibule, any caudal dislocation,
any discharge
Anterior rhinoscopy: [inform examiner that u would like to proceed with antr rhinoscopy using killians
forceps then explain to patient that it won’t hurt but let u know if there is any pain.]
Comment on
- mucosa (pale or pink)
- size of IT (ITH or boggy),
- MT, middle meatus – any discharge, any polyp, mass or crusting, concha bullosa
- floor of the nose,
- septum (any deviation, perforation, little’s area)
- Any ulceration, mass lesion,
Cottle’s sign – ask the patient to sniff and look for alar collapse (+ve)
Cottle’s test – pull the cheek gently laterally ask the patient to breath, if better or improved test is +ve
Posterior rhinoscopy examn (ET, FOR, nasopharynx). I would like to conform my finding using rigid
nasal endoscope
Proceed with oral cavity examn: Please ask patient to remove denture. Any oroantral fistula, palate
pushed down, sensation of palate.Check buccogingival sulcus – palpate for any mass (nasal of
nasopharyngeal mass through ITF enter buccogingival sulcus. IDL, Ear and neck examn, cranial nerve
examn
Dr JALAL H
NECK EXAMINATION
I would like to expose the neck from chin until upper chest for proper examination
Inspection
Look front, sides – comment on scar, mass, etc then describe the mass
- Start from 1a, 1b, 2, 3, 4, 5a, 5b, preauricular, post auricular and occipital.
If any mass obvious please examine the mass first then proceed with other neck level
Mass:
Inspection: site (right or left), location (level), size, surface, any pulsation, scar, sinus, margin, movement
on swallowing or deglutition if central. Please check whether superficial or deep to fascia and muscle.
Palpation: inspectory findings are confirmed. Any tenderness, consistency, movement vertically or
horizontally. Whether pulsatile. Mobile or fixed to underlying structures.
If thyroid – also check for eye signs, pulse, tremor, and warmth of skin, IDL or FNPLS for vocal cord
movement.
Check for bruit for vascular tumours, Check for laryngeal crepitus
Inform that I would like to do complete ENT examination and cranial nerves examination.
Neck swelling usually will be thyroid, branchial cyst or lymph node, lipoma.
Dr JALAL H
LARYNX EXAMINATION
- Ask patient to tell his name and address –to assess the voice, good voice -vocal cord meeting, no
hoarseness
- Ask patient to take deep breath and lean nearer to hear stridor
- Request patient to count 1-10 in a single breath – if can – no air leak – vocal cord meeting (good
approximation of glottis)
- Request patient to cough – good cough – able to produce good sub-glottic pressure
IDL:
- Request patient to open mouth and assess the oral cavity – big cavity – can use bigger mirror
- Please use proper IDL mirror - dip in cetrimide (if using heat – check on your hand whether too
hot before placing inside the mouth.
- Hold with thumb down, index finger at centre of tongue, middle finger lift the upper lip
- Comment on mucosa of larynx, vocal cord movement, epiglottis, pyriform sinus, aryepiglottic
fold, vallecula, base of tongue
II.Optic:
- visual acuity – ask patient read your name in name tag, snellen chart, or ask to read poster in the
clinic room
- visual field – ask patient to look straight, from the side bring a red pin and ask patient whether can
see the object
- follow light left, right, up, down – check eye movement – H direction
V: Trigeminal nerve
Papillary reflex
Sensation of face (ophthalmic, maxillary, mandibular) ask to close the eye and
is sensation felt and equal
Hard palate sensation
Motor component: Clench teeth – palpate masseter m
iv) HB grading
If the patient has got VII nerve palsy please tell examiner or straight away examine 4 areas:
3) Oral cavity – parapharyngeal tumour causing the VII nerve palsy and medialising lateral
pharyngeal wall.
HISTORY:
O/E:
EARS:
Rt Lt
[Mastoid cavity is present, facial ridge is high or low, the cavity is well epithelized, no pus discharge, no keratin or granulation]
Tuning fork - Rt Lt
Rinne’s + +
Weber’s ------------------
Free field voice test: Patient able to hear whisper at 2 feet indication normal hearing
NOSE:
Inspection:
1> Front: breathing with mouth closed, No obvious swelling, scar, deformity or deviation seen
Palpation:
5. Numbness:
Anterior Rhinoscopy:
1. Mucosa: pale or pink
2. IT: ITH or boggy
3. MT, middle meatus: No discharge, polyp, mass or crusting, concha bullosa
4. Floor of the nose:
5. Septum: No deviation, perforation, little’s area
ORAL CAVITY:
1. Mouth opening
2. Denture:
3. Lips:
4. Buccogingival sulcus:
6. Retromolar region:
9. Palate:
OROPHARYNX:
1. Tonsil:
3. Gag reflex:
IDL:
1. Base of tongue
2. Vallecula
3. Epiglottis
4. Piriform fossa
5. Arytenoids
6. Vocal cord
NECK:
Inspection:
Palpation:
1. Trachea
2. Laryngeal crepitus
CRANIAL NERVE:
Dr JALAL H
SWELLING
Inspection
1. Site
2. Size cm * cm
5. Pulsation
Palpation
2. Multiple/single
3. Tenderness
4. Consistency
5. Mobile/ fixed
6. Edges
9. Auscultation