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