ENT ASSESSMENT

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INTRODUCTION

ENT assessment which constitutes the assessment of the ears, nose and the throat, is a systematic
assessment of the functions of the ears, nose and the throat and to find any abnormalities and
abnormal findings of these systems. ENT assessment can be done by health professionals to
determine if a person has any abnormalities in the ENT system and to also manage the
abnormalities, if any at all. Various instruments are used and various techniques of assessment
are used in ENT assessment.

During the course of ENT assessment, various tests will be used for the assessment on the
ears, nose and the throat. Tests such as Romberg’s test or Rinne’s test can be helpful to
determine the functionality of these systems.

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OBJECTIVES

 Identify the structures of the ears, nose, mouth and throat.

 Discuss the system specific history for the ears, nose, mouth and throat.
 Describe the normal findings in the physical assessment of the ears, nose, mouth and
throat.
 Describe common abnormalities found in the physical assessment of the ears, nose,
mouth and the throat.
 Perform the physical assessment of the ears, nose, mouth and throat.

ASSESSMENT

1. PATIENT PROFILE

1.1 Patient details

 Name
 Age
 Sex
 Race
 Occupation
 Address
 Weight

1.2 Presenting Complains

 Written chronological orders
 Complains which led patient to the hospital

1.3 History of present illness

 Written in patients own language
 Let the patient explain

1.4 Past medical history

 Childhood
 Immunization
 Adolescence
 Adulthood
 Medication

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 1.5 Past surgical history
 If any

1.6 Allergies

1.7 Family history

 Any diseases related to genetics

1.8 Personal history

 Habits
 Addiction
 Sleep
 Sexual
 Food

1.9 Socio – economic History

2. GENERAL APPEARANCE
 Consciousness
 Orientation
 Nourishment
 Health
 Body built
 Activity
 Look
 Hygiene
 Speech

3. VITAL SIGNS
 Blood pressure
 Pulse rate
 Respiration
 Body temperature

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COMMON CHIEF COMPLAINS

EARS NOSE MOUTH AND THROAT

 Hearing loss  Pain  Halitosis
 Ottorhea  Drainage  Oral lesions
 Otalgia  Blockage or  Swelling
 Tinnitus congestion  Oral thrush
 Bleeding  Ulceration
 Pain
 Difficulty in
swallowing
 Hoarseness of voice

ENT ASSESSMENT

EQUIPMENTS

1. Otoscope
2. Nasal speculum
3. Pen torch
4. Tuning fork
5. Watch
6. Gauze piece
7. Cotton – tipped applicators

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EARS

ANATOMY
1. EARS
Three sections –
1. External ear
2. Middle ear
3. Inner ear

External ear –
1. Auricle or pinna
2. External auditory canal

Middle ear –
1. Ossicles
Malleus (hammer)
Incus (anvil)
Stapes (stirrup)
2. Tympanic membrane
3. Eustachian tube

Inner ear –
1. Labyrinth
2. Vestibule
3. Semicircular canals
4. Cochlea

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 FIG 1: Anatomy of the ear

ASSESSMENT OF THE EARS

Take history of –
Examination consists of three parts –
Ear pain (Otalgia)
1. Inspection and palpation of external ear
Infections
2. Auditory screening
Discharges
3. Otoscopic assessment
Hearing loss
Tinnitus
Vertigo
Self care

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1. Inspection and palpation of external ear

 Pinna
- Check for any lesions, wounds, scar marks
- Appearance
- Position : attached / not attached to cheeks
 Ear canal
- Any discharge, fluids, swelling
- Redness
- Wax : check for consistency
- Foreign bodies
 Tympanic membrane
- Colour (transparent) : turns yellow when infected
- Light reflex should be there (Otoscope)
- Landmarks : any birth defects
- Budging or retraction
- Perforation
- Scarring, damaged tissues, air bubbles
- Fluid accumulation

Normal findings Abnormal findings

 Fresh colour  Pale, red, cyanotic

 Positioned centrally and in  Small / large sized ears

proportion to the head

 No foreign bodies, redness,  Purulent drainage

drainage, deformities, nodules,
or lesions.  Clear or bloody drainage

 Hematoma behind ear over

mastoid

 Pain or tenderness on palpation

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2. Auditory screening

 Voice – whisper test

One ear covered, physician/nurse whispers words from a distance of 1 feet
– 2 feet from behind the patient. If the patient can’t hear, the examiner
keeps saying the words more louder until the patient can hear the words.
This is done for each ear.

Normal finding – patient is able to repeat words whispered at a distance of

2 feet.

 Webber’s and Rinne’s test (tuning fork)

a. Webber’s test – vibrating tuning fork is placed on the forehead, patient
is then asked if the sound is centralized / localized at the centre of the
head or whether it is louder in either ear.
b. Rinne’s test – vibrating tuning fork is placed behind the ear (mastoid
process), when the patient is no longer to hear or feel the vibration, the
tuning fork is held in front of the ear, the patient should be able to hear
the ringing sound.

Abnormal finding – if patient cannot hear the ringing sound:

conductive hearing loss in the ear.

Conductive hearing loss sensorineural

 Sound louder in affected  Sound quieter in the affected

ear ear

 Problems in outer and  Problems in cochlea, auditory

middle ear nerve, auditory cortex of the
brain.

c. Romberg’s test (vestibule) – patient stands with feet together and arms
at sides, closes eyes: should hold position for 20 seconds without
loosing balance.

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3. Otoscopic examination
 External ear – assess for colour, redness, swelling, cerumen, discharge, foreign
bodies, lesions.
 Tympanic membrane – normal is : shiny translucent with pearl gray colour.

Normal findings Abnormal findings

 Weber’s test – able to hear sound  Tympanic membrane – chalky patches

equally in both ears. on tympanic membrane, severe pain,
redness, swelling, narrowing, reddened,
 Rinne’s test – air conduction > bone drainage, dark yellow cerumen.
conduction.

 Tympanic membrane – pearly gray in

colour moves when patient blows
against resistance. No redness,
swelling, tenderness, lesions, drainage,
foreign body

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 FIG 2: Rinne’s and Weber’s test

FIG 3: Romberg’s test / sign

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NOSE

ANATOMY

FIG 4: Anatomy of nose and sinuses

ASSESSMENT OF NOSE Take history of

 External nose Discharge

 Internal nose Frequent colds
 Nasal cavity Sinus pain
 Septum Trauma
 Turbinate Epistaxis
 Paranasal sinuses Allergies
Altered smell
1. Frontal
Runny nose (Rhinorrhea)
2. Ethmoid
Airway obstruction
3. Maxillary
Loss of smell (anosmia)
4. Sphenoid

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ASSESSMENT OF NOSE

 External
- Tenderness
- Discharge
- Trauma
- Bleeding
- Lesions
- Masses
- Swelling
- Asymmetry
- Test patency of nostrils.

 Internal
- Deviated nasal septum
- Perforated nasal septum
- Polyps
- Bleeding
- Colour of mucous
- Nasal congestion

 Sinuses
- Palpate and check for tenderness and swelling
 Frontal sinuses
Superior to the eyes
In the frontal bone
2 in number and unequal in size
 Maxillary sinuses
In the maxilla
Largest Paranasal sinuses
Under the eyes
First Paranasal sinuses to develop
 Ethmoid sinuses
Ethmoid bone between nose and the eyes
Arranged in three –
Anterior
Middle
Posterior
 Sphenoid sinuses
Sphenoid bone
Divided into two and separated by a septum
Does not develop until adolescence

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 Normal findings Abnormal findings

 Nose in midline of the face  Broken, misshapen, swollen

nose
 No swelling, bleeding, lesions
or masses in internal ears  Occluded nasal passages

 Both nostrils present  Nasal septum is deviated

 Midline septum  Mucosa is red and swollen

 Mucosa in pink or dull in colour  Purulent drainage

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MOUTH AND THROAT

ANATOMY

FIG 5: Anatomy of mouth and throat

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FIG6: The Uvula

ASSESSMENT OF MOUTH AND THROAT

INSPECTION OF MOUTH

 Lips
- Colour
- Lesions
- Symmetry
 Oral cavity
- Breath odour
- Any foul smell
- Colour
- Lesions in buccal cavity
 Teeth and gums
- Redness
- Swelling
- Dental carries
- Gum bleeding
 Tongue
- Colour
- Texture
- Lesions
- Ulcers
- Tenderness of floor of the mouth
 Pharynx
- Colour
- Exudates
- Discharge
- Pus

 Uvula
- Colour
- Consistency
- Redness
- Midline

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 Normal findings Abnormal findings

 Fresh breath.  Lesions.

 Pink moist lips.  Growth.

 Tongue midline, symmetrical  Dry, cracked lips.

with adequate movement.
 Blisters.
 No pockets between gums and
teeth.  Coating of tongue

 No bleeding.  Red, tender, inflamed tongue,

gums, buccal mucosa.
 Smooth white teeth.
 Thrush
 No dental carries.
 Red, tender, swollen gingival.

 Bleeding gums.

INSPECTION OF THROAT

 Symmetry
 Swelling
 Masses
 Lumps
 Active range of motion
 Thyroid enlargement
 Gag reflex
 Position, size, colour and general appearance of tonsils and uvula
 Colour of Oropharynx
 Presence of swelling, exudates, lesions.

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PALPATION OF THROAT

 Tenderness
 Enlargement
 Mobility
 Contour

Normal findings Abnormal findings

 Soft palate and uvula rises when  Posterior pharynx is red with
patient says “ah”. white patches.

 Uvula is in midline.  Tonsils and uvula are red and

swollen.
 Throat is pink and vascular.
 Hoarse voice.
 No swelling, exudates or
lesions.  Grayish membrane covering
tonsils, uvula, soft palate.
 Gag reflex is present

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ASSESSMENT OF LYMPHNODES

 The nodes of the neck may be examined from in front or behind with the patient seated
and the neck exposed.

 Palpate one side at a time.

 Use the fingertips.

 Apply moderate pressure and rotate fingertips in each of the areas where nodes might be
found.

 Nodes are not normally palpable***

 Cervical lymph nodes are frequently enlarged in response to upper respiratory tract
infection.

ASSESSMENT OF THE THYROID GLAND

 Inspect the thyroid gland.

Normal abnormal

 Not visible on inspection  Local enlargement

 Palpate the thyroid gland for smoothness, note any areas of enlargement, masses and
nodules.
- Posterior approach
- Anterior approach

Normal abnormal

 Lobes are not palpable  Solitary nodules

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** If enlargement of the gland is suspected, auscultate over the thyroid area for bruit (soft
rushing sound created by turbulent blood flow).

**** SYMPTOMS TO REPORT TO THE PHYSICIAN.

 Pain and fever with mastoid tenderness.

 Uncontrolled secretions and drooling.

 Brudzinski’s sign – stiffness of neck, flexed knees (sign of meningitis).

 Fever of unknown origin.

 Treatment failure after three days of otitis media, streptococcus throat and peritonsil
abscess.

 Displaced uvula.

 Uncontrollable Epistaxis.

 Facial fractures.

 Sudden onset of deafness.

 Recent ENT history.

 Hoarseness of voice without any fever.

 Unexplained vertigo.

*** DIAGNOSTIC TEST

 Swab collection of ears, nose and throat for culture and sensitivity.

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CONCLUSION

Conducting an ENT exam in a routine way to assess the problems associated with ENT. When
uncertain of the findings, consult with other healthcare professionals. Airway, Breathing and
Circulation are Paramount to all ENT emergencies and resuscitation. Report to the physician
immediately to prevent further progressing of the disease.

BIBLIOGRAPHY

1. Anne Waugh, Allison Grant. Ross and Wilson, Anatomy & Physiology in Health and
Illness. 12th ed. International edition. Edinburgh. Elsevier. p. 192-195, 244, 246-249.
2. Gerard j. Tortora, Bryan Derrickson. Anatomy & Physiology. India Edition. Ansari
road, Daryaganj, New Delhi-110002. Wiley. 2015 p. 548-560, 754-758, 758-762.
3. Internet sources
o Muhammad Shahid. ENT assessment. Available from:
https://www.slideshare.net/muhammadshahid77/ent-assessment [accessed 1st
november 2021]
o Jeffrey Texiera, Joshua Jabaut. The Ear, Nose, and Throat Exam. Available from:
https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-education-
and-research-center-for-occupational-safety-and-health/2017MARCOEM/
Jabaut_Texeira_MARCOEM.pdf [accessed 1st november 2021]
o  Dr Laurence Knott. Ear, nosr and throat examination. Available from:
https://patient.info/doctor/ear-nose-and-throat-examination [accessed 1st
november 2021]

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 ASSAM DOWNTOWN UNIVERSITY

FACULTY OF NURSING

PRESENTATION ON

ENT ASSESSMENT

SUBMITTED TO – SUBMITTED BY –

MADAM B. CYNOSURE SHARMA RAPBANSHEMPHANG LAMIN

LECTURER, TEACHING ASSISTANT,
CLINICAL INSTRUCTOR, LAB
INSTRUCTOR
FACULTY OF NURSING
ASSAM DOWNTOWN UNIVERSITY
1ST YEAR M.Sc. NURSING
ROLL NO 001
22 ASSAM DOWNTOWN UNIVERSITY
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