Introduction to otolaryngology

and basic ENT examination

Prepared by kibra Demtsu
(MD)otolaryngologist
 Introduction to ENT

• Otolaryngology deals with the medical and surgical

condition of the ear , upper respiratory and

alimentary tract and related had and neck structures.

• Fields of subspecialty include

– Otology and neurotlogy deals with condition of the ear

and lateral skull base

– Head and neck oncology and micro vascular

reconstruction
– Rhinology deals with nose sinus and endoscopic

anterior base resection.

– Laryngology deals with voice ad air way

– Pediatric otolaryngology

– facial plastic surgery

 Ear examination
• External ear examination
– Look for position , size ,color , shape f the auricle
– Palpate for swelling , tenderness on the
auricle .tenderness on the tragus (otitis externa ,
and mastoid tendernes ( mastoditis
• Otoscopic examination
– Look on the EAC for color , swelling , presence of
discharge and foreign body
– Look on the Tympanic membrane for its color
(pale ), light reflex and handle of malus , presence
of peroration or discharge
• Clinical hearing tests
1Rhine test put vibrating 512 hz tuning fork on the
mastoid and bring it to the EAC ,
• It compares air conduction and bone conduction on the
same air
• IF AC> BC ,,normal or sensory neural hearing loss
• IF BC > AC ,,, conductive hearing loss
2 weber test put vibrating 512hz tuning fork on
b/n incisors , on the vertex or fore head
it compares bone conduction and air conduction on
the same ear.
If BC> AC shows conductive hearing loss on the
affected side
If AC >BC shows sensoryneural hearing loss
• Pure tone audiometry
 Examination of the nose
• External examination
• Look for appearance , color ,
swelling ,paranasl sinus tenderness
• Anterior rhinoscopy
• Look for nasal mucosa, septum for deviation
or swelling , lateral nasal wall for turbinate
enlargement , presence of mass including
poly, nasal discharge
• Nasal endoscopic examination
– First pass
• pass below the inferior turbinate
• Look for the nasal cavity and look for the
nasopahrynx (presence of discharge or mass on the
Rosen Muller fossa , Eustachian tube opening
• Second pass
– Pass between the middle turbinate and septum
– for the sphenoidal opening , superior meatus and posterior
ethimodal opening
• third pass look for details of the middle meatus (with
30 degree)
•
 Examination of the throat
• Examination of oropharynx
• Direct inspection of the oropharynx with light
• Look for the base of the tongue ( posterior one
third), lateral pharyngeal wall( tonsils and tonsillar
pillar), posterior pharyngeal wall and soft palate
• look for mucosa over the tongue , buccal mucosa
, gum and floor of the mouth
• look for the tooth
• Look for opening of the salivary glands
• Indirect Laryngoscopic evaluation
– Can be done with done with either 70 degree rigid endoscopy
or flexible fiberoptic laryngoscopy or laryngoscopy
– Look for the
• vallucula ( space b/n the tongue base and epiglottis

• Hypopharynx ( pyriform sinus, posterior pharyngeal wall and post

cricoid
• Supraglotiic structures( epiglottis , aryepiglottic structure and false
vocal cords )
• Glottis structure ( look for mobility of the vocal cords ,anterior and
posterior commissure
• Subglottis