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Basic ENT Hx & PE
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Basic ENT Hx & PE

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  • 1. Frederick Mars Untalan, MD Relearning the basic history taking & physical examination
  • 2. OUTLINE  Know what to ask  Know what to see  Common ENT diseases
  • 3. REMEMBER. . . . . . a thorough assessment begins with the HISTORY!
  • 4. HISTORY of PRESENT ILLNESS (HPI or Symptom Analysis)  Location and Radiation  Timing: Onset, Frequency & Duration  Quality and/or Characteristics  Quantity and/or Severity  Setting and/or Situation  Aggravating Factors  Alleviating Factors  Associated Factors/Manifestations  Underlying Concern and/or Perception
  • 5. EQUIPMENT NEEDED  Latex Gloves  Light Source  Cotton  Cup with water (optional)  Measuring tape (possible)
  • 6. GENERAL CONSIDERATIONS  The head and neck exam is not fixed in sequence.  Different parts of the exam may be included and/or excluded depending on the history and the purpose of the exam.
  • 7. Physical Diagnosis in Otolaryngology
  • 8. Health History  Determine presence/absence of age- and gender-specific diseases of the head and neck  Common chief complaints  Neck pain or stiff neck  Hoarseness; nasal discharge or obstruction  Neck mass  Headache or facial pain  Head injury ; otalgia; dysphagia; ear discharge
  • 9. General Approach to Head and Neck Assessment  Greet patient, explain assessment techniques  Environment  Quiet  Warm  Private  Adequate lighting  Upright sitting position  Compare right and left sides  Systematic approach
  • 10. Where the Head Ends and Neck Begins  Plane between the external occipital protuberance and inferior surface of the mandible  Neck  Anterior triangle is bordered by Mandible (above), Cervical midline(laterally) and Sternomastoid (anteriorly
  • 11. Where the Head Ends and Neck Begins Neck – Posterior triangle is bordered by Clavicle (below), trapezius (posteriorly) and Sternomastoid (anteriorly)
  • 12. Special Bony Areas  External Occipial Protuberance (notch in occipital area  Mastoid Process (behind Ear)  Zygomatic Arch (Cheekbone)  Orbit (eye socket)  Maxilla (upper jaw)  Mandible (lower Jaw)
  • 13. Assessment of the Face  Inspection  Shape  Symmetry Normal findings – Symmetrical features – Palpebral fissures equal – Nasolabial folds present bilaterally – Shape can be oval, round, or slightly square INSPECT Size, shape, and symmetry. Note placement of features , expression, movements and Skin characteristics. PALPATE Facial bones
  • 14. ABNORMALS
  • 15. Assessment of the Face  Abnormal findings  Deformed or absent structures  Asymmetry  More or less pronounced facial features  Diseases which may alter facial features: Bell’s palsy, Down syndrome, Graves’ disease, Myxedema, Cachexia, Cushing’s syndrome
  • 16. Replacement of Nonfunctional Facial Muscles  Microneurovascular free muscle transfer
  • 17. Mandible  Palpate and auscultate the TMJ when the client opens and closes the mouth  Normal findings  No discomfort, joint articulates smoothly without clicking or crepitus  Abnormal findings  Pain, tenderness, crepitus, clicking, or snapping sound
  • 18. TEMPORMANDIBULAR JOINT (TMJ) Located anterior to tragus, bilaterally Assess  Palpate with movement  Auscultate: Bell Abnormals  Tenderness, crepitus, clicking  Bruit  Pain with trismus
  • 19. Serous Otitis Media
  • 20. Tympanic Membrane Perforation
  • 21. Tympanic Membrane Perforation
  • 22. External Auditory Canal Foreign Body
  • 23. Otitis Externa
  • 24. Otowick in EAC
  • 25. Pharynx
  • 26. Esophagus - mid
  • 27. Esophagus - distal
  • 28. Foreign Bodies
  • 29. Foreign Body Ingestion
  • 30. Vocal Nodules
  • 31. Bilateral Singer’s Nodules
  • 32. Nasal Polyp
  • 33. Middle Turbinate Adhesions
  • 34. Middle Meatus-Maxillary Sinus Ostium Purulent Drainage Normal
  • 35. SINUSES: Frontal & Maxillary Assess Inspect Palpate Percuss: Direct Transilluminati on: Darkened room Abnormals  Swelling  Tenderness  Flatter sound  Unequal light
  • 36. CT Scan - Sinusitis
  • 37. Allergic Rhinitis
  • 38. Nasal Septal Perforation
  • 39. Bony Dorsum Deficiency
  • 40. Nasal Bone Fracture
  • 41. Dorsal Deficiency  More likely with osteotome rather than sharp rasp  Corrected with completion osteotomies or on- lay graft
  • 42. Septal Hematoma
  • 43. Cleft Anatomy
  • 44. Cleft Anatomy - The Nose
  • 45. Cleft Anatomy
  • 46. Controversies
  • 47. Post-tonsillectomy
  • 48. Peritonsillar Abscess
  • 49. Cleft Palate - Bifid Uvula
  • 50. Ranula
  • 51. Squamous Cell Carcinoma of Tongue ExophyticUlcerative
  • 52. Minor Salivary Gland Tumor
  • 53. Parotitis
  • 54. Pleomorphic Adenoma-Parotid
  • 55. Thyroglossal Duct Cyst
  • 56. Branchial Cleft Cyst
  • 57. THYROID  Inspect (Tangential lighting when swallowing)  Palpate  Palpate trachea  Posterior Approach  Anterior Approach  Auscultate (with Bell)
  • 58. Enlarged Thyroid
  • 59. PALPATE the THYROID  Posterior Approach  Displace to one side then palpate  Swallow
  • 60. Neck Masses
  • 61. NECK
  • 62. LYMPH NODES  Landmarks  Anterior Triangle ○ Mandible ○ Trachea ○ SCM muscle  Posterior Triangle ○ Clavical ○ Trapezius muscle ○ SCM muscle
  • 63. LYMPH NODES Location Head Face Neck Not normally palpated
  • 64. LYMPH NODES  Preauricular Nodes
  • 65. LOCATION of LYMPH NODES of the NECK Anterior Cervical Chain Overlying the sternocleidomastoid muscle Posterior Cervical Chain In the posterior triangle along the trapezius muscle Internal Jugular Chain Deep under the sternocleidomastoid muscle. Not normally palpated. Supraclavicular Just above & behind the clavicle at the sternocleidomastoid muscle
  • 66. LYMPH NODES  Anterior Cervical Nodes
  • 67. LYMPH NODES  Posterior Cervical Chain
  • 68. LYMPH NODES  Supraclavicular Nodes
  • 69. DOCUMENTATION Head: Normocephalic, no lumps, no lesions, no tenderness. Hair medium texture, evenly distributed.
  • 70. DOCUMENTATION Face: Symmetric, no drooping, no weakness, no involuntary movements. Temporal artery pulses palpable, no bruits. TMJ articulates smoothly without clicking, crepitus or pain.
  • 71. DOCUMENTATION Neck: Supple with full ROM, no pain. Symmetric, no lymphadenopathy or masses, trachea midline. Thyroid not palpable. No bruits.
  • 72. DOCUMENTATION Ears Inspection & otoscopy; tuning fork tests Nose Inspection, anterior & posterior rhinoscopy Oral cavity & oropharynx Indirect laryngoscopy to check the laryngeal inlet & hypopharynx
  • 73. OUTLINE  Know what to ask  Know what to see  Common ENT diseases
  • 74. Frederick Mars Untalan, MD Relearning the basic history taking & physical examination