ENT Examination

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ENT Examination

  1. 1. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Examination of the nose and throat
  2. 2. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Principal Nasal Symptoms airway obstruction runny nose (rhinorrhoea) sneezing loss of smell (anosmia) facial pain due to sinusitis snoring associated with nasal obstruction
  3. 3. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection  Nose  Shape - Deviation. Look from the sides & from above.  Deformities – Abnormal Nasal Creases  Scars  Discharge or crusting  Redness or evidence of skin disease  Offensive odour (From the Patient)  Rhinorrhoea
  4. 4. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection  Inspect the front of the nose first by tipping the nose up and inspecting without a speculum.  Insert a Thudicum speculum into the appropriate nostril. A light source is required to visualise the internal structures.  You should be able to identify the septum medially, the turbinates laterally. The inferior turbinates should be easy to visualise. Thudicum Speculum
  5. 5. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection  Inspect for inflammation (Rhinitis)  Comment on the septum. Is it straight or deviated.  Look in the mouth. Occasionally large polyps or tumours may be visible from arising behind the soft palate. Polyp right nostril TURBINATE SEPTUM
  6. 6. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Palpation If you see what you believe is a polyp then it is useful to assess sensitivity. Polyps are not sensitive to touch whereas turbinates are tender to touch. Polyps are grey / yellow whereas turbinates are pink.
  7. 7. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Nasal Airway Assessment  Hold a cold metal tongue depressor under the patient’s nose whilst they breath in and out through their nose. Condensation should be visible as air passes over the metal.  To assess nasal airway efficiency. Occlude one nostril and ask the patient to sniff. This gives a reasonable idea on nasal airway efficiency.
  8. 8. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Throat Examination History. Enquire on general history. Sore throat, feeling run down, visible lesions & causing pain. Ask about alcohol & tobacco habits. Ask about their general dental history.
  9. 9. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection 1 Ask the patient to remove any dentures. Inspect the lips. Note the Vermillion border & the corners of the mouth for any deviation. Retract the upper lip with the front teeth closed together. Note the maxillary labial frenum, gingivae, mucogingival line with teeth.
  10. 10. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Vermillion border maxillary labial frenum gingivae mucogingival line Inspection 2
  11. 11. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection 3  Note oral hydration  Halitosis?  Note any varicosities, missing teeth, dental carries, ulceration or haemangiomas.  Use a bright light & a tongue depressor, inspect the tonsils, uvula and the soft palate. Ask the patient to tilt their head upwards to inspect the hard palate.
  12. 12. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection 4  Note the mucosal lining of the cheeks, noting Stensen’s glands. (See slide 13.) Located behind the 2nd molar. It carries saliva from the Parotid gland. Any blockage can render the mouth dry.  Note the frenum. Note any ulceration / discharge.  Ask the patient to lift their tongue upwards to inspect the floor of the mouth. Note if the tip of the tongue can touch the roof of the mouth. Failure to do so may indicated tongue tie. (Ankyloglosia.)
  13. 13. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Parotid  The parotid salivary gland is located over the mandibular ramus, anteriorly and inferiorly to the ears.  Inspection of stensen’s duct may require inspection if the mouth is dry or if any parotid swelling is detected upon external palpation.
  14. 14. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Parotid Palpation  Palpated bilaterally  Start palpating anterior to the ears and move towards the cheek and then inferiorly towards the angle of the mandible.
  15. 15. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK Inspection 4 Any further examination of the larynx requires specialised equipment. Inspection of the oral cavity may also have a neurological element. C.N’s 7.9 &12

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