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EARS, NOSE & THROAT   HEAD & NECK      Relearning the basic history taking & physical                      examination Fre...
OUTLINE Know what to ask Know what to see Common ENT diseases
REMEMBER. . .      . . . a thorough          assessment begins          with the        HISTORY!
HISTORY of PRESENT ILLNESS              (HPI or Symptom Analysis)   Location and Radiation   Timing: Onset, Frequency & ...
EQUIPMENT NEEDED Latex Gloves Light Source Cotton Cup with water (optional) Measuring tape (possible)
GENERAL CONSIDERATIONS The head and neck exam is not   fixed in  sequence. Different parts of the exam may be included  ...
PhysicalDiagnosisinOtolaryngology
Health History Determine presence/absence of age- and  gender-specific diseases of the head and neck Common chief compla...
General Approach to Head      and Neck Assessment Greet patient, explain assessment  techniques Environment     Quiet  ...
Where the Head Ends and NeckBegins               Plane between the external                occipital protuberance and    ...
Where the Head Ends and NeckBegins              Neck                – Posterior triangle is                  bordered by ...
Special Bony Areas External Occipial  Protuberance (notch    in occipital area   Mastoid Process    (behind Ear)   Zygo...
Assessment of the Face  Inspection     Shape                      Normal findings     Symmetry                     – S...
ABNORMALS
Assessment of the Face Abnormal findings   Deformed or absent structures   Asymmetry   More or less pronounced facial ...
Replacement of Nonfunctional FacialMuscles   Microneurovascular free muscle transfer
Mandible Palpate and auscultate the TMJ when the  client opens and closes the mouth Normal findings   No discomfort, jo...
TEMPORMANDIBULAR            JOINT (TMJ)Located anterior to tragus,bilaterallyAssess               Abnormals Palpate with ...
Serous Otitis Media
Tympanic MembranePerforation
Tympanic MembranePerforation
External Auditory Canal Foreign Body
Otitis Externa
Otowick in EAC
Pharynx
Esophagus - mid
Esophagus - distal
Foreign Bodies
Foreign Body Ingestion
Vocal Nodules
Bilateral Singer’s Nodules
Nasal Polyp
Middle Turbinate Adhesions
Middle Meatus-Maxillary Sinus Ostium       Normal                    Purulent Drainage
SINUSES:       Frontal & MaxillaryAssess               Abnormals Inspect             Swelling Palpate             Tend...
CT Scan - Sinusitis
Allergic Rhinitis
Nasal Septal Perforation
Bony DorsumDeficiency
NasalBoneFracture
Dorsal Deficiency More likely with  osteotome rather  than sharp rasp Corrected with  completion  osteotomies or on-  la...
Septal Hematoma
Cleft Anatomy
Cleft Anatomy - The Nose
Cleft Anatomy
Controversies
Post-tonsillectomy
Peritonsillar Abscess
Cleft Palate - Bifid Uvula
Ranula
Squamous Cell Carcinomaof Tongue  Ulcerative         Exophytic
Minor Salivary Gland Tumor
Parotitis
Pleomorphic Adenoma-Parotid
Thyroglossal Duct Cyst
Branchial Cleft Cyst
THYROID Inspect   (Tangential lighting when swallowing) Palpate   Palpate trachea   Posterior Approach   Anterior App...
Enlarged Thyroid
PALPATE the THYROID Posterior Approach   Displace to one side then palpate   Swallow
Neck Masses
NECK
LYMPH NODES       Landmarks         Anterior Triangle           Mandible           Trachea           SCM muscle      ...
LYMPH NODES Location   Head   Face   Neck Not normally palpated
LYMPH NODES      Preauricular Nodes
LOCATION of LYMPH NODES of the                      NECK                             Overlying the sternocleidomastoidAnte...
LYMPH NODES Anterior Cervical Nodes
LYMPH NODES     Posterior Cervical Chain
LYMPH NODES   Supraclavicular Nodes
DOCUMENTATIONHead:Normocephalic, no lumps, no lesions, no tenderness. Hair medium texture, evenly distributed.
DOCUMENTATIONFace:Symmetric, no drooping, no weakness, no involuntary movements. Temporal artery pulses palpable, no bruit...
DOCUMENTATIONNeck:Supple with full ROM, no pain. Symmetric, no lymphadenopathy or masses, trachea midline. Thyroid not pal...
DOCUMENTATIONEarsInspection & otoscopy; tuning fork testsNoseInspection, anterior & posterior rhinoscopyOral cavity & orop...
OUTLINE Know what to ask Know what to see Common ENT diseases
EARS, NOSE & THROAT   HEAD & NECK      Relearning the basic history taking & physical                      examination Fre...
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
Basic ENT-HNS physical examination
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Basic ENT-HNS physical examination

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Basic ENT-HNS physical examination

  1. 1. EARS, NOSE & THROAT HEAD & NECK Relearning the basic history taking & physical examination Frederick Mars Untalan, MD
  2. 2. OUTLINE Know what to ask Know what to see Common ENT diseases
  3. 3. REMEMBER. . . . . . a thorough assessment begins with the HISTORY!
  4. 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. 5. EQUIPMENT NEEDED Latex Gloves Light Source Cotton Cup with water (optional) Measuring tape (possible)
  6. 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. 7. PhysicalDiagnosisinOtolaryngology
  8. 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. 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. 10. Where the Head Ends and NeckBegins  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. 11. Where the Head Ends and NeckBegins Neck – Posterior triangle is bordered by Clavicle (below), trapezius (posteriorly) and Sternomastoid (anteriorly)
  12. 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. 13. Assessment of the Face  Inspection  Shape Normal findings  Symmetry – Symmetrical features INSPECT – Palpebral fissures Size, shape, and symmetry. equal Note placement of features , – Nasolabial folds expression, movements and present bilaterally Skin characteristics. – Shape can be oval, PALPATE round, or slightly Facial bones square
  14. 14. ABNORMALS
  15. 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. 16. Replacement of Nonfunctional FacialMuscles  Microneurovascular free muscle transfer
  17. 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. 18. TEMPORMANDIBULAR JOINT (TMJ)Located anterior to tragus,bilaterallyAssess Abnormals Palpate with  Tenderness, movement crepitus, clicking Auscultate: Bell  Bruit  Pain with trismus
  19. 19. Serous Otitis Media
  20. 20. Tympanic MembranePerforation
  21. 21. Tympanic MembranePerforation
  22. 22. External Auditory Canal Foreign Body
  23. 23. Otitis Externa
  24. 24. Otowick in EAC
  25. 25. Pharynx
  26. 26. Esophagus - mid
  27. 27. Esophagus - distal
  28. 28. Foreign Bodies
  29. 29. Foreign Body Ingestion
  30. 30. Vocal Nodules
  31. 31. Bilateral Singer’s Nodules
  32. 32. Nasal Polyp
  33. 33. Middle Turbinate Adhesions
  34. 34. Middle Meatus-Maxillary Sinus Ostium Normal Purulent Drainage
  35. 35. SINUSES: Frontal & MaxillaryAssess Abnormals Inspect  Swelling Palpate  Tenderness Percuss: Direct  Flatter sound Transilluminatio  Unequal light n: Darkened room
  36. 36. CT Scan - Sinusitis
  37. 37. Allergic Rhinitis
  38. 38. Nasal Septal Perforation
  39. 39. Bony DorsumDeficiency
  40. 40. NasalBoneFracture
  41. 41. Dorsal Deficiency More likely with osteotome rather than sharp rasp Corrected with completion osteotomies or on- lay graft
  42. 42. Septal Hematoma
  43. 43. Cleft Anatomy
  44. 44. Cleft Anatomy - The Nose
  45. 45. Cleft Anatomy
  46. 46. Controversies
  47. 47. Post-tonsillectomy
  48. 48. Peritonsillar Abscess
  49. 49. Cleft Palate - Bifid Uvula
  50. 50. Ranula
  51. 51. Squamous Cell Carcinomaof Tongue Ulcerative Exophytic
  52. 52. Minor Salivary Gland Tumor
  53. 53. Parotitis
  54. 54. Pleomorphic Adenoma-Parotid
  55. 55. Thyroglossal Duct Cyst
  56. 56. Branchial Cleft Cyst
  57. 57. THYROID Inspect (Tangential lighting when swallowing) Palpate  Palpate trachea  Posterior Approach  Anterior Approach Auscultate (with Bell)
  58. 58. Enlarged Thyroid
  59. 59. PALPATE the THYROID Posterior Approach  Displace to one side then palpate  Swallow
  60. 60. Neck Masses
  61. 61. NECK
  62. 62. LYMPH NODES  Landmarks  Anterior Triangle  Mandible  Trachea  SCM muscle  Posterior Triangle  Clavical  Trapezius muscle  SCM muscle
  63. 63. LYMPH NODES Location  Head  Face  Neck Not normally palpated
  64. 64. LYMPH NODES  Preauricular Nodes
  65. 65. LOCATION of LYMPH NODES of the NECK Overlying the sternocleidomastoidAnterior Cervical Chain muscle In the posterior triangle along thePosterior Cervical Chain trapezius muscle Deep under the sternocleidomastoid Internal Jugular Chain muscle. Not normally palpated. Just above & behind the clavicle at the Supraclavicular sternocleidomastoid muscle
  66. 66. LYMPH NODES Anterior Cervical Nodes
  67. 67. LYMPH NODES  Posterior Cervical Chain
  68. 68. LYMPH NODES  Supraclavicular Nodes
  69. 69. DOCUMENTATIONHead:Normocephalic, no lumps, no lesions, no tenderness. Hair medium texture, evenly distributed.
  70. 70. DOCUMENTATIONFace:Symmetric, no drooping, no weakness, no involuntary movements. Temporal artery pulses palpable, no bruits. TMJ articulates smoothly without clicking, crepitus or pain.
  71. 71. DOCUMENTATIONNeck:Supple with full ROM, no pain. Symmetric, no lymphadenopathy or masses, trachea midline. Thyroid not palpable. No bruits.
  72. 72. DOCUMENTATIONEarsInspection & otoscopy; tuning fork testsNoseInspection, anterior & posterior rhinoscopyOral cavity & oropharynxIndirect laryngoscopy to check the laryngeal inlet & hypopharynx
  73. 73. OUTLINE Know what to ask Know what to see Common ENT diseases
  74. 74. EARS, NOSE & THROAT HEAD & NECK Relearning the basic history taking & physical examination Frederick Mars Untalan, MD

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