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Medi ci ne 1: HEENT/Neck Exami nati on Secti on 2A 2015

AY 2012-2013 Lecture 6


Outl i ne
Know what to ask
Know what to see
Knowledge of common ENT diseases

History of Present Illness
Location
Timing: onset, frequency, duration
Quality and/or Characteristics
Quantity and/or Severity
Setting and/or Situation
Aggravating and Alleviating Factors
Associated Factors
Underlying Concern

EENT EXAM
The ENT of head and neck is not fixed in
sequence
Different parts of the exam may be
excluded/included.

The ENT History
Briefer than the Internal Medicine history
(think surgical)
Key points (especially important in ENT):
o Smoking/alcohol history
o Numbers of infections (e.g. ear,
sinus, throat) in last 1, 2, 3
years
o Previous treatments
o Ears: hearing loss, pain, d/c,
tinnitus, vertigo
o Previous ENT surgeries

Ear - History
Otologic:
Hearing loss
o Onset and rate of progression
Otalgia
o Otologic vs. referred
Otorrhea
o Consistency?
Tinnitus
Vertigo
o Differentiate from !dizziness"
Noise exposure
Nasal
Obstruction, discharge etc.
Drugs
Ototoxic agents
Family History
Of hearing loss etc.

EAR EXAMI NATI ON
May be done while doing history taking.
Always examine both ears, not just the
affected ear.
Adults # pull ear backwards and upwards
Children # pull ear backwards and
downwards
Inspect auricles and mastoid region
o Size, shape, symmetry,
landmarks, color, position,
deformities or lesions
Palpate auricles and mastoid
o Tenderness, swelling, nodules

The Tympanic Membrane
Inspect external auditory canal (with
pneumatic otoscopy)
o Cerumen, color, lesions, d/c,
foreign bodies
Inspect tympanic membrane
o Landmarks
o Color, contour
o Perforations, mobility
o All 4 quadrants

Otitis Externa Normal Tympanic Membrane

Acute Otitis Media Tympanosclerosis

Perforation Cholesteatoma


Medi ci ne 1: HEENT/Neck Exami nati on Secti on 2A 2015
AY 2012-2013 Lecture 6


Ear # Hearing Assessment
Conducive Hearing Loss
o Disease affecting outer/middle
ear
Sensorineural Hearing Loss
o Disease affecting cochlea or CN
VIII
Mixed Hearing Loss
o Disease involving both middle and
inner ear
Response to questions during history
Response to a whispered voice
Tuning fork # air/bone conduction
o Rinne
o Weber

Interpretation of Tuning Fork Test
Test Expected
Fi ndi ngs
CHL SNHL
Weber No
lateralization
Lateralization
to ear with
loss
Lateralization
to better
hearing ear
Ri nne Air
conduction
better than
bone
conduction
Rinne (Rinne
positive)
Bone
conduction
better than
air
conduction
(Rinne
negative)
Air
Conduction
better than
bone
conduction

Nose and Paranasal Sinuses # History
Nasal
o Rhinorrhea
o Nasal obstruction
o Sneezing
o Discharge
o Olfaction
o Allergies
Sinuses
o Facial pain
o Dental pain
o Hearing loss
o Post-nasal drip
o Olfaction
o Congestion
o Discharge











NOSE AND PARANASAL SI NUSES EXAM
Inspect the external nose
o Share, size, color, nares
Palpate the ridge and soft tissues of the
nose
o Tenderness, displacement
cartilage/bone, masses
Evaluate patency of nares
Inspect nasal mucosa and septum
o Color, alignment, discharge,
swelling of turbinates, perforation
Inspect and palpate regions of the sinuses
Flexible/Rigid Endoscopy

Examples:
Sinusitis
Polyps
Septal perforation
Nasopharyngeal Carcinoma

Upper Aerodigestive Tract - History
Oral Cavity/Oropharynx:
o Pain
o Bleeding
o Dysarthria
o Numbness/Dysgeusia
o Referred otalgia
o Dry Mouth
Swallowing
o Dysphagia
! Solids vs. liquids
o Odynophagia
o Aspiration
o Reflux
Hypopharynx/Larynx:
o Dysphonia
o Dysphagia
o Cough/Hemoptysis
o Pain
o Shortness of breath
o Stridor
o Globus













Medi ci ne 1: HEENT/Neck Exami nati on Secti on 2A 2015
AY 2012-2013 Lecture 6


ORAL CAVI TY EXAMI NATI ON
Inspect lips and vermilion borders
o Symmetry, color, edema, surface
abnormalities
Inspect and palpate gingiva
o Color, lesions, tenderness
Inspect teeth
o Occlusion, caries, lose or missing
teeth
Inspect and palpate tongue and buccal
mucosa
o Color, symmetry, swelling,
ulcerations
Inspect palate, floor of mouth, uvula,
tonsils, oropharynx


NECK EXAMI NATI ON
Inspect the neck
o Symmetry, alignment of trachea,
fullness, masses, webbing, skin
folds, jugular vein distribution,
carotid artery prominence
Evaluate range of motion of neck
Palpate the neck
o Tracheal position, tracheal tug,
movement of hyoid bone and
cartilages with swallowing
Palpate the thyroid gland
o Size, shape, configuration,
consistency, tenderness, nodules
o Examine on deglutition

Lymph Node Groups
Palpate lymph nodes
o Size, consistency, tenderness,
warmth, mobility
Pre-auricular
Post-auricular
Occipital
Jugulodigastric
Submental/Submandibular
Facial
Anterior and Posterior Cervical
Supraclavicular










LARYNX EXAMI NATI ON
Indirect Laryngoscopy
o Hold patient$s tongue wrapped in
gauze with one hand
o Hold mirror in other hand against
soft palate
o Access vocal cord mobility,
lesions in region
Direct Laryngoscopy
o Posterior pharyngeal wall
o Posterior cricoid region, pyriform
recesses
o Vocal cord mobility and
appearance
o Arytenoid mucosa/cartilages,
aryepiglottic folds
o Epiglottis, valleculae, base of
tongue

Examples of Oral Cavity
Torus
Fibroma
Hemangioma
Papilloma
SCCA
Leukoplakia
Hypopharynx/Larynx # Fish bone
Vocal cord Papilloma
Vocal cord Nodule
Vocal Cord Polyp
Vocal Cord SCCA

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