RCSI Royal College of Surgeons in Ireland Coliste Roga na Minle in

irinn

HISTORY, EXAMINATION AND

RELEVANT ANATOMY IN
OTORHINOLARYNGOLOGY
OTOLOGY
 HISTORY

Otalgia
Otorrhoea
Vertigo/dizziness
Hearing loss/deafness
Tinnitus
Facial nerve
 Should also include

Previous ear surgery

Previous head injury
Systemic diseases like diabetes / hypertension
Use of ototoxic drugs
Exposure to noise during work
Family history deafness
History atopy / allergy
Examination of the Ear

Inspection
Palpation
Auroscope
Tuning fork test
Whisper test
 Examination of Ear

Inspection
Use headlight
Examine pinna and post-aural area
Look for post-aural or endaural or
tragal scars
Comment on obvious
lesion/swelling/erythema/
discharge/etc
 Auroscope

Use auroscopehold in correct manner

Examine ear canal
Inspect all 4 quadrants of tympanic
membrane
For perforations think
Dry or wet
Site
Central, marginal, subtotal, total
Size
Middle ear structures
Bloody drainage and granulation tissue

Granulation tissue at the ear cannal

Cause: papilloma, cancer, malignant otitis external
(osteomyelitis immunocompromised pt)
Bony exostosis in ear canal

Xde pain or any symptoms

Ada bila selalu di exposed oleh cold water waktu kecik
Normal je..
Kalau ada conductive hearing loss baru la buat sesuatu
 Handle of
Pars malleus
flaccida
(attic)

Umbo
Incus

Cone of
Pars tensa, light
Pale grey

Promontory

Annulus
Cholestoma

Complication:
Conductive hearing loss
Abscess formation
Infection of externa n media
Sigmoid sinus thrombosis
Treatment
Mastoidectomy
Ear drum repair

Tujuan: prevent complication

 Tuning fork

Striking the fork:

Do not strike the fork on hard
surface
Can damage the fork
Overtones are produced
May give a false result

Strike the fork on a hard

rubber pad, elbow or knee
 Webers test

Procedure :
Strike the fork and place the base on the vertex.
Alternative locations are:
Dorsum of the nose
Upper incisor
Chin

Patient response:
Ask if the sound is heard and whether it is heard in
the middle of the head or in both ears equally,
towards the left or towards the right
 Webers test

Interpretation :
In normally hearing subject, the tone is heard
centrally or bilaterally
Otherwise, the tone is generally heard on the
side of the better cochlea
 Rinnes test Procedure
Air Conduction (AC)
Strike the fork and hold it with the axis joining the tips
of the tines in line with the axis of EAC for 2s
The nearest tine should be approximately 2.5cm from
EAC

Bone Conduction (BC)

Immediately transfer the fork so that the base is
pressed firmly against the mastoid (no hair between
fork and mastoid!)
 Rinnes test
Patient response:
Patient should be asked first if he can hear the
tuning fork by AC
The confirm whether the tone sounds louder by AC
or by BC

Intrepretation:
AC is louder than BC: Rinnes positive
(normal ears and the vast majority of SNHL)
BC is louder than AC : Rinnes negative
(significant conductive element)
 Whisper test

Stand arm's length behind the seated patient so they

can not read your lips.
Rub tragus to mask non-tested ear
Whisper bisyllable words
Exhale before whispering to ensure as quiet a voice
as possible
Ask patient to repeat
If the patient responds correctly, hearing is
considered normal; if the patient responds incorrectly,
the test is repeated using different words
RHINOLOGY
 History

Nasal blockage/obstruction/congestion
Rhinorrhoea
Post nasal drip
Anosmia/hyposmia
Facial pain/discomfort
Epistaxis
 Examination of nose

Inspection
Change in shape / contour of the nose
Deformities congenital / acquired if any
Presence of clefts and sinuses
Presence of swelling : inflammatory, cysts, or tumours
Presence of ulceration : trauma / infective / neoplastic
 Anterior Rhinoscopy

Examination of the vestibule

(skin-lined cavity of the nares).
Septum
Inferior turbinate
Floor of the nose

Examination of nasal cavity using

thudicum's nasal speculum or Killians
speculum.
Management Steps Epistaxis

Abcd
Direct pressure
Topical decongestant (oxymetazoline)
Silver nitrate cautery
Merocel (nasal tampon)
Epistat balloon
Formal gauze packing
Posterior nasal packing
Embolization of IMA or sphenopalatino artery
Sphenopalatine artery (common artery yg sng bleed)
Tie up external carotid artery
Benefit outweight risk
Septal Spur
Saddle Nose Deformity
Examine post-nasal space
ORAL CAVITY
AND
OROPHARYNX
 Examination

7 sub-sites of oral cavity

Lips, gingiva, floor of mouth, tongue, Buccal
mucosa, hard palate, retromolar trigone
Oropharynx
Soft palate, tonsils, base of tongue, posterior
and lateral pharyngeal walls
Use head light
Patient sitting at the same level as
examiner
The patient's legs must be placed to one
side of the examiner
 Neck

Inspection
Palpation
Auscultation (if required)
 Palpation of Neck

Always ask for

tenderness
Position head and
neck in neutral position
Palpate from posterior
Bimanual
Define the Lower
Border of the Mandible
Follow the sequence
 Posterior triangle

Dont forget the

posterior triangle!
Start at mastoid
process, palpate
along posterior border
of SCM, along
clavicle and up along
anterior border of
trapezius
 Neck Lump

Site Consistency

Size Edge

Shape Overlying skin

Tenderness Transillumination

Mobility Pulsation