clinical examination of the ear, nose and throat dave pothier st mary’s 2003
TRANSCRIPT
![Page 1: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/1.jpg)
Clinical Examination of the Ear, Nose and Throat
Dave Pothier
St Mary’s 2003
![Page 2: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/2.jpg)
Important things to remember
• ABC is ALWAYS necessary• See patient as a whole• Look at patient from the time they enter
the room• Systemic problems give valuable clues• Look for health ‘props’
![Page 3: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/3.jpg)
Practice is vital
ENT examination/equipment is not intuitive
![Page 4: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/4.jpg)
Be familiar with gear
![Page 5: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/5.jpg)
THE EAR
![Page 6: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/6.jpg)
Position
• Good light• Headlight / reflected light from headmirror• Side on to patient• Inspect, Palpate, Use otoscope
NB look behind ear
![Page 7: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/7.jpg)
External anatomy
![Page 8: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/8.jpg)
Palpate
• Feel pinna • Feel lymph nodes• Palpate neck
![Page 9: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/9.jpg)
Canal
• Inspect pinna and concha• Otoscopic examination• Pull upwards, outwards
and backwards
• Look for cavity,
Otitis externa
Osteomas
Mastoid cavity
![Page 10: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/10.jpg)
TM
• Assess all quadrants• Look for malleus,
incus• Record abnormalities
![Page 11: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/11.jpg)
Pars flaccida
Long process incus
Handle of malleus
Umbo
Pars tensa
Canal wall
![Page 12: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/12.jpg)
Perforations
Central perforation Marginal perforation
![Page 13: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/13.jpg)
Don’t forget
• Tuning fork tests• Simple free field tests
• Look at audiological investigations
![Page 14: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/14.jpg)
THE NOSE
![Page 15: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/15.jpg)
Inspection
• Good light• Look at skin and scars• Assess shape
• Look at vestibules by lifting tip
![Page 16: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/16.jpg)
Palpation/inspection
• Occlude each nostril in turn and assess air entry
• Look at misting of tongue depressor
![Page 17: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/17.jpg)
Anterior rhinoscopy
• Use thuddicums speculum
hold it properly!
![Page 18: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/18.jpg)
Nasendoscopy
• Rigid
• Flexible
![Page 19: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/19.jpg)
Don’t forget
• Also examine neck and oral cavity
• Check postnasal space
• Ear disease may suggest pathology
![Page 20: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/20.jpg)
THE THROAT
![Page 21: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/21.jpg)
What does this area consist of?
• Mouth?• Pharynx?• Larynx?• Trachea?• Oesophagus?• Neck?
Best to view as much as possible
![Page 22: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/22.jpg)
Oral cavity
• Open wide!• Two tongue depressors• Examine every mucosal surface• Protrude tongue• Look at salivary orifices• Bimanual palpation• Percuss teeth
![Page 23: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/23.jpg)
Larynx
• Indirect / direct laryngoscopy
To be learned in OPD
![Page 24: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/24.jpg)
View of larynx
Tongue base
Vallecula
Epiglottis
False cord
Vocal cord
Piriform fossa
Arytenoid cartilage
![Page 25: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/25.jpg)
Neck
• Inspect• Palpate • Auscultate
![Page 26: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/26.jpg)
Inspection
• Scars• Lumps• Sinuses• Asymmetry• Stoma• Ask patient to swallow and protrude tongue• Ask patient to breathe deeply• Ask patient to count to ten
![Page 27: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/27.jpg)
Palpation
• Adequate exposure• Systematic• Develop system• From in front then mainly from behind
Submandibular area, both triangles
Supraclavicular area
![Page 28: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/28.jpg)
![Page 29: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/29.jpg)
Auscultation
• Listen for bruit
Thyroid and carotid
![Page 30: Clinical Examination of the Ear, Nose and Throat Dave Pothier St Mary’s 2003](https://reader037.vdocuments.us/reader037/viewer/2022102900/551b165b5503462e578b5d7c/html5/thumbnails/30.jpg)
Summary
• See patient as a whole – don’t focus in on one part of the body too soon
• Be systematic• Adequate exposure• Be familiar with toys• Suggest further assessments