HISTORY TAKING AND

EXAMINATION IN

OTORHINOLARYNGOLOG

Y

Dr. Ritesh Mahajan

HISTORY TAKING

• Name• Age• Sex• Religion• Occupation• Address

• Today I am going to present the history of (age) year old, male/female (name). He/she is a (religion) by religion and works at/as (occupation) in (city) and is a permanent resident of (address).

CHIEF COMPLAINTS

• He/she presented in the out patient department of ENT with chief complaints of:-

• In chronological order : Disease which started first.

• Right ear discharge – 2 years.• Difficulty in hearing – 1 year.• Ringing sensation in ear – 6 months.• Fever – 1 week.

PRESENT ILLNESS

• Patient was apparently alright 2 years back when he/ she started with (complaint).

• First describe the 1st chief complaint then its associated symptoms and relevant negative history.

• Then go on 2nd chief complaint and like wise.

• Then negative history of overall disease picture.

PAST HISTORY

• History of Tuberculosis / Syphilis/ Leprosy/epilepsy

 • History of infectious fever - Measles/Chicken pox/Typhoid

 • History of trauma or allergy

 • Any history of previous surgery

 • History of diabetes and hypertension

 • Diseases of CNS & Others.

FAMILY HISTORY

• Members of family.

• Similar complaints in any other member in the family

 • History of T.B./Diabetes/ Hypertension

 • Duration

 • Onset

PERSONAL HISTORY

 • Diet/Sleep/appetite

 • Micturation / bowel habits

• Habits: Smoking Pan chewing Alcohol intake

• Hygiene/Socio-economic Status

• Exposure to dusty atmosphere or chemical irritants or fumes

OTHERS

• Menstrual History.

• Socioeconomic history.

• Immunization history – in case of a child.

• Children: examiner should be told about the person from whom you have taken history, e.g. Mother in case of a child.

GENERAL PHYSICAL EXAMINATION

• Built• Nourishment• Orientation to time, place & person• Vital data:

 • Pulse• Respiratory rate• Blood pressure• Temperature• Pallor/Icterus/Cyanosis/Clubbing/Pedal oedema/

Generalised Lymphadenopathy

SYSTEMIC EXAMINATION

• CVS – S1, S2 heard, no audible murmurs.

• RS – normal vesicular breath sounds heard, no crepts, no wheezing.

• CNS - Higher mental functions, Motor functions, Sensory functions - normal.

• Cranial nerves – facial nerve, olfactory, hypoglossal, vagus, gloss pharyngeal, trigeminal, auditory nerve.

• Per Abdomen- soft, non tender, no organomegaly.

EAR

EXAMINATION OF THE EAR

Right and left ear

• Pre auricular region• Pinna• Post auricular region• External auditory canal• Tympanic membrane• Fistula test• Mastoid tenderness• Facial nerve

• Tunning fork tests –

• Rinne’s

• Weber’s

• Air bone conduction

EAR

• Pinna – Shape, Size, Position.

• Post aural – Swelling, Scar, 3 point tenderness test, Battle’s sign, Griesinger’s sign.

• Pre auricular area – Sinus, Swelling, Cyst, Accessory tragus, Lymph nodes.

• External Auditory Canal – upwards, backwards & outwards.

• Without speculum and with speculum. • Examine- roof, floor, anterior & posterior wall.

• Wax, Pus, Foreign body, Granulation, Fruncle, Osteoma, Laceration, Stenosis, Atresia.

EAR• Tympanic Membrane – Describe and identify normal anatomical

landmarks-

• Colour, cone of light, • 4 quadrants, umbo, • Handle of malleus, • Lateral process of malleus, • Anterior & posterior malleolar folds, • Pars tensa, • Pars flaccida, • Bony annulus, • Incudostapedial joint.

EAR

• Colour –

• Pink (otosclerosis), • Rising Sun (glomus jugular) , • Red (acute otitis media, myringitis, baro-otitis media), • Bluish (blood accumulation).

• Cone of light – ET block, Atelectasis, serous otitis media.

• Mobility – Siegalization and Valsalva maneuver.

EAR

• Pars tensa - Retraction, Granulation, Blebs, Sclerotic patches or perforation.

• Perforation – Type, Margins, Location, Size, Shape, Edge, Residual drum, Structures seen through perforation, Granulation, Postero-Superior retraction with cholesteatoma, Polyps, & Tympano-Sclerotic Patches.

• Pars Flaccida – Attic or Sharpnell’s membrane.

• Central perforation is ‘SAFE’ while Marginal/attic perforation is usually ‘UNSAFE’.

TUNING FORK TESTS

NOSE

EXAMINATION OF THE NOSE

Examination of external nose {skin and

osteocartilaginous framework}

• Inflammation • Scars • Sinus • Swelling • Neoplasm • Deformity

Examination of vestibule

• Furuncle • Fissure • Crusting • Dislocated caudal end of

the septum • Tumours

EXAMINATION OF THE NOSE

Anterior Rhinoscopy

• Nasal passage • Septum • Floor of nose • Lateral wall• Nasal mucosa• Turbinate hypertrophy• Shape of turbinate

Posterior Rhinoscopy

• Choana • Posterior ends of inferior

turbinates • Posterior end of septum• Discharge• Openings of the Eustachian tubes • Posterior end of middle turbinate• Fossae of Rosenmuller

EXAMINATION OF THE NOSE

Functional Examination of Nose

• Cold Spatula test

• Cotton-wool test

• Sense of smell• Cottle’s test

Paranasal sinus tenderness

• Maxillary• Frontal• Ethmoidal

ORAL CAVITY & OROPHARYNX

ORAL CAVITY & OROPHARYNX

INSPECTION:

• Lips• Teeth• Gums• Buccal mucosa• Anterior 2/3 of tongue• Floor of the mouth• Hard palate

ORAL CAVITY & OROPHARYNX

• Soft palate• Oro-antral fistula• Anterior pillar• Tonsil• Posterior pillar• Posterior

pharyngeal wall

ORAL CAVITY & OROPHARYNX

• Tongue :

• Anterior 2/3rd , & Posterior 1/3rd.• Size, Appearance, Swelling, Ulcer, Mobility, Dorsum and Floor of

Tongue.

• Tonsils:

• Gr. 1 – medial surface of tonsil hidden behind anterior pillar.• Gr. 2 – medial surface of tonsil just at level of anterior pillar.• Gr. 3 – size in between Gr. 2 and Gr. 3• Gr. 4 – tonsil touching each other ( kissing tonsils).

ORAL CAVITY & OROPHARYNX

• Tonsil 0: Tonsils fit within tonsillar fossa

• Tonsil 1+: Tonsils <25% of space between pillars

• Tonsil 2+: Tonsils <50% of space between pillars

• Tonsil 3+: Tonsils <75% of space between pillars

• Tonsil 4+: Tonsils >75% of space between pillars

ORAL CAVITY & OROPHARYNX

• PALPATION :

• Tongue• Buccal mucosa• Floor of mouth• Tonsils and its bed.• Base of tongue.• Swelling in oral cavity.

EXAMINATION OF LARYNX

• Redness of skin (abscess, perichondritis)

• Bulge or swelling (extension of growth or enlarged lymph nodes)

• Widening of larynx (growth of pyriform fossa)

• Surgical emphysema (accidental or surgical trauma)

• Palpate the hyoid bone, thyroid cartilage, thyroid notch, cricoid cartilage, and the tracheal rings.

• Movements of larynx (laryngeal crepitus).

STRUCTURES SEEN ON INDIRECT LARYNGOSCOPY

• Larynx - Epiglottis, aryepiglottic folds, arytenoids, cuneiform and corniculate cartilages, ventricular bands, ventricles, true cords, anterior commissure, posterior commissure, subglottis and rings of trachea.

• Laryngopharynx - Both pyriform fossae, postcricoid region, posterior wall of laryngopharynx.

• Oropharynx - Base of tongue, lingual tonsils, valleculae, medial and lateral glossoepiglottic folds.

EXAMINATION OF LARYNX

• Indirect laryngoscopy:

THANK YOU