ENT Examination and History Taking

Question 1

Inspection of ear

Answer 1

-Pinna (swelling, erythema, discharge from canal)
-Post-auricular scars
-Mastoid (swelling, erythema)- immediately posterior to pinna, gentle palpation for tenderness

Question 2

Examination of ear canal

Answer 2

-Otoscope and speculum
=Observe 4 quadrants of ear drum
-Light microscope for FB (crocodile forceps) and suction (OE)

Question 3

Hearing testing

Answer 3

-Tuning fork
=Rhine’s test (vibration on squamous part of temporal bine until cannot hear then place 10 cm away from ear- which is louder should be air)
=Faber’s test (tuning fork in middle of forehead, more left/right/middle

Question 4

Examination of nose

Answer 4

-Inspection (deviation)
-Airflow through nostril (cold metal speculum to see misting)
-Anterior nostrils (tilt head back, head torch and insert speculum)
-Nasal endoscopy (epistaxis, polyps rigid/ flexible for FB, masses and malignancies, airway obstruction)

Question 5

Examination of throat

Answer 5

-Open mouth and 2 tongue depressors
=cheek, buccal, floor, side of tongue, underneath tongue, roof of mouth, throat= aaahh

Question 6

Examination of cervical lymph nodes

Answer 6

-Along angle of jaw
-Pre auricular area
-Anterior triangle
-Supraclavicular region
-Posterior triangle
-Post auricular
-Occiptal

Question 7

Examination of thyroid

Answer 7

-Inspection (anterior then laterally)- swelling, lump, asymmetry, skin changes
-Palpate both sides with fingers, should move on swallowing

Question 8

Method of nasal endocopy

Answer 8

-Spray nasal anaesthetic and leave to work
-Lubricate scope
-Tilt nose and insert

Question 9

Cauterising nose

Answer 9

-Silver nitrate sticks= speculum and head torch, identify point, apply nitrate

Question 10

Otology history

Answer 10

-Hearing
-Tinnitus
-Otalgia
-Otorrhoea
-Vertigo
-Previous ear surgery
-Family history of ear disease

-Paediatric history: Neonatal history / Neonatal hearing / Immunisations

-Social history: Siblings / Smokers in house / Schooling / Speech Developing

Question 11

Rhinology history

Answer 11

-Nasal obstruction
-Nasal discharge
-Sense of smell
-Itch
-Sneezing
-Facial pain
-Surgery / trauma

-DH: Prescribed / OTC
-Social History: Smoking, occupation, pets

Question 12

Head and Neck history

Answer 12

-Hoarseness
-Pain (Throat / Ear)
-Difficulty swallowing
(dysphagia/odynophagia/regurgitation)
-Smoking history +/- Alcohol history
-Weight loss

-SH – Support Network / Family

Question 13

Describe audiograms

Answer 13

-Anything above the 20dB line is essentially normal. Y-axis decibels (volume), x-axis Hertz (pitch)

CIRCLE= air conduction R
CROSS= air conduction L
< Bone conduction R
> Bone conduction L
Other symbols= masked
Red= Right
Blue= Left

Question 14

Audiogram interpretation

Answer 14

-In sensorineural hearing loss both air and bone conduction are impaired
-In conductive hearing loss only air conduction is impaired
-In mixed hearing loss both air and bone conduction are impaired, with air conduction often being ‘worse’ than bone
-Presbycusis (age-related hearing loss)= bilateral and symmetrical hearing loss above 2000Hz (overall down-sloping line)
-Noise-induced hearing loss= notch on audiogram at 4000 Hz
-Meniere’s disease= low frequency sensorineural hearing loss

-Mild hearing loss= 20-40dB
-Moderate= 41-70
-Severe= 71-95
-Profound= >95

Question 15

What does a tympanogram measure?

Answer 15

-Tympanic mobility
=Peak around 0 (normal)
=Flat (no movement)= fluid/ hole in ear drum