ENT: History Taking & Examination

Question 1

Remind yourself of key points when examining a neck lump

Answer 1

• Site
  
  • Midline:
    
    • Does it move when swallow → thyroid & thyroglossal cysts
    • Does it move when protrude tongue → thyroglossal cyst
• Size
• Shape (regular or irregular)
• Consistency (soft→cyst, hard→malignancy, rubbery→lymph node)
• Fluctuance (fluctuant→cyst)
• Mobility (asking to turn head whilst palpating can help you determine this)
• Temperature (warm→inflammatory/infective)
• Overlying skin changes (erythema, punctum)
• Tenderness (tender→inflammatory/infective)
• Pulsatility & vascular bruit (may suggest carotid artery aneurysm)

Question 2

Describe how you should hold an otoscope

Answer 2

1. Ensure the light is working on the otoscope and apply a sterile speculum (the largest that will comfortably fit in the external auditory meatus).

2. Pull the pinna upwards and backwards with your other hand to straighten the external auditory canal.

3. Position the otoscope at the external auditory meatus:

• The otoscope should be held in your right hand for the patient’s right ear and vice versa for the left ear.
• Hold the otoscope like a pencil and rest your hand against the patient’s cheek for stability. This will prevent damage to the ear if there is sudden movement.

4. Advance the otoscope under direct vision. Be gentle with the otoscope and ensure movements are slow and considered otherwise you will cause discomfort.

Question 3

Briefly outline how you should do a hearing assessment (if asked to in an OSCE)

Answer 3

• Introduction
• General inspection
  
  • Surroundings
  • Patient
• Gross assessment of hearing (whisper 3 words in pts ear [two syllable or bi-digit] whilst rubbing tragus of other ear to mask. Start at 60cm away and move closer if need to)
• Weber’s and Rinne’s (512Hz tuning fork)
• Examine external ear (pinna, mastoid, pre-auricular region, conchal bowl)
• Palpate
  
  • Tragus for tenderness (otitis externa)
  • Cervical lymph nodes
• Otoscopy
  
  • External auditory canal
  • Tympanic membrane (colour, shape, cone of light, scarring, perforation)
• Complete examination
  
  • Audiometry
  • Tympanometry
  • ?Cranial nerve examination

Question 4

REMEMBER: always ask about balance issues in people presenting with hearing issues and vice versa to help you narrow down pathology