Examination of ENT Flashcards
Symptoms of ear
otalgia (earache) Hearing loss Discharge (otorrhoe) tinnitus vertigo facial palsy
Name 4 sites where pain in the ear may be referred from
TMJ Nose and sinuses Mandibular teeth Throat Larynx Cervical spine
How do you perform otoscopy?
In adults: pull the pinna upwards, backwards and outwards In children: pull the pinna backwards and downwards Due to differing structural alignments of the EAM
Common diseases of the ear
Ear wax - build up of war wax can affect hearing.
Otitis externa - diffuse inflammation of the skin in the ear canal. Can be bacterial, viral or fungal.
Otitis media - discharge from the middle ear through perforation of the tympanic membrane.Treat with NSAIDs then antibiotics
Cholesteatoma: sac of keratinising squamous epithelium in the middle ear. Defect in the middle ear with white cheesy material.
Glue ear: secretory otitis media with effusion. Due to Eustachian tube dysfunction. Grommet is inserted into the tympanic membrane to ventilate the middle ear cavity.
Hearing test used to asses ear
Free-field voice test: Stand behind the patient and whisper. Mask non-test ear by tragal rubbing and speak in a conversational voice. Use a combination of numbers and bi-syllable words.
Weber’s test: Tuning fork 256/512Hz placed on the frontal bone. Assesses if sound is heard equally in both ears
Rinne’s test: Tuning fork placed in front of the ear, when the patients cannot hear the sound, it is placed behind the ear (mastoid) to check hearing
Difference between conductive and sensorineural hearing loss
Conductive: problem is in the outer or middle ear
Sensorineural: problem is in the inner ear or cochlear nerve
How do tuning fork tests differentiate between the two types of hearing loss?
The inner ear is twice as sensitive to sound conducted by air than conducted by bone. Conductive hearing loss is caused by a problem in the outer or middle ear. In conductive hearing loss, the affected ear is subject to less environmental noise, and therefore becomes more sensitive to bone-conduction.
Weber’s test: Tuning fork vibrates and sound travels to the ears via bone. If there is sensorineural hearing loss on the left, sound is louder on the right. If there is conductive hearing loss, sound is louder on the left.
Rinne’s test: Compares air conduction with bone conduction. Normally patients should be able to hear sounds via bone conduction when air conduction has diminished. In conducting hearing loss, bone conduction is louder (R negative). In sensorineural hearing loss, air conduction is louder in the normal ear (R positive).
Common complaints in nasal disease
Nasal obstruction
Nasal discharge and postnasal drip
Sneezing
Loss of smell
Facial pressure/pain
Bleeding
Cosmetic deformities
Examination of the nose
Inspection: examine the shape of the nose, lift the tip of the nose
Anterior rhinoscopy with a thidichum speculum
Endoscopy
Common complaints in throat disease
Pain
Hoarseness
Dysphagia
Lumps in the neck
Stridor
Examination of the throat
Inspection: tongue depressor
Bimanual palpation of the floor of the mouth
Laryngoscopy
Inspection and palpation of the neck
What is Weber’s test used for?
Weber’s test investigates sensorineural deficit.
The base of a tuning fork is placed on the middle of the patient’s forehead:
If the sound is located more on one side, then either conduction deafness exists on that side, or sensorineural deafness exists in the other.
The test is repeated by covering the ear in which the sound was faintest. Normally the closed ear hears best by bone-conduction.
If no sound is heard in the covered ear sensorineural deafness is confirmed.
