Head & Neck Examination - Skull, Face, Nose & Ears

Question 1

How do you inspect the head and neck area?

Answer 1

1) Look at face and neck area:
- Expression
- Symmetry
- Swellings
- Hair distribution
2) Eyes:
- Lid lag
- Proptosis
- Check sclera for jaundice
3) Nose:
- Look at nose from different angles and notice any discharge
- Ask patient to block one nostral and assess airflow of other nostril (block nostril with their thumb)
- Elevate tip of nose to inspect nasal vestibule (use a light)
4) Ears:
- Examine outer ear (pinna) for any nodules
- Notice if pinna is pushed forward
- Look in the ear canal and note any discharges
- Check mastoid process for bruising

Question 2

How do you perform an auriscope examination?

Answer 2

1) Check for any pain in the ears
2) Hold auriscope in the correct way and ask patient to turn their head slightly away from you
3) Gently pull Pinna back and upwards
4) Rest your little finger on the patients cheek for support
5) Inspect the auditory canal and visualize the TM looking for surface landmarks
6) Repeat on other ear

Question 3

How do you perform palpation during a head & neck examination?

Answer 3

1) Palpate each mastoid process
2) Run your fingers around each orbital margin
3) Feel maxilla and mandible
4) Place your index and middle fingers over the TMJ and ask patient to open and close their mouth and then move the jaw sideways
5) Palpate nasal cartilages & bones
6) Feel for tenderness over the paranasal sinuses
7) Palpate the mastoid process on each side

Question 4

What hearing tests are performed during a H&N examination?

Answer 4

1) Whispered voice test:
- Rub tragus of ear NOT being tested and speak at conversational level 60cm form patients ear being tested
- Say a series of numbers and ask patient to repeat back to you
- If heard ok, then repeat this task whilst whispering
2) Tuning fork:
- Use a 512Hz fork

Rinne’s test:

• Compares air conduction to bone conduction in each ear
• Make the fork vibrate
• Hold it around 5cm from auditory meatus and ask if they can hear the sound
• Then place the base of the fork on the mastoid process and check if they can hear it
• Ask ‘which was louder?’
• Test is +ve(normal) if air conduction greater than bone conduction
• Test is -ve if BC greater than AC (conductive deafness)