Skull, Face, Nose, Ears

Question 1

What are the different sections to this examination?

Answer 1

Inspection - eyes, skull/face, nose, ears
Auriscope
Palpation - face/skull, nose, ears
Hearing tests - Speaking, Rinne’s, Weber’s

Question 2

What are you looking for on inspection of head, generally?

Answer 2

Shape of face/skull
Symmetry
Expression
Scars, skin (rashes, acne, blisters, vitiligo)
Swellings/pulsations
Hair (distribution, loss)
Movements (weakness)

Question 3

What are you looking for on inspection of the individual areas of the face/skull?

Answer 3

Eyes

• lid lap, proptosis, eye movements
• jaundice/anaemia in sclera
• features of thyroid eye disease

Skull/face

• Cushing’s features
• acromegaly
• bony changes suggestive of underlying disease/genetic syndromes

Nose

• look from front, side, above
• observe nasal pyramid
• note any discharge
• assess airflow in each nostril
• elevate tip and look inside with torch

Ears

• note nodules/lesions on pinna
• note if pinna pushed forward (mastoiditis)
• note any discharge
• look behind pinna
• look at mastoid process (bruising, Battle’s sign)

Question 4

What is palpated in this exam?

Answer 4

Face/Skull

• Mastoid process
• Orbital margin
• Tenderness on temporal artery
• Maxilla, mandible
• Feel TMJ as patient opens/closes jaw, and moves side to side

Nose

• Palpate nasal cartilage and bones
• Feel for tenderness over the paranasal sinuses (maxillary, ethmoidal, frontal)

Ears
- press in front of meatus or pull gently or pinna - pain = possible infection in canal

Question 5

How are the findings of the hearing tests interpreted?

Answer 5

Rinne’s

• Air louder than bone = Positive and normal
• Bone louder than air = conductive deafness

Weber’s

• Equal in both ears = normal
• Conductive loss = louder in affected ear
• Sensorineural loss = louder in good ear