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    Basic Physical Examination in ENT PDF

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    JayricDepalobos
    The document provides information on performing a basic physical examination of the head and neck region in the ENT department. It describes the necessary equipment including a chair with a headrest, light source, and various examination instruments. It then covers examining specific areas such as the ear by inspecting the pinna and using an otoscope, performing tuning fork tests to assess hearing, and examining the nose both externally and with anterior and posterior rhinoscopy. Oral structures like the tongue, palate, tonsils and oropharynx are also inspected. Indirect and direct laryngoscopy allow viewing of the larynx and vocal cords. Finally, the neck is examined including inspection of cervical lymph nodes and the thyroid and parathyroid g

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    © All Rights Reserved
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    Basic Physical Examination in ENT PDF

    Uploaded by

    JayricDepalobos
    277 views44 pages
    The document provides information on performing a basic physical examination of the head and neck region in the ENT department. It describes the necessary equipment including a chair with a headrest, light source, and various examination instruments. It then covers examining specific areas such as the ear by inspecting the pinna and using an otoscope, performing tuning fork tests to assess hearing, and examining the nose both externally and with anterior and posterior rhinoscopy. Oral structures like the tongue, palate, tonsils and oropharynx are also inspected. Indirect and direct laryngoscopy allow viewing of the larynx and vocal cords. Finally, the neck is examined including inspection of cervical lymph nodes and the thyroid and parathyroid g

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    The document provides information on performing a basic physical examination of the head and neck region in the ENT department. It describes the necessary equipment including a chair with a headrest, light source, and various examination instruments. It then covers examining specific areas such as the ear by inspecting the pinna and using an otoscope, performing tuning fork tests to assess hearing, and examining the nose both externally and with anterior and posterior rhinoscopy. Oral structures like the tongue, palate, tonsils and oropharynx are also inspected. Indirect and direct laryngoscopy allow viewing of the larynx and vocal cords. Finally, the neck is examined including inspection of cervical lymph nodes and the thyroid and parathyroid g

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    277 views44 pages

    Basic Physical Examination in ENT PDF

    Uploaded by

    JayricDepalobos
    The document provides information on performing a basic physical examination of the head and neck region in the ENT department. It describes the necessary equipment including a chair with a headrest, light source, and various examination instruments. It then covers examining specific areas such as the ear by inspecting the pinna and using an otoscope, performing tuning fork tests to assess hearing, and examining the nose both externally and with anterior and posterior rhinoscopy. Oral structures like the tongue, palate, tonsils and oropharynx are also inspected. Indirect and direct laryngoscopy allow viewing of the larynx and vocal cords. Finally, the neck is examined including inspection of cervical lymph nodes and the thyroid and parathyroid g

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    of 44

    Basic Physical Examination

    in ENT Head and Neck


    Department of Otolaryngology
    Head and Neck Surgery
    St. Lukes Medical Center
    EQUIPMENT
    1. Chair with Head
    rest
    2. Light Source
    3. Instrument
    Cabinet
    EQUIPMENT
    Head Mirror

    leaves both hands


    free for
    examination

    positioned over the


    left eye and close
    to the examiners
    face
    EQUIPMENT
    How to focus the head mirror

    The patient sits on the stool at the same level as the doctor.

    Patient's legs should be to one side of the examiner.

    The distance between the doctor and patient should not be


    more than 8 inches (Depending on the maximum focal length
    of head mirror).

    Fix the mirror on the left eye so that part of the mirror touches
    the nose.

    Adjust the mirror so that you are seeing through the hole.
    Close the right eye and focus the mirror by rotating it.

    Open both the eyes.


    EQUIPMENT
    Basic Instruments

    3. Ear specula
    4. Nasal Specula

    5. Tongue depressors

    6. Indirect laryngoscopy mirrors

    7. Posterior Rhinoscopy mirrors

    8. Nasal and aural forceps.

    9. Tuning forks, 512 Hz, 1024 Hz

    10. Otoscope
    EAR EXAM
    EAR EXAM
    EAR EXAM

    begin with
    inspection and
    palpation of the
    pinna (auricle) and
    structures
    surrounding the
    ear
    OTOSCOPY
    Otoscopy is used to
    visualize the ear
    canal/eardrum for
    the purpose of
    detecting abnormal
    conditions that
    might require
    further evaluation
    or treatment.
    OTOSCOPY

    grasp and retract


    the pinna backward
    and upward in
    adults and
    downwards in
    infants
    OTOSCOPY
    An - annulus fibrosus

    Lpi (long process of incus) -


    sometimes visible through a healthy
    translucent drum

    Um (umbo) - the end of the


    malleus handle and the centre of the
    drum

    Lr (light reflex) - antero-inferiorly

    Lp (Lateral process of the malleus)

    At (Attic) also known as pars


    flaccida

    Hm (handle of the malleus)


    PNEMATIC OTOSCOPY
    "allows the examiner to
    observe movement of the
    tympanic membrane
    directly". "If the tympanic
    membrane does not move
    perceptibly with
    applications of slight
    positive or negative
    pressure, a middle ear
    effusion is highly likely".
    (Bluestone and Klein,
    1990)
    PNEUMATIC OTOSCOPY
    TUNING FORK TEST
    Indication: Differentiate type of
    Hearing Loss

    Sensorineural Hearing Loss


    Conductive Hearing Loss
    TUNING FORK TEST

    Preparation

    Tuning fork should


    be 512 Hz to 1024
    Hz
    WEBER TEST
    Technique: Tuning Fork
    placed at midline forehead

    Normal: Sound radiates to


    both ears equally

    Abnormal: Sound lateralizes


    to one ear
    Ipsilateral
    Conductive Hearing Loss OR
    Contralateral Sensorineural
    Hearing Loss
    RINNE TEST
    Technique
    First: Bone Conduction
    Vibrating Tuning Fork held on
    Mastoid
    Patient covers opposite ear with

    hand
    Patient signals when sound ceases

    Move the vibrating tuning fork over

    the ear canal (Near, but not


    touching the ear)

    Next: Air Conduction


    Patient indicates when the sound
    ceases
    RINNE TEST
    Normal: Air Conduction is better than
    Bone Conduction
    Air conduction usually persists twice as long as
    bone

    Referred to as "positive test"

    Abnormal: Bone conduction better


    than air conduction
    Suggests Conductive Hearing Loss

    Referred to as "negative test"


    Test for Eustachian Tube
    Function
    1. Valsalva Maneuver:

    Method:
    After taking a deep breath, the patient pinches his nose and
    closes his mouth in an attempt to blow air in his ears. Otoscopy
    shows movement of the drum.

    Note: Failure of this test does not prove pathologic occlusion of


    the tube.

    This maneuver in the presence of nasal and nasopharyngeal


    infection carries the danger of transmission of infection to the
    ear.

    2. Toynbee's test:

    It is safer and confirms normal tubal function.

    Method: The nose is closed and the patient swallows. There is in


    drawing of the tympanic membrane, confirmed by otoscopy.
    NOSE
    EXAMINATION OF THE NOSE
    The nose can be examined in three
    parts:

    3. Examination of the external nose


    4. Anterior Rhinoscopy
    5. Posterior Rhinoscopy.
    EXAMINATION OF THE
    EXTERNAL NOSE
    Inspection:
    Congenital deformities (Clefts)
    Acquired Deformities
    Shape
    Swelling ( Inflammatory, cysts, tumors)
    Ulceration ( Trauma, neoplastic, infective)

    Palpation:
    Tenderness
    Crepitus
    Deformities
    Anterior Rhinoscopy
    1. Examination of the Vestibule

    Look for:
    Boil or Abcess
    Ulcerations and abrasions
    Excoriation because of discharge.
    ANTERIOR RHINOSCOPY

    2. Examination of
    the nasal cavity
    using a nasal
    speculum:
    POSTERIOR RHINOSCOPY

    Post Nasal Mirror:

    It consists of a
    handle on which a
    small mirror is
    attached to shaft
    at an angle of 110.
    POSTERIOR RHINOSCOPY
    Technique
    2. Hold the mirror like a pen in the right hand.

    4. Warm the mirror

    6. Ask the patient to open the mouth.

    8. Depress the anterior 2/3rds of the tongue

    10. Feel the warmth of the mirror on the back of the wrist. It should
    not be hot.

    12. Introduce the mirror from the angle of the mouth over the
    tongue depressor and slide it behind the uvula. Avoid touching
    the posterior wall of the pharynx as it may trigger gagging.

    14. Instruct the patient to breath through the nose.

    16. Tilt the mirror in different direction tot see various structures of
    the nasopharynx.
    POSTERIOR RHINOSCOPY
    PARANASAL SINUSES
    TRANSILLUMINATION TEST
    Dim the room lights.

    Place the lighted otoscope


    directly on the infraorbital rim
    (bone just below the eye).

    Ask the patient to open their


    mouth and look for light
    glowing through the mucosa
    of the upper mouth.

    Principle: In the setting of


    inflammation, the maxillary
    sinus becomes fluid filled and
    will not allow this
    transillumination.
    ORAL CAVITY
    ORAL CAVITY
    Tongue

    Check for:
    Common and taste sensations

    Size: Macroglossia in acromegaly,


    Down's syndrome
    Ulcers

    Movements: Restricted in
    hypoglossal palsies, tumor
    infiltration
    Fasciculation: Motor neuron disease

    Depapillation: Vitamin deficiencies

    Furrowing , as in geographic tongue

    Coating: Thrush, black hairy tongue


    ORAL CAVITY
    Buccal Mucosa: Parotid duct opening Opposite
    upper 2nd molar), red or white patches, ulcers,
    moisture

    Hard Palate: Swelling, ulcer, perforations,


    clefts etc.

    Uvula: Position, deviations (Towards the


    normal side in palsies), ulcers

    Floor of mouth: Wharton duct openings, ulcers,


    and bimanual palpation

    Teeth and occlusion



    OROPHARYNX
    Soft Palate: Swelling, ulcer,
    movement, perforations,
    clefts etc.

    Uvula: Position, deviations


    (Towards the normal side in
    palsies), ulcers

    Tonsillar pillars: congestion,


    ulcers, patches.

    Tonsils: Presence, size,


    crypts, ulcers

    Posterior pharyngeal wall:


    Lymphoid follicles, ulcers.
    LARYNGOSCOPY
    Definition
    Visual exam of the voice box (larynx)
    and the vocal cords.

    Laryngoscopy is also done to remove


    foreign objects stuck in the throat.
    LARYNGOSCOPY
    There are two main kinds:

    1.Indirect laryngoscopy - uses mirrors


    to examine the larynx and
    hypopharynx

    2.Direct laryngoscopy - uses a special


    instrument (flexible or rigid scope)
    INDIRECT LARYNGOSCOPY
    Technique

    3. Mirror is held like a pen in the right hand with the glass
    pointing downwards.

    5. Warm the mirror and test the temperature on the back of


    the hand.

    7. The patient is asked to stick out the tongue which is held


    with a piece of gauze.

    9. The patient is asked to breath through the mouth.

    11. The mirror is introduced into the mouth to the uvula which
    is gently pushed back to get a view of the larynx and the
    pyriform fossae.
    12. The patient is asked to say 'Aaa' and 'Eee'.
    INDIRECT LARYNGOSCOPY
    HEAD AND NECK
    NECK
    LYMPH NODE LEVELS
    I--Submental and
    submandibular nodes

    II--Upper jugulodigastric
    group

    III--Middle jugular nodes


    draining the naso- and
    oropharynx, oral cavity,
    hypopharynx, larynx.

    IV--Inferior jugular nodes


    draining the hypopharynx,
    subglottic larynx, thyroid, and
    esophagus.

    V-- Posterior triangle group

    VI--Anterior compartment
    group
    CERVICAL LYMPH NODES
    THYROID AND PARATHYROID
    GLANDS
    SALIVARY GLANDS
    THANK YOU

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