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  1. ENT Undergraduate Lecture introduction to ENT History and Clinical Examination Dr. ZAID AL-DAHWI Consultant ENT Head of ENT department KING SAUD MEDICAL CITY

  2. Evaluation of ENT Patient Personal history • Name • Age • Sex • Nationality • Residence • Occupation • Habbits (smoking) • Marital state

  3. Evaluation of ENT Patient History of present illness • We asked about: • The present symptoms • The onset, • The duration, • Progression and severity • Any systemic disease • e.g. diabetes, hypertension, coronary artery disease, liver or kidney disease, or a bleeding disorder. • Treatment has taken.

  4. Evaluation of ENT Patient History of past illness • History of • Similar complaints in the past, • Previous operations • Allergy to any drug.

  5. Evaluation of ENT Patient Family history • Family history of same disorder • Some diseases have a genetic basis, • e.g. certain types of SNHL

  6. Evaluation of ENT Patient THE CLINICAL EXAMINATION

  7. EXAMINATIONofTHE EAR

  8. Symptoms OF EAR • A patient with ear disease presents with one or more of the following complaints: • 1. Hearing loss. • 2. Tinnitus. • 3. Dizziness or vertigo. • 5. Earache. • 4. Ear discharge. • 6. Itching in the ear. • 7. Deformity of ear pinna. • 8. Swelling around the ear.

  9. Examination of Ear Pinna • Inspection • Size • microtia, • macrotia

  10. Examination of Ear Pinna • Inspection • size (microtia, macrotia) • shape • cauliflower ear

  11. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position • bat ear.

  12. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • Redness • Perichondritis

  13. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • Redness (perichondritis); • Swelling • Auricular haematoma, or abcess

  14. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • Redness (perichondritis); • Swelling • haematoma, or abcess • Sebacious cyst

  15. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • Redness (perichondritis); • Swelling (haematoma, sebacious cyst); • Vesicles (herpes zoster)

  16. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • redness (PERICHONDRITIS); • swelling (haematoma, SEBACIOUS CYST); • vesicles (herpes zoster); • sinus • preauricular sinus.

  17. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • redness (PERICHONDRITIS); • swelling (haematoma, SEBACIOUS CYST); • vesicles (herpes zoster); • sinus (preauricular sinus.) • Ulceration or neoplasm. • Basal cell carcinoma

  18. Examination of Ear Pinna • Inspection • size (microtia, macrotia); • shape (cauliflower ear); • position (bat ear). • redness (PERICHONDRITIS); • swelling (haematoma, SEBACIOUS CYST); • vesicles in concha and retroauricular groove (herpes zoster); • ulceration or neoplasm. • sinus (preauricular sinus). • Palpation ; • Fluctuation • (hematoma or abscess) • Tenderness • (furunculosis)

  19. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • Size of meatus • (narrow or wide),

  20. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • Size of meatus (narrow or wide), • swelling • furuncle,

  21. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • Size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp

  22. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • Size of meatus (narrow or wide), • swelling • furuncle, • Aural Polyp • Exostosis. Exostosis(cold water swimmers)

  23. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • Size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Exostosis • Osteomas. Osteomas (beningneoplasia)

  24. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • Size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Exostosis • Osteomas. • neoplasm. Squamouspapilloma in EAC

  25. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Tumour • contents of lumen • wax,

  26. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Tumour • contents of lumen • wax, • OtitisExterna • Necrotizing

  27. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Tumour • contents of lumen • wax, • OtitisExterna • Fungal • Otomycosis • Candida albicans

  28. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Tumour • contents of lumen • wax, • OtitisExterna • fungal • discharge

  29. Examination of external auditory canal • The pinna is pulled upwards and back­wards • Inspection • size of meatus (narrow or wide), • swelling • furuncle, • AuralPolyp • Tumour • contents of lumen • wax, • OtitisExterna • fungal • discharge • FB

  30. Examination of Mastoid • Acute Mastoiditis

  31. Examination of tympanic membrane • Normaltympanicmembrane is pearly white in color and semi­transparent

  32. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • A tympanic membrane is examined for: • (a) Colour. • Red and congested in acute otitis media, bluish in secretoryotitismedi or haemotympanum. A chalky plaque is seen in tympanosclerosis.

  33. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • A tympanic membrane is examined for: • (a) Colour. • Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis.

  34. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • A tympanic membrane is examined for: • (a) Colour. • Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis.

  35. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • . A tympanic membrane is examined for: • (a) Colour. Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis. • (b) Position. • retracting or • bulging.

  36. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • . A tympanic membrane is examined for: • (a) Colour. Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis. • (b) Position. • Retracting or • Bulging.

  37. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • . A tympanic membrane is examined for: • (a) Colour. Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis. • (b) Position. Tympanic membrane may be retracting or bulging. • (c) Surface of tympanic membrane. • show bullae , or • perforation

  38. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • . A tympanic membrane is examined for: • (a) Colour. Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis. • (b) Position. Tympanic membrane may be retracting or bulging. • (c) Surface of tympanic membrane. • show bullae , or • perforation

  39. Examination of tympanic membrane • Normal tympanic membrane is pearly white in colour and semi­transparent • . A tympanic membrane is examined for: • (a) Colour. Red and congested in acute otitis media, bluish in secretoryotitismedici or haemotympanum. A chalky plaque is seen in tympanosclerosis. • (b) Position. Tympanic membrane may be retracting or bulging. • (c) Surface of tympanic membrane. • show bullae , or • Perforation • Cholesteatoma

  40. Examination of facial nerve. • Paralysis of facial nerve may co-exist with disease of the ear,

  41. Auditory and Vestibular function • Tuning fork tests • Rinne test

  42. Auditory and Vestibular function • Tuning fork tests • Rinne test • Weber test

  43. Auditory and Vestibular function • Tuning fork tests • Rinne test • Weber test • Pure tone audiogram (PTA)

  44. Auditory and Vestibular function • Tuning fork tests • Rinne test • Weber test • Pure tone audiogram (PTA) • Tympanogram

  45. Auditory and Vestibular function • Tuning fork tests • Rinne test • Weber test • Pure tone audiogram (PTA) • Tympanogram • Nystagmus

  46. Auditory and Vestibular function • Tuning fork tests • Rinne test • Weber test • Pure tone audiogram (PTA) • Tympanogram • Spontaneous nystagmus • Fistula test

  47. EXAMINATIONof THE NOSE

  48. Symptoms of NOSE AND PARANASAL SINUSES • A patient with nose disease presents with one or more of the following complaints: • 1. Nasal obstruction. • 2. Nasal discharge. • 3. Post-nasal drip. • 4. Epistaxis. • 5. Sneezing. • 6. Headache or facial pain. • 7. Swelling or deformity. • 8. Disturbances of smell. • 9. Snoring. • 10. Change in voice (hyper- or hyponasality).

  49. EXAMINATION External Nose • signs of inflammation (furuncle, abscess)

  50. EXAMINATION External Nose • signs of inflammation (furuncle, abscess) • swelling • Glioma non-neoplastic lesion consisting of neuroglial tissue without the communication to the central nervous sytem