ENT Examination

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent

Ear Examination0/20

• Inspection
  • SymmetryCheck symmetry (proptosed auricle may indicate mastoiditis)
  • PositionPosition (low-set ears may indicate genetic syndromes)
  • Hearing aidsComment on whether hearing aids are being used
  • Skin changesComment on skin changes
  • Pinna deformitiesComment on pinna deformities
  • External auditory meatusComment on external auditory meatus
  • Mastoid areaComment on mastoid area
• Palpation
  • Pinna tugGently tug pinna (tenderness may suggest mastoiditis)
  • Mastoid palpationtenderness may suggest mastoiditis
  • Pre/postauricular lymph nodes
• OtoscopyExamine auditory canal (wax, foreign bodies, skin quality), tympanic membrane (color, structure, fluid), and visible features behind tympanic membrane (pars tensa, pars flaccida, handle/lateral process of malleolus, cone of light)
  • External canalCheck for discharge, foreign bodies, inflammation, or stenosis
  • Tympanic membraneCheck for color, structure, fluid, and visible features behind the tympanic membrane
  • Visible featuresCheck for pars tensa, pars flaccida, handle/lateral process of malleolus, cone of light
• Hearing Tests
  • Whisper TestCover one ear and softly whisper a number in the other ear
  • Rinné's TestUse 256Hz tuning fork on mastoid process then in front of ear. Normally, air conduction > bone conduction (Rinné positive)
  • Weber's TestPlace 256Hz tuning fork on center of forehead. Sound should be heard centrally in normal hearing

Nose and Sinuses Examination0/10

• InspectionSit facing the patient and ask them to look forward with their head neutral. Lift the tip of the nose with your thumb, use a light source, and inspect the nasal mucosa for abnormalities like bleeding, septal deviation, or enlarged turbinates.
  • SymmetryCheck for symmetry, proptosis, nasal flaring
  • Skin changesCheck for skin changes (rosacea, skin cancers, scarring), symmetry, septal deviation, nasal mucosa abnormalities (bleeding, enlarged turbinates)
  • Septal deviation
• PalpationPalpate nasal bones, assess for obstruction by blocking each nostril, percuss frontal and maxillary sinuses if concerned about sinusitis
  • Nose tendernessPalpate the nasal bones
  • Nasal obstructionBlock each nostril to assess any obstruction by asking the patient to inhale
  • Sinus tendernessPalpate frontal and maxillary sinuses for tenderness (sinusitis)
    • Frontal sinus
    • Maxillary sinus

Mouth and Throat Examination0/10

• General InspectionCheck for swelling at cheeks or mandible, drooling, skin changes (cancers, cyanosis of lips, angular stomatitis, ulcers)
• Oral Cavity InspectionExamine buccal mucosa, palate, teeth, tongue, hard and soft palates for signs of inflammation, infection, or abnormalities
• Oropharynx InspectionUse tongue depressor if needed, identify soft palate and uvula, ask patient to say 'ah', inspect tonsils for size, symmetry, and evidence of infection
  • UvulaCheck for deviation or swelling
  • TonsilsCheck for size, symmetry, and evidence of infection
  • Soft PalateCheck for symmetry and evidence of infection
• PalpationBimanual palpation of submandibular glands, palpate tongue and floor of mouth with gloved hand
  • Submandibular GlandsBimanual palpation of submandibular glands
  • Tongue and Floor of MouthPalpate tongue and floor of mouth with gloved hand
• Cervical Lymph Node Examination

• Hand wash