CLINICAL PRESENTATION EAR

Name/age/sex/occupation/address
PRESENTING COMPLAINTS
MAJOR
 Ear discharge
 Hard of hearing
 Ear ache
 Tinnitus
 Vertigo
MINOR
 Itching
 Fullness of ear

HISTORY OF PRESENTING COMPLAINTS

EAR DISCHARGE:
 Side
 Duration
 Onset
 Episodic continuous
 Amount-profuse/moderate/scanty
 Sticky/non sticky
 Colour-white/Yellow blood stained
 Smell-foul/non foul
 Associated with hard of hearing
 Aggravating factors-URI/Head bath/cold liquids
 Relieving factors
ACHE
 Side
 Duration
 Onset
 Characteristic
 Sleep disturbance
 Site
 Aggravating/relieving factors-chewing/eating/sneezing pressure over tragus pulling auricle
 Associated with otorrhea
HARD OF HEARING
 Side
 Duration
 Onset
 Progression
 Pain
 H/O noise induced trauma
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Rovanzers’11,CHMC
  H/O drug abuse

TINNITUS
 Side
 Duration
 Onset
 Progression
 Characteristic
 Pitch
 Sleep disturbance
 Aggravating factors-alcohol/exercise
 Relieving factors-drugs/yawning
VERTIGO
 H/O unsteadiness or fall
 Duration
 Episodic/constant
 Aggravating/Relieving factors
 Nausea/Vomiting/HOH/Otorrhea/fullness of ear
HISTORY OF ETIOLOGY
 Nasal obstruction/nasal discharge
 Post nasal discharge(hawking sensation)
 Facial pain
 Throat pain/irritation
HISTORY OF UNSAFE EAR/INTRA CRANIAL COMPLICATIONS
 Head ache, nausea, vomiting
 Angulation of mouth/improper closure of eyelids(XII N lesion)
 H/o suggestive of focal neurological defect due to cerebral or cerebellar lesions
HISTORY OF PAST ILLNESS
 No of similar episodes
 H/O of surgery
 Ototoxic topical medication
 H/O of exanthematous illness-causes florid infection,several inflammation of middle ear mucosa
beyond the limitation of healing process
 DM/HT/EPILEPSY/JAUNDICE/BLOOD TRANFUION
PERSONAL HISTORY
 Diet
 Tobacco abuse
 Alcohol abuse
 Swimming in ponds/infected water
 Working environment
 Frequent ear cleaning/ear picking
FAMILY HISTORY
 Family environment
 Family HOH-osteosclerosis,deafness associated with consanguineous marriage
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EAR EXAMINATION
PREAURICULAR REGION (NORMAL OR NOT)
 Scanning previous trauma or surgery
 Swelling-Zygomatic abscess/lymph node
 Sinus
 Tragus tenderness
AURICLE (NORMAL OR NOT)
 Size- Microtia,macrotia
 Shape- Cauliflower ear / Peri-chondritis
 Bat ear
 Redness - Furuncle
 Swelling-hematoma, abscess
 Scar
 Hong Kong ear-diffuse otitis externa
POST-AURICULAR REGION (NORMAL OR NOT)
 Obliteration of sulcus
 Scar
 Swelling-abscess/lymph node/ edema
 Thrombosis in mastoid region-Greisinger sign due to mastoid emissary vein thrombosis from the
extension of the sigmoid sinus thrombosis
 Mastoid –cat fur feeling or ironed out appearance in mastoiditis
 Mastoid tenderness
 Fistula
EAR
 Skin
 Discharge
 Granulation
 Polyp
 Wax
 Fungus
 Mass
 Sagging of wall
 Swelling- furuncle, osteoma, exostosis, neoplasm
TYMPANIC MEMBRANE
 Pars tensa
 Cone of light
 Distorted-early catarrh/AOM
 Multiple and broken-tympanosclerosisrly
 Absent-AOM/SOM
 Multiple-graft
 Congested-AOM
 Colour-normal(pearly white),LOS(lustre less grating),bluish (SOM, haemotympanum) otosclerosis
(flamingo pink sign-active stage),chalky plaque-tympanosclerosis
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  Bulged TM-AOM
 Retracted TM-SOM, tubal obstruction
 Retraction pocket,atelectasis,adhesive otitis media
 Perforation-number,site,shape,size
 Discharge

PARS FLACCIDA
 Perforation
 Retraction pocket
 Congestion
 Discharge
 Polyp
 White flakes (Cholesteatoma)
PERFORATION
 Middle ear mucosa over promontory
 ET orifice seen fully or partially, pus if any
 Round window
 Long process of incus
 Chorda tympani
 Incudo-stapedial joint
MIDLLE EAR MUCOSA
 Pale/congested
 Edematous
 Dirty discharge
 Granulation/polypoidal
FUNCTIONAL EXAMINATION OF THE EAR
HEARING
 Tuning fork tests
 Rinnie
 Weber
 ABC
VESTIBULAR FUNCTION TESTS
 Nystagmus
 Fistula test
FACIAL NERVE
 Check movements of the facial muscles
DIAGNOSIS
 Unilateral/Bilateral
 Acute/chronic
 Suppurative/non-suppurative otitis media
 Tubo-tympanic/attico-antral
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  Conductive/SN/mixed hearing loss
 Active/inactive
 Associated with nose/throat pathology
 Associated with intracranial complications

CLINICAL PRESENTATION NOSE

Name/age/sex/occupation/address
PRESENTING COMPLAINTS
MAJOR
 Nasal obstruction
 Nasal discharge
 Head ache
 Disturbance of smell
 Epistaxis
MINOR
 Sneezing
 Nasal mass/deformity
 Pain in the nose
 Bad odor
 Hawking sensation
 Snoring
 Change of voice-hypo/hypernasality
HISTORY OF PRESENTING COMPLAINTS
NASAL OBSTRUCTION
 Side
 Onset
 Duration
 Progressive/non-progressive/cyclical
 Frequency
 Aggravating or precipitating factors-UTI,allergy,weather changes seasonal ,diurnal
 Relieving factors
NASAL DISCHARGE
 Side
 Onset
 Duration
 Quantity
 Anterior/posterior nasal
 Color
 Consistency
 Smell
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Rovanzers’11,CHMC
  Blood stained
HEAD ACHE
 Side
 Onset
 Duration
 Character-throbbing/dull aching
 Periodicity
 Associated with-vomitting,epilepsy,LOC
 Aggravating/relieving factors

DISTURBANCE OF SMELL
 Duration
 Onset
 Complete, incomplete/perverted
 Taste disturbance
 H/O Trauma/epilepsy/fever
 Aggravating factors
EPISTAXIS
 Side
 Anterior/posterior
 Amount
 Provoked, unprovoked
 Duration
 How it stops
ALLERGY
 Sneezing/itching nose,eyes,palate,watering eyes
 H/O of postnasal drip
PAST HISTORY
According to case
PERSONAL HISTORY
 Diet
 Smoking
 Alcohol
 Frequent nose picking
 Dusty environment
 Industry working-painting
 Agricultural work
FAMILY STORY
 Malignancy
 House overcrowding
EXAMINATION OF THE NOSE
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  Skin
 Vestibule
 Collumella
 Intercantheral line
 Tip
 Alae
 Nasolabial fold
 Nasomaxillary fold
 Scars
ANTERIOR RHINOSCOPY
 Septum-position/spur/crust/perforation
 Lateral nasal wall-inferior & middle turbinate and meatus
 Floor
 Mucosa-color/consistency/bleeding points/blood clots/edema/crust drainage
 Mass-side, probable site of origin distance from the anterior nasal septum. Shape, Surface
 Cold spatula test
POSTERIOR RHINOSCOPY
 Roof
 Posterior end of nasal septum
 Posterior part of inferior and middle turbinate

CLINICAL PRESENTATION THROAT

Name/age/sex/occupation/address
MAJOR
 Difficulty in swallowing
 Change of voice
 Pain-neck/sore throat/ear pain
 Swelling neck
 Aspiration
 Hemoptysis
 Cough with expectoration
 Dyspnea
MINOR
 Sore throat
 Snoring
 Halitosis
 Repeated clearing of throat
 Ear block
 Regurgitation
 Stridor
HISTORY OF PRESENTING ILLNESS
DIFFICULTY IN SWALLOWING
 Onset
 Duration
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  Solid/liquid/semisolid
 Amount of feeds/absolute dysphagia
 Dysphagia due to pain or regurgitation
 Progressive/non progressive
 H/O of foreign body ingestion/corrosive/trauma
 Pain
CHANGE OF VOICE
 Duration
 Onset
 Progression
 Quality
 Aggravating/relieving factors
PAIN-NECK PAIN/SORE THROAT/EAR PAIN
 Site
 Duration
 Character
 Radiation
 Aggravating/relieving factors
SWELLING NECK
 Site
 Duration
 Onset
 Progression
 Aggravating/relieving factors
ASPIRATION
 Chocking spells(cough with taking food)

H/O cough
 Expectoration
 Hemoptysis
 Associated with fever
DIFFICULTY IN BREATHING
 Duration
 Rest of exertion
 Inspiration/expiration
 Noisy breathing
 Relieving factors
 H/O frequent clearing of throat
 H/O nasal regurgitation
 H/O weight loss and anorexia
 Snoring
 Halitosis
 Ear block
HISTORY OF PAST ILLNESS

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  Treatment of present symptoms –medical/surgical-tracheostomy,biopsy,admission in hospital ,blood
transfusion if any
 Any other neck surgeries like thyroidectomy,tonsillectomy
 H/O: PTB/DM/HT/Drug allergy
FAMILY HISTORY
 Malignancy
 Socio-economic status
PERSONAL HISTORY
 Diet
 Tobacco abuse
 Alcohol abuse
 Occupation-industrial pollution/agricultural work exposure to chemicals, voice abuse in teacher

EXAMINATION OF THROAT
Oral cavity and oropharynx
 Lip
 Gingivolabial fold
 Teeth
 Gums
 Gingivobuccal sulcus
 Floor of mouth
 Anterior 2/3 of tongue
 Hard palate
 Soft palate
 Anterior pillar
 Tonsillar fossa
 Posterior pillar
 Retromandibular trigone
 Posterior pharyngeal wall
INDIRECT LARYNGOSCOPY
 Posterior 1/3 of tongue
 Valleculla
 Median and lateral glossoepiglottic fold
 Epiglottis
 Aryepiglottic fold
 Arytenoids
 Ventricular band
 Vocal chord,anterior and posterior commissure
 Subglottic area
 Pyriform fossa
 Posterior cricoid area
 Posterior pharyngeal wall
GROWTH PRESENTS

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  Ulcerative/proliferative
 Color and surface of growth
 Extent
 Probable site of origin
 Vocal cord involvement
 Vocal cord mobility
 Edema of ventricular band
 Granulations
 Arytenoid edema
 Pooling of saliva-pyriform fossa
 Lateral wall – tubal elevation
 PNS tenderness
DIAGNOSIS

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