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Dr. ZAID AL-DAHWI Consultant ENT Head of ENT department KING SAUD MEDICAL CITY Dr. ZAID AL-DAHWI Consultant ENT Head of ENT department KING SAUD MEDICAL CITY ENT Undergraduate Lecture

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

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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. Evaluation of ENT Patient

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

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

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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.

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Examination of Ear Pinna Inspection Size microtia, macrotia

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

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

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

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

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

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

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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.

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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

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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)

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

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Examination of external auditory canal The pinna is pulled upwards and back wards Inspection Size of meatus (narrow or wide), swelling furuncle,

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

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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)

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Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swelling furuncle, Aural Polyp Exostosis Osteomas. Osteomas (bening neoplasia)

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Examination of external auditory canal The pinna is pulled upwards and backwards Inspection Size of meatus (narrow or wide), swelling furuncle, Aural Polyp Exostosis Osteomas. neoplasm. Squamous papilloma in EAC

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

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Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swelling furuncle, Aural Polyp Tumour contents of lumen wax, Otitis Externa Necrotizing

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Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swelling furuncle, Aural Polyp Tumour contents of lumen wax, Otitis Externa Fungal Otomycosis Candida albicans

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Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swelling furuncle, Aural Polyp Tumour contents of lumen wax, Otitis Externa fungal discharge

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Examination of external auditory canal The pinna is pulled upwards and backwards Inspection size of meatus (narrow or wide), swelling furuncle, Aural Polyp Tumour contents of lumen wax, Otitis Externa fungal discharge FB

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Examination of Mastoid Acute Mastoiditis

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Examination of tympanic membrane Normal tympanic membrane is pearly white in color and semi transparent

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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 secretory otitis medi or haemotympanum. A chalky plaque is seen in tympanosclerosis.

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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 secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis.

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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 secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis.

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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 secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. retracting or bulging.

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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 secretory otitis medici or haemotympanum. A chalky plaque is seen in tympanosclerosis. (b) Position. Retracting or Bulging.

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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 secretory otitis medici 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

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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 secretory otitis medici 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

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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 secretory otitis medici 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

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

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Auditory and Vestibular function Tuning fork tests Rinne test

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Auditory and Vestibular function Tuning fork tests Rinne test Weber test

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

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

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

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

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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).

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EXAMINATION External Nose signs of inflammation (furuncle, abscess)

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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

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EXAMINATION External Nose signs of inflammation (furuncle, abscess) swelling Glioma Dermoid congenital nasal dermoid. encephalocele.

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EXAMINATION External Nose signs of inflammation (furuncle, abscess) swelling Glioma Dermoid Neoplasm basal cell carcinoma

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EXAMINATION External Nose signs of inflammation (furuncle, septal abscess), swelling (dermoid or glioma) neoplasm (basal cell or squamous cell carcinoma). Nasal Deformity

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EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards.

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EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards. It is examined for a furuncle,

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EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards. It is examined for a furuncle, a dislocated caudal end of the septum, and

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EXAMINATION NASAL Vestibule It can be easily examined by tilting the tip of nose upwards. It is examined for a furuncle, a dislocated caudal end of the septum, and Tumours Squamous cell carcinoma

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Anterior Rhinoscopy Look for: Septum. Deviation or spur,

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Anterior Rhinoscopy Look for: Septum. Deviation or spur, Perforation,

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Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess).

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Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Bleeding Point (Littles area) Kiesselbach's plexus

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Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer, perforation, Swelling (haematoma or abscess). Floor: FB

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Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer, perforation, Swelling (haematoma or abscess). Floor: FB Lateral Wall (Turbinates): Pale, Hypertrophy

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Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Floor of nose. swelling (dental cyst), neoplasm (haemangioma), or granulations (foreign body ) Lateral wall. Look at the turbinates and meatuses. Pale mucosa and HIT(allergy), rudimentary in atrophic rhinitis),

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Para-Nasal-Sinuses Eye Examination Ethmoiditis and orbital cellulitis

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Anterior Rhinoscopy Look: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Floor of nose. swelling (dental cyst), neoplasm (haemangioma), or granulations (foreign body ) Lateral wall. Look at the turbinates and meatuses. Pale mucosa and HIT(allergy), rudimentary in atrophic rhinitis), discharge in the middle meatus (infection of maxillary, frontal or anterior ethmoidal sinuses),

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Anterior Rhinoscopy Look for the following points: Septum. Deviation or spur, ulcer, perforation, swelling (haematoma or abscess). Floor of nose. swelling (dental cyst), neoplasm (haemangioma), or granulations (foreign body ) Lateral wall. Look at the turbinates and meatuses. Pale mucosa and HIT(allergy), rudimentary in atrophic rhinitis), discharge in the middle meatus (infection of maxillary, frontal or anterior ethmoidal sinuses), mass (polyp, or carcinoma).

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Posterior Rhinoscopy INDIRECT FIBEROPTIC FLEXIBLE

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Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of inferior turbinates.

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Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of inferior turbinates. Mass (adenoid or tumour)

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Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of inferior turbinates. Mass (adenoid or tumour) Choanal atresia

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AND LARYNX Symptoms of PHARYNX A patient presents with one or more of the following complaints: Sore throat. Odynophagia (painful swallowing), Dysphagia (difficulty in swallowing). Earache. Disorders of voice, e.g. hoarseness Halitosis (bad smell from the mouth). Respiratory obstruction. Repeated ckaking of throat. Cough and expectoration. Mass in the neck. Disturbance of salivation. Xerostomia or Excessive salivation. Disturbance of taste Trismus. Lesion on oral cavity.

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EXAMINATION OF OROPHARYNX Inspection : 1. Tonsils and pillars 2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall

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EXAMINATION OF OROPHARYNX Inspection : 1. Tonsils and pillars 2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall ACUTE FOLLICULAR TONSILLITIS

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EXAMINATION OF OROPHARYNX Inspection : 1. Tonsils and pillars 2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall PERITONSILLAR ABCESS

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EXAMINATION OF LARYNX AND HYPOPHARYNX External Examination of Larynx inspection Palpation Indirect Laryngoscopy

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Flexible or Rigid Fibreoptic Endoscopy (a) Flexible endoscopy. (b) Rigid endoscopy.

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Laryngoscpy Larynx Epiglottitis 4 year old drooling toxic child

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Laryngoscpy Larynx Carcinoma Dysphonia / Hoarseness for >3 weeks

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Laryngoscpy Larynx Reinkes Oedema Smoking

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Laryngoscpy Vocal cord nodules

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NECK Examination Palpation

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Neck lump Brachial cyst

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Neck lump Thyroglossal Duct Cyst

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Neck lump Parotid Salivary gland: Warthin's Tumors

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Neck lump Submandibular salivary gland Neoplasia Usually inflammatory

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Neck lump Goitre

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Neck lump Ludwig's angina

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Neck lump TB Usually multiple nodes Cold abscess

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Neck lump Metastatic Neck Lymph Nodes Primary Carcinoma Lymphoma (common) Secondary Mouth Pharynx Larynx Infraclavicular (lung, breast, stomach)

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Thank you