1. EARS, NOSE & THROAT
HEAD & NECK
Relearning the basic history taking & physical
examination
Frederick Mars Untalan, MD

2. OUTLINE
 Know what to ask
 Know what to see
 Common ENT diseases

3. REMEMBER. . .
. . . a thorough
assessment begins
with the
HISTORY!

4. HISTORY of PRESENT ILLNESS
(HPI or Symptom Analysis)
 Location and Radiation
 Timing: Onset, Frequency & Duration
 Quality and/or Characteristics
 Quantity and/or Severity
 Setting and/or Situation
 Aggravating Factors
 Alleviating Factors
 Associated Factors/Manifestations
 Underlying Concern and/or Perception

5. EQUIPMENT NEEDED
 Latex Gloves
 Light Source
 Cotton
 Cup with water (optional)
 Measuring tape (possible)

6. GENERAL CONSIDERATIONS
 The head and neck exam is not fixed in
sequence.
 Different parts of the exam may be included
and/or excluded depending on the history and
the purpose of the exam.

7. Physical
Diagnosis
in
Otolaryngology

8. Health History
 Determine presence/absence of age- and
gender-specific diseases of the head and neck
 Common chief complaints
 Neck pain or stiff neck
 Hoarseness; nasal discharge or obstruction
 Neck mass
 Headache or facial pain
 Head injury ; otalgia; dysphagia; ear discharge

9. General Approach to Head
and Neck Assessment
 Greet patient, explain assessment
techniques
 Environment
 Quiet
 Warm
 Private
 Adequate lighting
 Upright sitting position
 Compare right and left sides
 Systematic approach

10. Where the Head Ends and Neck
Begins
 Plane between the external
occipital protuberance and
inferior surface of the
mandible
 Neck
 Anterior triangle is bordered
by Mandible (above), Cervical
midline(laterally) and
Sternomastoid (anteriorly

11. Where the Head Ends and Neck
Begins
Neck
– Posterior triangle is
bordered by Clavicle
(below), trapezius
(posteriorly) and
Sternomastoid
(anteriorly)

12. Special Bony Areas
 External Occipial
Protuberance (notch
in occipital area
 Mastoid Process
(behind Ear)
 Zygomatic Arch
(Cheekbone)
 Orbit (eye socket)
 Maxilla (upper jaw)
 Mandible (lower Jaw)

13. Assessment of the Face
 Inspection
 Shape Normal findings
 Symmetry – Symmetrical features
 INSPECT – Palpebral fissures
Size, shape, and symmetry. equal
Note placement of features , – Nasolabial folds
expression, movements and present bilaterally
Skin characteristics. – Shape can be oval,
 PALPATE round, or slightly
Facial bones square

14. ABNORMALS

15. Assessment of the Face
 Abnormal findings
 Deformed or absent structures
 Asymmetry
 More or less pronounced facial features
 Diseases which may alter facial features: Bell’s palsy,
Down syndrome, Graves’ disease, Myxedema,
Cachexia, Cushing’s syndrome

16. Replacement of Nonfunctional Facial
Muscles
 Microneurovascular free muscle transfer

17. Mandible
 Palpate and auscultate the TMJ when the
client opens and closes the mouth
 Normal findings
 No discomfort, joint articulates smoothly without
clicking or crepitus
 Abnormal findings
 Pain, tenderness, crepitus, clicking, or snapping
sound

18. TEMPORMANDIBULAR
JOINT (TMJ)
Located anterior to tragus,
bilaterally
Assess Abnormals
 Palpate with  Tenderness,
movement crepitus, clicking
 Auscultate: Bell  Bruit
 Pain with trismus

21. Serous Otitis Media

22. Tympanic Membrane
Perforation

23. Tympanic Membrane
Perforation

24. External Auditory Canal
Foreign Body

25. Otitis Externa

26. Otowick in EAC

27. Pharynx

28. Esophagus - mid

29. Esophagus - distal

30. Foreign Bodies

31. Foreign Body Ingestion

32. Vocal Nodules

34. Bilateral Singer’s Nodules

35. Nasal Polyp

37. Middle Turbinate Adhesions

38. Middle Meatus-Maxillary Sinus Ostium
Normal
Purulent Drainage

39. SINUSES:
Frontal & Maxillary
Assess Abnormals
 Inspect  Swelling
 Palpate  Tenderness
 Percuss: Direct  Flatter sound
 Transilluminatio  Unequal light
n: Darkened
room

40. CT Scan - Sinusitis

41. Allergic Rhinitis

42. Nasal Septal Perforation

44. Bony Dorsum
Deficiency

45. Nasal
Bone
Fracture

46. Dorsal Deficiency
 More likely with
osteotome rather
than sharp rasp
 Corrected with
completion
osteotomies or on-
lay graft

47. Septal Hematoma

48. Cleft Anatomy

49. Cleft Anatomy - The Nose

50. Cleft Anatomy

51. Controversies

54. Post-tonsillectomy

55. Peritonsillar Abscess

56. Cleft Palate - Bifid Uvula

57. Ranula

58. Squamous Cell Carcinoma
of Tongue
Ulcerative Exophytic

59. Minor Salivary Gland Tumor

60. Parotitis

61. Pleomorphic Adenoma-Parotid

62. Thyroglossal Duct Cyst

63. Branchial Cleft Cyst

64. THYROID
 Inspect (Tangential lighting when swallowing)
 Palpate
 Palpate trachea
 Posterior Approach
 Anterior Approach
 Auscultate (with Bell)

65. Enlarged Thyroid

66. PALPATE the THYROID
 Posterior Approach
 Displace to one side then palpate
 Swallow

67. Neck Masses

68. NECK

70. LYMPH NODES
 Landmarks
 Anterior Triangle
 Mandible
 Trachea
 SCM muscle
 Posterior Triangle
 Clavical
 Trapezius muscle
 SCM muscle

71. LYMPH NODES
 Location
 Head
 Face
 Neck
 Not normally
palpated

72. LYMPH NODES
 Preauricular Nodes

73. LOCATION of LYMPH NODES of the
NECK
Overlying the sternocleidomastoid
Anterior Cervical Chain
muscle
In the posterior triangle along the
Posterior Cervical Chain
trapezius muscle
Deep under the sternocleidomastoid
Internal Jugular Chain
muscle. Not normally palpated.
Just above & behind the clavicle at the
Supraclavicular
sternocleidomastoid muscle

74. LYMPH NODES
 Anterior Cervical Nodes

75. LYMPH NODES
 Posterior Cervical Chain

76. LYMPH NODES
 Supraclavicular Nodes

77. DOCUMENTATION
Head:
Normocephalic, no lumps, no lesions, no
tenderness. Hair medium texture,
evenly distributed.

78. DOCUMENTATION
Face:
Symmetric, no drooping, no weakness, no
involuntary movements. Temporal
artery pulses palpable, no bruits. TMJ
articulates smoothly without clicking,
crepitus or pain.

80. DOCUMENTATION
Neck:
Supple with full ROM, no
pain. Symmetric, no
lymphadenopathy or
masses, trachea midline.
Thyroid not palpable.
No bruits.

81. DOCUMENTATION
Ears
Inspection & otoscopy; tuning fork tests
Nose
Inspection, anterior & posterior rhinoscopy
Oral cavity & oropharynx
Indirect laryngoscopy to check the laryngeal inlet &
hypopharynx

82. OUTLINE
 Know what to ask
 Know what to see
 Common ENT diseases

83. EARS, NOSE & THROAT
HEAD & NECK
Relearning the basic history taking & physical
examination
Frederick Mars Untalan, MD