Examination of the Ear

ORAL ACTIVITY

Includes: Lips-buccal mucosa-Gums and teeth-Hard palate-Ant 2/3 tongue-Floor of mouth-retro molar trigone.

SYMPTOMATOLOGY:
  • Pain /referred pain
  • Salivation: Dryness/ excessive salivation
  • Disturbance of taste sensation
  • Difficulty in opening mouth
  • Bleeding from gums
  • Red painful gums
  • Sore tongue
  • Recurrent painful lip and oral ulcers
  • Small clusters of vesicles
  • Fissures over lips and angle of mouth
  • Ill-fitting dentures
  • Foul breath

EXAMINATION OF ORAL CAVITY::

LIPS:
  • PMoisture /color /lumps /ulcers /cracking / scaliness
  • Swelling/ulcers/vesicles/crusts/scaly/redness/nodular lesion/Chancre
  • Hemorrhagic red multiple spots over lips and oral mucosa
  • Bluish pigmented spots over lips and oral mucosa.
  • Unilateral / bilateral cleft lips
  • Angioedema lips: Diffuse-nonpitting-tense swelling-non-itching
ORAL mucosa:

Alveolar mucosa /labial mucosa / buccal mucosa /mucosa over hard and soft palate

  • Change in color
  • Vesicles /bullae
  • White striae
  • Submucosal fibrosis (Blanched appearance with sub mucosal scars)
  • Leukoplakia –Persistent painless thickened white patches
  • Erythroplakia
  • Bluish pigmentation
  • Atrophic changes in mucosa
  • Reddish swollen Stensen’s ductal papilla
  • Aphthous ulcers
  • White patches and nodules
  • Koplik’s spots: small white speks with red back ground
  • Fordyce spots-small yellowish spots/granules
  • Petechiae-small red spots
Gums and teeth:

Teeth/gingiva/Gingival margins/ alveolar mucosa/intedental papillae/gingival sulcus

  • Toothache
  • Loose tooth
  • Impaction
  • Dental caries
  • Artificial dentures
  • Missing tooth
  • Redness of gingiva
  • Swollen interdental papillae
  • Gum bleeding
  • Gingival (Gum) hyperplasia-swollen heaped up masses (dilantin, pheno, pregnancy, leukemia)
  • Bluish black lining of gums (lead line)
  • Swelling and ulceration of gingival (gum) margins and interdental papillae
Roof of the mouth: Hard palate
  • Cleft palate
  • High arch
  • Oronasal / oroantral fistula
  • Bulging
  • Bony growth
  • Torus palatinus: a mid line mass
  • Ulcers
  • Oral thrush (thick white plaques) –candidiasis
  • Deep purple color lesions –Kaposi’s Sarcoma
Tongue Anterior 2/3:tip / dorsum / lateral borders / under surface
  • Ulcers: Chronic non healing / pain full: yes /No
  • Persistent ulcers or nodule: white / red
  • Indurations: yes / no
  • Fissures / nodules
  • Hairy tongue
  • Geographic tongue: Scattered smooth red areas denuded of papillae.
  • Smooth tongue (Atrophic glossitis - Bald tongue) -absent papillae- Vitamin deficiency/anti cancer drugs
  • Hairy Leukoplakia: feathery, corrugated pattern-in HIV/AIDS
  • Macroglossia
  • Haemangioma / Lymphangioma
  • Edema / Abscess
  • Deviation on protrusion; Yes / No
Floor of the mouth:
  • Short frenulum –Ankyloglossia
  • Aphthous ulcers: Painful, small oval or round ulcers-white or yellowish grey withreddened halo.
  • Ranula / Sublingual dermoid / Ludwig’s angina
  • Wharton’s duct:
  • Bimanual palpation
Retro molar trigone:
  • Impacted last molar
  • Tumour lesion

OROPHARYNX

IIncludes: Tonsils and pillars-Soft palate-Base of tongue-posterior pharyngeal wall.

SYMPTOMATOLOGY:
  • Sore throat
  • Painful swallowing
  • Fever
  • Difficulty in swallowing
  • Neck stiffness
  • Change in voice: Hypernasality
  • Muffled or hot potato voice
  • Referred ear pain.
  • Snoring
  • Halitosis
  • Hard of hearing
EXAMINATION OF ORAL CAVITY::
Tonsils and pillars:
  • Hypertrophied -Obstructive
  • Small and embedded
  • Large normal tonsils
  • Crypts: White and yellow spots (follicular tonsillitis
  • Membranes
  • Ulceration over tonsils
  • Mass over tonsils
  • Pus on squeezing
  • Exudates over tonsils
  • Palpation: Hard /pulsation, tenderness in tonsillar area /elongated styloid process.
  • Pillars: Congestion
  • Congestion: Pillars / posterior pharyngeal wall /tonsils
Movement of soft palate:
  • Soft palate movement on- ah /yawn
  • Asymmetrical: Deviation – Right /Left
  • Gag reflex: yes / No
  • Soft palate: Bulging / Redness / tenderness
  • Bifid uvula
  • Nasal regurgitation
Posterior pharyngeal wall:
  • Reddened throat with exudates
  • Gray exudates (pseudomembrane) over Uvula / Phx / tongue
  • Granular pharyngitis
  • Purulent discharge
Base of tongue and Valleculae
On IL mirror
  • Normal /congested mucosa.
  • Mass- solid / cystic
Palpation of tongue base:

LARYNX

SYMPTOMATOLOGY:
Hoarseness:
  • Duration
  • Sudden/gradually worsening
  • Association with Dysphagia / Dyspnoea /Strider
  • Diurnal variation
  • Vocal abuse
  • Fatigability
  • Chronic rhino nasal allergy: Yes / No
  • History of Asthma: yes / No
  • On topical steroids: Yes / No
  • Smoking Duration:
  • History Hypothyroidism: yes / No
  • Loudness
  • Pitch
  • Tone
  • Preceding /associated RTI
Quality of voice:
  • Hoarseness
  • Breathy
  • Husky voice
  • Week cry
  • Bitonal
  • Dysphonic /spasmodic
  • Whispered or feeble
  • Aphonia
  • Puberphonia
  • Strider
  • Aspiration: Episodes of cough on oral feeds
  • Easy fatigability of voice
  • Breathing difficulty: sudden /gradual
  • Stridor (Noisy breathing): acute /gradual
  • Cough and expectorant: Clear/blood stained/purulent/foul smelling fever/Dry cough
  • Irritant paroxysmal cough: yes /no
  • Dysphagia: sudden / Gradual
  • FB history: Fish bone / chicken or mutton bone / Coin /seeds
  • Throat pain: Duration –
  • Acute or chronic
  • Radiation of pain: yes / no
  • Difficulty in swallowing: For solids or liquids/Duration: acute or chronic
  • Fever: high /mild /decreased appetite
  • Weight loss
  • FB sensation in throat (hawking)
  • Snoring
  • Mass in the neck: yes /No
PERSONAL HISTORY:
  • Smoking
  • Alcohol
  • Spicy food
  • Tobacco chewing /Pan
  • Radiation exposure
Profession:
  • Teacher
  • Singer
EXAMINATION OF LARYNX
  • External examination
  • Indirect laryngoscopy
  • Flexible or rigid fibre optic endosscopy
  • Assessment of voice
  • Assessment of cervical lymph nodes.
  • Asses of neck mass
INDIRECT LARYNGOSCOPY:
  1. Oropharynx:
    • External examination
    • Indirect laryngoscopy
    • Flexible or rigid fibre optic endosscopy
    • Assessment of voice
    • Assessment of cervical lymph nodes.
    • Asses of neck mass
  2. Oropharynx:
    • External examination
    • Indirect laryngoscopy
    • Flexible or rigid fibre optic endosscopy
    • Assessment of voice
    • Assessment of cervical lymph nodes.
    • Asses of neck mass
  3. Larynx-Epiglottis:
    • Ary epiglottic folds
    • Arytenoids-corniculate-
    • Ventricular bands-ventricles
    • True vocal folds: Oedema
    • Position of vocal cord: Median /Para median /Moderated abduction/full
    • Vocal cord movement: Normal
    • Nodules: single / multiple
    • Laryngeal: Polyp / ulceration / submucosal hemorrhage
    • Anterior and posterior commissure
    • Sub glottis: stenosis/web
    • Tracheal rings
  4. Laryngopharynx-
    • Pyriform fossae: mass lesion/pooling saliva /FB
    • Post cricoid region
    • Posterior wall of laryngopharynx
  5. Assesment of voice:
  6. Neurological assessment:
  7. External examination of larynx:
  8. Skin:
    • Redness
    • Swelling / tenderness
    • Widening of laryngeal frame work
    • Surgical emphysema /Soft tissue swelling
    • Movement of larynx: With deglutition / side to side
    • Laryngeal crepitus: Present/absent
    • Carotid pulsation

EXAMINATION OF NECK

Lymph nodes / Neck mass:
Memorial Sloan Kettering LN levels:
  1. Upper Horizontal Chain Of Lymph Nodes:
    • Sub mental and submandibular-Level I
    • Submandibular
    • Parotid
    • Post auricular
    • Occipital
    • Facial
  2. Upper Horizontal Chain Of Lymph Nodes:
    • Internal jugular group (Levels II, III &IV)
      • Upper
      • Middle
      • Lower
    • Spinal accessory chain (Level V)
    • Prelaryngeal (Level VI (juxtavisceral chain))
    • Pretracheal(Level VI (juxtavisceral chain))
    • Para tracheal(Level VI (juxtavisceral chain))
    • Mediastinal nodes
  3. Lymph nodes:
    • Lymph node enlargement: Acute /Chronic
    • Tender: Yes/No
    • Hard / firm / rubbery /soft / Discrete / Matted /tenderness
    • Size
    • Shape
    • Mobility in both (side to side and up and down) direction: yes / No
    • Fixity to skin
    • Fixity to muscle / Bone
  4. Trachea and thyroid gland
    • Tracheal deviation: Mass effect-mediastinal mass, atelectasis or large pneumothorax
    • Thyroid gland: Moving with deglutition
    • Size
    • Shape
    • Consistency: Firm /hard /soft
    • Fixity: skin /muscle/bone
    • Nodules / tenderness /Bruit over the gland
    • Carotid artery pulsation: present / absent.
INVESTIGATIONS
  1. Flexible fibre optic endoscopy (rhinolaryngoscopy):
  2. Direct laryngoscopy:
    • For glottic cancers:
      • Size
      • Site
      • Extent
      • Exophytic
      • Deep infiltration
      • VC mobility
      • Involvement of anterior commisure
      • Spread to vocal process
      • Supraglottic / subglottic spread
      • Ventricle checked
      • Paraglottic space
      • Hypopharynx
      • Neck mass /lymph node
    • Laryngoscopy for supraglottic cancers:
      • Size
      • Site
      • Extent
      • Extension to vallecula /pre glottic space: Involved /No
      • Tongue base involvement: Involved /No
      • Extension to lateral pharyngeal wall: Involved /No
      • Medial wall of pyriform sinus: Involved /No
      • Vocal cord mobility: Yes /No
      • Paraglottic space: Involved /No
      • Hypopharynx: Involved /No
      • Neck mass: yes /No
    • Laryngoscopy for subglottic tumours:
      • Size
      • Site
      • Extent
      • Vocal cord mobility: Yes / No
      • Paraglottic space; Involved / No
      • Oesophagus / posterior tracheal wall: involved /No
      • Neck mass: present / No
  3. Videostroboscopy
    • Fundamental frequency
    • Bilateral symmetry
    • Periodicity of successive vibrations
    • Glottic closure
    • Amplitude of vibration
    • Mucosal wave
    • Non-vibration portion

Welcome to my ENT department which offers comprehensive medical and surgical services at affordable cost to the patients in Kerala and beyond. The prime object behind this movement is to provide all sorts of advanced treatment in ENT,

Read more
Quick Contact

Subscribe to our newsletter

Copyright ©2020.All Rights Reserved By Mesiarc.