Dr.

Ritesh Mahajan
• Name
• Age
• Sex
• Religion
• Occupation
• Address

• Today I am going to present the history of (age) year

old, male/female (name). He/she is a (religion) by
religion and works at/as (occupation) in (city) and is a
permanent resident of (address).
• He/she presented in the out patient department of ENT
with chief complaints of:-

• In chronological order : Disease which started first.

• Right ear discharge – 2 years.

• Difficulty in hearing – 1 year.
• Ringing sensation in ear – 6 months.
• Fever – 1 week.
• Patient was apparently alright 2 years back when he/
she started with (complaint).

• First describe the 1st chief complaint then its

associated symptoms and relevant negative history.

• Then go on 2nd chief complaint and like wise.

• Then negative history of overall disease picture.

• History of Tuberculosis / Syphilis/ Leprosy/epilepsy

• History of infectious fever - Measles/Chicken pox/Typhoid

• History of trauma or allergy

• Any history of previous surgery

• History of diabetes and hypertension

• Diseases of CNS & Others.

• Members of family.

• Similar complaints in any other member in the family

• History of T.B./Diabetes/ Hypertension

• Duration

• Onset
• Diet/Sleep/appetite

• Micturation / bowel habits

• Habits: Smoking Pan chewing Alcohol intake

• Hygiene/Socio-economic Status

• Exposure to dusty atmosphere or chemical irritants or

fumes
• Menstrual History.

• Socioeconomic history.

• Immunization history – in case of a child.

• Children: examiner should be told about the person

from whom you have taken history, e.g. Mother in
case of a child.
• Built
• Nourishment
• Orientation to time, place & person
• Vital data:

• Pulse
• Respiratory rate
• Blood pressure
• Temperature
• Pallor/Icterus/Cyanosis/Clubbing/Pedal oedema/
Generalised Lymphadenopathy
• CVS – S1, S2 heard, no audible murmurs.

• RS – normal vesicular breath sounds heard, no crepts,

no wheezing.

• CNS - Higher mental functions, Motor functions,

Sensory functions - normal.

• Cranial nerves – facial nerve, olfactory, hypoglossal,

vagus, gloss pharyngeal, trigeminal, auditory nerve.

• Per Abdomen- soft, non tender, no organomegaly.

 Right and left ear

• Pre auricular region • Tunning fork tests –

• Pinna
• Post auricular region • Rinne’s
• External auditory canal
• Tympanic membrane • Weber’s
• Fistula test
• Mastoid tenderness • Air bone conduction
• Facial nerve
• Pinna – Shape, Size, Position.

• Post aural – Swelling, Scar, 3 point tenderness test, Battle’s sign,

Griesinger’s sign.

• Pre auricular area – Sinus, Swelling, Cyst, Accessory tragus,

Lymph nodes.

• External Auditory Canal – upwards, backwards & outwards.

• Without speculum and with speculum.

• Examine- roof, floor, anterior & posterior wall.
• Wax, Pus, Foreign body, Granulation, Fruncle, Osteoma,
Laceration, Stenosis, Atresia.
 • Tympanic Membrane – Describe and identify normal anatomical
landmarks-

• Colour, cone of light,

• 4 quadrants, umbo,
• Handle of malleus,
• Lateral process of malleus,
• Anterior & posterior malleolar folds,
• Pars tensa,
• Pars flaccida,
• Bony annulus,
• Incudostapedial joint.
• Colour –

• Pink (otosclerosis),
• Rising Sun (glomus jugular) ,
• Red (acute otitis media, myringitis, baro-otitis media),
• Bluish (blood accumulation).

• Cone of light – ET block, Atelectasis, serous otitis media.

• Mobility – Siegalization and Valsalva maneuver.

• Pars tensa - Retraction, Granulation, Blebs, Sclerotic patches or
perforation.

• Perforation – Type, Margins, Location, Size, Shape, Edge,

Residual drum, Structures seen through perforation, Granulation,
Postero-Superior retraction with cholesteatoma, Polyps, &
Tympano-Sclerotic Patches.

• Pars Flaccida – Attic or Sharpnell’s membrane.

• Central perforation is ‘SAFE’ while Marginal/attic perforation is

usually ‘UNSAFE’.
 Examination of external Examination of vestibule
nose {skin and
osteocartilaginous
framework}

• Inflammation • Furuncle
• Scars • Fissure
• Sinus • Crusting
• Swelling • Dislocated caudal end of
the septum
• Neoplasm
• Tumours
• Deformity
 Anterior Rhinoscopy Posterior Rhinoscopy

• Nasal passage • Choana

• Septum • Posterior ends of inferior
• Floor of nose turbinates
• Lateral wall • Posterior end of septum
• Nasal mucosa • Discharge
• Turbinate hypertrophy • Openings of the Eustachian
• Shape of turbinate tubes
• Posterior end of middle turbinate
• Fossae of Rosenmuller
Functional Examination of Paranasal sinus
Nose tenderness

• Cold Spatula test • Maxillary

• Cotton-wool test • Frontal
• Sense of smell • Ethmoidal
• Cottle’s test
INSPECTION:

• Lips
• Teeth
• Gums
• Buccal mucosa
• Anterior 2/3 of tongue
• Floor of the mouth
• Hard palate
• Soft palate
• Oro-antral fistula
• Anterior pillar
• Tonsil
• Posterior pillar
• Posterior
pharyngeal wall
• Tongue :

• Anterior 2/3rd , & Posterior 1/3rd.

• Size, Appearance, Swelling, Ulcer, Mobility, Dorsum and Floor of
Tongue.

• Tonsils:

• Gr. 1 – medial surface of tonsil hidden behind anterior pillar.

• Gr. 2 – medial surface of tonsil just at level of anterior pillar.
• Gr. 3 – size in between Gr. 2 and Gr. 3
• Gr. 4 – tonsil touching each other ( kissing tonsils).
• Tonsil 0: Tonsils fit within
tonsillar fossa

• Tonsil 1+: Tonsils <25% of

space between pillars

• Tonsil 2+: Tonsils <50% of

space between pillars

• Tonsil 3+: Tonsils <75% of

space between pillars

• Tonsil 4+: Tonsils >75% of

space between pillars
• PALPATION :

• Tongue
• Buccal mucosa
• Floor of mouth
• Tonsils and its bed.
• Base of tongue.
• Swelling in oral cavity.
• Redness of skin (abscess, perichondritis)

• Bulge or swelling (extension of growth or enlarged lymph nodes)

• Widening of larynx (growth of pyriform fossa)

• Surgical emphysema (accidental or surgical trauma)

• Palpate the hyoid bone, thyroid cartilage, thyroid notch, cricoid

cartilage, and the tracheal rings.

• Movements of larynx (laryngeal crepitus).

• Larynx - Epiglottis, aryepiglottic folds, arytenoids, cuneiform and
corniculate cartilages, ventricular bands, ventricles, true cords,
anterior commissure, posterior commissure, subglottis and rings of
trachea.

• Laryngopharynx - Both pyriform fossae, postcricoid region,

posterior wall of laryngopharynx.

• Oropharynx - Base of tongue, lingual tonsils, valleculae, medial

and lateral glossoepiglottic folds.
• Indirect laryngoscopy: