Physical Examination
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1 Otorhinolaryngologic Approach Sasan Dabiri, M.D. Department of Otorhinolaryngology Head & Neck Surgery Amir A lam hospital Tehran University of Medical Sciences
2 General Notes Parts of an : Inspection Palpation Percussion (not indicated in ENT) Auscultation (in neck mass & pulsatile tinnitus) Gentle (very important) Attention to patient s rights Don t miss any part due to this
3 Face Deformity Asymmetry Skin lesion Eye movement
4 Face Deformity Asymmetry Skin lesion Eye movement Palpation Tenderness Fracture Muscle force Mass
5 Neck Skin lesion (including fistula) Asymmetry (mass, LAP, muscle, )
6 Neck Skin lesion (including fistula) Asymmetry (mass, LAP, muscle, ) Palpation Tenderness (abcess) Mass (where, specify, ) Lymphadenopathy Thyroid Laryngo-trachea Auscultation
7 Ear Auricle External Auditory Canal Tympanic Membrane
8 Ear Auricle External Auditory Canal Tympanic Membrane
9 Ear Palpation Auricular tenderness Tragus sign
10 Ear Palpation Auscultation Pulsatile tinnitus (periauricular auscultation)
11 Ear Palpation Auscultation Auditory Evaluation Without tuning fork Whispered voice With tuning fork (512 Hz) Weber test o NL : midline o SNHL : lateralized to other o CHL : lateralized to same Rinne test o NL or SNHL : AC > BC (+) o CHL : BC > AC (-) Schwabach test
12 Ear Palpation Auscultation Auditory Evaluation Vestibular Evaluation R/O central etiology Romberg test Finger to Nose test Dix-Hallpike test Caloric test Head Thrust test Head Shake test
13 Nose Deformity Septum Turbinate Cavity Palpation Fracture Tenderness
14 Throat Tongue (lesion, movement) Oropharynx ( including tonsils & parapharynx) Uvula & Palate (including movement) Buccal (including Stensen s orifice) Mouth floor (including Warthon s orifice) Gingiva & Dentoalveolar area
15 Throat Tongue (lesion, movement) Oropharynx ( including tonsils & parapharynx) Uvula & Palate (including movement) Buccal (including Stensen s orifice) Mouth floor (including Warthon s orifice) Gingiva & Dentoalveolar area
16 Throat Tongue (lesion, movement) Oropharynx ( including tonsils & parapharynx) Uvula & Palate (including movement) Buccal (including Stensen s orifice) Mouth floor (including Warthon s orifice) Gingiva & Dentoalveolar area
17 Throat Tongue (lesion, movement) Oropharynx ( including tonsils & parapharynx) Uvula & Palate (including movement) Buccal (including Stensen s orifice) Mouth floor (including Warthon s orifice) Gingiva & Dentoalveolar area
18 Throat Tongue (lesion, movement) Oropharynx ( including tonsils & parapharynx) Uvula & Palate (including movement) Buccal (including Stensen s orifice) Mouth floor (including Warthon s orifice) Gingiva & Dentoalveolar area
19 Throat Tongue (lesion, movement) Oropharynx ( including tonsils & parapharynx) Uvula & Palate (including movement) Buccal (including Stensen s orifice) Mouth floor (including Warthon s orifice) Gingiva & Dentoalveolar area Palpation Tongue (induration, force) Mouth floor (submandibular gland, mass)
20 Larynx (Indirect Laryngoscopy [IDL]) With mirror With lens (rigid or flexible)
21 hanks for your attention
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