1. 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

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

3. 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

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

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

8. 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.

9. Examination of Ear Pinna Inspection Size microtia, macrotia

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

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

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

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

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

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

16. 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.

17. 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

18. 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)

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

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

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

22. 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)

23. 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)

24. 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

25. 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,

26. 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

27. 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

28. 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

29. 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

30. Examination of Mastoid Acute Mastoiditis

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

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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

38. 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

39. 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

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

41. Auditory and Vestibular function Tuning fork tests Rinne test

42. Auditory and Vestibular function Tuning fork tests Rinne test Weber test

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

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

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

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

48. 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).

49. EXAMINATION External Nose signs of inflammation (furuncle, abscess)

50. 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

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

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

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

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

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

56. 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

57. 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

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

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

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

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

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

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

64. 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),

65. Para-Nasal-Sinuses Eye Examination Ethmoiditis and orbital cellulitis

66. 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),

67. 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).

68. Posterior Rhinoscopy INDIRECT FIBEROPTIC FLEXIBLE

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

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

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

73. 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.

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

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

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

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

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

79. Laryngoscpy Larynx Epiglottitis 4 year old drooling toxic child

80. Laryngoscpy Larynx Carcinoma Dysphonia / Hoarseness for >3 weeks

81. Laryngoscpy Larynx Reinke’s Oedema Smoking

82. Laryngoscpy Vocal cord nodules

83. NECK Examination Palpation

84. Neck lump Brachial cyst

85. Neck lump Thyroglossal Duct Cyst

86. Neck lump Parotid Salivary gland: Warthin's Tumors

87. Neck lump Submandibular salivary gland Neoplasia Usually inflammatory

88. Neck lump Goitre

89. Neck lump Ludwig's angina

90. Neck lump TB Usually multiple nodes Cold abscess

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

92. Thank you