COMPLETE DETAILS OF HISTORY TAKING AND EXAMINATION IN ENT

1. Dr. Ritesh Mahajan

2. • 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).

3. • 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.

4. • 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.

5. • 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.

6. • Members of family.
• Similar complaints in any other member in the family
• History of T.B./Diabetes/ Hypertension
• Duration
• Onset

7. • 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

8. • 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.

9. • Built
• Nourishment
• Orientation to time, place & person
• Vital data:
• Pulse
• Respiratory rate
• Blood pressure
• Temperature
• Pallor/Icterus/Cyanosis/Clubbing/Pedal oedema/
Generalised Lymphadenopathy

10. • 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.

12. Right and left ear
• Pre auricular region
• Pinna
• Post auricular region
• External auditory canal
• Tympanic membrane
• Fistula test
• Mastoid tenderness
• Facial nerve
• Tunning fork tests –
• Rinne’s
• Weber’s
• Air bone conduction

13. • 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.

14. • 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.

15. • 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.

17. • 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’.

20. Examination of external
nose {skin and
osteocartilaginous
framework}
• Inflammation
• Scars
• Sinus
• Swelling
• Neoplasm
• Deformity
Examination of vestibule
• Furuncle
• Fissure
• Crusting
• Dislocated caudal end of
the septum
• Tumours

21. Anterior Rhinoscopy
• Nasal passage
• Septum
• Floor of nose
• Lateral wall
• Nasal mucosa
• Turbinate hypertrophy
• Shape of turbinate
Posterior Rhinoscopy
• Choana
• Posterior ends of inferior
turbinates
• Posterior end of septum
• Discharge
• Openings of the Eustachian
tubes
• Posterior end of middle turbinate
• Fossae of Rosenmuller

23. Functional Examination of
Nose
• Cold Spatula test
• Cotton-wool test
• Sense of smell
• Cottle’s test
Paranasal sinus
tenderness
• Maxillary
• Frontal
• Ethmoidal

25. INSPECTION:
• Lips
• Teeth
• Gums
• Buccal mucosa
• Anterior 2/3 of tongue
• Floor of the mouth
• Hard palate

26. • Soft palate
• Oro-antral fistula
• Anterior pillar
• Tonsil
• Posterior pillar
• Posterior
pharyngeal wall

27. • 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).

28. • 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

29. • PALPATION :
• Tongue
• Buccal mucosa
• Floor of mouth
• Tonsils and its bed.
• Base of tongue.
• Swelling in oral cavity.

30. • 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).

31. • 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.

32. • Indirect laryngoscopy: