Dr. ZAID AL-DAHWI Consultant ENT Head of ENT department KING SAUD MEDICAL CITY Dr. ZAID AL-DAHWI...
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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
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
Slide 2
Personal history Name Age Sex Nationality Residence Occupation
Habbits (smoking) Marital state Evaluation of ENT Patient
Slide 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
Slide 4
History of past illness History of Similar complaints in the
past, Previous operations Allergy to any drug. Evaluation of ENT
Patient
Slide 5
Family history Family history of same disorder Some diseases
have a genetic basis, e.g. certain types of SNHL Evaluation of ENT
Patient
Slide 6
Slide 7
Slide 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.
Slide 9
Examination of Ear Pinna Inspection Size microtia,
macrotia
Slide 10
Examination of Ear Pinna Inspection size (microtia, macrotia)
shape cauliflower ear
Slide 11
Examination of Ear Pinna Inspection size (microtia, macrotia);
shape (cauliflower ear); position bat ear.
Slide 12
Examination of Ear Pinna Inspection size (microtia, macrotia);
shape (cauliflower ear); position (bat ear). Redness
Perichondritis
Slide 13
Examination of Ear Pinna Inspection size (microtia, macrotia);
shape (cauliflower ear); position (bat ear). Redness
(perichondritis); Swelling Auricular haematoma, or abcess
Slide 14
Examination of Ear Pinna Inspection size (microtia, macrotia);
shape (cauliflower ear); position (bat ear). Redness
(perichondritis); Swelling haematoma, or abcess Sebacious cyst
Slide 15
Examination of Ear Pinna Inspection size (microtia, macrotia);
shape (cauliflower ear); position (bat ear). Redness
(perichondritis); Swelling (haematoma, sebacious cyst); Vesicles
(herpes zoster)
Slide 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.
Slide 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
Slide 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)
Slide 19
Examination of external auditory canal The pinna is pulled
upwards and backwards Inspection Size of meatus (narrow or
wide),
Slide 20
Examination of external auditory canal The pinna is pulled
upwards and back wards Inspection Size of meatus (narrow or wide),
swelling furuncle,
Slide 21
Examination of external auditory canal The pinna is pulled
upwards and backwards Inspection Size of meatus (narrow or wide),
swelling furuncle, Aural Polyp
Slide 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)
Slide 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)
Slide 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
Slide 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,
Slide 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
Slide 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
Slide 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
Slide 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
Slide 30
Examination of Mastoid Acute Mastoiditis
Slide 31
Examination of tympanic membrane Normal tympanic membrane is
pearly white in color and semi transparent
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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
Slide 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
Slide 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
Slide 40
Examination of facial nerve. Paralysis of facial nerve may
co-exist with disease of the ear,
Slide 41
Auditory and Vestibular function Tuning fork tests Rinne
test
Slide 42
Auditory and Vestibular function Tuning fork tests Rinne test
Weber test
Slide 43
Auditory and Vestibular function Tuning fork tests Rinne test
Weber test Pure tone audiogram (PTA)
Slide 44
Auditory and Vestibular function Tuning fork tests Rinne test
Weber test Pure tone audiogram (PTA) Tympanogram
Slide 45
Auditory and Vestibular function Tuning fork tests Rinne test
Weber test Pure tone audiogram (PTA) Tympanogram Nystagmus
Slide 46
Auditory and Vestibular function Tuning fork tests Rinne test
Weber test Pure tone audiogram (PTA) Tympanogram Spontaneous
nystagmus Fistula test
Slide 47
Slide 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).
Slide 49
EXAMINATION External Nose signs of inflammation (furuncle,
abscess)
Slide 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
Slide 51
EXAMINATION External Nose signs of inflammation (furuncle,
abscess) swelling Glioma Dermoid congenital nasal dermoid.
encephalocele.
Slide 52
EXAMINATION External Nose signs of inflammation (furuncle,
abscess) swelling Glioma Dermoid Neoplasm basal cell carcinoma
Slide 53
EXAMINATION External Nose signs of inflammation (furuncle,
septal abscess), swelling (dermoid or glioma) neoplasm (basal cell
or squamous cell carcinoma). Nasal Deformity
Slide 54
EXAMINATION NASAL Vestibule It can be easily examined by
tilting the tip of nose upwards.
Slide 55
EXAMINATION NASAL Vestibule It can be easily examined by
tilting the tip of nose upwards. It is examined for a
furuncle,
Slide 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
Slide 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
Slide 58
Anterior Rhinoscopy Look for: Septum. Deviation or spur,
Slide 59
Anterior Rhinoscopy Look for: Septum. Deviation or spur,
Perforation,
Slide 60
Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer,
perforation, swelling (haematoma or abscess).
Slide 61
Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer,
perforation, swelling (haematoma or abscess). Bleeding Point
(Littles area) Kiesselbach's plexus
Slide 62
Anterior Rhinoscopy Look for: Septum. Deviation or spur, ulcer,
perforation, Swelling (haematoma or abscess). Floor: FB
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),
Slide 65
Para-Nasal-Sinuses Eye Examination Ethmoiditis and orbital
cellulitis
Slide 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),
Slide 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).
Slide 68
Posterior Rhinoscopy INDIRECT FIBEROPTIC FLEXIBLE
Slide 69
Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of
inferior turbinates.
Slide 70
Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of
inferior turbinates. Mass (adenoid or tumour)
Slide 71
Posterior Rhinoscopy Look for: Hypertrophy of posterior ends of
inferior turbinates. Mass (adenoid or tumour) Choanal atresia
Slide 72
Slide 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.
Slide 74
EXAMINATION OF OROPHARYNX Inspection : 1. Tonsils and pillars
2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall
Slide 75
EXAMINATION OF OROPHARYNX Inspection : 1. Tonsils and pillars
2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall ACUTE
FOLLICULAR TONSILLITIS
Slide 76
EXAMINATION OF OROPHARYNX Inspection : 1. Tonsils and pillars
2. Soft palate 3. Base of tongue 4. Posterior pharyngeal wall
PERITONSILLAR ABCESS
Slide 77
EXAMINATION OF LARYNX AND HYPOPHARYNX External Examination of
Larynx inspection Palpation Indirect Laryngoscopy