ENT - Clinical

Head Light
1- Killan Nasal Speculum

Use For :
• Anterior Rhinoscopy [ Examination Anterior
Two Third of Nasal Cavity ]

How To Use :
• Dominant Hand For Manipulation
• Non Dominant Hand For Speculum
• Fixation Tip Of The Nose By Index

2- Thudicum Nasal speculum

Use For :
• Anterior Rhinoscopy [ Examination Anterior
Two Third of Nasal Cavity ]
3- Metallic Tongue Depressor : Used For :

1- Examination Of Oral Cavity And Oropharynx

We Put The Depressor on The Anterior Two Third To
Prevent Gag Reflex
2- Examination of Nasal Patiency
3- Control The Tongue ( ForceFul ) To Take Biopsy Or
Remove Foregin body

Landmark Seperated Between Oral Cavity And

Oropharynx :
1. Anterior Pillar Of The Tonsil
2. Junction Between Hard And Soft Palate
3. Junction Between Anterior Two Third And Posterior One
Third Of The Tongue

4- Wood Tongue depressors :

• Used with Nasopharyngeal Mirror to Examin

Nasopharynx
• Examination Of Oral Cavity And Oropharynx
• Disposble
Nasal Patency Is A Measure Of How Open The Nose Is
Nasal Patency Examin By :

1. Cotton Test : Put Some Cotton Under The Nose Of patient And Ask Him To
Blowing With His Nose And See If Cotton Move Or Not

2. Cold Speculum Test : Put Metallic Tongue Depressor Under The Nose Of The
Patient And Ask Him To Blow His Nose To See Fogging If Formed or Not

3. StethoScope
4. NG Tube
5. CT Scan
6. EndoScope
7. Rhinogram

Case : Neonate peresnt With Choanal Atresia To EM At 3 Am , How To Check His

Nasal Patency With As Fast as Possible ?
By Using Stethoscope or NG Tube
5- Examination Of Posterior One Third

1- Nasophayngeal Mirror ( Post-Nasal Mirror ) ( Bayonet Shaped To Avoid Effect

On Axis Of Vision )

2- Endoscope ( Best Method )

 6- Laryngeal Mirror For Indirect Laryngoscopy
For Assessnent of Movement of Vocal Cord ( Larynx )
( Use Like Post-Nasal Mirror )
7- Jobson Horne Probe
Two End
1. Serrated End : by Rolling Cotton on it , it is used
for Mobbing
2. Ring End : Removal of Wax , F.B , Otomycotic
debris ,

• Putting Substances Inside Nose Like Silver

nitrate

8- Foreign Body Probe

One Ring End
9 - Tilley Nasal Dressing Forceps

Used For :
• Inserted And Remove Of Packing In Case Of
Epistaxis
• Remove Of Foreign Body
10 - Tilley Hankel Forceps

• Two Joints With Cup End

• For Taking Biopsy
Ear
1- Auroscope ( otoscope )

Use For Examination of :

• External Auditory Meatus
• Tympanic Membrane

How To Use : Striaght The External Auditory Meatus

By :
• Adult : Pull The Ear Upward And Backward
• Children : Pull The Ear Downward And Backward

Magnification Power : 2
2 - Crocodile Ear Forceps :
• Two Joints With Serruted End

• It Can Be Introduced Through the Aural

Speculum and Used for Remove Wax And
Foreign Body

3 - Cup Forceps
• Two Joints With Small Cup End
( Same As Tilley Hankel Forceps But Smaller in Size
For Ear )
• For Taking Biopsy or Granulation Tissue
4- Aural Speculum

Use For Examination of :

• External Auditory Meatus
• Tympanic Membrane

Advantage :
• Protection of Skin Of External Auditory Meatus
• Streightness Of External Auditory Meatus
• By Pass The Hair bearing Area
• Good Illumination
• Good Localization
5- Pneumatic Otoscopy or Siegle Speculum
Consist of Pumb And Speculum

Advantages :
• Magnifiction Power : 4
• Assessment of Mobility Of Tympanic Membrane
• Differentiated Between Tympanic Membrane Perforation And Tympanic retraction
pocket
• Instillation of Drugs
• Fistula Test
6 - Barany box : Used to Make Some Noise in One Ear And To Examin The Other Ear
Clearly
6-Tuning Fork

• Used For Hearing Assessment By Rinne’s and Weber Test

• Standard : 512 Hz
Rinne’s Test :
Comparism Between Bone Conduction And Air Conduction :
• Positive Test ( Air Conduction More Than Bone Conduction ) Mean either Normal
Or Sensory neural Deafness
• Negative Test ( Bone Conduction More Than Air Conduction ) Mean Conductive
Deafness

Weber Test :
Site Of Examination ( Glabella , Upper Teeth , Vertex )
• Vibration Shifted Toward The Normal Ear In Sensory Neural Deafness
• Vibration Shifted Toward The Effected Ear In Conductive Deafness

Weber Better Than Rinne’s Because Weber Is 5 dB While Rinne’s Is 15 dB Mean

Weber More Sensitive

( Note For Y : In a normal ear, air conduction is greater than bone conduction, that is to say sound is more
efficiently transmitted to the cochlea via air than via bone. So, a patient who hears the tuning fork loudest when
it is placed 1cm from the external auditory meatus has a positive Rinne’s test and a person who hears loudest
when placed over the mastoid process has a negative Rinne’s test. The challenge in making these
interpretations is in the case of a false positive Rinne’s test where there is unilateral sensorineural hearing loss.
This is where Weber’s test is most useful in providing further clues )
SYMPTOMS OF ENT
Symptoms Of Nose

1. Rhinorrhea : Clear Nasal Discharge

2. Anosmia : Is the partial or full loss of smell
3. Parosmia : Abnormal sense or Diversion Sense of Smell
4. Cacosmia : Sense Of Bad Smile Duo To internsic Cause
5. phantosmia : Sense of Smells that aren't really Exist
6. HypoNasal Speech ( Rhinolalia clausa ) : Is the sound of speech that results from
too little air escaping through the nose
7. HyperNasal Speech ( Rhinolalia aperta ) : Is the sound of speech that results from
too much air escaping through the nose while talking
8. Snoring : Is the hoarse or harsh sound that occurs when air flows past relaxed
tissues in your throat, causing the tissues to vibrate as you breathe.
9. Epistaxis: Nosebleeding
Symptoms of Ear
1. Dizziness : Physical Unsteadiness, imbalance
2. Tinnitus : Sensation of a ringing, roaring, or buzzing sound in the ears or head
3. Otalgia
4. Otorrhea : drainage of liquid from the ear
5. Vertigo – Illusion of movement; a sensation as if the external world were revolving
around an individual
6. deafness
7. Headache
8. Itching

Symptoms of Throat
1. Aspiration
2. Swelling
3. Stridor
4. Hoarseness : An abnormally rough or harsh-sounding voice
5. Dysphagia : Difficulty swallowing.
6. Odynophagia : Painful Swallowing
7. Cough
8. Hemoptysis
9. Redness
Indication Of Septoplasty
1. Symptomatic Septal Deviation
2. Cosmetic ( SeptoRhinoPlasty )
3. To Easy Access
4. To Take Graft
5. Approch to Other Surgery Like Hypophysectomy
Normal TM
Otitis Externa
Otitis Externa

Signs of Inflammation Present :

• Discharge , Redness , Itching , Swelling of Canal Wall And Pain

Clinical Presention
• Commonly Patient Present With Sign Of Inflammation
• Other Presention With Acute Perichondritis In Immunocompromised Patient like DM
Duo to Psudomonaus Areginousa

• These Cases Above Present After History of Minor Trauma Or Some Cases May
Present With History of Entering Water To Ear

Mx
1. Aural Toilet
2. Topical AB Or ( Topical Antiseptic )
3. Analgesia
4. Avoiding Water
5. Triple Systemic AB in Certain Condition ( Immunocompromised like DM ,
Malignant Otitis externa )
Acute Sever Perichondritis
( Malignant Otitis Externa )
Sever Swelling Cause Sever Narrowing
Otomycosis
Otomycosis

Clinical Feature : Itching , Pain , Discharge , Deafness ( Duo To Fungel Debries Inside
The Ear Called Wet Newspaper Appearence )

Clinical Present : Patient Present With History Of :

• Swimming Or Entering Water To Ear
• Chronic Otitis Media With AB Abuse ( Which Kill Normal Flora )

There Are Two Common Type Of Fungel Infection

1. Candida Albicans ( Appear As White Clear Like Fat By AuroScope )
2. Aspergillus ( Many Black Dot Inside Ear By AuroScope )

Mx
1. Aural Toilet
2. Topical AntiFungle
- Candida Albicans ( Nystatin )
- Aspergillus ( Azols )

1. Avoiding Water
Candida Albicans ( Appear As White Clear Like Fat By AuroScope )
Aspergillus ( Many Black Dot Inside Ear By AuroScope )
Otitis Media With Effusion
Otitis Media With Effusion
Accumulation Of Fluid Within Middle Ear

Clinical Presentation : Painless Deafness After :

• History Of Upper Respiratory Tract Infection
• History Of Acute Otits Media Without Perforation Which Resolve Spontenousely
Leaving Fluid Inside Ear
• Estuchin Tube Dysfunction

Signs May Seen By Auroscope :

• Handle of Malleus And Lateral process Not Appear Clearly
• Swelling of Cones of light With No Light Reflex
• Bulging of Tympanic Membrane
• Shiny Appearance Of Tympanic Membrane
• Air bubbles Within Tympanic Membrane
• Air Fluid Level
• Clear Yellow Fluid Behind Tympanic Membrane

Mx :
1. No Rule For Medical Tx
2. Watchful Waiting ( Even For 3 Month )
3. If No Improve Occur Surgical Tx Can Be Done [ Myringotomy , Grommet Insertion ]
Air Bubble
Acute Otitis Media
Acute otitis media

Clinical Presentation :
• Sever Pain And Other Constitutional Symptoms After History Of Upper
Respiratory Tract Infection
• When Perforation Occur This Will Lead to Discharge ( SeroSanguineous
Discharge ) —-> This Will Lead To Relief The Pain And Fever And Patient Become
More Comfortable

Mx
1. Analgesia ( Like Paracetamol ) ( First Line )
2. Systemic AB ( In Some Condition Only Like Severe ill Patient , Congenital
Anomalies , High Grade Fever , Child Less Than 2yrs )
3. Aural Toilet And Topical AB —> If Perforation Occur
4. Avoidenss Of Water
Complications

1. Facial N. paralysis
2. Labyrinthitis
3. IntraCranial Complications [ Meningitis , Extradural Abscess ,
Subdural Abscess And Brain Abscess ]
4. Abscesses in [ Mastoid , Zygomatic , Petrous , Bezold`s Abscess ]
5. TympanoSclerosis [ There is white patches on the tympanic
membrane due to hyaline degeneration of collagen and calcium
deposit occur during healing Stage of the T.M ]
Chronic Otitis Media
Chronic otitis media

Clincal Presentation : Patient Present With :

• Painless Deafness
• Or Recurrent Foul Smelling Discharge

Two Form
• Inactive Chronic Otitis Media Present As Dry Perforation
• While Active Form Present With Sign of Inflammation ( Swelling , Redness ,
Discharge ) With History of Recurrence

Mx :
1. Aural toilet
2. Avoiding water
3. Topical AB [ Better Than Systemic Because Drug Directly Penterate Perforation ]
4. Systemic AB
5. Surgical intervention [ Mastodectomy , Myringoplasty With or Without
Mastodectomy , … ]

Chronic OM Became Painful In Two Cases

• If Complication Occur
• If Acute Exacerbation Occur
Classification Of Chronic O.M
Complication Of Chronic Otitis Media
InActive
Active
Traumatic Perforation
Traumatic Perforation of Tympanic Membrane By AuroScope :
1. Perforation With Irregular Margin
2. Bleeding
3. No Sign of Inflammation

Mx
• Watchful Waiting
• Avoid Water
Nasal Bone Fracture
Nasal Bone Fracture

When We Move The Nose To the Right Or Left We Will Hear Creptation
Mx :

Reduction
• Close Reduction
1st Method : Digital Pressure
2nd Method : Instrument ( Ash Forceps or Walsham Forceps )
• Open Reduction Under GA

Fixation by Cast for 10 Days

1st Method : Digital Pressure
2nd Method : Instrument ( Ash Forceps or Walsham Forceps )
Fixation by Cast for 10 Days
Emergency cases of Nasal bone fracture
1. Epistaxis
2. Septal Hematoma ( blood between mucoperichondrium and cartilage )
3. CSF Rhinorrhea
4. History of Other Organs Fracture Like Teeth or Orbital Bone
Sign of Basal Skull Fracture
Sign of Basal Skull Fracture

• Panda Or Raccoon Eye

• Battle Sign
• CSF Rhinorrhea
• CSF Otorrhea
• Bleeding Per Ear
• HemoTympania
Sign of Basal Skull Fracture

• Panda Or Raccoon Eye

Sign of Basal Skull Fracture

• Panda Or Raccoon Eye

• Battle’s Sign
• HemoTympanum
Sign of Basal Skull Fracture

• Panda Or Raccoon Eye

• Battle’s Sign
• HemoTympanum
Septal Hematoma
Septal Hematoma

• Patient Present With Painless Nasal Obstruction

• If Nasal Obstruction Continous For Few Days Then Infection May Occur Which
lead To Formation Of ——> Septal Abscess So Patient May Present With
Systemic Manifestation Like [ Fever , Tenderss ]... If Condition Continous
Then —-> Cartilage Necrosis Which Lead To —-> Septal Deformity ( Saddle
Nose Deformity Which Mx By SeptoRhinoPlasty or Filler injection )

• History Of Trauma or Bleeding Tendency May Present

Mx
1- Drainage by
• Needle Aspiration ( Risk Of Recurrence )
• Or Drinage By Incision and ( Less Recurrence Rate )
2- Compression by Nasal Packing

Mx of Septal Abscess is The Same But With AntiBiotics

Impacted Ear Wax
Cerumen ( Impacted Ear Wax )

Mx :
1. Instrumant By Jobson-Horne Probe
2. Suction by Suction Tube

3. Ear Syringing
• With Water At Body Temperature ( To Avoid Caloric Response Which Stimulated
Inner Ear Cause Vertigo ) ( Water Less Cost Than N/S )
• Complicatin of Syringing ( Fungel Infection - Trauma To Tympanic membrane )
• Contrindication If Syringing ( Active Infection - Perforation of Tympanic
Membrane - History Of Recurrent Vertigo - Phsychological Problem )
Mx :
• Insturmation By Jobson-Horne Probe
Mx :
• Suction by Section Tube
Mx :
• Ear Syringing
Foregin Body In Nose
Foregin Body Of Nose
• Commenst Site - Inferior Turbinate
• Mucopurulnt Discharge With Foul Smell Of Nose
Mx
1. Instrument
2. Suction
3. Cyanoacreglate Glue
Foregin Body In Ear
Foregin Body In Ear

• Commenst Site - Isthmus ( Junction Between Cartilgenous Site And Bony Part )

• Most Common Foregin Body

1- Insect
2- Cotton

Mx
Removal by Instrument Or Washing
Foregin Body In Throat
Foregin Body In Throat

• Commesnt Site - Tonsilar Region

• Most Common Foregin Body Fish Bone in Tonsilar Region

Mx
Removal By Instrument
Epistaxis Mx
Thank You
Ali Ameen