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ENT
Clinical Diagnosis of the Otologic and Neurotologic Patient (History and Examination)
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
11 sections · 105 slides
Overview
- Scope of the clinical evaluation
- Roadmap of the otologic assessment
The otologic history
- Structure of the otologic history
- Systemic disease and drug history
- Systemic diseases affecting the otologic system
- Systemic diseases affecting the otologic system (continued)
- Systemic diseases affecting the otologic system (continued)
- Systemic diseases affecting the otologic system (continued)
- Methods of gathering historical data
Hearing loss
- Laterality of hearing loss
- Bilateral hearing loss: causes
- Duration and stability of hearing loss
- Fluctuating hearing loss
- Symptoms associated with hearing loss
- Past and family history in hearing loss
- Noise exposure and ototoxic medication
- Agents and medications that can cause vestibular and auditory ototoxicity
- Agents and medications that can cause vestibular and auditory ototoxicity (continued)
- Agents and medications that can cause vestibular and auditory ototoxicity (continued)
- Agents and medications that can cause vestibular and auditory ototoxicity (continued)
Dizziness
- Value of history in the dizzy patient
- Character of the dizziness
- Hearing loss with vertigo
- Episodic versus constant vertigo
- Time course of vertiginous attacks
- Vestibular migraine and chronic dizziness
- Associated symptoms in dizziness
- Exacerbating factors in dizziness
- Trauma and chronic ear disease in dizziness
Ear drainage
- Type of otorrhea
- Symptom patterns with otorrhea
- Gradenigo syndrome and petrous apicitis
- Duration and predisposing factors in otorrhea
Tinnitus and otalgia
- Nonpulsatile tinnitus
- Pulsatile tinnitus: causes
- Autophony and audible breathing
- Comorbidities and symptoms with tinnitus
- Laterality and associations in otalgia
- Duration and referred causes of otalgia
- Referred otalgia and the head and neck exam
Physical examination
- Examination of the auricle
- Preauricular pits and sinus tracts
- Otoscope head and speculum
- Inspection of the external auditory canal
- Otomycosis and bony canal lesions
- Keratosis obturans and canal cholesteatoma
- Tympanic membrane: instruments and views
- Otoscopic view of the tympanic membrane
- Tympanic membrane perforation
- Large subtotal perforation with healthy middle ear mucosa
- Scutum erosion and attic retraction
- Attic retraction pocket with scutum erosion
- Colour and mobility of the tympanic membrane
- Granular and bullous myringitis
- Granulation tissue across the tympanic membrane
- Retraction, atelectasis and myringosclerosis
- Red chorda tympani sign
- Retrotympanic vascular mass and Brown's sign
- Retrotympanic red mass of middle ear and jugular paraganglioma
- Schwartze's sign in otosclerosis
Tuning fork and head and neck
- Tuning fork used for bedside hearing assessment
- The Weber test
- The Rinne test
- Air bone gap estimated from fork frequency
- Estimation of hearing loss by Rinne exam
- Head and neck examination in otologic disease
- Neck examination in pulsatile tinnitus
Vestibular examination
- Basis of nystagmus in unilateral weakness
- Crista ampullaris and cupula of the semicircular canal
- Characterising nystagmus
- Grading intensity of nystagmus
- Frenzel lenses and recorded testing
- The fistula test
- The Dix-Hallpike manoeuvre
- Interpreting the Dix-Hallpike and supine roll test
- The head thrust test
Cranial nerves and cerebellum
- Cranial nerve examination: I to VI
- Cranial nerve examination: VII to XII
- Hypoglossal nerve testing
- House-Brackmann grading of facial nerve deficits
- House-Brackmann facial nerve grading scale
- House-Brackmann facial nerve grading scale (continued)
- Cerebellar testing in the dizzy patient
- Gait, Romberg and Fukuda tests
- Central versus peripheral localisation
Summary
- Conclusion
- High-yield points
- References
- References
- References
- References
- References
- References
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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