Chapter II - ENT Examination

Nose and Throat

After examination of the ears, the physician the proceeds with inspection of the nose. The nasal bone, cartilage, passages, inferior and middle turbinates are all inspected through a speculum or by tilting the tip of the nose with a penlight. More focus is given to the contour of the septum and the color of the mucus membrane. After this comes the inspection of the throat or the oral cavity. The patient is asked to open the mouth and checked for bad breath, lesions, tonsillitis, caries, uvular anomalies, palatal anomalies, tongue texture, and for any oral mucosal ulcers or lesions. The examination then usually concludes with a direct and indirect laryngoscopy to look for any vocal chord paralysis, lesions, nodes, adenoids, etc.

In transcription , physical assessment with regards to ears, nose, and throat is usually bundled up with examination of the eyes and the head and is generally transcribed under the heading HEENT (H-head, E-eyes, E-ears, N-nose, T-throat.) The assessment begins with external exam of the ears and nose and the oral mucosa. After a cursory and brief external exam, the physician then proceeds to each individual part. Usually starts with proper examination of the inner ear with otoscopy. External auditory canal and tympanic membranes are inspected for color, translucency and position of the eardrum and wax and tear of the eardrums are specially looked for. The tympanic membranes generally appear translucent and pinkish gray in color and any significant variation in the texture usually denotes some disease process. The tympanic membranes are then checked for mobility with air inflation and the malleus for its oblique position behind the upper part of the drum. After this hearing assay is done with specific tests already discussed above.

Nose and throat have already been discussed in the anatomical section in detail. Below mentioned are few important points in regards to otorhinolaryngology.

Breathing starts with the air entering the nasal cavity. The nasal cavi-ties, also known as nostrils, are divided into the right and the left sides by a vertical partition called septum. These nasal cavities have mucous membranes and small hairs, called vibrissae, which warm, moisten, and filter the incoming air. The receptors for the sense of smell are also located in the nasal cavities among the epithelial cells. These receptors are known as olfactory neurons, and they are located up in the nasal cavities. The nose is the primary organ for smelling. As we sniff, the air flows through the nose and over structures called turbinates in the nasal cavity. The turbulence caused by this disruption slows the air and directs it toward the olfactory epithelium. At the surface of the olfactory epithelium, odor molecules carried by the air contact olfactory receptor neurons, which transduce the features of the molecule into electrical impulses in the brain.

Air passes from the nasal cavities to the pharynx.
The pharynx is the combined part of the digestive system and respiratory system of many animals. It is situated immediately posterior to the mouth and nasal cavity, and is cranial to the oesophagus, larynx, and trachea. Because both food and air pass through the pharynx, special adaptations are necessary to prevent choking or aspiration when food or liquid is swallowed. In humans the pharynx is important in vocalization.

The human pharynx is conventionally divided into three sections:, lying behind the nasal cavity. Posterosuperiorly this extends from the level of the junction of the hard and soft palates to the base of skull, laterally to include the fossa of Rosenmüller. The inferior wall consists of the superior surface of the soft palate.

Nasopharynx
Oropharynx
Hypopharynx

, which lies behind the oral cavity. The anterior wall consists of the base of tongue and vallecula; the lateral wall is made up of the tonsil, tonsillar fossa, and tonsillar (faucial) pillars; the superior wall consists of the inferior surface of the soft palate and the uvula.

which includes the pharyngoesophageal junction (postcricoid area), the piriform sinus, and the posterior pharyngeal wall.

Adenoids
Physical Assessment, also known as pharyngeal tonsils, are located in the nasopharynx. The palatine tonsils, at times referred to as just tonsils’, are located in the oropharynx. The larynx is found in the laryngopharynx and is responsible for sound production or phonation. There is a leaf-shaped structure situated at the top of the larynx, which closes the passage to the lungs while swallowing, thus preventing the food particles and other irritants from entering the lungs. This leaf-shaped structure is called epiglottis The larynx is a short passage that connects the pharynx with the trachea.