ABC of Ear, Nose and Throat
Harold S. Ludman, Patrick J. Bradley, Harold S. Ludman, Patrick J. Bradley
- English
- ePUB (mobile friendly)
- Available on iOS & Android
ABC of Ear, Nose and Throat
Harold S. Ludman, Patrick J. Bradley, Harold S. Ludman, Patrick J. Bradley
About This Book
ABC of Ear, Nose and Throat is a long established best-selling guide to the management of common conditions of the Ears, Nose and Throat. It follows a symptomatic approach for evaluation and prioritisation of common presentations, and provides guidance on primary care assessment and management, and on when and why to refer for a specialist opinion.
Fully revised to reflect the current practice of oto-rhino-laryngology and head and neck surgery, new chapters address the increasing specialization and improved understanding of the likely causes and specialist treatment for symptoms such as tinnitus, nasal discharge, nasal obstruction, facial plastic surgery, head and neck trauma and foreign bodies, and non-specialist assessment and examination. There is new content on rhinoplasty, pinnaplasty, non-melanoma skin tumours, thyroid disease and head and neck cancer, with many new full colour illustrations and algorithms throughout. This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.
Frequently asked questions
Information
- Taking a history of the symptoms, followed by inspection, palpation and site specific examination of the ENT should be performed in its entirety when a patient first presents with an ENT complaint
- The ability for the non-specialist to perform such an examination is limited because of lack of appropriate equipment and clinical expertise
- Examination of each site; ear, nose, mouth and neck when examined by the non-specialist should be performed in a repetitive systematic manner and the positive findings recorded, thus ensuring that should a patient represent at a later time the previous findings can be reviewed in the light of any new findings
- The specialist examination and investigation is the only definitive current method to ensure a definitive correct diagnosis can be made thus resulting in a correct and appropriate patient management
Examination
Equipment necessary
- For the earâan otoscope (auriscope), comprising a handle, with battery power, light source and cone specula of various sizes and low-level magnification lens; a tuning fork vibrating at 512 kHz (lower frequencies excite vibration sense and higher ones decay too rapidly) (Figure 1.1).
- For the noseâThudichum's or Killian's nasal speculae.
- For the mouth and oropharynxâLack's tongue depressors, or spatulae (not as good, because the hand blocks the view and there is a lack of leverage)
- For the neckâa systematic plan is described below.
- For allâGood lighting; ideally from a headlight, or heard mirror and light source (Figure 1.1).
- The larynx, pharynx (nasopharynx [or postnasal space], oropharynx and hypopharynx)âessential parts of the specialty (Figure 1.2) require specialist equipment, which is described in the relevant chapters.
Normal ear anatomy
The external auditory canal
The tympanic membrane (TM or drumhead)
Examination of the ear
Inspection
- Examine the face for evidence of muscle weakness, as in a cranial nerve examination.
- Seek scars, from surgical or other trauma, skin inflammation, swellings, pits or sinuses around the pinna. Scars from previous surgery may be difficult to find.
Palpation
- Feel the mastoid tip, mastoid bone, the pinna itself, and also the parotid and temperomandibular joint area. Pressure on the mastoid tip and the region above and behind it must allow for any pain and tenderness of which the patient complains.
Otoscopy (with auriscope)
Hearing tests
- Speech material can be used in a quiet room as a Free Field Speech Test (FFST).
- Use conversational material and so-called âspondeeâ two-syllable words.
- Tuning fork tests in the non-specialist clinic include: the Rinne test and the Weber's test, which usually allow differentiation between conductive and sensorineural hearing loss.
- Pure tone audiometry and tympanometry.