Primary Care Otolaryngology

Chapter 2

Evaluating and Keeping Track of Patients

Taking an Otolaryngology History and Performing a Head and Neck Exam The ENT history begins with the chief complaint followed by a descrip- tion of the location, duration, frequency, and quality of the presenting symptoms. In addition, always inquire about the aggravating and reliev- ing factors . Next, ask the patient about associated symptoms . The follow- ing is a short list that can be used: General/systemic symptoms (fever, chills, cough, heartburn, dizziness, • etc); Otologic (tinnitus, otalgia, otorrhea, aural fullness, hearing loss, ver- • tigo); Facial (swelling, pain, numbness); • Nasal (congestion, rhinorrhea, post-nasal drip, epistaxis, decreased • smell); Sinus (pressure, pain); • Throat (soreness, odynophagia, dysphagia, globus sensation, throat • clearing); Larynx (vocal changes or weakness, hoarseness, stridor, dyspnea); and • Neck symptoms (pain, lymphadenopathy, torticollis, supine dyspnea). • The head and neck exam involves inspection (and palpation if practical) of all skin and mucosal surfaces of the head and neck. Otolaryngologists utilize special equipment to better assess the ears, nose, and throat. A bin- ocular microscope provides an enlarged, three-dimensional image, giving the physician a superior view of the ear canal and tympanic membrane. The microscope also permits the bimanual removal of wax and foreign bodies. Indirect mirror exam with a headlight permits examination of the

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