This document outlines the key components of performing a thorough head and neck examination in otolaryngology. It describes how to take a detailed patient history, including the HPI, and examines the various structures of the head and neck through inspection, palpation, and other examination techniques. Common abnormal findings and ENT diseases are also reviewed. Performing a systematic and well-documented head and neck exam is important for properly assessing patients' ENT complaints.

1. Frederick Mars Untalan, MD
Relearning the basic history taking & physical
examination

3. OUTLINE
 Know what to ask
 Know what to see
 Common ENT diseases

4. REMEMBER. . .
. . . a thorough
assessment begins
with the
HISTORY!

5. HISTORY of PRESENT ILLNESS
(HPI or Symptom Analysis)
 Location and Radiation
 Timing: Onset, Frequency & Duration
 Quality and/or Characteristics
 Quantity and/or Severity
 Setting and/or Situation
 Aggravating Factors
 Alleviating Factors
 Associated Factors/Manifestations
 Underlying Concern and/or Perception

6. EQUIPMENT NEEDED
 Latex Gloves
 Light Source
 Cotton
 Cup with water (optional)
 Measuring tape (possible)

7. GENERAL
CONSIDERATIONS
 The head and neck exam is not fixed
in sequence.
 Different parts of the exam may be
included and/or excluded depending on
the history and the purpose of the exam.

8. Physical
Diagnosis
in
Otolaryngology

9. Health History
 Determine presence/absence of age- and
gender-specific diseases of the head and
neck
 Common chief complaints
 Neck pain or stiff neck
 Hoarseness; nasal discharge or obstruction
 Neck mass
 Headache or facial pain
 Head injury ; otalgia; dysphagia; ear discharge

10. General Approach to Head
and Neck Assessment
 Greet patient, explain assessment
techniques
 Environment
 Quiet
 Warm
 Private
 Adequate lighting
 Upright sitting position
 Compare right and left sides
 Systematic approach

11. Where the Head Ends and Neck
Begins
 Plane between the
external occipital
protuberance and inferior
surface of the mandible
 Neck
 Anterior triangle is bordered
by Mandible (above),
Cervical midline(laterally)
and Sternomastoid
(anteriorly

12. Where the Head Ends and
Neck Begins
Neck
– Posterior triangle is
bordered by
Clavicle (below),
trapezius
(posteriorly) and
Sternomastoid
(anteriorly)

13. Special Bony Areas
 External Occipial
Protuberance (notch
in occipital area
 Mastoid Process
(behind Ear)
 Zygomatic Arch
(Cheekbone)
 Orbit (eye socket)
 Maxilla (upper jaw)
 Mandible (lower
Jaw)

14. Assessment of the Face
 Inspection
 Shape
 Symmetry
Normal findings
– Symmetrical
features
– Palpebral fissures
equal
– Nasolabial folds
present bilaterally
– Shape can be oval,
round, or slightly
square
INSPECT
Size, shape, and symmetry.
Note placement of features ,
expression, movements and
Skin characteristics.
PALPATE
Facial bones

15. ABNORMALS

16. Assessment of the Face
 Abnormal findings
 Deformed or absent structures
 Asymmetry
 More or less pronounced facial features
 Diseases which may alter facial features: Bell’s
palsy, Down syndrome, Graves’ disease,
Myxedema, Cachexia, Cushing’s syndrome

17. Replacement of Nonfunctional Facial
Muscles
 Microneurovascular free muscle transfer

18. Mandible
 Palpate and auscultate the TMJ when
the client opens and closes the mouth
 Normal findings
 No discomfort, joint articulates smoothly without
clicking or crepitus
 Abnormal findings
 Pain, tenderness, crepitus, clicking, or snapping
sound

19. TEMPORMANDIBULAR
JOINT (TMJ)
Located anterior to tragus, bilaterally
Assess
 Palpate with
movement
 Auscultate: Bell
Abnormals
 Tenderness,
crepitus, clicking
 Bruit
 Pain with trismus

22. Serous Otitis Media

23. Tympanic Membrane
Perforation

24. Tympanic Membrane
Perforation

25. External Auditory Canal
Foreign Body

26. Otitis Externa

27. Otowick in EAC

28. Pharynx

29. Esophagus - mid

30. Esophagus - distal

31. Foreign Bodies

32. Foreign Body Ingestion

33. Vocal Nodules

35. Bilateral Singer’s Nodules

36. Nasal Polyp

38. Middle Turbinate Adhesions

39. Middle Meatus-Maxillary Sinus Ostium
Purulent Drainage
Normal

40. SINUSES:
Frontal & Maxillary
Assess
Inspect
Palpate
Percuss:
Direct
Transilluminati
on: Darkened
room
Abnormals
 Swelling
 Tenderness
 Flatter sound
 Unequal light

41. CT Scan - Sinusitis

42. Allergic Rhinitis

43. Nasal Septal Perforation

45. Bony
Dorsum
Deficiency

46. Nasal
Bone
Fracture

47. Dorsal Deficiency
 More likely with
osteotome rather
than sharp rasp
 Corrected with
completion
osteotomies or on-
lay graft

48. Septal Hematoma

49. Cleft Anatomy

50. Cleft Anatomy - The Nose

51. Cleft Anatomy

52. Controversies

55. Post-tonsillectomy

56. Peritonsillar Abscess

57. Cleft Palate - Bifid Uvula

58. Ranula

59. Squamous Cell Carcinoma
of Tongue
ExophyticUlcerative

60. Minor Salivary Gland
Tumor

61. Parotitis

62. Pleomorphic Adenoma-Parotid

63. Thyroglossal Duct Cyst

64. Branchial Cleft Cyst

65. THYROID
 Inspect (Tangential lighting when swallowing)
 Palpate
 Palpate trachea
 Posterior Approach
 Anterior Approach
 Auscultate (with Bell)

66. Enlarged Thyroid

67. PALPATE the THYROID
 Posterior Approach
 Displace to one side then palpate
 Swallow

68. Neck Masses

69. NECK

71. LYMPH NODES
 Landmarks
 Anterior Triangle
○ Mandible
○ Trachea
○ SCM muscle
 Posterior Triangle
○ Clavical
○ Trapezius muscle
○ SCM muscle

72. LYMPH NODES
Location
Head
Face
Neck
Not normally
palpated

73. LYMPH NODES
 Preauricular Nodes

74. LOCATION of LYMPH NODES
of the NECK
Anterior Cervical Chain
Overlying the sternocleidomastoid
muscle
Posterior Cervical Chain
In the posterior triangle along the
trapezius muscle
Internal Jugular Chain
Deep under the sternocleidomastoid
muscle. Not normally palpated.
Supraclavicular
Just above & behind the clavicle at the
sternocleidomastoid muscle

75. LYMPH NODES
 Anterior Cervical Nodes

76. LYMPH NODES
 Posterior Cervical Chain

77. LYMPH NODES
 Supraclavicular Nodes

78. DOCUMENTATION
Head:
Normocephalic, no lumps, no lesions, no
tenderness. Hair medium texture,
evenly distributed.

79. DOCUMENTATION
Face:
Symmetric, no drooping, no weakness, no
involuntary movements. Temporal
artery pulses palpable, no bruits. TMJ
articulates smoothly without clicking,
crepitus or pain.

81. DOCUMENTATION
Neck:
Supple with full ROM, no
pain. Symmetric, no
lymphadenopathy or
masses, trachea midline.
Thyroid not palpable.
No bruits.

82. DOCUMENTATION
Ears
Inspection & otoscopy; tuning fork tests
Nose
Inspection, anterior & posterior rhinoscopy
Oral cavity & oropharynx
Indirect laryngoscopy to check the laryngeal inlet &
hypopharynx

83. OUTLINE
 Know what to ask
 Know what to see
 Common ENT diseases

84. Frederick Mars Untalan, MD
Relearning the basic history taking & physical
examination