HEAD AND NECK EXAMINATION MODULE GOALS -Evaluate history of ear pain and hearing loss -Otologic examination: auricle/external auditory canal/tympanic membrane -Evaluate history of nasal congestion; sinusitis; epistaxis -Intranasal examination -Evaluate dysphagia/odynophagia -Examination of oral cavity -Evaluate neck mass -Neck examination METHODS 1. Discuss what you are about to do. Inform patient of intention of examination Explain how exam will be conducted 2. Prepare your patient for examination Patient to be sitting upright in examination chair Patient privacy to be respected Patient may need to loosen necktie or shirt collar 3. Prepare yourself for the examination Approach exam systematically Compare bilaterally when applicable Review patient complaints as exam progresses 4. Follow exam sequence Observe Visualize Palpate SPECIFIC OBSERVATIONS 1. Otologic examination Auricle skin/soft tissue exam anterior and posterior External auditory canal visualize with speculum/otoscope proper positioning of auricle to visualize external auditory canal/tympanic membrane Tympanic membrane visualize malleus/umbo insufflation for mobility/pneumatic otoscopy Hearing - Tuning fork examination Weber test Rinne test
Intranasal examination position of speculum visualize septum inferior turbinates middle turbinates 3. Oral cavity examination Ability to open mouth asymmetry trismus Visualize (may utilize tongue blades to assist visualization) Hard palate mucosal lesions Soft palate/uvula palate elevation Tonsils (if present) size! symmetry lul cerati ons Tongue anterior 2/3 mucosal lesions posterior 1/3 (tongue base) tongue mobility Floor of mouth Wharton's ducts Mucosal lesions Buccal mucosae Stenson's ducts Mucosal lesions Gingivolabial sulci Dentition Remove dentures if edentulous patient Palpate Floor of mouth masses: bony/soft tissue Buccal mucosae soft tissue masses Tongue base soft tissue masses Neck examination Salivary glands Parotid glands: visualize/palpate Facial nerve examination 5 branches Submandibular glands: ~isualize/palpate Sublingual glands: visualize/palpate Levels of the neck: visualize/palpate I-V Spinal accessory nerve function Thyroid examination 2. 4.
Evidence Testing: Scenario #1: Patient complains of hearing loss Scenario #2: Patient complains of nasal congestion Scenario #3: Patient complains of neck mass Scenario #4: Patient complains of sore throat Scenario #5: Patient complains of trouble swallowing Scenario #6: Patient complains of hoarseness Student Worksheet: 1. Otologic Examination Auricles: skin/soft tissue External auditory canal: skin / soft tissue Tympanic membrane malleus! umbo insufflation: mobility Tuning fork Weber/Rinne 2. Intranasal examination Nasal Septum Inferior turbinates Middle turbinates 3. Oral cavity: Mandible mobility Hard palate Soft palate/uvula Tonsils Tongue/Tongue base/circumvallate papillae Floor of mouth/Wharton' s ducts Buccal mucosae/Stenson's ducts Gingivolabial sulci Dentition Palpate:. Floor of mouth Buccal mucosae Tongue base 4. Neck Examination: IdentifY~arotid glands Identify: Identify:
Facial nerve function Submandibular glands Sublingual glands Lymphatic levels of the neck: I-V Neck mass: Firm VS. Soft Tender vs. Non-tender Skin changes YS. No Skin Changes Mobile vs. Fixed Nerve compromise VS. None Thyroid gland Palpate: Parotid glands Submandibular glands Sublingual glands Lymphatic levels of the neck (I-V) Thyroid gland
Student Name: Revised: February 14. 2000 Head and Neck PE Module Pre-test/Post-test What does tympanic membrane insufflation evaluate for? 1 2. What are 3 abnormalities of the tympanic membrane? What are 5 causes of hearing loss? What are the functions of the nasal septum and nasal turbinates? 5. What are 5 causes of nasal obstruction? 6. What are 5 causes of throat pain? 7. Name all major salivary glands/location/and type of saliva they produce. 8. What is the significance of the presence of a neck mass? What are infectious causes of a neck mass? 9. 10. What are neoplastic causes of a neck mass? 3. 4.
STUDENT NAME: Revised: February 14,2000 Head and Neck PE Module Evaluation Form Did the student examine and record the following? Yes No External ear examination Tympanic membrane/mobility Intranasal examination with speculum Oral cavity examination with palpation Neck examination Explain examination procedure Position patient correctly Inspect Palpate intraorally Neck palpation in all levels Thyroid palpation Stand to the side of the patient TOTALS Evaluator: