HISTORY

• Non-specific questions might include: pain, congestion, runny nose, bleeding, post-nasal drip

• More focused questions may include: seasonal congestions?, sneezing fits?, itchy palate (common in some allergies), fevers, chills, night sweats, international travel hx?, immunocopmrimised? (invasive fungal sinusitis can be fatal in these pts), DM? (Zygomycetes), fam. Hx. Of CF?, nasal trauma?, breathing difficulty? (esp. w/ WG, sarcoid), hematuria (WG), TB exposure?, Nickel or woodworking exposure? (sinus/nasal cancer), dental disease or teeth pain?

PHYSICAL EXAM – KNOWING YOUR ANATOMY IS EXTREMELY IMPORTANT HERE!

• Face (swelling, erythema, tenderness), Eyes (vision, chemosis – conjunctiva swelling, proptosis=exopthalmos – eyes sticking out, epiphora – eye tearing, EOM), Oral Cavity (dentition, trismus – difficulty opening the mouth.

• NEURO (TRIGEMINAL NERVE – KNOW IT UP AND DOWN) – the maxillary branch of V runs through the rotundum and gives off the infraorbital branch.

1. V2 – infraorbital nerve - numbness over the upper lip

2. V2 – ant. sup. alveolar n. – maxillary incisor problems

3. V2 – post. sup. alveolar n. – maxillary molar problems

4. V2 – greater palatine n. – numbness over the palate

5. V3 – inf. Alveolar n. – numbness over the chin

6. V3 – lingual n. – weird taste

Nasal Exam – use the speculum to examine anterior septum (deviation, bleeds), turbinate swelling, valve area, “cottle maneuver” (lateral pulling of the cheek improves nasal breathing); use the endoscope to explore the lateral wall of the nose:

1. Inferior Meatus – nasolacrimal duct empties

2. Middle Meatus – anterior ethmoids, maxillary, and frontal sinuses drain here.

3. Superior Meatus – posterior ethmoid sinus drains here.

• Technique – 30 degree 4 mm telescope that goes into inf. Meatus, middle turbinate to the sphenoethmoidal recess, middle meatus.

Category: ENT Notes