Clinical handbook

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School of Medicine

University of Auckland

Clinical handbook



Mr Jim Bartley

Prof Randall Morton
2011 Revision by Miss Michelle Wong and Dr Jacqui Allen

2012 Revision by Dr Nikola Lilic and Mr Richard Douglas

Department of

Otolaryngology - head and neck surgery,

counties manukau dhb

A Tertiary Teaching Hospital and Integrated Health Care Service serving the community of Counties Manukau



  1. History taking in patients with ear disease

page 3

  1. Clinical Examination

page 6

  1. Basic Audiometry

page 13


  1. History taking in patients with nose disease

page 17

  1. Clinical examination

page 19


  1. History taking in patients with head and neck disease

page 21

  1. Clinical examination of the mouth and oropharynx

page 23

  1. Clinical examination of the neck and salivary glands

page 24

  1. Clinical examination of the larynx

page 27


page 28

Please also see
A. History Taking in Patients with Ear Disease
In much of medicine, but no more so than in Otolaryngology, the General Practitioner can and must obtain vital clues from an adequate clinical history, before examining the patient. Many relevant features of a good history are noted in the following sections.

The following symptoms referable to the ear should be recorded, taking note of their severity and their duration:
1. Hearing Loss

2. Ear discharge (Otorrhoea)

3. Pain (Otalgia)

4. Itching

5. Tinnitus

6. Vertigo

1. Hearing loss:

Hearing loss is the most common symptom of ear disease and is generally classified in one of two basic categories.

“Conductive hearing loss” is deafness caused by:

  • occlusion of the external auditory meatus by wax or discharge

  • a perforation of the tympanic membrane

  • an effusion in the middle ear cavity

  • or defects of the ossicles

A “sensorineural hearing loss” implies damage to the inner ear or nerve.

Regardless of the cause, the deafness may be of a degree so slight or more typically of an onset so gradual as to escape the patient's notice and someone else notices the deafness first. In fact usually by the time the patient perceives a problem, the hearing loss can be quite significant, so asking family or friends about the patient’s hearing is important.
Additional features in the history of hearing loss:

  • Onset:

Sudden hearing loss may occur in a number of circumstances, for example following barotrauma (flying or diving), upper respiratory tract infection, exposure to excessive noise or blasts, drug administration (e.g. gentamicin) or head injury.

  • Laterality:

Unilateral losses are more likely to have a specific cause (e.g. acoustic neuroma or vascular). Deafness due to age or noise exposure is bilateral and usually symmetrical.

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