Ear Nose &Throat –

In depth review of Common

Presentations in Primary Care
Dr Adekunle Olowu
Assistant Professor of Family Medicine
in Clinical Medicine, Weill-Cornell
Medicine, Qatar
Consultant Family Medicine
Al Thumama Health Centre
 Disclosure

The presenter has no actual or

potential conflict of interest, no
financial relationship with any
commercial interest related to the
content of this presentation
Introductory Activity:
-Introduce yourselves
-What makes a good
Presentation?
3 minutes
 Presentation Outline
• Learning Objectives
• ENT Basic Anatomy
• ENT History Taking
• ENT Physical Examination
• ENT CASE presentations & discussions
• Conclusion
 Learning Objectives
• Understanding how basic anatomy helps in working
out diagnosis of common ENT conditions

• Summary of ENT History Taking and Physical

examination

• How to diagnose and manage common ENT

conditions in primary care

• How to diagnose and manage common ENT

emergencies in primary care
Anatomy: Structure of the Ear
Anatomy: Structure of the Nose
&Throat
 History Taking:
• Presenting Complaints
• History of presenting complaints
• PMH or PSH or Perinatal History
• Gynaecology/Obstetrics History
• Drugs
• Allergy
HEENT-Examination of the Ear
-Inspection of the External Ear-Pinna,
External Auditory Canal

-Auroscopy Or Otoscopy

-Hearing Tests/Rhine & Weber’s Tests

- Cranial Nerves Examination

Ear Examination
 HEENT-Examination of the Nose
Inspection-Nasal deviation/bleeding/polyp etc

-Rhinoscopy to view turbinates etc

Palpation-Tenderness around the Frontal & Maxillary

Sinuses

Other necessary examination eg face, cranial nerves ,chest

etc

11
 HEENT-Examination of the
Throat
-Inspection with Light Source, Tongue
Depressor and Nasopharynx mirror

-Examine the palates, pharynx and tonsils

 Common ENT conditions-
EAR-1
Painful and Discharging Ear:
History: pain and dicharge from the ears
Examination :tenderness on
auroscopy/discharge visible/FB seen etc
Diagnosis:Otitis Externa/Media/FB/impacted
wax/Furunculosis
Management/Treatment:analgesia/a/biotics/
ear syringing
 Case 1
• History:26 year old with left ear ache and
creamish-brown left ear discharge for a few
days .
• Examination revealed mucopurulent left
ear discharge
• Diagnosis?
• Treatment ?
 Common ENT conditions-
EAR-2
• Hearing Loss and Ear Wax/Hearing aids:
-History:hearing loss, tinnitus
-Examination: Wax/impaired hearing test
-Diagnosis:Congenital deafness,C.D.-Ear
Wax,FB,Glue Ear(middle ear effusion),S.D-
Drugs,Noise Induced,Acoustic
Neuroma,Presbyacusis,Infections,Meniere’s
-Management/Treatment:Treat cause,
ReferUrgently,May need Hearing Aids, Cochlear
Implants
 Common ENT conditions-
NOSE-2
Sinusitis: Inflammation of the sinuses
History:URTI symptoms,rhinitis
Examination:Pyrexia,Tenderness on the face
around the sinuses,
Diagnosis:Clinical
Management/Treatment:Analgesics.Decong
estants,Antibiotics
 Case 2
• History: 8 year old girl who presented
with history of blocked nose with
slight cough and headache.

• Examination revealed congested and

hyperaemic right nasal cavity.

• Any
Diagnosis
follow up?
& Treatment?

17
 Common ENT conditions-
NOSE-3
• Nasal Discharge/Rhinitis:
History:Discharge from the Nose

Examination: Reveals
inflammation/congestion

Causes/Diagnosis:URTI/ Nasal
polyps/Trauma/Tumor/Foerign Body/Allergy

Management/Treatment: Treat the Cause

 Common ENT conditions-
THROAT-1
• Sore Throat:
History: Pain on swallowing, fever etc
Examination:Inflammed Pharynx or Tonsils
Diagnosis:Usually Viral Pharyngitis or
Tonsillitis via Throat Swabs
Diff.Diag.: Glandular fever;Tonsillar Tumor
Management/Treatment:Analgesics,Antipyr
etics,Throat Gargle,??antibiotics
• Complications: Quinsy
 Case 3
• History: 31 year old man with history of
sore throat, runny nose and cough for 6
days
• Examination of the throat revealed
inflammation in the pharynx
• Diagnosis & Treatment?
 Case 4
• History: 26 year old lady, known
hypothyroid c/o severe sore throat and
difficulty in swallowing of a few days’
duration
• No other significant pmh
• On Levothyroxine 25mcg daily
• Examination revealed bilateral enlarged
inflamed tonsils
• Diagnosis and Treatment?
 Common ENT conditions-
THROAT-2
• Hoarse Voice
History: change in voice quality
Examination: may reveal cause
Causes/Diagnosis: Laryngitis, URTI
Diff.Diag.:Vocal Cord
Nodules/Neuro/Muscular
problems/Trauma/Laryngeal Cancer
-Remember Laryngeal Stridor:
 Common ENT conditions-
THROAT-3
• Snoring and Obstructive Sleep Apnea
History: loud noise and breathing problems
during sleep, Daytime sleepiness,
Overweight or Obese, Large tonsils
Examination:ENT
Diagnosis:Clinical
Management/Treatment: Change
positions,Loose weight,CPAP,Ref early
 Common ENT conditions-
THROAT-4
• Difficulty in Swallowing
History: Difficulty in Swallowing
Examination:Throat exam
Diagnosis:Neurological-
CVA,MND,Infection,Oesophageal carcinoma
Management/Treatment: Refer early,Treat
Cause
 Common ENT Emergencies-1
• Airway Obstruction and Stridor
History: establish cause of airway narrowing
Examination: Epiglottitis, Visible
FB,Trauma.laryngeal-Cong.Lar.Str.,Croup,
paralysis
Diagnosis:
Management/Treatment: Urgent:
Rescucitate/dial 999 for urgent transfer to
hospital
Common ENT Emergencies-2
• Foreign Bodies:
History of choking or difficulty in breathing

Examination:o/e FB may be visible

Diagnosis:FB causing obstruction

Management/Treatment:Remove
obstruction or refer
 Case 5
• History: 5 year old boy who
presented with pain in the right ear
for 4 days
• Examination revealed green coloured
substance embedded in Wax in the
right ear
• Diagnosis & Treatment ?
 Common ENT Emergencies-3
• Epistaxis:
History: Bleeding from the nose

Examination: Rhinoscopy shows

blood/bleeding vessel

Diagnosis: as above

Management/Treatment: Pressure bridge of

Nose,ENT ref for cauterization
 Common ENT Emergencies-4
• Sudden hearing loss
History: Hearing loss of sudden onset
Examination: Hearing tests negative
Diagnosis:Ref Urgently
Management/Treatment:ENT
 Summary
• ENT conditons are common in primary
care(about 10%) of consultations
• Take a good history
• Examination patient appropriately
• Diagnosis may require help of laboratory
tests/swabs but largely clinical
• Emergencies need prompt referral via
ambulance after resuscitation
 References
Ø

Sandhu DPS, Waddell A (2016) Teaching ENT in Primary Care. Otolaryngol

(Sunnyvale) 6: 228. doi:10.4172/2161-119X.1000228

Chantal,S et al,(2014) Oxford Handbook of General practice

www.bing.com/images
Thank You/Shukran