History
- • Ear: pain, discharge, hearing loss, tinnitus, vertigo
- • Nose: obstruction, discharge, epistaxis, anosmia
- • Throat: dysphagia, hoarseness, sore throat, stridor
Examination sequence
- • WIPE — patient sitting upright
- • Ear: inspect pinna, mastoid; otoscope (canal, TM landmarks)
- • Hearing: whisper test, Rinne, Weber (tuning fork 512 Hz)
- • Nose: external inspection, anterior rhinoscopy with Thudichum
- • Mouth/throat: inspect lips, gingiva, tongue, tonsils, posterior pharynx
- • Neck: lymph nodes, thyroid, salivary glands
- • Cranial nerve screen V/VII/IX/X/XI/XII
Positive findings
- • Rinne positive (AC>BC) bilateral + Weber central → normal or symmetrical SNHL
- • Rinne negative + Weber to affected side → conductive HL on affected side
- • Quinsy: trismus, uvula deviation, peritonsillar swelling
Differentials
- • Otalgia: otitis externa, OM, TMJ, referred (tonsils, dental)
- • Hoarseness >3 wk: laryngeal cancer until proven otherwise
Viva questions
Q. Red flags for ENT cancer?
A. Persistent hoarseness, neck lump, dysphagia, otalgia, unexplained weight loss, smoker/heavy drinker.
Q. How to differentiate OE vs OM?
A. OE: tenderness on tragal pressure, canal oedema; OM: bulging red TM, often after URTI.
Common mistakes
- • Not examining cranial nerves
- • Skipping neck nodes
- • Forgetting tuning fork tests
