Ear, Nose, and Throat Exam

System/Body Area

Elements of Examination

Constitutional

• Measurement of any three of the following seven vital signs: 1) sitting or standing blood pressure, 2) supine blood pressure, 3) pulse rate and regularity, 4) respiration,

5) temperature, 6) height, 7) weight (May be measured and recorded by ancillary staff)

• General appearance of patient (eg, development, nutrition, body habitus, deformities, attention to grooming)

• Assessment of ability to communicate (eg, use of sign language or other communication aids) and quality of voice

Head and Face

• Inspection of head and face (eg, overall appearance, scars, lesions and masses)

• Palpation and/or percussion of face with notation of presence or absence of sinus tenderness

• Examination of salivary glands

• Assessment of facial strength

Eyes

• Test ocular motility including primary gaze alignment

Ears, Nose, Mouth

and Throat

• Otoscopic examination of external auditory canals and tympanic membranes including pneumo-otoscopy with notation of mobility of membranes

• Assessment of hearing with tuning forks and clinical speech reception thresholds (eg, whispered voice, finger rub)

• External inspection of ears and nose (eg, overall appearance, scars, lesions and masses)

• Inspection of nasal mucosa, septum and turbinates

• Inspection of lips, teeth and gums

• Examination of oropharynx: oral mucosa, hard and soft palates, tongue, tonsils and posterior pharynx (eg, asymmetry, lesions, hydration of mucosal surfaces)

• Inspection of pharyngeal walls and pyriform sinuses (eg, pooling of saliva, asymmetry, lesions)

• Examination by mirror of larynx including the condition of the epiglottis, false vocal cords, true vocal cords and mobility of larynx (Use of mirror not required in children)

• Examination by mirror of nasopharynx including appearance of the mucosa, adenoids, posterior choanae and eustachian tubes (Use of mirror not required in children)

Neck

• Examination of neck (eg, masses, overall appearance, symmetry, tracheal position, crepitus)

• Examination of thyroid (eg, enlargement, tenderness, mass)

Respiratory

• Inspection of chest including symmetry, expansion and/or assessment of respiratory effort (eg, intercostal retractions, use of accessory muscles, diaphragmatic movement)

• Auscultation of lungs (eg, breath sounds, adventitious sounds, rubs)

Cardiovascular

• Auscultation of heart with notation of abnormal sounds and murmurs

• Examination of peripheral vascular system by observation (eg, swelling, varicosities) and palpation (eg, pulses, temperature, edema, tenderness)

Chest (Breasts)

Gastrointestinal

(Abdomen)

Genitourinary

Lymphatic

• Palpation of lymph nodes in neck, axillae, groin and/or other location

Musculoskeletal

Extremities

Skin

Neurological/

Psychiatric

• Test cranial nerves with notation of any deficits

Brief assessment of mental status including

• Orientation to time, place and person,

• Mood and affect (eg, depression, anxiety, agitation)