image credit: jasleen_kaur – otoscope

 

Editor:  Joel Hardman

Reviewed: Janice Yeung

 

 

In a hurry? Make sure you know

  • Important signs and symptoms for early referral; Upper airway obstruction (stridor, foreign body), active bleeding, button batteries

 

What history should JMOs know/collect?

  • Standard history including duration and nature of symptoms. Important general points in medical background (other than previous ENT issues) include; diabetes, immunosuppression, anti platelet/anti coagulation, smoking
    • Ears – pain, discharge, hearing, dizziness, previous otology issues/surgery
    • Nose – (facial) pain, rhinorrhea, nasal obstruction, allergies, previous sinonasal issues/surgery
    • Throat – breathing, voice changes, swallowing, smoking,

 

What examinations and investigations should JMOs perform/collect results of?

  • Ears – otoscopy, swab discharge
  • Nose – anterior rhinoscopy, CT paranasal sinuses
  • Throat – Oral cavity examination, neck palpation, lateral airways xray, CT neck soft tissues

 

What additional information would impress you?

  • Knowing specific drops/sprays used by the patient
  • Tuning fork assessment in otology exam
  • Details of previous ENT interventions

 

What are common mistakes/omissions made by JMOs?

  • Incidental radiological findings of fluid in the mastoid air cells or mucosal thickening in the paranasal sinuses are rarely significant in the absence of clinical signs and symptoms
  • The best treatment for otitis externa is topical drops rather than oral antibiotics

 

 

Helpful resources

Textbook – ABC of Ear, Nose and Throat (Harold S. Ludman, Patrick J. Bradley)

 

Podcasts

Watson, Zara.  (2017). Epistaxis. [podcast].  Available at:  https://onthewards.org/epistaxis/ [Accessed 5 April 2017]

Hardman, Joel.  (2017). Sore ear. [podcast].  Available at:  https://onthewards.org/sore-ear/  [Accessed 9 August 2017]

Hardman, Joel.  (2018). Hearing loss. [podcast].  Available at:  https://onthewards.org/hearing-loss/  [Accessed 6 March 2018]