ENT Examination

Overview – ENT Examination

The ENT examination (ear, nose and throat) is a core clinical skill in both general and specialist medical settings. It plays a critical role in evaluating common patient complaints such as hearing loss, facial pain, sinus pressure, sore throat, or suspected infection. This high-yield OSCE station requires a structured approach covering inspection, palpation, otoscopy, hearing tests, and sinus examination. This guide walks through each step and highlights key clinical signs and differentials for final-year medical students.

Introduction

  • Wash hands, introduce yourself, and gain informed consent
  • Explain the examination and ensure the patient is comfortable and seated upright

General Inspection

  • Observe hair distribution:
  • Look for scars or deformities: trauma, cleft lip, prior surgeries
  • Assess facial features:
    • High-arched palate (Marfan syndrome)
    • Abnormal facies (Cushing’s, Addison’s, Graves’, Down’s, Turner’s)
  • Assess skin:
  • Check facial symmetry, muscle fasciculations, and eye signs:
    • Pallor (anaemia), icterus, conjunctivitis, discharge, periorbital oedema

Vital Signs

  • Pulse: Tachycardia (infection), bradycardia (raised intracranial pressure)
  • Blood pressure: Hypertension may suggest increased ICP
  • Respiratory rate: Bradypnoea in raised ICP
  • Temperature: Fever indicates infection

Ear Examination

Inspection

  • Look for redness (infection), swelling (gouty tophi), scars, lesions (BCC/SCC), and discharge

Palpation

  • Tug test: pain indicates otitis externa
  • Cervical lymphadenopathy → infection or malignancy

Otoscopy

  • Pull pinna upward and backward
  • Examine left ear with left hand, right ear with right hand
  • Observe for:
    • Otitis externa (red, swollen canal)
    • Tympanic membrane inflammation, bulging (otitis media)
    • Normal landmarks: malleus, light reflex, pars flaccida and tensa
    • Signs of chronic disease: sclerosis, rupture
    • Cerumen impaction
ENT Examination procedure

Hearing Tests

  • Whisper test: e.g. “69” and “100” while masking other ear
  • Weber’s test: Lateralisation suggests conductive (towards affected) or sensorineural (towards normal) loss
  • Rinne’s test: Air > Bone (normal); Bone ≥ Air suggests conductive loss
Weber Test
ENT examination: Rinne Test

Nose Examination

Visual Inspection

  • Look for:
    • Redness, acne rosacea, skin cancers (BCC, SCC)
    • Scars, deformity, nasal deviation
    • Nasal polyps, septal defects
    • Discharge (pus, blood), inflamed turbinates

Palpation

  • Assess for tenderness or obstruction
  • Sinus examination:
    • Percuss frontal and maxillary sinuses
    • Transilluminate maxillary sinuses (dull = sinusitis)

Throat Examination

Visual Inspection

  • Assess:
    • Hydration status
    • Cyanosis (central or peripheral)
    • Oral lesions: ulcers, leukoplakia, petechiae
    • Pigmentation (Addison’s), angular stomatitis
    • Glossitis, gingival changes (hyperplasia, bleeding – AML, methotrexate)
    • Dentition and dead teeth (cardiovascular risk)
    • High-arched palate (Marfan’s)
    • Tonsillar swelling, exudate, pharyngeal inflammation
    • Palatal movement on “Ah” (IX & X nerve integrity)
    • Halitosis (uraemia, liver disease, ketosis)

Palpation

  • Bimanual exam for parotid swelling
  • Palpate tongue and buccal mucosa for lumps
  • Examine cervical lymph nodes

Summary – ENT Examination

The ENT examination is a structured assessment vital for evaluating head and neck pathology. It involves inspection, otoscopy, sinus testing, hearing checks, and oral examination — all essential for OSCEs and clinical rotations. For a broader context, see our Clinical Skills Overview page.

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