In line with the general propaedeutic procedure, any examination of ENT-outand inpatients should start from taking a medical history. After that physician can proceed to ENT examination.
Several general rules apply to ENT examination:
► the patient is seated to the left of the light source and instrument table;
► the physician sits at the table in front of the patient; the patient?s legs are placed outward of the table;
► the source of light is located at theright auricle level of the patient 10 cm away.
Use of Head Mirror
► The head mirror placed on the forehead by using the forehead strap. The head mirror hole is placed in front of the left eye (fig. 2.1).
► Distance between the mirror and the examining organ is 30-35 cm (mirror focal distance).
► At first, head mirror is used to direct the beam of reflected light to the patient?s nose. After that the examiner closes uses the left eye (right eye is closed) to look through the head mirror hole. Examiner turns the mirror until he sees the spot of focused light on the patient?s nose. Next examiner opens the right eye and continues examination with two eyes.
2.1. NOSE AND PARANASAL SINUSES EXAMINATION
Stage One. Visual Inspection and Palpation
► The physician perfroms inspection of external nose and areas of paranasal sinuses.
► External nose palpation. Place forefingers of both hands along the ridge of the nose and use light massaging movements to palpate the areas of the nose root, lateral nasal walls, dorsum nasi and tip of the nose.
► Palpation of anterior wall and floor of frontal sinuses.
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Fig. 2.1. Head mirror positioned on the physician?s forehead
Place thumbs of both hands on the forehead above the eyebrows and softly press the area; after that place the thumbs and press on the area of the orbital roof at the medial cantus of the eye. The palpation is performed on exit points of the first branches of the trigeminal nerve - the ophthalmic nerve (n. ophthalmicus). Walls of frontal sinuses generally are painless on palpation (fig. 2.2).