AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 1

Most important, remember that the clinical rotations are about you! While it is important to work as part of a team, and at times that may mean doing menial tasks, your education should never be compromised. If you find yourself in a situation that is caustic or is compromising your education, identify an advocate who can help you. There are always people who can and will help. It is wise to do this confidentially, but do not hesitate to seek help if needed. There will be no other time during your career when you will be exposed to the sheer vastness that medicine has to offer, so do not let one bad apple ruin that opportunity for you. The second goal of this book is to teach you a little about common ear, nose, and throat (ENT) problems. Since the great majority of you will not become otolaryngologists, it becomes much more important for you to understand how to recognize potentially dangerous problems that should be referred to an otolaryngologist, as well as how to manage uncomplicated problems that can be taken care of at the point of primary care. Head and Neck Exam The ENT history begins with the chief complaint followed by a description of the location, duration, frequency, and quality of the presenting symp- toms. In addition, always inquire about the aggravating and relieving factors . Next, ask the patient about associated symptoms. The following is a short list that can be used: • General/systemic symptoms (fever, chills, cough, heartburn, dizziness, etc.) • Otologic (tinnitus, otalgia, otorrhea, aural fullness, hearing loss, vertigo) • Facial (swelling, pain, numbness) • Nasal (congestion, rhinorrhea, postnasal drip, epistaxis, decreased sense of smell) • Sinus (pressure, pain) • Throat (soreness, odynophagia, dysphagia, globus sensation, throat clearing) • Larynx (vocal changes or weakness, hoarseness, stridor, dyspnea) • Neck symptoms (pain, lymphadenopathy, torticollis, supine dyspnea) The head and neck exam involves inspection (and palpation if practical) of all skin and mucosal surfaces of the head and neck. Otolaryngologists use special equipment to better assess the ears, nose, and throat.

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Primary Care Otolaryngology