EN2.1 | ENT History Taking and Case Presentation — Summary & Reflection

KEY TAKEAWAYS

ENT history taking is a five-domain clinical skill: (1) chief complaint characterisation, (2) ear symptoms (hearing loss — sudden vs gradual, unilateral vs bilateral; otalgia; otorrhoea — foul-smelling discharge = cholesteatoma alarm; tinnitus — pulsatile = vascular imaging; vertigo — positional brief = BPPV, episodic minutes-hours with SNHL = Meniere's), (3) nose/sinus symptoms (unilateral obstruction + epistaxis in adolescent male = JNA; ethmoidal polyps bilateral allergic; epistaxis — anterior = Little's area, posterior = sphenopalatine, elderly/hypertensive), (4) throat/larynx symptoms (hoarseness >3 weeks = laryngoscopy mandatory; referred otalgia with normal ear = examine oropharynx and larynx), (5) systemic, drug, and social history. Red-flag combinations include: cessation of chronic otorrhoea + new headache (intracranial CSOM complication), sudden hearing loss (SSHL = emergency), pulsatile tinnitus (vascular lesion), progressive painless cervical mass in smoker (SCC), and JNA presentation (never biopsy). Case presentation follows a six-part structure: demography → HPI with characterisation → systematic positives/negatives → background history → examination → summary with differential. Documentation requires explicit laterality and a TM diagram for ear disease.

REFLECT

Think about the last patient you saw in an outpatient clinic — any patient, not necessarily ENT. How structured was your history? Did you ask about each symptom domain systematically, or did you follow the patient's narrative without probing? Now think specifically about the ENT domains: do you routinely ask about hearing loss, tinnitus, and vertigo in every patient? If a patient mentioned ear pain and you found a normal ear drum, would your immediate reflex be to examine the oropharynx and larynx? The goal of this reflection is not self-criticism but honest calibration: ENT history-taking skill is built by deliberate practice, not by passively observing consultations. Identify one ENT symptom domain you are least confident eliciting, and make a plan to focus on it in your next clinical posting.