EN2.2 | Headlamp Based ENT Examination Workflow — Summary & Reflection

KEY TAKEAWAYS

The ENT examination workflow is a three-region sequential skill: (1) Ear — inspect pinna/periauricular region, straighten canal (upward-backward traction in adults), examine EAC, then TM (identify pars tensa, pars flaccida, handle of malleus, light reflex; central vs attic/marginal perforation = safe vs unsafe CSOM); (2) Nose — anterior rhinoscopy with Thudichum speculum at 1 cm depth, horizontal blade insertion, first position (inferior turbinate, septum) then head-tilted-back position (middle meatus for mucopus); (3) Throat/neck — tongue depressor on anterior 2/3 of tongue, patient says 'Ah', assess tonsil grade/symmetry/exudate, uvula position, posterior pharyngeal wall; neck examination including laryngeal crepitus (absent = Muller's sign = postcricoid mass). Coaxial illumination via headlamp (head mirror or LED) is the enabling principle for all three regions. Key interpretive decision in the ear: central perforation = CSOM safe (tubotympanic); attic/marginal perforation = CSOM unsafe (atticoantral, cholesteatoma). Key interpretive decision in the throat: asymmetric tonsillar enlargement + uvular deviation = peritonsillar abscess until proven otherwise.

REFLECT

Think about the last time you watched an ENT examination being performed. Did the examiner explain what they were looking for, or did they simply perform the steps silently and announce the diagnosis? Good clinical teaching requires narrating the examination out loud — stating each step, each finding, and each interpretation as it happens. As you practice this examination in the skills laboratory, challenge yourself to narrate simultaneously: 'I am pulling the pinna upward and backward to straighten the canal... I can see the external auditory canal, no discharge, no wax... I can see the tympanic membrane... the handle of malleus is visible... I see a central perforation in the pars tensa with intact pars flaccida...' This narrated practice accelerates skill acquisition and directly prepares you for the OSCE, where your verbal commentary is assessed alongside your technique.