HEARI HE ARING NG abn abnorma ormall or normal normal? ? Onset Ons et sud sudden den or or gradu gradual? al? Unilateral or bilateral? Which is the better ear? What is the functional capacity of each ear? can one hear hear and unders understan tand? d? Does Does he only hear loud noises? Is it worsened in crowds? Is the loss const constant ant or fluctuating? Associated symptoms: vertigo, tinnitus, drainage draina ge or fullness of the ears?
HEARING Past history: Syst Sy stemic emic disease? disease? vas vascula cularr problems problems Previous surgery to the ear? Hx of hea head d tr trau auma ma Ear infections infections as a child
HEARING Personal and Social: Noise ex exposure? posure? occupa occupation? tion? Drug intake intake:: aminoglycosides aminoglycosides (injectio (injections, ns, wound irrigations) diuretics, salicylates
Previous use of hearing aids? Family history: congenital or familial
TINNITUS
Unilateral or bilateral? Associat Assoc iated ed sympt symptoms oms hearing loss, loss, vertigo vertigo High pitched or low pitched? Continuous, intermittent, intermittent, pulsatile? Duratio Dur ation n rec recent ent or long-s long-stan tanding? ding? Altered by head position or pressure on neck? Drug Dr ug inta intak ke as aspi piri rine ne an and d quini quinine? ne?
EAR DISCHARGE Which ear? Unilateral or bilateral? Onset and duration? Continuous or intermittent? Predisposing factors? Sinusitis, colds, allergy Character: mucoid, mucopurulent, purulent, serous Associated otalgia Odor foul Odor oul-sm -smel ellin ling g or nonnon-ffoul oul? ? Associated Associat ed symptoms symptoms headache, hearing loss, dizziness, facial weakness Past history of ear trauma or surgery
OTALGIA Onset and duration? Continuous or intermittent? Location Loc ation deep, superfici superficial, al, circumaur circumaural al Natur Na ture e sha sharp, rp, dull, dull, borin boring g Pain on manipul manipulation ation of of ear? point pointss to otit ot itis is ex exte terna rna Associated Associat ed symp symptoms toms ear discharg discharge, e, hearing loss, tinnitus, headache, vertigo, sore throat
PINNA DEFORMITY Acquired, traumatic Congenit Cong enital al since birth birth? ? Family history of similar lesions? Birth and maternal history history Is there hearing loss?
EPISTAXIS Unilateral or bilateral? Anterior,, posterior Anterior po sterior,, or diffuse diffuse? ? Spontaneous or post-traumatic? Duration and onset Amount of blood loss Associated problems: colds, strong blowing of nose, medical problems such as hypertension, hypert ension, use of anticoagulan anticoagulants, ts, signs of blood dyscrasias, dyscrasias, renal disease dise ase
OBSTRUCTION AND RHINORRHEA Unilateral or bilateral? Duration and onset Constant or seasonal? Change in character with change in position Facial pain Spontaneous or post-traumatic Associated symptoms: frequent sneezing, headache, postnasal postnasal drip, nasal pruritus, sore throat, earache, asthma Drug use use of nasal drops drops;; antihypertensiv antihypertensives, es, cocaine sniffing, tranquilizers, hormones
NASAL DEFORMITY Congenital or acquired Recent acqui acquired red with tra trauma uma Associated problems such as epista e pistaxis, xis, nasal obstruction Alcohol intake History of acne rosacea History of trauma
ORAL ULCERATIONS Duration and onset Persistent or intermittent Location Loc ation and pattern pattern ar are e they in crops? crops? Painful or nonpainful? Use of immunosuppressive drugs, sexual habits and venereal disease Associated problems fever ever,, malaise, malaise, other mucosal ulcers (vaginal, anal, urethral)
INTRAORAL MASS LESIONS Duration and onset Location Rapidity of growth Painful or nonpainful Odynophagia Trismus
Presence of lymph nodes Previous dental extractions or surgical consult?
ALTERATIONS IN TASTE Dysgeusia, hypogeusia, or ageusia Onset and duration Associated problems in smell, medications, head injury injur y, headache, headache, ear surgery sur gery (chor (chorda da tympa tympani ni cut), cut), facial facial pain and visual disturbances
ODYNOPHAGIA Onset and duration Location Loc ation ref referred erred to ear? ear? Constant or intermittent? Is it progr p rogressive? essive? Occurs with solids or liquids? Associated symptoms of hoarseness, stridor, odynophagia History of foreign body ingestion History of corrosive intake
DYSPHAGIA Duration Localization With solids or liquids? Associated symptoms
HOARSENESS Duration (congenital or acquired) Intermittent or progressive Pattern or time of day worsened History of vocal abuse, occupation Environment Envir onment exposur exposure e to chemicals Stridor Pain History of trauma, surgery under general anesthesia, neck and chest surgery, thyroid status Endotra Endot racheal cheal int intubat ubation ion
AIRWAY OBSTRUCTION STRIDOR Duration Exercise intolerance Nature Natur e str strido idorr in inspi spirrat atory ory or expir expirat atory ory or or both; both; history of foreign body Exacerbation Exacerba tion by exercise exercise or sleep Relieved by change in position, opening mouth, protruding tongue Associated with recent viral infection History of trauma to neck; neck or chest surgery medications
NECK MASSES Location Duration Size: stable, growing, alternating Single or multiple Tender or nontender Discrete, multiple, matted Pulsatile Erythematous Associated problems such as weight loss, hyperthyroidism, nasal obstruction, dysphagia, hoarseness, intraoral lesions, pigmented skin lesions, ear pain
DISCRETE SWELLING Duration Pain Facial asymmetry Constant or intermittent
DIFFUSE SWELLING Uniglandula Unigl andularr or multig multiglandu landular lar Duration Painful or nonpainful Exacerbation Exacerba tion with eating Previous history history of mumps or vaccina vaccination tion Associated problems: e.g. Xer Xerostomia, ostomia, alcohol intake, starvation, iodides, bromides, antihypertensives, tranquilizers, joint pains, fever, skin rashes
