EENT Physical Assessment and Diagnostic Tests

1. Place the vibrating tuning fork on the mastoid process to test BC.
2. Once the patient no longer hears the sound, move the fork in front of the ear canal to test AC.

Diagnostic Interpretations:

• Normal (Positive Rinne): $AC > BC$. The patient hears the sound better through the air than through the bone.
• Conductive Hearing Loss (Negative Rinne): $BC > AC$. This occurs when there is an obstruction or issue in the external or middle ear.
• Sensorineural Hearing Loss: Both AC and BC are diminished, but the relationship remains $AC > BC$.

The Weber Test

The Weber test compares bone conduction between the two ears by placing the vibrating tuning fork on the center of the patient's forehead.

• Normal: The sound is heard equally in the middle of the forehead.
• Conductive Hearing Loss: The sound lateralizes to the affected (impaired) ear.
• Sensorineural Hearing Loss: The sound lateralizes to the unaffected (healthy) ear.

Clinical Tip: Comparing Results If a patient has a negative Rinne in the left ear ($BC > AC$) and the Weber test lateralizes to the left ear, the diagnosis is left-sided conductive hearing loss. If the Rinne is normal in both ears but the Weber lateralizes to the right, the diagnosis is right-sided sensorineural hearing loss.

Oral and Pharyngeal Assessment

The oral cavity examination involves a thorough inspection of the soft and hard tissues to identify signs of infection, nutritional deficiency, or malignancy.

Oral Cavity Inspection

• Gingivae and Teeth: The gingivae (gums) should normally be pink and firm. The clinician should assess the teeth for caries (cavities), discoloration, and overall hygiene.
• Tongue: The tongue should be inspected for moisture and any masses or ulcerations. Specific conditions to note include glossitis (a smooth tongue often resulting from vitamin deficiency) and geographic tongue.
• Palates and Floor of Mouth: The hard and soft palates should be inspected for plaques, petechiae, or masses. The floor of the mouth should be checked for edema or masses.

Pharynx and Tonsils

When inspecting the pharynx, the clinician evaluates the tonsils for size and the presence of any white plaques or exudate.

Neurological Check: The Gag Reflex Testing the gag reflex is a standard method to evaluate the integrity of the vagus nerve (Cranial Nerve X).

Diagnosing Streptococcal Pharyngitis

When a patient presents with a sore throat, clinicians must differentiate between viral and bacterial causes. While viral pharyngitis often presents with a cough and runny nose, Streptococcal pharyngitis is more likely if certain criteria are met.

To assist in this diagnosis, clinicians use the Centor criteria, often remembered by the mnemonic FLEA:

• Fever
• Lack of cough
• Exudates on tonsils
• Anterior cervical adenopathy (swollen lymph nodes)

If a patient meets two or more of these criteria, a rapid strep test is indicated to confirm the diagnosis.