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An Overview of the Head and Neck – Clinical Methods


An Overview of the Head and Neck - Clinical Methods

Thank you for choosing URMC Department of Otolaryngology (Ear, Nose & Throat). They can cause facial and neck disfigurement; impair speech and vision; and affect the sense of smell and the ability to swallow. While lung cancer cases are decreasing, cancers in the head and neck are on the rise. Albans which is located in the eastern section of Brooklyn approximately 4 miles away. Frequent occurrence of colds, hay fever reactions, and seasonal exacerbation of these problems should be recorded. If you would like more information about your sense of taste, the fact sheet Taste and Taste Disorders may answer some of your questions. Frequent redness or swelling of the eyes should be noted also.

Many deny and tolerate hearing loss for a considerable period of time before being coerced by  a family member to seek medical care. We specialize in the management of diseases and cancers of these areas, and our doctors and staff are dedicated to the care of our patients with head and neck cancer and disease.. Still, it is fundamentally a preventable disease, as the risk factors are in big part associated with modifiable behaviors. The patient should be asked about the possibility of previous swelling or tenderness under the jaw, in the preauricular area, in the palate or on the tongue, or any limited or painful jaw motions. For the jaw and temporomandibular joints, a history should be taken to document the presence and duration of the following: trauma, braces or orthodontic treatment, clicking or crunching sounds when opening the mouth, preauricular swelling, tenderness to palpation, teeth grinding at night, frequent clenching of teeth during the day, or pain or discomfort into the temple or down the side of the neck. Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. The Department maintains an active pediatric tumor practice at the Lucille Salter Packard Children’s Hospital.

For the pharynx, larynx, and thyroid gland, the examiner should inquire about the presence and duration of sore throats and previous antibiotic treatment for pharyngitis or mouth ulcers. Questions should be asked about difficulty swallowing, the presence of gland or node enlargement in the neck, the presence of hoarseness (Chapter 125), or the presence of blood in the sputum (hemoptysis). They can also occur along other important portions of the blood supply in the neck and throat. I also use an MP3 player with the Universal Sound Therapy track Tinnitus Masker Deluxe allows you to choose exactly which sounds you find best mask your tinnitus and mix them together to create realtime masking relief via. Tobacco use should be documented, and the number of years of usage recorded. Unusual use of the voice, such as professional singing or talking consistently above a noisy environment, should be noted. If you are hoarse more than two weeks, make sure you don’t have cancer of the larynx.

The Efficacy of Surgical Modifications of the Upper Airway in Adults with Obstructive Sleep Apnea. About ATA MISSION: The American Tinnitus Association is tinnitus through the development of resources to cure tinnitus research progresses. Because almost one-third of AIDS patients present with head and neck disorders, any history of risk factors for the disease should be investigated (high-risk sexual practices, use of intravenous drugs with shared needles, blood transfusions). In collecting information about problems involving the face, the patient should be asked about discomfort in the cheek or forehead, unusual pains following dental procedures, or unusual sensitivity to sunlight. Inquiries should be made about prolonged occupational exposures to sunlight, chemicals, or dust. Patients should be asked if they have used protective hats or masks when around these substances. Questions about the severity of acne in adolescence or recurrent skin infections should be noted.

The patient should be asked about visual disturbances related to sagging eyelid or the presence of any double vision, which indicates obstruction of vision. Bringing up blood. This is often caused by something other than cancer. Swallowing problems …Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods difficult. The patient should be asked about recent respiratory infections or allergy, and medical treatment for severe allergy should be recorded. Swallowing problems. Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods—and sometimes liquids—difficult.

The quality, duration, and type of noise should be documented, and the patient’s hunting experience or other exposure to gunfire should be recorded. The frequency of aircraft exposure or scuba diving needs to be documented. Symptoms related to the ear such as ringing in the ear, or tinnitus (Chapter 121), are very common, and specific questions should be asked about duration, intensity, unilateral or bilateral presence, and pulsating or throbbing quality. Fullness in the ear should be documented, and balance disorders or vertigo require particular elaboration (Chapter 123). Frequent probing of the ear for wax removal or itching, or the placement of foreign bodies in the ear, should be documented. The presence of persistent pain in the ear, or otalgia (Chapter 122), or knowledge about drum perforations in the past, is needed. Questions relating to unusual sensitivity to sudden or loud sounds, particularly those associated with or related to other ear symptoms such as tinnitus, vertigo, fullness, or fluctuant hearing loss, need to be recorded.

An Overview of the Head and Neck - Clinical Methods
Intermittent, changing, or fluctuant hearing loss may be present. A nasal speculum, a transilluminator on a battery handle, and a sterile swab for culture material are needed for the examination ( and ). Latest imaging techniques and types of radiotherapy now define the extent of lesion and deliver radiotherapy with precision. Sinus examinations should always be done in a darkened area, and the use of a decongestant spray such as oxymetazolin or 0.5% neosynephrine is encouraged. During examination of the nose (Chapter 128), a careful external inspection should be carried out with notation made of any previous injury, trauma, or congenital deformity. Frontal and maxillary sinuses should be transilluminated, and the speculum should be used to evaluate the intranasal cavity (). A fiberoptic examination can be carried out along with percussion and palpation over the maxillary and frontal sinuses to denote tenderness.

Equipment needed includes a penlight or a headlight, disposable tongue blades, a sterile swab for culture, and rubber gloves for palpation (see ). Widening of the foramen ovale permits the former and widening of the eustachian tube enables the latter. Examination of this area should include inspection of the palate, tonsillar fossae, gums, tongue, cheeks, teeth, and the openings of the submaxillary and parotid ducts (Chapters 129–131) ( and ). Careful bimanual palpation of the submaxillary gland () with palpation and massage of the parotids () with observation for secretion from the ducts should be carried out. Equipment needed to evaluate this area of the body consists of disposable tongue blades and the use of x-rays of jaw joints in opened and closed position. Examination involves careful palpation of the jaw joints at rest and in motion (). The patient should be asked to bite down firmly on a wooden tongue blade to see if this will elicit pain in the joint.

Tapping on the teeth with a metal probe may help identify isolated dental disease that is referred to the jaw joint area. Further, scientists are confident that they are now laying the foundation to understanding the finest details about our sense of smell–research that may help them understand how smell affects and interacts with other physiological processes. X-ray is often utilized to document lesions around the larynx and pharynx, particularly CT scans of the neck. Fainting, light headedness, body weakness, spots before the eyes, general light-headedness, tightness in the head, and loss of consciousness are generally not of vestibular origin. Further palpation of the thyroid (), larynx, and hyoid bone should be done (Chapter 132). Mirror or fiberoptic examinations are vital in order to document the motion of the vocal cords and lesions of the epiglottis and larynx. Careful inspection of the face as a patient talks will reveal many factors.

The examiner should look carefully for signs of trauma, previous facial surgery, eye swelling, or “bags under the eye,” which might indicate fluid or allergic disorders. So if they do occur, see your doctor to be sure. The patient should be evaluated in the presence of good lighting (preferably sunlight), and it is often helpful if cosmetic surgery is to be considered to have frontal and profile photographs taken. Examination of the face involves inspection for blepharochalasia (eyelid sagging), excess wrinkling, or redundancy of skin in various areas of the chin, neck, upper neck, and face. Regional inspection of the face should be made to document skin lesions such as keratoses, moles, or scars. Facial asymmetry, nasal distortions, prominent ears, malocclusion (overbite or underbite), or excessive hair should be documented. Enlargement in the sides of the face, which indicates masseter hypertrophy or abnormal facial movements such as tics, should be documented.

The patient should have the face palpated for tenderness or protrusions, and for any associated lymph node enlargement in the submandibular or preauricular areas. The patient should be asked to perform basic facial movements, such as smiling, pursing the lips, and closing the eyes tightly, to document any asymmetry of motion or previous facial paralysis. Many specific and general questions are needed in order accurately to evaluate a person with a communication disorder (Chapter 126). One of the first observations to be made is the loudness of the patient’s voice as he or she speaks, since many patients with conductive loss talk very softly, whereas patients with sensorineural hearing impairment talk loudly. The obvious response of the patient to the examiner’s normal voice will provide clues as to the severity of hearing impairment. Equipment needed to evaluate the ears properly consists of a wax curette with a round circular blunt end, a standard ear wax syringe, or 50 cc plastic syringe. An emesis basin to catch the water is needed also.

A thin, small wire applicator with a small tuft of cotton on the end is helpful to remove secretion from the ear canal; and a battery otoscope with a pneumatic attachment for moving the eardrum inward and outward is mandatory. A penlight for inspection of the outer meatus or observation while removing wax is helpful (). Standard hydrogen peroxide or aqueous zephiran is helpful to dissolve wax. A standard 256 Hz tuning fork is necessary for adequate Weber and Rinne testing. The use of an electric audiometer, an impedance bridge, routine mastoid films, cultures of the ear canal, or CT scans of the temporal bone are often needed for complete evaluation. Prior to examination, the patient should be asked about any drum perforation or previous ear surgery. If there has been none, then it is proper to irrigate the ear with a standard ear syringe.

The ear canal should be inspected with a penlight, and the pinna should be moved to discern any possible tenderness. If the canal appears clear, the otoscope should be used to examine the canal and the eardrum carefully with pneumatic pressure applied (). The Weber and Rinne test should be performed in a quiet area and recorded (–). Air conduction with a tuning fork should be compared between ears to note any difference. The patient’s response to normal conversation when facing the examiner and with the face turned away should be noted. All secretions from the ear should be cultured. The eyes should be checked for nystagmus in all gazes and at the time of pressure with the pneumatic otoscope to document the possibility of nystagmus created by ear pressure movement.

Romberg and tandem gait tests should be performed on patients who have any complaints of vertigo (Chapter 127). It is also helpful to carry out standard Hallpike maneuvers to determine positional nystagmus. Weber test for lateralization of sound. Fork should be placed in midline of head after being set in motion. Patient should be asked if sound is heard best in right or left ear. Normally sound will not lateralize either way.