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2.3 Symptomatology ofEar, Nose andThroat (ENT) andHead andNeck Surgery Diseases
2.3 Symptomatology ofEar,
Nose andThroat (ENT) andHead andNeck Surgery Diseases (Table 2.3)
Table 2.3 Symptomatology of ENT and head and neck diseases
Symptoms of ear diseases
Ear discharge Hearing loss Pain Tinnitus Vertigo Injury Facial palsy Deformity Foreign body Swelling Bleeding Vesicle Itching Blockage Heaviness Headache Fever
Nose/paranasal sinus diseases Oral cavity diseases Oropharynx
Nasal obstruction Rhinorrhoea Epistaxis Deformity Facial pain Swelling Decreased or loss of smell Foul smell Bleeding H/o foreign body Itching nose Nasal/palate mass Postnasal drip Numbness on face Pus discharging from nose Loosening or numbness of teeth Watering of eye Loss or change in vision Trismus Headache
Pain Halitosis Loose denture Discharge Swelling/growth Deformity Injury Trismus Ulcer Ankyloglossia Altered salivation Altered taste Discoloration of mucosa Lump in cheek Difculty in chewing Numbness of tongue or mouth Swelling of jaw Ill-tting denture Oral ulcer
Pain in throat Dysphagia Odynophagia Postnasal drip F B sensation change of voice stridor swelling/growth Ulcer in oropharynx H/o FB ingestion Cough Dyspnoea Trismus Pain aggravated on swallowing
67
Head and neck diseases
Swelling/lump Pain Stridor Injury Change of voice Dysphagia Restricted neck movement Pain while movement of neck Odynophagia
68
2 Local Examination ofORL: Head andNeck Surgery
2.4 Symptomatology ofENT
andHead andNeck Disease (Table2.4)
Table 2.4 Symptoms of thyroid disease, anterior skull base diseases, and maxillofacial and middle skull base
diseases
Thyroid disease/parathyroid disease or tumours
Neck swelling Increased weight despite decreased appetite Weight loss despite increased appetite Diarrhoea/constipation Loss of temporal hair Altered menstruation Dry skin Heat/cold intolerance Dysphagia Respiratory distress Hoarseness of voice
Anterior skull base
Loss of vision Nasal mass Headache Altered sense of smell Swallowing problem Change of voice
Maxillofacial trauma/ orthognathic
Trismus Pain Swelling Decrease in or loss of vision Bleeding nasal or oral Facial deformity Occlusal deformity Loss of teeth Anophthalmos H/o trauma + Dental occlusal deformities Facial deformity Lengthening of face
Middle skull base (sellar, parasellar, etc.)
Headaches Vision problems Unexplained tiredness Mood changes Irritability Changes in menstrual cycles Erectile dysfunction Infertility Inappropriate breast growth/ production of breast milk Cushing’s syndrome Weight gain Bruising easily Irritability, anxiety, depression
Dizziness Confusion Flushing of face Weak muscles Irregular heartbeat Acromegaly Lowered sex drive Impotency Loss of body hair Abnormal sexual development and growth in children
2.5 Symptomatology ofENT andHead andNeck Diseases
69
2.5 Symptomatology ofENT
andHead andNeck Diseases (Table2.5)
Table 2.5 Symptoms of head and neck oncology, salivary gland diseases, trachea and bronchus, lateral skull base
disease and nasopharynx
Trachea and
Head and neck oncology Salivary gland diseases Nasal mass/swelling/
growth Loss of smell Neck swelling Oral ulcer/growth/swelling Dysphagia Odynophagia Ear pain Hoarseness of voice Haemoptysis Lump in neck Persist nasal obstruction Nose bleed Double vision Persistent hoarse voice Persistent numbness or weakness Difculty breathing Referred ear pain Halitosis Loosening of teeth Unexplained weight loss Fatigue Jaw pain
Swelling in neck, retromandibular area, oral cavity, submandibular area Dry mouth Hypersecretion of saliva Facial nerve weakness Numbness over face Odynophagia Trismus Pain and swelling in gland area while having meal
bronchus Lateral skull base Nasopharynx Dyspnoea
Cough Haemoptysis Stridor Wheezing Shortness of breadth Pneumonia Fever Chest discomfort Fatigue Difculty talking on phone
U/L hearing loss Vertigo Tinnitus Symptoms of facial nerve paralysis Headache Tiredness Gait dysfunction
Nasal obstruction Epistaxis Palatal bulge Headache Hearing loss Blood in saliva Mouth breather Diplopia Cheek swelling Lump in neck
70
2 Local Examination ofORL: Head andNeck Surgery
2.6 Symptomatology ofENT
andHead andNeck Diseases (Table2.6)
Table 2.6 Symptomatology of laryngeal disorders, hypopharyngeal disorder, oesophageal disorder, facial cosmetic
and facial plastic surgery and craniofacial disorders
Larynx Laryngopharynx Oesophagus Hoarseness of voice
Breathy voice Loss of vocal pitch Inability to speak loudly Dysphonia Dyspnoea Stridor Throat pain Neck pain Odynophagia Tingling sensation in throat Dry cough Cough after eating or lying down Choking or coughing while swallowing Throat clearing Dry throat Irritation in throat
Dysphagia Odynophagia Hoarseness of voice Throat pain Regurgitation of food Burning sensation in throat Lump in neck Ear pain
Dysphagia Odynophagia Burning sensation Cough Weight loss Vomiting Chest pain Haematemesis Difcult breathing Dry mouth H/o aspiration
Facial cosmetic/ aesthetic surgery
Loss of hair Thinning of hair Wrinkle on face Double chin Spot of face Growth/swelling/ulcer Unwanted hair Deviated nose Deviated face Twisted nose Thickening of skin of nose
Craniofacial deformities
Swelling Cleft lip deformities Non-cleft lip deformity Cleft palate deformity Triple nose Absence of nose Difculty in breathing Small jaw
2.7 Red Flag Symptoms oftheHead andNeck
2.7 Red Flag Symptoms
oftheHead andNeck (Table2.7)
Table 2.7 Red ag symptoms of head and neck
Location Clinical features Possible diagnosis Head Nuchal rigidity/reduced range of movement Meningitis Face Loss of cranial nerve functions Cranial nerve palsy
Ischaemic stroke
Eye Ptosis
Incomplete lid closure Xanthelasma Exophthalmos Yellow sclera Conjunctival injection Conjunctival pallor Horner syndrome
Mouth Angular cheilitis
Tonsillar erythema Strawberry tongue Vesicle, blister Coated tongue
6th cranial nerve palsy Ischaemic stroke Hyperlipidemia Graves’ disease Jaundice Conjunctivitis Anaemia Arterial dissection, tumour
Iron deciency Acute tonsillitis Scarlet fever Herpes viral infection Leucoplakia, candidiasis
71
72
2 Local Examination ofORL: Head andNeck Surgery
2.8 Signs ofENT andHead
andNeck Surgery Diseases (Table2.8)
Table 2.8 Signs of ENT and head and neck with their denition
Sign Denition Diagnosis Omega sign Infantile omega-shaped epiglottis Laryngomalacia Phelp’s sign Loss of crest of bone (caroticojugular crest)
between carotid canal and jugular bulb—a CT nding
Schwartz sign (amingo ush sign)
Rising sun sign in ear Red vascular hue seen behind TM High jugular bulb
Steeple’s sign Loss of normal shouldering of the air column due to
Stankiewicz’s sign Fat protrudes into nasal cavity on compression of
Tea pot sign Start of dribbling of CSF from nose when a patient
Tear drop sign Tear drop-shaped opacication seen hanging from
Uvula pointing sign When scleroma involves the nasopharynx, uvula
Aquino’s sign Blanching of tympanic mass when a gentle pressure
Barber chair sign/ Lhermitte’s sign
Bezold’s sign Inammatory oedema at the tip of mastoid process Descending mastoiditis Bocca’s sign Absence of postcricoid crackle (Muir’s crackle) Ca postcricoid Brudzinski sign Bending of patient’s neck usually produces exion
Bryce’s sign Manual compression may result in escape of uid
Griesinger’s sign Oedema in postmastoid area due to mastoid
Increased vascularity in submucous layer of promontory
oedema of tracheal mucosa
eye from outside
comes to sitting position from supine
roof of maxillary sinus on X-ray PNS
points towards nasopharynx
is applied over carotid artery It is electric shock-like sensation in the spine and
extremities
of knee and hip
and gas in airway—a gurgling sound
emissary vein
Glomus jugulare
Active stage of otosclerosis
Glomus tumour Aberrant ICA
ALTB
Orbital injury during FESS
CSF rhinorrhoea
Orbital oor fracture
Rhinoscleroma involving nasopharynx
Glomus jugulare
Post-RT of cervical spine
Meningitis
Laryngocoele
Lateral sinus thrombophlebitis
(continued)
2.8 Signs ofENT andHead andNeck Surgery Diseases
Table 2.8 (continued)
Sign Denition Diagnosis Berry’s sign Absence of carotid pulse when it engulfed Thyroid carcinoma Enroth’s sign Chemosis and oedema of conjunctiva and lids Hitselberger’s sign Loss of sensation in posterosuperior part of EAC Acoustic neuroma Holman-Miller sign
(antral sign) Halo sign/
handkerchief sign
Hennebert’s sign Pressure-induced dizziness Meniere’s disease/congenital
Hondousa sign Widening of gap between ramus of mandible and
Irwin Moore’s sign Positive squeeze test Chr. tonsillitis Laugier’s sign Blood behind TM Skull base fracture Light house sign Small pin hole perforation with pulsatile ear
Lyre’s sign Bowing with displacement of carotid artery due to
Leudet’s sign Clicking sound tinnitus, caused by reex spasm of
Milian’s ear sign Erysipelas can spread to pinna but not cellulitis Erysipelas Trotter’s sign/triad U/L COHL, trigeminal neuralgia, soft palate
Rising sun sign in neck
Battle’s sign Bluish discoloration over mastoid Fracture of temporal bone Chvostek’s sign Spasm of facial muscle when tapped It is sign of hypocalcaemia Dodd’s sign/
Crescent’s sign Furstenberg’s sign Pulsation and expansion of the mass with crying,
Trousseau’s sign Carpopedal spasm upon constriction of extremities Hypocalcaemia Thumb sign Thumb-like impression on X-ray lateral view due to
Charcot’s triads Nystagmus, scanning speech, intention tremors Multiple sclerosis Browne’s sign Blanching noted when pressure applied with
Anterior bowing of the posterior wall of maxillary sinus on X-ray face lateral view
CFS separates from blood when the mixture is placed on paper resulting in central blood with outer ring of CSF
maxillary border
discharge
vascular mass on bifurcation of carotid artery
the tensor palati muscle
immobility and trismus Lower border of lymph node is not palpable of
supraclavicular lymph node
Crescent of air seen between mass and posterior pharyngeal wall
straining or compression of jugular vein
swollen epiglottis
Siegel’s speculum to tympanic membrane
JNA
CSF rhinorrhoea
syphilis Infratemporal involvement of JNA
ASOM
Carotid body tumour
Inammation of ET
Nasopharyngeal carcinoma
Nodal metastasis in level Vb group of LN due to carcinoma stomach
It is positive in AC polyp and absent in JNA
Encephalocoele
Acute epiglottitis
Glomus tumour
73
74
2 Local Examination ofORL: Head andNeck Surgery
2.9 Syndrome inENT andHead
andNeck Surgery (Table2.9)
Table 2.9 Various syndrome of otolaryngology and head and neck surgery
Name of syndrome Denition Arhinia choanal atresia
microphthalmia Anterior ethmoidal nerve
syndrome (Sluder’s neuralgia)
Ramsay Hunt syndrome, type 2
Eagle’s syndrome It is syndrome characterized by elongation of styloid process and calcication of
Crouzon syndrome It is a genetic disorder, also known as branchial arch syndrome characterized by
Von Hippel-Lindau Retinal angiomas, cerebellar haemangioblastoma Frey’s syndrome It is also known as gustatory sweating Supermarket syndrome Dizziness+nausea+light headedness induced by light and shelves and crowd
Syndrome associated with cleft palate
Pierre Robin syndrome Micrognathia+glossoptosis+cleft palate Treacher Collins
syndrome Nagar’s acrofacial
dysostosis Goldenhar syndrome It is a rare congenital disorder characterized by abnormal development of eye ear and
Mobius syndrome It is a rare congenital neurological disorder characterized by facial palsy and inability
Hallermann-Streiff syndrome
Gordon’s syndrome Camptodactyly+club feet+cleft palate
Syndrome associated with hearing loss
Craniofacial deafness hand syndrome
Mal de debarquement syndrome
Susac’s syndrome Encephalopathy, retinal artery occlusion and SNHL Cogan’s syndrome B/L SNHL, episodic dizziness and B/L interstitial keratitis
Syndrome autosomal dominant
Waardenburg syndrome (most common)
Branchiootorenal syndrome
Stickler syndrome Hearing loss (SNHL, COHL or MHL) may be progressive
Aplasia/hypoplasia of nose+microphthalmia and midface retrusion
It is presented as ipsilateral foreheadache due to irritation of anterior ethmoidal nerve ending in nose. This is caused by septal spur touching middle turbinate
It is also known as herpes zoster oticus caused by reactivation of herpes zoster in geniculate ganglion. It is presented as LMN facial palsy, vesicle on face and ear, deafness, vertigo and ear pain
stylohyoid ligament presented as throat pain, neck pain which radiates to ipsilateral ear
craniosynostosis (premature fusion of certain skull bones, exophthalmos, hypertelorism and beak-like nose (psittacosis)); this syndrome is named after Octave Crouzon, a French physician
It is a genetic disorder characterized by down slanting eye, notched lower eyelids, small and slanting lower jaw, prominent ear and cleft palate
This disorder affects limb and face
spine. It is also known as oculoauriculovertebral syndrome. It is rst documented by Maurice Goldenhar, an ophthalmologist
to move eye from side to side It is a rare disorder characterized by distinctive malformation of the skull and facial
region, hypotrichosis, eye abnormality, dental defect, degenerative skin changes over skull and nose
Aplasia/hypoplasia of nose+blepharophimosis+depressed nasal bridge+downslanted palpebral ssure
A sensation of rocking or swaying back and forth without vertigo, difculty concentration and fatigue, in idle age woman due to week long cruise
Clinical features
U/L or B/L SNHL, pigmentary changes—like greying hair, white forelock, heterochromia iridis, partial albinism, facial features—fused eyebrows, high nasal bridge, hypoplastic alae nasi
Hearing loss is COHL or MHL or SNHL Others are preauricular sinus, branchial cyst or sinus, renal problem+Mondini dysplasia
Micrognathia (small jaw) with cleft palate (Pierre Robin sequence)
(continued)
2.9 Syndrome inENT andHead andNeck Surgery
Table 2.9 (continued)
Name of syndrome Denition CHARGE syndrome Coloboma, choanal atresia, cranial nerve problems and unusually shaped ears. Hearing
loss may be conductive, sensorineural or mixed (mild to profound)
Treacher Collins syndrome
Neurobromatosis type II (NFII)
Autosomal recessive syndrome
Usher syndrome type 1 SN hearing loss (profound and congenital), vestibular dysfunction (vertigo), no benet
Usher’s syndrome type 2 Moderate to severe, downward sloping, congenital SNHL No vestibular dysfunction Usher’s syndrome type 3 Progressive, sensorineural hearing loss, later onset Pendred syndrome Hearing loss is sensorineural and may be progressive
Jervell and Lange­Nielsen syndrome
X-linked syndrome
Alport syndrome Hearing loss is progressive and sensorineural
X-linked congenital stapes xation with perilymph gusher
Mitochondrial
Maternally Inherited Diabetes and Deafness (MIDD)
Kearns-Sayre syndrome (KSS)
Biotinidase deciency Hearing loss in >75% of cases, skin rashes, alopecia, seizure, ataxia
Albinism deafness syndrome
Alport’s syndrome It is characterized by kidney disease, hearing loss and eye problem (anterior lenticonus
Albinism deafness syndrome (ALDS)
Abruzzo-Erickson’s syndrome
Art’s syndrome SNHL+hypotonia+ataxia Stickler syndrome It is a group of vary rare genetic disorder (progressive arthro-ophthalmo-dystrophy)
Syndrome of head and neck
MEN IIA (Sipple syndrome)
MEN IIB RET mutation+mucosal neuroma
Hearing loss (conductive), malar hypoplasia, microtia/anotia, stenosis/atresia of EAC, ear tag, etc.
Progressive hearing loss (SNHL), B/L, acoustic neuroma by 30years of age
with hearing aid
Inner ear malformations (Mondini malformation) may be present Balance dysfunction is present, enlarged thyroid gland (goitre)
Bilateral, profound sensorineural hearing loss is present at birth Abnormal heart rhythm (long Q-T) Syncopal episode and possible sudden death
Kidney problems (nephritis), near-sightedness (myopia) Hearing loss in males is mixed and may be progressive
Hearing loss is sensorineural and often found in the high frequencies and diabetes
Hearing loss is bilateral and sensorineural, unsteady gait (ataxia), short stature, delayed puberty, progressive paralysis of the eye, muscles (ophthalmoplegia) and progressive blindness (retinopathy)
A rare disorder characterized by congenital nerve deafness (SNHL) and pie baldness with no ocular albinism
or maculopathy) Hypopigmented skin patches, neurological speech impairment and SNHL and partial
albinism Cleft palate+ocular coloboma+hypospadias+SNHL
affecting connective tissue, especially collagen. It is characterized by distinct facial abnormality, ocular problem, hearing loss, joint and skeletal problem
RET proto-oncogene chromosome 10 mutation+medullary carcinoma+pheochromocytoma+parathyroid hyperplasia
75
History andExamination ofEar
3
3.1 Symptoms/History/Chief
Complaints ofEar Diseases
1. Symptoms/chief complaints—There are var-
ious common symptoms with which patients can present to ENT surgeon. These common symptoms are ear discharge, hearing loss, pain, tinnitus, vertigo, injury/trauma, facial palsy, deformity, foreign body, swelling, bleeding and vesicle. Patients can present with single symptoms or combination of symptoms.
(a) Ear discharge—This is one of the com-
monest symptoms of infective ear diseases.
• Duration of discharge – Acute discharge (if duration is less
than 12 weeks)—ASOM, trauma, CSF otorrhoea or furunculosis.
– Chronic discharge (if duration is
more than 12 weeks)—CSOM, allergic, cholesteatoma.
• Onset of discharge – Sudden onset (discharge develops
abruptly)—CSF otorrhoea, bleed­ing, ASOM.
– Gradual/insidious onset (discharge
develops slowly)—CSOM, otomycosis.
• Colour of discharge—The discharge
has been classied into various types
depending on colour of discharge (Table3.1).
• Consistency of discharge – Thin discharge (it is watery so that it
can ow easily) caused by ASOM, CSF otorrhoea, eczematoid derma­titis, acute infection in CSOM.
– Thick discharge (thick, stick to
wall) caused by CSOM, cholestea­toma, wax, otomycosis, tubercular otitis media (OM), furunculosis, allergic otitis media.
• Type of discharge—The various
types of ear discharge have been reported (Table3.2).
Table 3.1 Different colours of ear discharge with differ­ential diagnosis
Colour of discharge D/D Colourless CSF otorrhoea, acute otitis
media Yellow CSOM with bacterial infection Reddish (discharge
mixed with blood)
White Otomycosis (candida), CSOM,
Brown Wax Black Otomycosis (Aspergillus niger) Red/bleeding Granulation, haemangioma,
Greenish Aspergillus fumigatus
CSOM with granulation,
ASOM, CSOM with
cholesteatoma
ASOM
trauma, glomus tympanicum
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2025 S. K. Kashyap, S. Sagar, Clinical Methods of Otorhinolaryngology, Skull Base & Head Neck Surgery, https://doi.org/10.1007/978-981-96-1765-4_3
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