Overview Of History Taking in ENT

Ear
- Past medical history
Diabetes - Furunculosis , otomycosis , malignant otitis externa
Renal disease - Alports syndrome , drugs - nephrotoxicity and ototoxicity
Thyroid disease - Goiters can be associated with sensorineural hearing loss
(Pendreds syndrome)
Tuberculosis - Tuberculous otitis media
URTI - Otitis media with effusion / acute otitis media (OME / AOM)
Chief complaint HOPI
Ear discharge
(otorrhoea)

- Onset
Acute
Chronic
- Duration
- Laterality
Unilateral
Biltaral
- Discharge
*Character
*Amount - scanty ,
profuse
*Constant or
intermittent
a) Watery : Viral
infection , CSF
othorrhoea
b) Mucoid : TM
perforation
c) Mucopurulent :
Acute / Chronic OM
d) Purulent :
Furuncolosis ,
Cholestestoma ,
malignancy
e) Blood stained :
Bullous myringitis ,
granulations
f) Frank blood :
Glomus jugulare ,
tumour

Associated
symptoms
- Associated ear
symptoms

PMH / DH
- History of trauma
- History of URTI
- Past history of
dermatologic
disease / otitis
externa / otitis media
- Ear surgery

FH / SH

Ear pain
(otalgia)

Deafness /
Hearing loss

Whitish , yellowish ,
blackish - otomycosis
Wet blotting paper
appearance - Candidal
infection
- Severity
- Onset
- Duration
- Continuous /
Intermittent
- Aggravating /
Relieving factors
- Character
*Dull aching , stabbing
- Severity
Furunculosis : severe
AOM : severe (child
unable to sleep at
night)

- Onset
- Duration
- Constant or
intermittent ?
Menieres disease fluctuant , episodic.
OME - worse when
patient has URTI
- Laterality
-- Unilateral

- Nasal discharge
rhinosinusitis
- Sore throat ,
fever tonsilitis ,
pharyngitis
- Sore throat ,
dysphagia
malignancy
(oropharynx ,
laryngopharynx)
- Neck pain
cervical spine
disease
- Pain on chewing
TMJ
dysfunction
- Dental disease

Trauma
Drug history

Family histo
of deafness
otosclerosis

Occupation

Vertigo /
Dizziness /
Sense of
imbalance
Vertigo = false
sense of
orientation of
oneself to
ones
surroundings

-- Bilateral
- Severity
- Type
a) Sensorineural
hearing loss - poor
speech discrimination
- Vertigo - sensation of
spinning of room
around patient or vice
versa
Duration
- less than a minute BPPV
- a few minute migranous vertigo
- a few hours Menieres disease
- a few days
(vestibular neuronitis)
True vertigo , the room
and its object rotate
Episodic Menieres
disease

Tinnitus
= ringing in the
ear

Brought on by
alteration in head or
body position BPPV
, orthostatic vertigo.
- Subjective (patient
only perceives it) /
Objective (heard by
other person also)
- Pulsative / Nonpulsatile
- Continuous / Noncontinuous
- Onset Acute /
Chronic
- Laterality :
Unilateral / Bilateral
- Duration

Ear discharge
- Past history of
labyrinthitis / fistula migraine
in the lateral
migrainous vertigo
semicircular canal.
- Drugs :
Tinnitus
a) Antihypertensives
Menieres disease b) Antidepressants
Nausea , vomiting
Menieres
disease ,
labyrinthitis
Postural
hypotension
VBI , cervical
spondylosis
Syncope =
peripheral vertigo
is not associated
with syncope

Hearing loss
Vertigo
Otalgia
Otorrhoea

- Past history of
otologic surgery
- H/o noise
exposure, ototoxic
agents, head injury,
CNS
infections

Family histo
of otologic
disease

- Progression
- Quality (character /
pitch) : Popping,
clicking or cricket,
swishing, pulsating or
throbbing, ringing,
buzzing, hissing,
rustling, or roaring
- Aggravating /
relieving factors
- Severity

Facial
asymmetry
Swelling in the
pre-/postauricular area
Bleeding from
the ear
Nose
Chief complaint

HOPI

Nasal obstruction

Duration
- Acute
- Chronic

Associated
symptoms

PMH / DH

FH / SH

Laterality
- Unilateral : DNS ,
foreign body , tumor
- Bilateral : ethmoidal
polyposis , allergic
rhinitis
Continuous or
intermittent

Nasal discharge
(rhinorrhoea)

Aggravating factors
- temperature
changes , food , drugs
, dust
Duration
- Short - URTI
- Long - allergic
rhinitis , chronic
sinusitis
Unilateral or
Bilateral ?
- Unilateral : mass ,
foreign body
Severity (amount)
- Scanty , moderate ,
copious

Sneezing

Watery : Allergic
rhinitis , CSF
rhinorrhoea
Mucopurulent :
Chronic rhinitis ,
sinusitis
Purulent : Acute
sinusitis
Blood-stained :
Foreign body ,
malignancy , infected
masses
Aggravating factors

Pruritus (eyes ,
nose , palate ,

Family history
Drug / food allergy

Contact
or anima

pharynx , skin) ,
rhinorrhoea
allergic rhinitis

Current medications

Occupa
Home environm

- History of trauma
e.g nose picking ,
skull base fractures
- Drugs :
anticoagulants

- Family
bleeding

Anosmia /
hyposmia /
cacosmia

Epistaxis / Bloodstained sputum

- Amount of blood loss

- Bleeding from other
sites / easy bruising

Headache / Facial
pain
Snoring / Sleep
apnea

Site
- Frontal region
Early morning
headaches

- DM / HPT / obesity
(excessive weight
gain)

Throat
Chief complaint

HOPI

Sore throat

- Clarify whether it
is pain or
discomfort ?
- Is it experienced
at rest or during
movement of oral
cavity / chewing /
swallowing
- Onset
- Duration
- Progression
- Constant or
intermittent
- Aggravating
factors
- Relieving factors
- Severity
- Localised or
spread to adjacent
areas ?

Associated
symptoms
Fever
Cough
Runny nose
(symptoms of upper
respiratory tract
infection)
Hoarseness
Neck swelling
Dysphagia
Odynophagia
Colicky pain and
swelling of the gland
, usually postprandial
sialolithiasis
(salivary gland
calculi)
Unilateral pain
sometimes radiating
to the ipsilateral ear ,
Trismus , dysphagia
Quinsy

PMH / DH

FH / SH

Dysphagia

- Onset : Foreign
body ingestion
- Progress
a) Solid liquid :
Tumor
b) Liquid solid :
achalasia cardia

Odynophagia
Mode of onset tongue bite , sharp
teeth
Duration
Bleeding
Discharge
History of ulcers
elsewhere in the
body e.g cold
sores
Growth /
Progression
Difficulty in breathing Onset
/ S.O.B (stridor)
- sudden : foreign
body inhalation
(children)
- gradual a/w
hoarseness ,
throat pain (adult)
malignancy
Hoarseness
- Hypo-nasal voice
?
- Hyper-nasal
voice ?
Lump / neck swelling - Site
- Onset
- Progress
- Aggravating
factors
- Relieving factors
- Pressure
symptoms

Aphthous ulcers
Quinsy

Ulcers

History of intubation
subglottic
stenosis

Stridor
Neck swelling
Dysphagia

- GERD
- History of trauma /
surgery
- Tuberculosis
- Lymphoma

Occupati
singer , te