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What kind of doctor is an ENT doctor?

ENT ( otorhinolaryngologist) is a doctor who studies and treats diseases of the ear, throat, nose, and nearby areas of the head and neck. The tasks of an ENT specialist include timely detection of pathologies in specified areas of the body, making the correct diagnosis, prescribing adequate treatment, as well as preventing the development of complications from various organs.

Which organ diseases does an “adult” ENT treat?

As follows from the above, ENT specialists treat diseases of several organs and systems at once. This is explained by the fact that damage to any of the listed organs is almost always accompanied by disruption of the functions of others closely related to it ( anatomically and functionally) structures.

The areas of activity of an otorhinolaryngologist include:

• Ear diseases. This group includes not only diseases of the auricle, but also pathologies of the external ear canal, tympanic cavity and inner ear (structure responsible for converting sound waves into nerve impulses that travel to the brain, creating the sensation of sound).

• Diseases of the nose. The nasal passages belong to the initial section of the upper respiratory tract. Thanks to their special structure, they provide cleansing, warming and humidification of the inhaled air. Damage to the nasal mucosa may be caused by infectious agents ( bacteria, viruses) or other factors ( injuries, diseases of the spine and so on).
• Diseases of the pharynx. The pharynx is the area of ​​the throat that connects the nose, mouth, larynx and esophagus. Diseases of the pharynx include infectious and inflammatory lesions of its mucous membrane, caused by the development of pathogenic microorganisms ( bacteria, viruses) and a decrease in the body's defenses. ENT specialists also treat pharyngeal injuries, burns or other injuries.
• Diseases of the larynx. The larynx belongs to the upper respiratory tract and is located between the pharynx and trachea ( connects them). The larynx contains the vocal apparatus, represented by two vocal cords. When a person speaks, the vocal cords stretch and vibrate ( from exposure to exhaled air), resulting in the formation of sounds. Any diseases of the larynx, as well as speech impairment associated with damage to the vocal cords, are treated by ENT.
• Tracheal diseases. The trachea belongs to the upper respiratory tract and provides air passage to the bronchi, from where it enters the lungs. Damage to the trachea can be observed with a variety of colds, with infectious and inflammatory lesions of the pharynx or oral cavity, and so on. In all of these cases, ENT can take part in healing process (along with other specialists).

Pediatric ENT

It is worth noting that the anatomical structure and functions of the ENT organs in children differ from those in adults. Also, in children of the first years of life, some diseases and pathological processes may occur differently than in a teenager or adult, which must be taken into account when making a diagnosis and prescribing treatment. That is why there was a need to create such a narrow specialty as a pediatric otolaryngologist. This doctor treats the same ear, nose and throat diseases in children that occur in adults.

ENT surgeon

The responsibilities of an ENT specialist include not only conservative, but also surgical ( operational) treatment of many pathologies of the ear, nose and throat ( such as deviated nasal septum, removal of various growths from the nasal cavity, removal of purulent-infectious foci that are not amenable to drug treatment, and so on). It is worth noting that the specialist must not only perform the operation itself, but also monitor the patient in the postoperative period, prescribing further drug treatment, dealing with issues of preventing the development of complications, rehabilitation, and so on.

ENT oncologist

Oncology is a field of medicine that deals with the study and treatment of tumor diseases.

An ENT oncologist diagnoses and treats:

• laryngeal cancer;
• tonsil tumors ( organs of the lymphatic system located in the pharynx);
• tumors ( including cancer) pharynx;
• benign neoplasms of the nasal cavity;
• malignant tumors nasal cavity;
• tumors of the paranasal sinuses;
• ear tumors.

It is worth noting that every otorhinolaryngologist should be able to suspect the presence of a tumor in a patient, however, only an oncologist can carry out a full diagnosis and treatment of this pathology. Also, any tumors in the listed areas should be removed only after consultation with an oncologist. The fact is that the tactics of surgical treatment of benign and malignant tumors are significantly different, which is why if the diagnosis is made incorrectly, serious complications may develop ( such as tumor metastasis - the spread of tumor cells throughout the body).

Audiologist

This is a doctor who studies and diagnoses hearing disorders, and also takes part in the rehabilitation of patients with this pathology. It is worth noting that the causes of hearing loss can be very different ( damage to the auricle, damage to the eardrum or tympanic cavity, diseases of the nerve structures that provide functioning auditory analyzer and so on). The audiologist does not treat all of these pathologies, but only determines the level of damage, after which he refers the patient to the necessary specialist for further treatment.

The responsibilities of an audiologist include:

• detection of hearing impairments;
• identifying the cause of hearing loss;
• referral for treatment;
• teaching the patient how to prevent disease progression.

ENT specialist

A phoniatrist is a doctor who identifies, diagnoses and treats pathologies associated with various speech defects.

Speech problems can be caused by:

• Damage to the vocal cords (performing a voice-forming function).
• Damage to areas of the central nervous system responsible for speech. In this case, neurologists, neurosurgeons and other specialists are also involved in the treatment process ( if necessary).
• Speech disorders associated with mental illness. In this case, psychiatrists, neurologists, and neuropathologists are involved in treatment.

Are ENT consultations paid or free?

Consultations with an ENT specialist in public medical institutions are free, however, for this you need to have a compulsory health insurance policy, as well as a referral to an ENT specialist from a family doctor ( if an existing health problem requires urgent medical care, this direction is not needed). Free medical services provided by an ENT specialist include patient examination, diagnostic and therapeutic measures. At the same time, it is worth noting that some studies are paid for, which the doctor must clearly warn the patient about and obtain his consent to perform these procedures.

Paid ENT consultations can be obtained in private medical centers, as well as when calling a doctor from such a center to your home.

What ear diseases does ENT treat?

An otorhinolaryngologist deals with the diagnosis and treatment of infectious, inflammatory, traumatic and other ear lesions.

Otitis ( external, middle, purulent)

This is an inflammatory disease of the ear, most often caused by a decrease in the body's defenses and the development of pathogenic microorganisms in various areas auditory analyzer.

Otitis may be:

• External. In this case, the skin of the auricle or external auditory canal is affected, with frequent involvement of the eardrum. The cause of the development of this disease may be non-compliance with personal hygiene rules ( that is, picking the ears with various dirty objects - pins, matches, keys, etc.). Treatment is predominantly local - ENT prescribes ear drops with antibiotics ( drugs that destroy pathogenic microorganisms). In case of complications ( that is, when an abscess forms - a cavity filled with pus) surgical treatment is indicated.
• Average In this case, the structures of the middle ear become inflamed ( tympanic cavity) - the eardrum and auditory ossicles, which ensure the transmission of sound waves. Without treatment, this pathology can lead to permanent hearing loss, so otorhinolaryngologists recommend starting to take anti-inflammatory drugs as early as possible. With the development of purulent otitis media ( that is, with the accumulation of pus in the tympanic cavity) antibiotics are prescribed, and if they are ineffective, the eardrum is pierced and the pus is removed.
• Internal. Internal otitis (labyrinthitis) is an inflammation of the inner ear, in which sound waves are converted into nerve impulses, which then enter the brain. This pathology may be accompanied by ringing or noise in the ears, hearing loss, headaches, and so on. Treatment consists of prescribing antibiotics ( with a bacterial form of the disease), and if they are ineffective - in surgical removal of the purulent focus.

Ear wax plugs

Wax plugs are accumulations of earwax, which is secreted by special glands located in the skin of the external auditory canal. In case of violation of personal hygiene rules ( that is, if you don’t clean your ears for a long time) this wax can dry out, forming a dense plug that clogs the lumen of the ear canal. This leads to decreased hearing on the affected side and also promotes infection.

Treatment for wax plugs involves removing them. To do this, the ENT specialist can rinse the ear with warm water or remove the plug using special instruments.

Ear injuries

Injury to the auricle can occur under various circumstances ( during a fight, during a road accident, during a fall, etc.). This injury is not accompanied by hearing impairment and usually does not pose any serious threat to the life and health of the patient, but requires a thorough examination and stopping bleeding ( If there are any) and further observation.

In case of traumatic damage to the tympanic cavity or inner ear, more serious complications are possible associated with damage to the auditory ossicles, eardrum and other structures of the auditory analyzer. In this case, the patient may experience hearing loss, bleeding from the ear, headaches and dizziness ( caused by brain damage during trauma) and so on. Patients with such injuries should be hospitalized for a full examination, as they have a high likelihood of having skull fractures and other injuries. Treatment may be symptomatic ( relief of pain, removal of inflammatory tissue swelling, and so on) or surgical, aimed at eliminating existing lesions ( fractures, bleeding from damaged vessels, etc.).

What throat diseases does ENT treat?

If you experience pain, sore throat or any other symptoms in your throat, you should contact an ENT specialist. The doctor will be able to make the correct diagnosis and prescribe treatment in a timely manner.

Tonsillitis ( sore throat, inflammation of the tonsils, tonsils)

Angina ( acute tonsillitis) is characterized by inflammation of the tonsils ( tonsil). These tonsils belong to the body’s immune system and take part in the fight against pathogenic bacteria and viruses that penetrate into the body. Airways along with the inhaled air. Sore throat manifests itself as severe pain in the throat, as well as general symptoms intoxication - general weakness, increased body temperature, and so on. Quite often, a white or gray coating may appear on the tonsils, which over time can turn into dense purulent plugs.

Treatment consists of prescribing antibacterial ( in case of bacterial sore throat) or antiviral drugs ( if a sore throat is caused by viruses) and in symptomatic therapy ( anti-inflammatory, antipyretic and other medications are used). An ENT specialist may also prescribe a throat lavage. antiseptic solutions that destroy pathogenic microorganisms.

Chronic tonsillitis develops in advanced, untreated cases of tonsillitis and is characterized by a long-term, sluggish inflammatory process in the area of ​​the palatine tonsils, which over time leads to disruption of their functions. Systemic manifestations ( such as increased body temperature) are usually absent, but in almost all patients there is painful enlargement cervical lymph nodes, constant hyperemia ( redness) mucous membrane of the tonsils, as well as their enlargement and painful thickening.

Conservative treatment chronic tonsillitis is to use antibacterial drugs, however, this does not always give the expected result. In case of frequent exacerbations of tonsillitis, as well as in case of ineffectiveness of drug therapy, the otolaryngologist may recommend surgical treatment ( tonsil removal), which will solve the problem of sore throat once and for all.

Pharyngitis

The cause of the development of pharyngitis ( inflammation of the pharyngeal mucosa) may be bacterial or viral infections, as well as other irritants ( inhalation of hot air or steam, prolonged breathing through the mouth in the cold, inhalation of certain chemicals, and so on). The disease manifests itself as severe pain and sore throat. Sometimes there may be an increase in body temperature, headaches, enlarged cervical lymph nodes, and so on. When examining the mucous membrane of the pharynx, the ENT specialist notes its pronounced hyperemia ( redness) and swelling.

Treatment consists of eliminating the root cause of the disease ( For a bacterial infection, antibiotics are prescribed, for a viral infection, antivirals, and so on.), as well as in symptomatic therapy ( anti-inflammatory drugs are used to relieve swelling of the mucous membrane and eliminate pain).

Laryngitis ( inflammation of the larynx)

This term refers to an inflammatory lesion of the larynx that develops against the background of colds or systemic infectious diseases (measles, scarlet fever and others).

Laryngitis can manifest itself:

• Sore throat– due to swelling of the laryngeal mucosa.
• Hoarseness of voice- due to damage to the vocal cords.
• Difficulty breathing– due to swelling of the mucous membrane and narrowing of the lumen of the larynx.
• Dryness and sore throat.
• Cough.
• Systemic reactions– increase in temperature, general weakness, headaches and so on.

When treating acute laryngitis, the otorhinolaryngologist uses antibacterial, antiviral ( if necessary) and anti-inflammatory drugs. He may also prescribe gargling with antiseptic solutions several times a day ( if laryngitis develops against the background of a bacterial infection of the pharynx or nasal cavity). Extremely important point is to ensure complete rest for the vocal cords, so the doctor may recommend that the patient not talk for 4 to 6 days, and also not eat hot, cold or irritating foods ( that is, spicy seasonings and dishes).

Laryngeal stenosis

This is a pathological condition characterized by narrowing of the lumen of the larynx as a result of progression inflammatory process in her tissues. The cause of stenosis may be trauma ( for example, a swallowed sharp object that enters the child’s respiratory tract), burnt ( occurs when inhaling certain toxic substances, hot steam or air from fires), extremely severe allergic reactions, and so on.

The main manifestation of this pathology is respiratory failure associated with difficulty getting air into the lungs. In this case, breathing can become noisy, hoarse, and each breath is given to the patient with great effort. Over time, signs of a lack of oxygen in the body may appear - increased heart rate, cyanosis skin, psychomotor agitation, fear of death, and so on.

An important point is the prevention of laryngeal stenosis, which consists of timely and adequate treatment of inflammatory diseases of this organ. In case of severe stenosis, when conservative measures are ineffective, an ENT specialist may prescribe surgery– laryngoplasty, designed to restore the normal lumen of the larynx and prevent its further narrowing.

Does ENT treat tracheitis and bronchitis?

Inflammation of the lower respiratory tract - trachea ( tracheitis) and bronchi ( bronchitis) may be a consequence of infectious and inflammatory diseases of the nose, pharynx or larynx. These pathologies are usually treated by a therapist or pulmonologist. At the same time, due to the anatomical and functional connection between the trachea, bronchi and ENT organs, otorhinolaryngologists can often take part in the treatment process.

What nasal diseases does ENT treat?

An otolaryngologist deals with the diagnosis and treatment of diseases and injuries of the nasal cavity and paranasal sinuses.

Adenoids

Adenoids are commonly referred to as an overly enlarged pharyngeal tonsil, which belongs to the organs of the immune system. The growth of this tonsil leads to blockage of the airways and disruption of normal nasal breathing, which is usually the reason for contacting an ENT specialist.

In most cases, adenoids appear in children early age, which is due to the characteristics of their body ( in particular, an overreaction of the immune system to bacterial and viral infections). Frequent colds upper respiratory tract, stimulating immune activity and leading to a gradual increase in the pharyngeal tonsil. Over time, it increases so much that it blocks most of the airways, as a result of which the child begins to experience difficulty breathing through the nose. Children may also experience a constant runny nose, cough, hearing loss, increased body temperature and other signs of an infectious and inflammatory process.

At the initial stage of development of the disease, an ENT specialist can prescribe conservative treatment, which is aimed at fighting the infection ( antibacterial, antiviral and anti-inflammatory drugs) and to strengthen the general defenses of the child’s body ( immunostimulants, multivitamins). If drug treatment is ineffective, the adenoids enlarge, and it becomes more and more difficult for the child to breathe, an ENT surgeon performs surgical removal of the adenoids.

Polyps

Nasal polyps are pathological growths of the mucous membrane of the paranasal sinuses that protrude into the nasal passages, thereby disrupting the normal nasal breathing, and also leading to a decrease in the sense of smell, frequent infectious and inflammatory diseases of the nose, and so on.

The reasons for the formation of polyps are unknown. It is believed that frequent infectious and viral lesions of the nasal mucosa can contribute to the development of the disease. Polyps can appear as in children ( in this case, you should contact a pediatric ENT specialist), as well as in adults.

Drug treatment of polyps consists of prescribing steroid drugs. However, often conservative measures are not enough ( polyps continue to grow, increasingly disrupting nasal breathing), and therefore the ENT recommends removing them surgically. At the same time, it is worth noting that the relapse rate ( re-formation of nasal polyps) after surgery is about 70%.

Rhinitis ( acute, chronic, vasomotor)

Acute rhinitis is an acute inflammation of the nasal mucosa, the development of which is most often caused by viral and bacterial infections. Other causes of rhinitis may be dirty ( dusty) air, inhalation of certain chemicals, and so on. When irritants come into contact with the nasal mucosa, they activate the body’s immune system, resulting in characteristic manifestations of the disease - runny nose, nasal congestion ( due to swelling of its mucous membrane), increased body temperature, headaches, and so on.

With untreated or frequently recurring acute rhinitis, it can develop into chronic form, in which signs of inflammation ( runny nose, nasal congestion) remain in the patient almost constantly.

Vasomotor rhinitis, which develops with frequent allergic diseases nose, in case of disturbance of the nervous regulation of the nasal mucosa, as well as in diseases of the vegetative ( autonomous) nervous system. All data causal factors lead to disruption of the functional activity of the nasal mucosa, which is accompanied by swelling and nasal congestion ( observed almost constantly), copious discharge mucus from the nose, itching ( burning) in the nose and so on.

Treatment of ordinary acute rhinitis comes down to eliminating the cause of the disease, as well as symptomatic therapy. An ENT specialist can prescribe anti-inflammatory, antiviral or antibacterial drugs, and to normalize nasal breathing - vasoconstrictor drops ( they constrict the vessels of the nasal mucosa, as a result of which the severity of its swelling decreases). Treatment of vasomotor rhinitis usually requires a more detailed examination, long-term drug therapy and the participation of other specialists involved in the treatment of diseases of the nervous system ( neurologists, neuropathologists).

Sinusitis ( sinusitis, frontal sinusitis, sphenoiditis)

Sinusitis is an inflammation of the paranasal sinuses, located in the bones of the skull around the nasal passages. The paranasal sinuses are important for the normal formation of the voice, and also take part in humidifying and warming the inhaled air. That is why their defeat can lead to the development of serious respiratory complications. Any inflammatory processes in the nose associated with swelling of its mucous membrane can contribute to the development of sinusitis. These diseases manifest themselves as pain in the affected sinuses, nasal congestion, runny nose, as well as increased body temperature and other systemic reactions.

Depending on the location of the lesion, there are:

• Sinusitis. Inflammation of the maxillary sinuses, located in the cavities of the maxillary bones. When the mucous membrane of the sinuses becomes inflamed, it swells, as a result of which the normal ventilation of the sinuses themselves is disrupted, and favorable conditions are created for the development of infection. For the treatment of non-purulent ( catarrhal) for sinusitis, the ENT prescribes antibiotics, nasal rinsing with antiseptic solutions, and anti-inflammatory drugs. If the disease progresses and pus forms in maxillary sinuses puncture may be required ( puncture) and removal of pus.
• Frontit. Inflammation of the frontal sinus, manifested by severe headaches, eye pain, lacrimation, increased body temperature, and so on. Treatment of frontal sinusitis is carried out with antibacterial and anti-inflammatory drugs. If they are ineffective, as well as in the case of accumulation of pus in the frontal sinus, the ENT specialist can also puncture the sinus.
• Ethmoiditis. It is characterized by inflammation of the cells of the ethmoid labyrinth located in the ethmoid bone of the nose. It manifests itself as pain in the bridge of the nose, headaches and pain in the eyes, and increased body temperature. Treatment of ethmoiditis is carried out with antibiotics, and if they are ineffective, the otolaryngologist performs surgery ( opening the source of infection, removing pus and local application antibacterial drugs and antiseptic solutions).
• Sphenoiditis. It is characterized by inflammation of the sphenoid sinuses located in the posterior parts of the nose. The main symptoms are headaches in the parietal region and in the occipital region. Systemic signs of the disease do not differ from those of other sinusitis. Untreated sphenoiditis can quickly become complicated by damage to the optic nerves and visual impairment, and therefore treatment ( medical or surgical) should be started as soon as possible.

Deviated nasal septum

It’s worth noting right away that there are no people with a completely straight nasal septum ( everyone has it slightly curved). At the same time, its excessive curvature or deviation in one direction or another can significantly disrupt nasal breathing, causing the development of many diseases.

Manifestations of a deviated nasal septum may include:

• Difficulty in nasal breathing– through one nostril ( if the partition is tilted to one side) or through both nostrils ( if the septum is curved in several areas, as a result of which the passage of air in both nasal passages is disrupted).
• Chronic rhinitis– constantly present signs of inflammation of the nasal mucosa ( runny nose, nasal congestion, etc.).
• Dry nose– as a result of uneven distribution of air, one of the nostrils will always be dry.
• Decreased sense of smell– a person has difficulty identifying odors through one or both nostrils.
• Frequent rhinitis– as a result of changes in the nasal passages, they are disrupted protective function, which contributes to the development of bacterial and viral infections.
• Changing the shape of the nose– typical if the curvature of the nasal septum occurs as a result of injury.

In case of severe curvature of the nasal septum, which impairs nasal breathing and leads to a deterioration in the patient’s quality of life, surgical correction is indicated. Drug treatment of this pathology is ineffective and can only be prescribed during the period of preparation for surgery ( vasoconstrictors are used to facilitate nasal breathing).

Nose injuries

Traumatic injuries to the bones and tissues of the nose occur quite often in ENT practice. In this case, the doctor must correctly assess the extent of damage and provide the patient with urgent help (if necessary), order additional examinations, and also promptly call specialists from other fields of medicine for consultation.

In case of traumatic injury to the nose, the following may occur:

• Closed soft tissue injury. May be accompanied by contusion, bruising or bruising in the area of ​​injury. Serious treatment is usually not required - just apply cold to the damaged tissue for a few minutes.
• Fracture of the nasal bones. A formidable condition that may be accompanied by damage to the orbit, paranasal sinuses and other adjacent tissues.
• Fracture of the walls of the paranasal sinuses. May be accompanied by a violation of their structure and functions.
• Deviation of the nasal septum. Usually occurs simultaneously with fractures of the nasal bones. It can be extremely pronounced, requiring surgical correction.

Treatment of nasal injuries is prescribed by an ENT specialist after all necessary tests and making a diagnosis, taking into account the opinions of other specialists ( a maxillofacial surgeon for fractures of the facial skull bones, a neurosurgeon for damage to nearby nerves, an ophthalmologist for damage to the orbit and eye, and so on).

Does ENT remove foreign bodies from the ear, nose and throat?

Entry of a foreign body into the nasal passages, external auditory canal or respiratory tract ( into the larynx, trachea) is most often observed in children, as they like to put various small objects in their nose, mouth and ears. The removal of foreign bodies from the nose and ear is usually carried out by an ENT specialist, who can use special devices for this ( forceps, scissors and so on). If a foreign body is stuck in the nostril, there are usually no difficulties. If the child cannot “blow it out” on his own, the foreign object is removed with forceps. At the same time, when removing a foreign object from the ear, you should be extremely careful, since careless manipulation can lead to damage to the eardrum.

The situation with foreign bodies of the larynx is much more complicated. The fact is that a large number of special nerve receptors designed to protect the respiratory tract are concentrated in this area. If any foreign object of sufficiently large size enters the larynx ( e.g. small toy, coin, bead), laryngospasm may develop - a pronounced contraction of the muscles of the larynx, accompanied by a tight closure of the vocal cords. In this case, breathing becomes impossible, as a result of which, without emergency medical assistance, the person dies within a few minutes. There is no point in waiting for an ENT specialist in this condition, but you need to call as soon as possible “ ambulance» or take the child to the nearest medical center.

Symptoms of diseases of the ENT organs ( runny nose, cough, hearing loss, ear congestion, tinnitus, headache, fever)

As mentioned earlier, the main task of an otorhinolaryngologist is to make a diagnosis and prescribe treatment for diseases of the ENT organs. At the same time, any person should know the symptoms and signs that may indicate damage to these organs and, if they occur, they should consult with an ENT specialist as soon as possible.

The reason for contacting an ENT specialist may be:

• Runny nose. A sudden runny nose most often indicates the presence of acute rhinitis. At the same time, a long, sluggishly progressing runny nose can be a sign of chronic nasal diseases.

• Cough. A dry, painful cough, accompanied by a sore or sore throat, may be a sign of sore throat, pharyngitis, laryngitis, tracheitis or bronchitis. At the same time, a cough accompanied by yellow or greenish sputum may indicate the presence of pneumonia ( pneumonia), which requires consultation with a therapist or pulmonologist.
• A sore throat. May indicate inflammatory diseases of the pharynx, tonsils or larynx.
• Hearing loss. This symptom can be observed in diseases of the external auditory canal, tympanic cavity or inner ear.
• Ear congestion. Appearance this symptom may often be associated with normal events that do not require medical intervention ( for example, during takeoff or landing of an airplane, or when water gets into the ear while swimming). At the same time, if ear congestion persists for a long time, it is recommended to visit an ENT specialist who can identify the cause of this phenomenon ( wax plugs, inflammatory diseases of the external auditory canal or tympanic cavity, and so on) and help eliminate it.
• Noise ( ringing) in the ears. Noise or ringing in the ears may occur with prolonged exposure to excessively loud sounds ( for example, when listening to loud music). This phenomenon usually does not cause serious harm to health and does not require medical attention, but with frequent repeated noise exposure it can cause hearing loss. Other causes of this symptom may be diseases of the tympanic cavity, inner ear, or nerve fibers, through which impulses travel from the hearing organ to the brain.
• Headache and increased body temperature. These symptoms most often indicate the presence of an infectious-inflammatory process in the body. Quite often, similar symptoms occur with a common cold, without requiring a visit to the doctor. At the same time, if the temperature becomes too high ( more than 38 – 39 degrees), and headaches do not go away for several days in a row, it is recommended to consult a specialist.

Is an ENT consultation necessary during pregnancy?

If before pregnancy a woman did not suffer from any chronic diseases of the ENT organs, and during pregnancy there is no damage to these organs, consultation with an otolaryngologist is not required. At the same time, it is worth remembering that most infectious and inflammatory diseases of the nose or throat are almost always accompanied by systemic signs of infection and quite often require drug treatment ( the use of antibiotics that can harm the fetus). That is why, throughout pregnancy, a woman is advised to closely monitor her health, and if the first signs of a cold or sore throat appear, immediately consult a doctor without self-medicating.

Preventative visit to ENT

Healthy people who do not have signs of diseases of the ENT organs may require preventive visits to this specialist only during the passage of the medical commission necessary for employment in certain positions ( for example, doctors, chefs, etc.). At the same time, in the presence of any chronic diseases of the upper respiratory tract, as well as after performing operations on the ENT organs, patients are recommended to regularly visit an otolaryngologist within the time frame established by the doctor in order to promptly notice and prevent the development of possible complications.

How is an appointment with an ENT specialist at the clinic?

During a patient’s appointment at the clinic, the doctor gets to know him and then carefully questions him about the symptoms of the disease that has arisen. Then he examines the patient and, if necessary, prescribes additional laboratory and instrumental tests to confirm or refute the diagnosis.

What questions can an ENT specialist ask?

When meeting a patient for the first time, the doctor is interested in the circumstances of the onset of the disease, its course, and general state patient's health.

During the first consultation, the doctor may ask:

• How long ago did the first signs of the disease appear? cough, runny nose, stuffy ears, etc.)?
• What contributed to the appearance of the first symptoms ( hypothermia, cold, injury)?
• Has the patient taken any self-medication? If so, what was its effectiveness?
• Has the patient had similar diseases before? If yes - how often ( how many times in Last year ) and what treatment did you take?
• Does the patient suffer from any chronic diseases of the ENT organs? If yes, how long ago and what treatment did you take?
• Has the patient had any surgery on the ENT organs ( removal of tonsils, removal of adenoids and so on)?

What instruments does the ENT use when examining a patient?

After a thorough interview, the doctor moves on to an objective examination of the patient, during which he often uses certain instruments. Today, the list of devices that can be used in the diagnosis of ENT diseases is quite large. However, there are standard instruments that are available in the office of any otolaryngologist and which he almost always uses when examining a patient.

The main tools of ENT are:

• Forehead reflector. It is a round mirror with a hole in the center. This device helps the doctor visually examine the patient's throat, as well as the narrow nasal passages and external auditory canal. The essence of his work is this: using special fasteners, the doctor installs a mirror so that the hole is directly in front of his eye. Next, he sits down opposite the patient and turns on the lamp, which is usually located on the side of the patient. The light from the lamp is reflected from the mirror and hits the area under study ( in the nasal passage, in the throat, in the ear), and the doctor sees everything that happens inside through the central hole.
• Medical spatula. This is a long thin plate that can be plastic or wood. During a throat exam, the doctor uses a spatula to press down on the root of the patient's tongue, which allows them to examine deeper parts of the throat. It is worth noting that most medical spatulas used today are disposable. Reusable iron spatulas are used somewhat less frequently.
• Otoscope. Conventional otoscope ( ear examination device) is a lens system, a light source and a special ear specula. All this is attached to the handle, which makes the device convenient to use. Using an otoscope, the doctor can examine the external auditory canal and the outer surface of the eardrum, and also remove foreign bodies or wax plugs. More modern otoscopes can be equipped with video cameras, which allows them to be used for more complex and delicate manipulations.
• Nasal speculum. This is a metal device shaped like scissors, but instead of cutting surfaces it is equipped with two longitudinal blades connected in the form of a funnel. A mirror is used to examine the nasal passages and is applied as follows. The doctor inserts the working end of the device into the patient's nostril, and then squeezes its handle. As a result of this, the blades expand, pushing apart the walls of the nasal passage, which allows a more thorough examination of the nasal cavity.
• Mirror for posterior rhinoscopy. Rhinoscopy is a procedure during which the nasal cavity is examined. Posterior rhinoscopy is performed using special round mirrors attached to a long thin handle. The doctor asks the patient to open his mouth, and then inserts this mirror into the throat, pointing it upward. This allows you to visually examine the nasopharynx and posterior sections of the nasal cavity, identifying the presence of an inflammatory process, polyps or adenoid growths.
• Ear or nasal tweezers. They have a special curved shape and are designed to remove foreign objects from the external auditory canal or nasal passages, and are also used during surgical procedures.
• Surgical instruments. In surgical practice, the otorhinolaryngologist uses special instruments designed to remove adenoid growths ( adenotom), palatine tonsils ( tonsillitis), nasal polyps ( loop for nasal polypotomy) and so on.

Examination of the ear by an ENT specialist

During the examination, the ENT sequentially assesses the condition of the auricle, after which he begins to examine the external auditory canal and eardrum ( using an otoscope). In this case, the doctor pays attention to the presence visible damage skin in the examined areas, as well as for the presence of signs of an infectious and inflammatory process.

After examination, the ENT specialist may press lightly on the auricle or behind the ear area. If the patient feels pain, he should inform the doctor about it. The doctor also palpates ( probes) behind the ear, occipital and cervical The lymph nodes, determining their size, consistency and pain.

How does an ENT check hearing?

Hearing testing can be carried out using speech, as well as through the use of special equipment. In the first case, the patient stands at a distance of 6 meters from the doctor ( The ear being examined should be facing towards the doctor), after which the ENT specialist begins to whisper various words. Under normal conditions, the patient will be able to repeat them, while a person with hearing loss will have difficulty distinguishing low-pitched sounds.

Hearing examination using special equipment ( audiometry) provides more accurate data regarding the condition of the patient’s auditory analyzer. The essence of the method is as follows. The patient sits on a chair, and a special earphone is put on the ear being examined. Next, a sound signal of varying intensity begins to flow through the earphone ( at first barely audible, and then louder and louder). As soon as the patient distinguishes the sound, he must inform the doctor about it or press a special button. The study is then repeated on the second ear.

It is worth noting that today there are many modifications of audiometry that make it possible to identify the most various disorders hearing

What does the ENT see when examining the throat?

To perform this procedure, the doctor asks the patient to open his mouth, stick out his tongue and say the letter “a” or yawn. If necessary, he can also use a medical spatula.

When examining the throat, the ENT specialist pays attention to the condition of the mucous membrane of the pharynx - detects its hyperemia ( redness), swelling, the presence of pathological plaque ( its color and location are assessed) and so on. In addition, the doctor evaluates the condition of the palatine tonsils ( tonsil), taking into account their size, shape and the presence or absence of signs of inflammation. The presence of plaque in the tonsil area may indicate acute tonsillitis ( sore throat). After examining the throat, the ENT will also palpate the cervical and other lymph nodes.

Examination of the nose by an ENT specialist

When examining the nasal passages ( anterior rhinoscopy) the doctor usually uses a sterile nasal speculum, which he inserts into each nostril one by one, while directing light from the frontal reflector into it. During the examination, the doctor evaluates the size of the nasal passages ( aren't they narrowed?), condition of the nasal concha ( are they enlarged?) and nasal septum ( Isn't it crooked?), and also reveals polyps, adenoid growths ( this may require a posterior rhinoscopy) and other pathological changes.

If the patient has a stuffy nose. Rhinoscopy can be performed only 5 to 10 minutes after using vasoconstrictor drops, since otherwise the swollen and hyperemic mucous membrane may be traumatized, which can lead to bleeding.

After the examination, the doctor feels the walls of the nose, and also lightly presses with his fingers in the area of ​​the maxillary and frontal sinuses. If the patient feels pain, there is a high probability that he has sinusitis or frontal sinusitis.

What tests can an ENT specialist prescribe?

Quite often, a competent specialist can make a preliminary diagnosis based on data from a survey and clinical examination of the patient. At the same time, in some cases it is required additional research (often instrumental). Value laboratory tests at the same time, it is relatively small and comes down to identifying signs of the presence of an infectious-inflammatory process in the body ( Why is a general blood test sufficient?). Other tests ( biochemical blood test, urine test and so on) are prescribed only in the presence of concomitant pathologies or when preparing the patient for surgery.

smear ( sowing) on microflora in ENT infections

If a patient has an infectious-inflammatory disease of the ENT organs, it is extremely important to accurately determine the causative agent of the infection, since the outcome of treatment largely depends on this. For this purpose, a bacterioscopic or bacteriological examination is performed.

The essence of bacterioscopy is as follows. From the surface of the affected mucous membrane ( nose, throat, tonsils and so on) or a sample of material is taken from the external auditory canal. To do this, glass rods or sterile cotton swabs can be used, which are rubbed once over the surface of the area under study. Next, the samples are placed in a special tube and sent to the laboratory under sterile conditions. In the laboratory, the obtained samples are stained using a special technique and then examined under a microscope. This allows you to determine the form of the infectious agent and, in some cases, make a diagnosis.

Bacteriological examination is carried out simultaneously with microscopy. Its essence is as follows. The material obtained from the patient is inoculated on special nutrient media ( To do this, a cotton swab is passed several times over the surface of the dish with the nutrient medium), after which it is placed in a thermostat, which creates optimal conditions for the growth and reproduction of bacteria. After a certain time cups with nutrient media colonies of microorganisms that appear on them are removed and examined. This allows you to accurately determine the type of pathogen, as well as assess its sensitivity to certain antibiotics, which is extremely important in the process of prescribing antibacterial therapy.

Examination of ENT organs ( X-ray, computed tomography, MRI, endoscopy)

Quite often, to confirm the diagnosis or exclude a disease ( for example, bone fractures due to injury to the nose) the doctor may prescribe additional instrumental studies.

During diagnosis, the ENT may use:

• X-ray of the ear. Can be prescribed to identify pathological processes ( for example, collections of pus) in the tympanic cavity. X-rays are also useful in diagnosing fractures and identifying radiopaque foreign bodies ( consisting of iron, stone and so on).
• X-ray of the sinuses and nasal cavity. Allows you to detect swelling of the mucous membrane of the nasal sinuses, as well as detect the accumulation of pus in them. In case of trauma, it is also possible to identify fractures of the walls of the sinuses and detect foreign bodies in this area.
• X-rays of light. This study is not intended to diagnose diseases of the ENT organs, but it allows us to exclude pneumonia, which can be a complication of bacterial and viral infections of the upper respiratory tract.
• Computed tomography ( CT). This modern research, based on the method x-ray radiation, combined with computer technologies. CT scans can provide detailed, clear images of many internal organs and structures that cannot be distinguished on a regular x-ray. Visible most clearly on CT bone formations, and therefore it is most often used to identify fractures of the bones of the nose or ear area, as well as to identify foreign bodies in the tissues of the head.
• Magnetic resonance imaging ( MRI). This is a modern study that allows you to obtain a layer-by-layer three-dimensional image of the area under study. Unlike CT, MRI can visualize more clearly soft fabrics and liquids, and therefore it can be used to identify benign and malignant tumors of the ENT organs, to determine the prevalence purulent process in the tissues of the head and neck, and so on.
• Endoscopic examination of the ear, nose or throat. The essence of this method is as follows. To the study area ( into the external auditory canal, nasal passages, pharynx or larynx) a thin flexible tube is inserted, at the end of which a video camera is attached. As the tube advances over the area being examined, the physician can visually ( at multiple magnification) assess the condition of the mucous membrane, identify pathological changes or tissue growths.

Who can be admitted to the ENT department?

Patients who need urgent specialized care or planned surgical intervention on the ENT organs can be hospitalized in this department of the hospital. Also, those patients who develop ( or may develop) potentially dangerous complications of inflammatory diseases of the ear, nose or throat. In the hospital, such patients are under constant supervision of specialists and also receive the most effective treatment.

Indications for hospitalization in the ENT department are:

• Purulent sinusitis. The accumulation of pus in the paranasal sinuses can lead to the melting of the sinus wall and the spread of pus into the surrounding tissues, including the brain, which can cause the development of meningitis ( serious, often fatal complication).
• Purulent otitis media. As mentioned earlier, the accumulation of pus in the tympanic cavity can lead to rupture of the eardrum or destruction of the auditory ossicles, which will lead to partial or complete deafness.
• Acute otitis in children of the first year of life. In children, infection can spread faster than in adults, which is why childhood infections require more attention from doctors.
• The presence of a foreign body in the respiratory tract or external auditory canal. If the foreign body is located shallowly and its removal is not difficult, hospitalization is not required.
• Injuries to the nose, ear or respiratory tract. The danger in this case is that when these organs are injured, blood vessels, nerves or skull bones could be damaged, which must be promptly identified and appropriate treatment initiated.
• Preoperative preparation. During this period of time, all necessary examinations are carried out and certain medications are prescribed.
• Postoperative period. After doing some complex operations the patient must remain in the hospital, where doctors can prevent or promptly eliminate possible complications.

Is it possible to call an ENT specialist to your home?

As a rule, otorhinolaryngologists are not called to your home. In case of damage to the ENT organs, the patient should consult a family doctor, who will assess his condition and, if necessary, refer him to an ENT specialist. For a disease requiring urgent treatment (for example, in case of injury, when a foreign body enters the respiratory tract) you should call an ambulance. Doctors who arrived at the scene of the incident will provide emergency care to the patient, and if necessary, take him to the hospital, where he can be examined by an ENT specialist.

At the same time, it is worth noting that some private clinics practice visiting a specialist to your home ( for a fee). In this case, the doctor can take with him all the necessary tools in order to examine the patient, make a diagnosis and prescribe treatment. In severe cases, when the doctor doubts the correctness of the diagnosis, he may recommend that the patient visit the clinic and undergo additional examinations.

For what ENT diseases are antibiotics prescribed?

Antibiotics are special drugs that can destroy various microorganisms, while having virtually no effect on the cells of human tissues and organs. In the practice of an ENT doctor, these drugs are used to treat or prevent bacterial infections of the ear, throat, nose, or paranasal sinuses.

When choosing an antibiotic, the doctor is first guided by data about the disease itself, as well as about the microorganisms that most often cause it. If a bacterial infection is detected, antibiotics are prescribed wide range actions active against large numbers various bacteria. At the same time, it is recommended to collect material for bacteriological testing, according to which the doctor can select the drug that will be most effective against a specific infectious agent.

It is worth noting that when viral diseases (for example, with the flu) antibiotics are ineffective because they have no effect on viral particles. In this case, the use of antibacterial drugs is justified only for preventive purposes ( to prevent the development of bacterial infections) for a short period of time determined by the doctor.

What procedures can an ENT perform?

As mentioned earlier, for some diseases, an otolaryngologist may prescribe special procedures for rinsing the nose, ears or throat.

Rinsing the nose and paranasal sinuses ( "cuckoo")

To rinse your nasal passages at home, you can use a regular syringe and salt water. To do this, dissolve 1 - 2 teaspoons of salt in a glass of warm water, then, throwing back your head, use a syringe ( without a needle) pour the solution into one nostril and “release” it through the other. This procedure has a disinfecting effect ( saline solution is toxic to pathogenic bacteria), and also helps cleanse the nasal passages and improve nasal breathing.

To rinse the nose in a clinic, an ENT specialist may prescribe a “cuckoo” procedure. Its essence is as follows. The patient lies down on the couch ( back down) and slightly throws his head back. The doctor takes a syringe and fills it with an antiseptic solution ( a substance that destroys pathogenic microorganisms - furatsilin, miramistin, and so on can be used). Next, the doctor inserts the tip of the syringe ( without needle) into one nostril, and a special vacuum aspirator ( a device that creates negative pressure in the nasal passages and thereby sucks fluid out of them). Then he begins to slowly press on the plunger of the syringe, the liquid from which enters the nasal passages, rinses them and is immediately removed using an aspirator. During the study, the patient must constantly say “ku-ku”. In this case, the soft palate is raised, which contributes to a more complete cleansing of the nasal passages.

Washing ( blowing) ears ( "steamer")

This procedure involves blowing out the auditory tubes ( small holes connecting the pharyngeal cavity with the tympanic cavity of the ear and ensuring the normal functioning of the auditory ossicles), which are often affected by infectious and inflammatory diseases of the ENT organs. The essence of the method is as follows. The doctor inserts a special device into the patient's nostril ( a kind of pear with a special tip that tightly blocks the entrance to the nostril), after which he asks to pronounce the word “steamer”. When the patient pronounces this word, his velum is positioned in such a way that it almost completely blocks the exit through the posterior sections of the nasal passages. At the same moment, the doctor presses forcefully on the bulb, creating increased air pressure, which exits through the posterior sections of the nasal passage at high speed and “blows through” the auditory tubes.

Washing the throat and tonsils

Throat rinsing can be done with conventional antiseptic solutions ( salt, soda) at home. Washing of the palatine tonsils ( if there are purulent plugs in them) performs ENT in a clinic setting. The fact is that these tonsils have peculiar gaps in their structure ( gaps), which fill with pus when they become inflamed. "Wash" it ( pus) from there it is impossible to use regular gargling, so the doctor uses special techniques for this - rinsing the lacunae of the tonsils with a special syringe or vacuum removal of pus. In the first case, a syringe with a special thin ( not spicy) with a needle that is placed directly into the lacuna, after which an antiseptic solution is injected under pressure, which “squeezes out” the pus. In the case of vacuum removal of pus, a special device is attached to the tonsil, which tightly grips its tissue, and then creates negative pressure, “pulling” pus from the lacunae ( This procedure is very painful and is therefore performed under local anesthesia.).

What operations can an ENT perform?

As stated earlier, an otolaryngologist can perform various operations on ENT organs.

The ENT specialist's competence includes:

• Laryngoplasty– recovery operations normal shape larynx.
• Otoplasty– correction of the shape of the ears.
• Septoplasty– elimination of deviated nasal septum.
• Tympanoplasty– washing the tympanic cavity and restoring the integrity and location of the auditory ossicles.
• Myringoplasty– restoration of the integrity of the eardrum.
• Stapedoplasty– replacement of the stapes ( one of the auditory ossicles) prosthesis.
• Adenoidectomy– removal of adenoids.
• Polypotomy– removal of nasal polyps.
• Tonsillectomy– removal of palatine tonsils ( tonsil).
• Repositioning of the nasal bones– restoration of the bone frame of the nose after fractures.

Jokes about ENT

Qualified doctors ( ENT, proctologist and gynecologist) will help teachers find cheat sheets for students during exams. Fast, high quality, cheap.

When examining a patient, the ENT decided to check his hearing and whispered:
- Twenty…
The patient shouts back:
- I hear from a fool!

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A runny nose appeared. I went to the ENT specialist, who prescribed me nasal drops. I bought it and read the list of adverse reactions - “drowsiness ( sometimes insomnia), eye pain, headaches, ringing in the ears, increased irritability, muscle pain, cramps, nausea, vomiting, depression, abdominal pain, diarrhea, nosebleeds...” So I’m sitting and thinking - maybe this runny nose will go away on its own...

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Medical examination in first grade. The ENT specialist asks the child:
- Do you have any problems with your nose or ears?
- Yes, they prevent me from putting on a sweater...

Before use, you should consult a specialist.

Endoscopy is a modern, painless and informative method that allows for a high-quality ENT examination and diagnosis of the anatomical formations of the ear, nose and throat.

Contraindications:

• allergic reactions to the anesthetic used;
• with caution if you are prone to nosebleeds;
• problems with blood clotting;
• neurotic disorders.

Equipment used:

• rigid endoscope;
• light source for conducting endoscopic examination ENT organs;
• ENT combine ATMOS S 61.

When patients come to see us, they cannot always specifically describe the symptoms of their current condition, and we often hear “Doctor, I have something bursting here” or “This is somehow painful and unpleasant.” The doctor’s task in this case is to carefully understand the cause of the discomfort and make the correct diagnosis for further comprehensive treatment of the disease. It happens that a routine examination of ENT organs is not enough. Then endoscopy comes to the rescue (from the Greek “endon” - inside, “scopeo” - looking).

When choosing a clinic for an ENT examination by a doctor, you need to pay attention to the equipment of its ENT room and the prices for this service. Serious medical institutions have in their arsenal not only ordinary rigid endoscopes, but also modern devices (“ENT combines”), with the help of which you can not only conduct a thorough examination of organs, but also immediately perform all the necessary medical manipulations. Should be wary and suspicious low price endoscopy of ENT organs - the cost of an endoscopic examination of organs, carried out in detail and painlessly, cannot be less than 1000 rubles. After all, the cost of the examination consists of the competent, thorough work of a specialist and the high-quality and high-precision equipment he uses. All this together allows you to see an accurate picture and make a correct diagnosis of the disease.

Medical service	price, rub.
Videoendoscopy of the nasal cavity and nasopharynx	3000
Videoendoscopy of the pharynx and larynx	3000
Videoendoscopy of the ear	3000
Endoscopy of the nasal cavity and nasopharynx	2500
Endoscopy of the pharynx and larynx	2500
Endoscopy of the ear	2500
Collection of material for bacteriological examination (one anatomical area)	500
Audiometric testing using an Interacoustics diagnostic audiometer	1500
Accumetric hearing testing using whispered and spoken speech, as well as a set of tuning forks	500
Tympanometric hearing test	1500
Otomicroscopic examination using the HEINE Beta 200 R otoscope	500
Sinus scanning using sinuscan “Oriola”	500

Endoscopic examination at the ENT Clinic of Dr. V.M. Zaitsev":

Informative and accurate

Endoscopy is the most modern and accurate way to diagnose the ear, nose and throat organs. An ENT doctor gets the opportunity to see what cannot be seen with the naked eye.

Safe and painless

Endoscopy, unlike X-rays, does not expose the patient to radiation. In most cases, the procedure does not even require anesthesia and does not cause any unpleasant or painful sensations. If anesthesia is still necessary, it is carried out by lubricating the mucous membranes and is not associated with injection.

Highly technological

To carry out endoscopic examinations, we have the most modern technology and equipment from the world's most famous manufacturers - leaders in the field of otorhinolaryngology: ATMOS ENT combine with monocular and binocular illuminator, light source for endoscopy, rigid endoscopes with a diameter of 4 and 2.7 mm with different viewing angles.

Modern and clear

Our patients have access to the video endoscopy procedure. During the examination, you can display on the screen what the endoscope “sees” and clearly show the patient the essence of the problem. If necessary, you can make a video recording (for example, to transfer it to a hospital when a patient is hospitalized).

Affordable and economical

The cost of endoscopy of ENT organs, as well as prices for other clinic services, has not changed for more than three years: 1000 rubles. for a routine examination, 1,500 rubles. - during videoendoscopy. The price of an ENT examination in Moscow in our clinic remains one of the lowest in the city.

I.Methods for examining the nose and paranasal sinuses.

Patients are examined in a specially equipped room, protected from bright sunlight. The patient is positioned on a chair next to the instrument table to the right of the light source. The examiner puts a frontal reflector on his head and illuminates the nose area with a beam of reflected light.

Stages of patient examination:

1. History

2. Examination of the external nose – shape, skin color, palpation: soft tissue swelling, bone crepitus

3. Anterior rhinoscopy - performed using a nasal speculum. Attention is paid to the shape of the septum, the condition of the nasal turbinates, the color of the mucous membrane, the presence of mucus, pus, and crusts.

4. Posterior rhinoscopy – a nasopharyngeal speculum and a spatula are required. The nasopharynx, choanae, orifices of the auditory tubes, and vomer are examined.

Respiratory function is examined using the Vojacek test - a piece of fluffy cotton wool is brought to one nostril, closing the other, and its movement is observed.

Olfactory function is determined using four standard solutions. These can be: 0.5% acetic acid solution (weak odor); pure wine alcohol (medium smell); valerian tincture (strong); ammonia (ultra-strong).

The paranasal sinuses are examined using radiography, diaphanoscopy (examination in a dark room using a light bulb - the method has historical value), puncture of the sinuses using a Kulikovsky needle, as well as trephine puncture of the sinuses (frontal).

General treatments:

Treatment is divided into two groups - conservative and surgical.

Conservative treatment includes: toileting the nose using cotton wicks (or rinsing with soda-saline solution, infusions medicinal herbs), infusion of medicines into the nose in drops (adults 3 - 5 drops, children - 1 - 3), administration of ointments (cotton wool is wound around the probe, also medicinal substances administered using turundas), insufflation of powders (using a special powder blower), inhalations, warming thermal procedures.

Surgical treatment methods include: trimming the turbinates (conchotomy), resection of deviated nasal septum, ultrasound of the inferior turbinates, galvanocaustics (cauterization of the mucous membrane electric shock), cryotherapy (cold cauterization using liquid nitrogen), cauterization of the mucous membrane chemicals

II.Methods for studying the auditory analyzer.

· History taking

External examination and palpation

· Otoscopy – determines the condition of the external auditory canal and the condition of the eardrum. It is carried out using an ear funnel.

· Functional studies of the ear. Includes examination of auditory and vestibular functions.

Auditory function is examined using:

1. Whispering and colloquial speech. Conditions: soundproofed room, complete silence, room length at least 6 meters. (norm: whispered speech – 6m, spoken – 20m)

2. Tuning forks determine air conductivity - they are brought to the external auditory canal, bone conductivity - tuning forks are placed on the mastoid process or on the parietal region.

3. Using an audiometer, the sounds entering the headphones are recorded in the form of a curve called an audiogram.

Methods for studying vestibular function.

Rotational test is carried out using a Barany chair

Caloric test - warm water (43g) is injected into the external auditory canal using a Janet syringe, and then cold water (18g)

· Pressor or fistula test - air is pumped into the external auditory canal with a rubber balloon.

These tests make it possible to identify autonomic reactions (pulse, blood pressure, sweating, etc.), sensory reactions (dizziness) and nystagmus.

The human ear perceives sound pitches from 16 to 20,000 hertz. Sounds below 16 hertz are infrasound, above 20,000 hertz are ultrasound. Low sounds cause vibrations of the endolymph, reaching the very top of the cochlea, high sounds - at the base of the cochlea. With age, hearing deteriorates and shifts towards low frequencies.

Approximate limit of sound volume location:

· Whispered speech – 30db

· Conversational speech – 60db

· Street noise – 70db

· Loud speech – 80db

· Scream at the ear – up to 110db

· Jet engine – 120db. In humans, such a sound causes pain.

Research methods auditory function:

1. Whispered and spoken speech (norm – 6 meters whispered, spoken – 20 meters)

2. Tuning forks

3. Audiometry - the resulting curve is called an audiogram

Methods for studying vestibular function:

1. Rotational test in the Barany chair

2. Color test (warm and cold water is injected into the external auditory canal using a Janet syringe)

3. Pressor or fistula test (air is pumped into the external auditory canal with a rubber balloon)

The body's reactions are detected: pulse, blood pressure, sweating, dizziness, nystagmus (involuntary movements of the eyeballs).

III.Pharynx examination methods

1. History

2. External examination - the submandibular lymph nodes are palpated.

3. Examination of the middle part of the pharynx - pharyngoscopy. This is done using a spatula. The oral mucosa, soft palate and uvula, anterior and posterior arches, the surface of the tonsils, and the presence of lacunae contents are examined.

4. Examination of the hypopharynx - hypopharyngoscopy. It is carried out using a laryngeal mirror.

5. Finger examination nasopharynx is performed in children to determine the size of the adenoids

General principles therapy and care

1. Gargling.

2. Inhalations

3. Irrigation of the mucous membrane

4. Rinsing the lacunae of the tonsils with a special syringe with nozzles.

5. Lubricating the mucous membrane with antiseptic solutions (Lugol's solution) using a long threaded probe on which cotton wool is wound.

6. Warm compress on the neck or submandibular region for sore throats.

IV.Examination of the larynx begin with examination and palpation of the cartilage of the larynx and soft tissues of the neck. During an external examination, it is necessary to establish the shape of the larynx; by palpation, determine the cartilages, their mobility, the presence of pain, and crepitus.

Indirect and direct laryngoscopy.

Other methods of examining the larynx include: stroboscopy, giving an idea of ​​the movement of the vocal folds, radiography, tomography, endoscopy using fiberglass optics, endophotography.

CHAPTER 1 METHODS OF RESEARCH OF ENT ORGANS

CHAPTER 1 METHODS OF RESEARCH OF ENT ORGANS

Labor omnia vincit.Labor conquers everything.

Methods of examination and research of ENT organs have a number of general principles.

1. The subject sits down so that the light source and table with instruments are to his right.

2. The doctor sits opposite the person being examined, placing his feet on the table; The subject's legs should be outward.

3. The light source is placed at the level of the subject’s right ear, 10 cm from it.

4. Rules for using the frontal reflector:

a) strengthen the reflector on the forehead using a forehead bandage. The reflector hole is placed opposite the left eye (Fig. 1.1).

b) the reflector should be removed from the organ under study at a distance of 25-30 cm (focal length of the mirror);

c) using a reflector, direct a beam of reflected light onto the subject’s nose. Then close the right eye, and look through the reflector hole with the left and turn it so that the beam is visible

Ris. 1.1. Position of the frontal reflector on the doctor's head

light (“bunny”) on the nose. Open the right eye and continue examining with both eyes.

1.1. TECHNIQUE FOR STUDYING THE NOSE AND PARONAL SINUSES

Stage 1. External examination and palpation.

1) Examination of the external nose and places of projection of the paranasal sinuses on the face.

2) Palpation of the external nose: the index fingers of both hands are placed along the back of the nose and with light massaging movements they feel the area of ​​the root, slopes, back and tip of the nose.

3) Palpation of the anterior and lower walls of the frontal sinuses: the thumbs of both hands are placed on the forehead above the eyebrows and gently press on this area, then the thumbs are moved to the area of ​​the upper wall of the orbit to the inner corner and also apply pressure. The exit points of the first branches of the trigeminal nerve (n. ophthalmicus). Normally, palpation of the walls of the frontal sinuses is painless (Fig. 1.2).

4) Palpation of the anterior walls of the maxillary sinuses: the thumbs of both hands are placed in the area of ​​the canine fossa on the anterior surface of the maxillary bone and apply gentle pressure. The exit points of the second branches of the trigeminal nerve (n. infraorbitalis). Normally, palpation of the anterior wall of the maxillary sinus is painless.

Rice. 1.2. Palpation of the walls of the frontal sinuses

5) Palpation of the submandibular and cervical lymph nodes: the submandibular lymph nodes are palpated with the head of the person being examined slightly tilted forward using light massaging movements with the ends of the phalanges of the fingers in the submandibular region in the direction from the middle to the edge of the lower jaw.

The deep cervical lymph nodes are palpated first on one side, then on the other. The patient's head is tilted forward (when the head is tilted backward, the anterior cervical lymph nodes and main vessels of the neck also shift posteriorly, which makes them difficult to feel). When palpating the lymph nodes on the right, the doctor’s right hand lies on the crown of the subject, and with the left hand they make massaging movements with a soft deep immersion into the tissue with the ends of the phalanges of the fingers in front of the anterior edge of the sternocleidomastoid muscle. When palpating the lymph nodes on the left, the doctor’s left hand is on the crown of the head, and palpation is performed with the right hand.

Normally, the lymph nodes are not palpable (cannot be felt).

Stage 2. Anterior rhinoscopy. Inspection of the nasal cavity is carried out under artificial lighting (frontal reflector or autonomous light source), using a nasal speculum - a nasal dilator, which must be held in the left hand as shown in Fig. 1.3.

Rice. 1.3. Anterior rhinoscopy: a - correct position of the nasal dilator in the hand; b - position of the nasal dilator during examination

Rhinoscopy may be front, middle and back.

1) Inspection of the nasal vestibule (first position during anterior rhinoscopy). Using the thumb of the right hand, lift the tip of the nose and examine the vestibule of the nose. Normally, the vestibule of the nose is free and there is hair.

2) Anterior rhinoscopy is performed alternately - one and the other half of the nose. A nasal dilator is placed on the open palm of the left hand with its beak down; The thumb of the left hand is placed on top of the nasal dilator screw, the index and middle fingers are placed outside under the jaw, IV and V should be between the jaws of the nasal dilator. Thus, the II and III fingers close the jaws and thereby open the beak of the nasal dilator, and the IV and V fingers push the jaws apart and thereby close the beak of the nasal dilator.

3) The elbow of the left hand is lowered, the hand with the nasal dilator should be mobile; The palm of the right hand is placed on the parietal region of the patient to give the head the desired position.

4) The beak of the nasal dilator in a closed form is inserted 0.5 cm into the vestibule of the right half of the patient’s nose. The right half of the nasal dilator beak should be in the lower inner corner of the vestibule of the nose, the left half should be on the upper third of the wing of the nose.

5) Using the index and middle fingers of the left hand, press the jaw of the nasal dilator and open the right vestibule of the nose so that the tips of the beak of the nasal dilator do not touch the mucous membrane of the nasal septum.

6) Examine the right half of the nose with the head in a straight position; normally the color of the mucous membrane is pink, the surface is smooth, moist, the nasal septum is midline. Normally, the nasal turbinates are not enlarged, the common, lower and middle nasal passages are free. The distance between the nasal septum and the edge of the inferior turbinate is 3-4 mm.

7) Examine the right half of the nose with the patient’s head slightly tilted downwards. In this case, the anterior and middle sections of the lower nasal passage and the bottom of the nose are clearly visible. Normally, the lower nasal meatus is free.

8) Examine the right half of the nose with the patient’s head slightly tilted back and to the right. In this case, the middle nasal meatus is visible.

9) With fingers IV and V, push back the right branch so that the nose of the beak of the nasal dilator does not close completely (and does not pinch the hairs) and remove the nasal dilator from the nose.

10) Inspection of the left half of the nose is carried out in a similar way: the left hand holds the nasal dilator, and the right hand lies on the crown, while the right half of the beak of the nasal dilator is located in the upper-inner corner of the vestibule of the nose on the left, and the left - in the lower-outer corner.

III stage. Study of the respiratory and olfactory functions of the nose.

1) There are a large number of methods for determining the respiratory function of the nose. The simplest method is V.I. Vojacek, which determines the degree of air passage through the nose. To determine breathing through the right half of the nose, press the left wing of the nose to nasal septum the index finger of the right hand, and with the left hand they bring a fluff of cotton wool to the right vestibule of the nose and ask the patient to take a short breath and exhale. Nasal breathing is determined similarly through the left half of the nose. The respiratory function of the nose is assessed by the deviation of the cotton wool. Breathing through each half of the nose can be normal, difficult or absent.

2) Determination of the olfactory function is carried out alternately on each half of the nose with odorous substances from an olfactometric set or using an olfactometer. To determine the olfactory function on the right, press the left wing of the nose against the nasal septum with the index finger of the right hand, and with the left hand take a bottle of an odorous substance and bring it to the right vestibule of the nose, ask the patient to inhale with the right half of the nose and determine the smell of this substance. Most often, substances with odors of increasing concentration are used - wine alcohol, valerian tincture, acetic acid solution, ammonia, etc. Determination of the sense of smell through the left half of the nose is done in the same way, only the right wing of the nose is pressed with the index finger of the left hand, and the odorous substance is brought to the right side with the right hand. left half of the nose. The sense of smell may be normal(normosmia), reduced(hyposmia), absent(anosmia), perverted(cocasmia).

IV stage. Radiography. It is one of the most common and informative methods for examining the nose and paranasal sinuses.

Most often used in the clinic following methods. With nasofrontal projection (occipito-frontal) in the supine position, the patient's head is placed so that the forehead and tip

noses touched the cassette. The resulting image best shows the frontal and, to a lesser extent, the ethmoid and maxillary sinuses(Fig. 1.4 a).

With a nasomental projection (occipitomental) the patient lies face down on the cassette with his mouth open, touching it with his nose and chin. This image clearly shows the frontal as well as the maxillary sinuses, cells of the ethmoidal labyrinth and sphenoid sinuses (Fig. 1.4 b). In order to see the level of fluid in the sinuses on an x-ray, the same positions are used, but in an upright position of the patient (sitting).

With lateral (bitemporal) or profile projection the subject’s head is placed on the cassette so that the sagittal plane of the head is parallel to the cassette, x-ray passes in the frontal direction slightly in front (1.5 cm) from the tragus of the auricle. In such a photograph there are clearly

Rice. 1.4. The most common radiological positions used in the study of the paranasal sinuses: a - nasofrontal (occipito-frontal); b - nasomental (occipitomental);

Rice. 1.4. Continuation.

c - lateral (bitemporal, profile); g - axial (chin-vertical); d - computed tomogram of the paranasal sinuses

the frontal, sphenoid and, to a lesser extent, ethmoid sinuses are visible in their lateral image. However, in this projection, the sinuses on both sides overlap each other and one can only judge their depth, and diagnosing lesions of the right or left paranasal sinuses is impossible (Fig. 1.4 c).

With axial (chin-vertical) projection the patient lies on his back, tilts his head back and places his parietal part on the cassette. In this position, the chin area is in a horizontal position, and the X-ray beam is directed strictly vertically to the thyroid notch of the larynx. In this arrangement, the sphenoid sinuses are well differentiated separately from each other (Fig. 1.4 d). In practice, as a rule, two projections are used: nasomental and nasofrontal; if indicated, other projections are also prescribed.

In the last decade, computed tomography (CT) and magnetic nuclear resonance imaging (MRI) methods, which have much greater resolution capabilities, have become widespread.

V stage. Endomicroscopy of the nose and paranasal sinuses. These methods are the most informative modern diagnostic methods using optical systems visual inspection, rigid and flexible endoscopes with different angles review, microscopes. The introduction of these high-tech and expensive methods has significantly expanded the horizons of diagnostics and surgical capabilities of an ENT specialist. For a detailed description of the methods, see section 2.8.

1.2. TECHNIQUE FOR RESEARCHING THE PHARYN

1. Examine the neck area and the mucous membrane of the lips.

2. Regional lymph nodes of the pharynx are palpated: submandibular, in the retromandibular fossae, deep cervical, posterior cervical, in the supraclavicular and subclavian fossae.

Stage II. Endoscopy of the pharynx. Oroscopy.

1. Take the spatula in your left hand so that the thumb supports the spatula from below, and the index and middle (or ring) fingers are on top. The right hand is placed on the patient's crown.

2. Ask the patient to open his mouth, use a spatula to pull back the left and right corners of the mouth alternately and examine the vestibule of the mouth: the mucous membrane, the excretory ducts of the parotid salivary glands located on the buccal surface at the level of the upper premolar.

3. Examine the oral cavity: teeth, gums, hard palate, tongue, excretory ducts of the sublingual and submandibular salivary glands, floor of the mouth. The floor of the mouth can be examined by asking the subject to lift the tip of the tongue or by lifting it with a spatula.

MESOPHARINGOSCOPY

4. Holding a spatula in your left hand, press the front 2/3 of the tongue downwards without touching the root of the tongue. The spatula is inserted through the right corner of the mouth, the tongue is pressed not with the plane of the spatula, but with its end. When you touch the root of the tongue, gagging immediately occurs. The mobility and symmetry of the soft palate is determined by asking the patient to pronounce the sound “a”. Normally, the soft palate is well mobile, the left and right sides are symmetrical.

5. Examine the mucous membrane of the soft palate, its uvula, anterior and posterior palatine arches. Normally, the mucous membrane is smooth, pink, and the arches are contoured. Examine the teeth and gums to identify pathological changes.

The size of the palatine tonsils is determined by mentally dividing into three parts the distance between the medial edge of the anterior palatine arch and the vertical line passing through the middle of the uvula and soft palate. The size of the tonsil protruding up to 1/3 of this distance is classified as degree I, protruding up to 2/3 - as degree II; protruding to the midline of the pharynx - to the III degree.

6. Examine the mucous membrane of the tonsils. Normally, it is pink, moist, its surface is smooth, the mouths of the lacunae are closed, and there is no discharge in them.

7. Determine the contents in the crypts of the tonsils. To do this, take two spatulas, in the right and left hands. With one spatula, press the tongue downwards, with the other, gently press through the front arch onto the tonsil in the area of ​​its upper third. When examining the right tonsil, the tongue is squeezed out with a spatula in the right hand, and when examining the left tonsil, with a spatula in the left hand. Normally, there is no content in the crypts or it is scanty, non-purulent in the form of minor epithelial plugs.

8. Examine the mucous membrane of the posterior pharyngeal wall. Normally, it is pink, moist, smooth, and rare, up to 1 mm in size, lymphoid granules are visible on its surface.

EPIPHARYNGOSCOPY (POSTERIOR RHINOSCOPY)

9. The nasopharyngeal speculum is secured in the handle, heated in hot water to 40-45 ° C, and wiped with a napkin.

10. Using a spatula, taken in the left hand, press down the front 2/3 of the tongue. Ask the patient to breathe through the nose.

11. The nasopharyngeal mirror is taken in the right hand, like a pen for writing, inserted into the oral cavity, the mirror surface should be directed upward. Then place the mirror behind the soft palate, without touching the root of the tongue and the back wall of the pharynx. Direct a beam of light from the frontal reflector onto the mirror. With slight turns of the mirror (1-2 mm), the nasopharynx is examined (Fig. 1.5).

12. During posterior rhinoscopy, you need to examine: the vault of the nasopharynx, choanae, the posterior ends of all three nasal conchae, the pharyngeal openings of the auditory (Eustachian) tubes. Normally, the vault of the nasopharynx in adults is free (there may be a thin layer of pharyngeal tonsil), the mucous membrane is pink, the choanae are free, the vomer is

Rice. 1.5. Posterior rhinoscopy (epipharyngoscopy):

a - position of the nasopharyngeal mirror; b - picture of the nasopharynx during posterior rhinoscopy: 1 - vomer; 2 - choanae; 3 - posterior ends of the lower, middle and upper nasal concha; 4 - pharyngeal opening of the auditory tube; 5 - tongue; 6 - pipe roller

midline, mucous membrane of the posterior ends of the turbinates Pink colour with a smooth surface, the ends of the shells do not protrude from the choanae, the nasal passages are free (Fig. 1.5 b).

In children and adolescents, in the posterior part of the nasopharyngeal vault there is a third (pharyngeal) tonsil, which normally does not cover the choanae.

On the lateral walls of the nasopharynx at the level of the posterior ends of the inferior turbinates there are depressions - the pharyngeal openings of the auditory tubes, in front of which there are small ridges - the pharyngeal edges of the anterior cartilaginous walls of the auditory tubes.

FINGER EXAMINATION OF THE NASOPHARYNX

13. The patient sits, the doctor stands behind to the right of the patient. Gently press with the index finger of the left hand left cheek patient between teeth with open mouth. Index finger the right hand quickly passes behind the soft palate into the nasopharynx and feels the choanae, the arch of the nasopharynx, and the lateral walls (Fig. 1.6). In this case, the pharyngeal tonsil is felt with the end of the back of the index finger.

Hypopharyngoscopy is presented in section 1.3.

Rice. 1.6. Digital examination of the nasopharynx:

a - the position of the doctor and the patient; b - position of the doctor’s finger in the nasopharynx

1.3. TECHNIQUE FOR STUDYING THE LARYNX

Stage I. External examination and palpation.

1. Examine the neck and the configuration of the larynx.

2. Palpate the larynx and its cartilages: cricoid, thyroid; determine the crunch of the cartilage of the larynx: with the thumb and forefinger of the right hand, take the thyroid cartilage and gently move it to one side and then to the other. Normally, the larynx is painless and passively mobile in the lateral direction.

3. Regional lymph nodes of the larynx are palpated: submandibular, deep cervical, posterior cervical, prelaryngeal, pretracheal, paratracheal, in the supra- and subclavian fossae. Normally, the lymph nodes are not palpable (cannot be felt).

Stage II. Indirect laryngoscopy (hypopharyngoscopy).

1. The laryngeal mirror is strengthened in the handle, heated in hot water or over an alcohol lamp for 3 s to 40-45 ° C, wiped with a napkin. The degree of heating is determined by applying a mirror to the back surface of the hand.

2. Ask the patient to open his mouth, stick out his tongue and breathe through his mouth.

3. Wrap the tip of the tongue from above and below with a gauze napkin, take it with the fingers of your left hand so that the thumb is located on the upper surface of the tongue, middle finger- on the lower surface of the tongue, and the index finger raised upper lip. Slightly pull the tongue towards you and downwards (Fig. 1.7 a, c).

4. The laryngeal mirror is taken in the right hand, like a pen for writing, and inserted into the oral cavity with a mirror plane parallel to the plane of the tongue, without touching the root of the tongue and the back wall of the pharynx. Having reached the soft palate, lift the tongue with the back of the mirror and place the plane of the mirror at an angle of 45° to the median axis of the pharynx; if necessary, you can slightly lift the soft palate upward, the light beam from the reflector is directed exactly at the mirror (Fig. 1.7 b). The patient is asked to make prolonged sounds “e”, “and” (at the same time the epiglottis will move anteriorly, opening the entrance to the larynx for inspection), then take a breath. Thus, one can see the larynx in two phases of physiological activity: phonation and inspiration.

Correction of the position of the mirror must be done until the picture of the larynx is reflected in it, but this is done with great care, with very subtle small movements.

5. Remove the mirror from the larynx, separate it from the handle and immerse it in a disinfectant solution.

Rice. 1.7. Indirect laryngoscopy (hypopharyngoscopy): a - position of the laryngeal mirror (front view); b - position of the laryngeal mirror (side view); c - indirect laryngoscopy; d - picture of the larynx during indirect laryngoscopy: 1 - epiglottis; 2 - false vocal folds; 3 - true vocal folds; 4 - arytenoid cartilage;

5 - interarytenoid space;

6 - pear-shaped pocket; 7 - fossae of the epiglottis; 8 - root of the tongue;

9 - aryepiglottic fold;

IMAGE AT INDIRECT LARYNGOSCOPY

1. In the laryngeal mirror you can see an image that differs from the true one in that the anterior parts of the larynx in the mirror are at the top (they appear behind), the rear parts are at the bottom (they seem to be in front). The right and left sides of the larynx in the mirror correspond to reality (do not change) (Fig. 1.7 d).

2. In the laryngeal mirror, first of all, the root of the tongue with the lingual tonsil located on it is visible, then the epiglottis in the form of an unfolded petal. The mucous membrane of the epiglottis is usually pale pink or slightly yellowish in color. Between the epiglottis and the root of the tongue, two small depressions are visible - the pits of the epiglottis (valleculae), bounded by the median and lateral lingual-epiglottic folds.

4. Above vocal folds pink vestibular folds are visible; between the vocal and vestibular folds on each side there are depressions - laryngeal ventricles, inside of which there may be small accumulations of lymphoid tissue - laryngeal tonsils.

5. Below in the mirror the posterior parts of the larynx are visible; arytenoid cartilages are represented by two tubercles on the sides top edge larynx, have a pink color with a smooth surface, the posterior ends of the vocal folds are attached to the vocal processes of these cartilages, and the interarytenoid space is located between the bodies of the cartilages.

6. Simultaneously with indirect laryngoscopy, indirect hypopharyngoscopy is performed, and the following picture is visible in the mirror. From the arytenoid cartilages upward to the lower lateral edges of the lobe of the epiglottis there are aryepiglottic folds; they are pink in color with a smooth surface. Lateral to the aryepiglottic folds are pear-shaped pouches (sinuses) - lower section pharynx, the mucous membrane of which is pink and smooth. Tapering downward, the pear-shaped pouches approach the esophageal sphincter.

7. During inhalation and phonation, the symmetrical mobility of the vocal folds and both halves of the larynx is determined.

8. When inhaling, a triangular space is formed between the vocal folds, which is called the glottis, through which the lower part of the larynx is examined - the subglottic cavity; It is often possible to see the upper rings of the trachea, covered with pink mucous membrane. The size of the glottis in adults is 15-18 mm.

9. When examining the larynx, you should make a general overview and assess the condition of its individual parts.

1.4. EAR EXAMINATION METHOD

Stage I. External examination and palpation. The examination begins with the healthy ear. The auricle, the external opening of the auditory canal, the postauricular area, and in front of the auditory canal are examined and palpated.

1. To examine the external opening of the right auditory canal in adults, it is necessary to pull the auricle backwards and upwards, grasping the helix of the auricle with the thumb and forefinger of the left hand. To examine on the left, the auricle must be pulled back in the same way with the right hand. In children, the auricle is pulled not upward, but downward and posteriorly. When the auricle is pulled back in this manner, the bony and membranous cartilaginous parts of the auditory canal are displaced, which makes it possible to insert the ear funnel up to the bony part. The funnel holds the ear canal in a straight position, and this allows otoscopy.

2. To examine the area behind the ear, turn the right auricle of the person being examined anteriorly with the right hand. Pay attention to the postauricular fold (the place where the auricle attaches to the mastoid process), normally it is well contoured.

3. With the thumb of the right hand, gently press on the tragus. Normally, palpation of the tragus is painless; in an adult, it is painful with acute external otitis; in a young child, such pain also appears with secondary otitis.

4. Then, with the thumb of the left hand, the right mastoid process is palpated at three points: the projection of the antrum, the sigmoid sinus, and the apex of the mastoid process.

When palpating the left mastoid process, pull the auricle with your left hand, and palpate with your right finger

5. Using the index finger of your left hand, palpate the regional lymph nodes of the right ear anteriorly, inferiorly, posteriorly from the external auditory canal.

Using the index finger of your right hand, palpate the lymph nodes of your left ear in the same way. Normally, the lymph nodes are not palpable.

Stage II. Otoscopy.

1. Select a funnel with a diameter corresponding to the transverse diameter of the external auditory canal.

2. Pull the patient’s right ear backwards and upwards with your left hand. Using the thumb and index fingers of the right hand, the ear funnel is inserted into the membranous-cartilaginous part of the external auditory canal.

When examining the left ear, pull the pinna with your right hand, and insert the crow with the fingers of your left hand.

3. The ear funnel is inserted into the membranous-cartilaginous part of the ear canal to hold it in a straightened position (after pulling the auricle upward and backward in adults); the funnel cannot be inserted into the bony part of the ear canal, as this causes pain. When inserting the funnel, its long axis must coincide with the axis of the ear canal, otherwise the funnel will rest against its wall.

4. Lightly move the outer end of the funnel in order to sequentially examine all parts of the eardrum.

5. When inserting a funnel, there may be a cough, depending on irritation of the endings of the branches of the vagus nerve in the skin of the ear canal.

Otoscopic picture.

1. Otoscopy shows that the skin of the membranous-cartilaginous region has hair, and there is usually earwax here. The length of the external auditory canal is 2.5 cm.

2. The eardrum is gray with a pearlescent tint.

3. Identification points are visible on the tympanic membrane: the short (lateral) process and the handle of the malleus, the anterior and posterior malleus folds, the light cone (reflex), the navel of the tympanic membrane (Fig. 1.8).

4. Below the anterior and posterior malleus folds, the tense part of the tympanic membrane is visible; above these folds, the loose part is visible.

5. There are 4 quadrants on the eardrum, which are obtained by mentally drawing two lines, mutually perpendicular. One line is drawn down the handle of the hammer, the other - perpendicular to it through the center (umbo) of the eardrum and the lower end of the handle of the hammer. The quadrants that arise in this case are called: anterosuperior and posterosuperior, anterioinferior and posteroinferior (Fig. 1.8).

Rice. 1.8. Diagram of the eardrum:

I - anterosuperior quadrant; II - anterioinferior quadrant; III - posteroinferior quadrant; IV - posterosuperior quadrant

Cleaning the external auditory canal. Cleaning is done by dry method or washing. When dry cleaning, a small piece of cotton wool is wound onto a threaded ear probe so that the tip of the probe is fluffy, in the form of a brush. The cotton wool on the probe is slightly moistened with petroleum jelly, inserted into the external auditory canal during otoscopy and the earwax contained in it is removed.

To rinse the ear canal, warm water at body temperature is drawn into the Janet syringe (to avoid irritation of the vestibular apparatus), a kidney-shaped tray is placed under the patient’s ear, and the tip of the syringe is inserted into the initial part of the external auditory canal.

passage, having previously pulled the auricle upward and backward, and direct a stream of liquid along the postero-superior wall of the auditory canal. The pressure on the syringe plunger should be gentle. If the rinsing is successful, pieces of earwax along with water fall into the tray.

After rinsing, it is necessary to remove the remaining water; this is done using a probe with a cotton wool wrapped around it. If there is a suspicion of perforation of the eardrum, ear lavage is contraindicated due to the risk of causing inflammation in the middle ear.

Study of the function of the auditory tubes. The study of the ventilation function of the auditory tube is based on blowing through the tube and listening to the sounds of air passing through it. For this purpose, you need a special elastic (rubber) tube with ear plugs at both ends (otoscope), a rubber bulb with an olive at the end (Poltzer balloon), and a set of ear catheters of various sizes - from number 1 to number 6.

5 methods of blowing the auditory tube are performed sequentially. The possibility of performing one or another method allows you to determine I, II, III, IV or V degrees of pipe patency. When performing the study, one end of the otoscope is placed in the external auditory canal of the subject, and the other - in the doctor. Through an otoscope, the doctor listens to the sound of air passing through the auditory tube.

Empty sip test allows you to determine the patency of the auditory tube during the swallowing movement. When the lumen of the auditory tube is opened, the doctor hears a characteristic slight noise or crackling sound through the otoscope.

Toynbee's method. This is also a swallowing movement, but performed by the subject with his mouth and nose closed. During the examination, if the tube is passable, the patient feels a push in the ears, and the doctor hears a characteristic sound of air passing.

Valsalva method. The subject is asked to take a deep breath, and then perform increased expiration (inflation) with the mouth and nose tightly closed. Under the pressure of exhaled air, the auditory tubes open and air forcefully enters the tympanic cavity, which is accompanied by a slight cracking sound, which is felt by the patient, and the doctor listens to a characteristic noise through an otoscope. If the patency of the auditory tube is impaired, the Valsalva experiment fails.

Rice. 1.9. Blowing of the auditory tubes, according to Politzer

Politzer method(Fig. 1.9). The olive of the ear balloon is inserted into the vestibule of the nasal cavity on the right and held with the second finger of the left hand, and with the first finger the left wing of the nose is pressed against the nasal septum. One olive of the otoscope is inserted into the patient’s external auditory canal, and the second into the doctor’s ear and the patient is asked to say the words “steamboat”, “one, two, three”. At the moment of pronouncing the vowel sound, the balloon is squeezed with four fingers of the right hand, with the first finger serving as a support. At the moment of blowing when pronouncing a vowel sound, the soft palate deviates posteriorly and separates the nasopharynx. Air enters the closed cavity of the nasopharynx and presses evenly on all walls; At the same time, part of the air passes with force into the pharyngeal openings of the auditory tubes, which is determined by the characteristic sound heard through the otoscope. Then, in the same way, but only through the left half of the nose, the left auditory tube is blown, according to Politzer.

Blowing the auditory tubes through the ear catheter. First, anesthesia of the nasal mucosa is performed with one of the anesthetics (10% lidocaine solution, 2% dicaine solution). Otoscope olives are inserted into the doctor's ear and into the test subject's ear. The catheter is held in the right hand, like a pen for writing. During anterior rhinoscopy, the catheter is passed along the bottom of the strip.

Ti your nose with the beak down to the back wall of the nasopharynx. Then the catheter is turned inward by 90° and pulled towards you until its beak touches the vomer. After this, carefully turn the beak of the catheter downwards and then approximately 120° further towards the ear being examined so that the catheter ring (and therefore the beak) faces approximately the outer corner of the eye of the side being examined. The beak enters the pharyngeal opening of the auditory tube, which is usually felt with the fingers (Fig. 1.10). The olive of the balloon is inserted into the socket of the catheter and lightly compressed. When air passes through the auditory tube, noise is heard.

Rice. 1.10. Catheterization of the auditory tube

If all tests are performed with positive result, then the patency of the auditory tube is assessed as grade I, if it is possible to obtain a positive result only with catheterization, the patency of the tube is assessed as grade V.

Along with the ventilation function of the auditory tube, it is important (for example, when deciding whether to close a defect in the eardrum). drainage function. The latter is assessed by the time of passive entry of various liquid substances from the tympanic cavity into the nasopharynx. The appearance of a substance in the nasopharynx is recorded during endoscopy of the area of ​​the pharyngeal opening of the auditory tube (dyes are used for this).

for example methylene blue); By taste sensations patient (test with saccharin) or during X-ray contrast examination of the auditory tube. If the drainage function of the auditory tube is good, the substance used appears in the nasopharynx after 8-10 minutes, if it is satisfactory - after 10-25 minutes, if unsatisfactory - after more than 25 minutes.

Stage III. Radiation diagnostic methods. X-rays of the temporal bones are widely used to diagnose ear diseases; the most common are three special styling: according to Schüller, Mayer and Stenvers. In this case, radiographs of both temporal bones are taken at once. The main condition for traditional radiography of the temporal bones is image symmetry, the absence of which leads to diagnostic errors.

Lateral plain radiography temporal bones, according to Schuller(Fig. 1.11), allows us to identify the structure of the mastoid process. On radiographs, the cave and perianthral cells are clearly visible, the roof of the tympanic cavity and the anterior wall of the sigmoid sinus are clearly defined. From these images one can judge the degree of pneumatization of the mastoid process; destruction of the bone bridges between the cells, characteristic of mastoiditis, is visible.

Axial projection, according to Mayer(Fig. 1.12), allows you to more clearly display the bone walls of the external auditory canal, the supratympanic recess and mastoid cells than in the Schüller projection. An expansion of the atticoantral cavity with clear boundaries indicates the presence of cholesteatoma.

Oblique projection, according to Stenvers(Fig. 1.13). With its help, the apex of the pyramid, the labyrinth and the internal auditory canal are removed. The greatest importance is the ability to assess the condition of the internal auditory canal. When diagnosing neuroma of the vestibulocochlear (VIII) nerve, the symmetry of the internal auditory canals is assessed, provided that the alignment of the right and left ears is identical. Laying is also informative in the diagnosis of transverse fractures of the pyramid, which are most often one of the manifestations of a longitudinal fracture of the base of the skull.

The structures of the temporal bone and ear are more clearly visualized using CT and MRI.

Computed tomography (CT). It is performed in axial and frontal projections with a slice thickness of 1-2 mm. CT allows

Rice. 1.11. Survey radiograph of the temporal bones in the Schüller arrangement: 1 - temporomandibular joint; 2 - external auditory canal; 3 - internal auditory canal; 4 - mastoid cave; 5 - perianthral cells; 6 - cells of the apex of the mastoid process; 7 - front surface of the pyramid

Rice. 1.12. Survey radiograph of the temporal bones in position, according to Mayer: 1 - cells of the mastoid process; 2 - antrum; 3 - anterior wall of the auditory canal; 4 - temporomandibular joint; 5 - internal auditory canal; 6 - core of the labyrinth; 7 - border of the sinus; 8 - tip of the mastoid process

Rice. 1.13. X-ray of the temporal bones in position, according to Stenvers:

1 - internal auditory canal; 2 - auditory ossicles; 3 - mastoid

Rice. 1.14. Computed tomography scan of the temporal bone is normal

detect both bone and soft tissue changes. In the presence of cholesteatoma, this study makes it possible to determine with great accuracy its distribution, to establish a fistula of the semicircular canal, caries of the hammer and incus. CT of the temporal bone is increasingly used in the diagnosis of ear diseases (Fig. 1.14).

Magnetic resonance imaging(MRI) has advantages over computed tomography in identifying soft tissue

formations, differential diagnosis of inflammatory and tumor changes. This is the method of choice in diagnosing neuroma of the VIII nerve.

1.4.1. Study of the functions of the auditory analyzer

Depending on the tasks facing the doctor, the scope of research performed may vary. Information about the state of hearing is necessary not only for diagnosing ear diseases and deciding on the method of conservative and surgical treatment, but also for professional selection, selection hearing aid. It is very important to examine hearing in children in order to identify early hearing impairments.

Complaints and anamnesis. In all cases, the study begins with clarification complaints. Hearing loss can be unilateral or bilateral, permanent, progressive, or accompanied by periodic deterioration and improvement. Based on complaints, the degree of hearing loss is tentatively assessed (communication is difficult at work, at home, in a noisy environment, during excitement), the presence and nature of subjective tinnitus, autophony, the sensation of iridescent fluid in the ear, etc. are determined.

Anamnesis suggests the cause of hearing loss and tinnitus, changes in hearing in the dynamics of the disease, the presence concomitant diseases affecting hearing, to clarify the methods of conservative and surgical treatment used for hearing loss and their effectiveness.

Hearing research using speech. After identifying complaints and collecting anamnesis, a speech hearing test is performed to determine perception of whispered and spoken speech.

The patient is placed at a distance of 6 m from the doctor; the ear being examined should be directed towards the doctor, and the assistant closes the opposite one, tightly pressing the tragus to the opening of the external auditory canal with the second finger, while the third finger lightly rubs the second, which creates a rustling sound that muffles this ear, excluding overlistening (Fig. 1.15) .

The subject is explained that he must loudly repeat the words he hears. To eliminate lip reading, the patient should not look in the direction of the doctor. In a whisper, using the air remaining in the lungs after unforced exhalation, the doctor pronounces words with low sounds (number, hole, sea, tree, grass, window, etc.), then

Rice. 1.15. Testing hearing acuity using whispered and spoken speech: a - Weber’s experience; b - Jelle's experiment

words with high sounds are treble (thicket, already, cabbage soup, hare, etc.). Patients with damage to the sound-conducting apparatus (conductive hearing loss) hear low sounds worse. On the contrary, when sound perception is impaired (sensorineural hearing loss), hearing for high-pitched sounds worsens.

If the subject cannot hear from a distance of 6 m, the doctor reduces the distance by 1 m and re-examines the hearing. This procedure is repeated until the subject hears all spoken words. Normally, when studying the perception of whispered speech, a person hears low sounds from a distance of at least 6 m, and high sounds - 20 m.

The study of spoken speech is carried out according to the same rules. The results of the study are recorded in a hearing passport.

Study with tuning forks - next stage of hearing assessment.

Air conduction study. For this purpose, tuning forks C 128 and C 2048 are used. The study begins with a low-frequency tuning fork. Holding the tuning fork by the stem with two fingers,

the impact of the jaws on the tenor of the palms causes it to oscillate. The tuning fork C 2048 is vibrated by abruptly squeezing the jaws with two fingers or by snapping the nail.

The sounding tuning fork is brought to the external auditory canal of the subject at a distance of 0.5 cm and held in such a way that the jaws oscillate in the plane of the axis of the auditory canal. Starting from the moment the tuning fork is struck, a stopwatch measures the time during which the patient hears its sound. After the subject stops hearing the sound, the tuning fork is moved away from the ear and brought closer again without exciting it again. As a rule, after such a distance from the ear of the tuning fork, the patient hears the sound for a few seconds. The final time is based on the last answer. A study is carried out similarly with a tuning fork C 2048, the duration of perception of its sound through the air is determined.

Bone conduction study. Bone conductivity is examined with a C 128 tuning fork. This is due to the fact that the vibration of tuning forks with a lower frequency is felt by the skin, and tuning forks with a higher frequency are heard through the air by the ear.

A sounding tuning fork C 128 is placed perpendicularly with its stem on the platform of the mastoid process. The duration of perception is also measured with a stopwatch, counting the time from the moment the tuning fork is excited.

If sound conduction is impaired (conductive hearing loss), the perception of a low-sounding tuning fork C 128 through the air deteriorates; When studying bone conduction, the sound is heard longer.

Impairment of air perception of a high tuning fork C 2048 is accompanied primarily by damage to sound perception.

hearing aid (sensorineural hearing loss). The duration of the sound of C 2048 through air and bone also decreases proportionally, although the ratio of these indicators remains, as normal, 2:1.

Quality tuning fork tests carried out for the purpose of differential express diagnosis of damage to the sound-conducting or sound-perceiving sections of the auditory analyzer. For this purpose experiments are carried out Rinne, Weber, Jelle, Federice, when performing them, use a tuning fork C 128.

Rinne's experience It consists of comparing the duration of air and bone conduction. A sounding tuning fork C 128 is placed with its stem against the area of ​​the mastoid process. After the cessation of perception of sound by the bone, the tuning fork, without stimulation, is brought to the external auditory canal. If the subject continues to hear the sound of a tuning fork through the air, Rinne’s experience is regarded as positive (R+). If the patient, after the tuning fork stops sounding on the mastoid process, does not hear it in the external auditory canal, Rinne’s experience is negative (R-).

With a positive Rinne experiment, air conductivity of sound is 1.5-2 times higher than bone conductivity, with a negative one - vice versa. A positive Rinne experience is observed normally, a negative one is observed when the sound-conducting apparatus is damaged, i.e. with conductive hearing loss.

When the sound-receiving apparatus is damaged (i.e., with sensorineural hearing loss), sound conduction through the air, as normal, prevails over bone conduction. However, the duration of perception of the sounding tuning fork by both air and bone conduction is less than normal, so Rinne’s experience remains positive.

Weber's experiment (W). It can be used to evaluate the lateralization of sound. A sounding tuning fork C 128 is placed at the crown of the subject so that the leg is in the middle of the head (see Fig. 1.15 a). The jaws of the tuning fork must oscillate in the frontal plane. Normally, the subject hears the sound of a tuning fork in the middle of the head or equally in both ears (normal<- W ->). With unilateral damage to the sound-conducting apparatus, the sound is lateralized into the affected ear (for example, to the left W -> ), with unilateral damage to the sound-receiving apparatus (for example, on the left), the sound is lateralized in healthy ear(in this case - to the right<-

With bilateral conductive hearing loss, the sound will be lateralized towards the worse-hearing ear, and with bilateral sensorineural hearing loss - towards the better-hearing ear.

Jelle's experiment (G). The method makes it possible to detect disturbances in sound transmission associated with immobility of the stapes in the window of the vestibule. This type of pathology is observed, in particular, with otosclerosis.

A sounding tuning fork is placed at the crown of the head and at the same time the air in the external auditory canal is condensed using a pneumatic funnel (see Fig. 1.15 b). At the moment of compression, a subject with normal hearing will feel a decrease in perception, which is associated with a deterioration in the mobility of the sound-conducting system due to the pressing of the stapes into the niche of the vestibule window - Jelle’s experience is positive (G+).

If the stapes is immobilized, no change in perception will occur at the moment of condensation of air in the external auditory canal - Jelle’s experience is negative (G-).

Federici experiment (F). It consists of comparing the duration of perception of the sounding tuning fork C 128 from the mastoid process and the tragus when it obstructs the external auditory canal. After the sound stops mastoid process The tuning fork is placed with its leg on the tragus.

In normal conditions and in cases of impaired sound perception, Federici’s experience is positive, i.e. the sound of a tuning fork from the tragus is perceived longer, and if sound conduction is impaired, it is perceived negatively (F-).

Thus, Federici's experience, along with other tests, allows us to differentiate between conductive and sensorineural hearing loss.

The presence of subjective noise (SN) and the results of a hearing test using whispered (SH) and spoken speech (SS), as well as tuning forks, are entered into the hearing passport. Below is a sample hearing passport of a patient with right-sided conductive hearing loss (Table 1.1).

Conclusion. There is hearing loss on the right side due to a type of sound conduction disorder.

These methods make it possible to comprehensively assess hearing acuity and, by the perception of individual tones (frequencies), determine the nature and level of its damage in various diseases. The use of electroacoustic equipment makes it possible to dose the strength of a sound stimulus in generally accepted units - decibels (dB), to conduct hearing tests in patients with severe hearing loss, and to use diagnostic tests.

An audiometer is an electrical sound generator that produces relatively pure sounds (tones) through both air and bone. A clinical audiometer examines hearing thresholds in the range from 125 to 8000 Hz. Currently, audiometers have appeared that allow one to study hearing in an expanded frequency range - up to 18,000-20,000 Hz. With their help, audiometry is performed in an extended frequency range up to 20,000 Hz through the air. By converting the attenuator, the supplied audio signal can be amplified to 100-120 dB when studying air conduction and up to 60 dB when studying bone conduction. The volume is usually adjusted in steps of 5 dB, in some audiometers - in smaller steps, starting from 1 dB.

From a psychophysiological point of view, various audiometric methods are divided into subjective and objective.

Subjective audiometric techniques are most widely used in clinical practice. They are based on

subjective sensations of the patient and on the conscious response, depending on his will. Objective, or reflex, audiometry is based on the reflex unconditioned and conditioned responses of the subject that occur in the body during sound exposure and do not depend on his will.

Taking into account the type of stimulus used when examining a sound analyzer, there are subjective methods such as tone threshold and suprathreshold audiometry, a method for studying auditory sensitivity to ultrasound, and speech audiometry.

Pure-tone audiometry there is threshold and suprathreshold.

Tone threshold audiometry performed to determine the thresholds for the perception of sounds of various frequencies during air and bone conduction. Using air and bone telephones, the threshold sensitivity of the hearing organ to the perception of sounds of various frequencies is determined. The results of the study are recorded on a special grid form, called an “audiogram”.

An audiogram is a graphical representation of hearing threshold. The audiometer is designed to show hearing loss in decibels compared to normal. Normal hearing thresholds for sounds of all frequencies by both air and bone conduction are marked by the zero line. Thus, a pure-tone threshold audiogram primarily makes it possible to determine hearing acuity. Based on the nature of the threshold curves of air and bone conduction and their relationship, one can obtain a qualitative characteristic of the patient’s hearing, i.e. determine whether there is a violation sound conduction, sound perception or mixed(combined) defeat.

At sound conduction disorders The audiogram shows an increase in air conduction hearing thresholds mainly in the range of low and medium frequencies and, to a lesser extent, in high frequencies. Auditory thresholds by bone conduction remain close to normal; between the threshold curves of bone and air conduction there is a significant so-called air-bone gap(cochlear reserve) (Fig. 1.16 a).

At impaired sound perception air and bone conduction are affected to the same extent, the bone-air gap is practically absent. In the initial stages, the perception of high tones mainly suffers, and in the future this disorder

appears at all frequencies; there are breaks in the threshold curves, i.e. lack of perception at certain frequencies (Fig. 1.16 b).

Mixed, or combined hearing loss characterized by the presence on the audiogram of signs of impaired sound conduction and sound perception, but a bone-air gap remains between them (Fig. 1.16 c).

Tone threshold audiometry allows you to determine damage to the sound-conducting or sound-receiving sections of the auditory analyzer only in the most general form, without more specific

Rice. 1.16. Audiogram for impaired sound conduction: a - conductive form of hearing loss; b - sensorineural form of hearing loss; c - mixed form of hearing loss

localization. The form of hearing loss is clarified using additional methods: suprathreshold, speech and noise audiometry.

Pure tone suprathreshold audiometry. Designed to identify the phenomenon of accelerated increase in volume (FUNG - in domestic literature, the phenomenon of recruitment, recruitment phenomenon- in foreign literature).

The presence of this phenomenon usually indicates damage to the receptor cells of the spiral organ, i.e. about intracochlear (cochlear) damage to the auditory analyzer.

A patient with decreased hearing acuity develops increased sensitivity to loud (suprathreshold) sounds. He notes unpleasant sensations in the sore ear if people talk to him loudly or sharply increase his voice. The presence of FUNG can be suspected during a clinical examination. This is evidenced by the patient’s complaints about intolerance to loud sounds, especially with a sore ear, the presence of dissociation between the perception of whispered

and colloquial speech. The patient does not perceive whispered speech at all or perceives it at the sink, while he hears spoken speech at a distance of more than 2 m. When carrying out Weber's experiment, a change or sudden disappearance of the lateralization of sound occurs; during a tuning fork study, the audibility of the tuning fork suddenly stops when it is slowly moved away from the diseased ear.

Methods of suprathreshold audiometry(there are more than 30 of them) allow you to directly or indirectly identify FUNG. The most common among them are the classical methods: Lushera - determination of the differential threshold for perception of sound intensity, Fowler volume equalization(for unilateral hearing loss), small increment index intensity (IMPI, more often referred to as SISI -test). Normally, the differential sound intensity threshold is 0.8-1 dB; the presence of FUNG is indicated by its decrease below 0.7 dB.

Study of auditory sensitivity to ultrasound. Normally, a person perceives ultrasound during bone conduction in the frequency range up to 20 kHz or more. If hearing loss is not associated with damage to the cochlea (neurinoma of the VIII cranial nerve, brain tumors, etc.), the perception of ultrasound remains the same as normal. When the cochlea is damaged, the threshold for ultrasound perception increases.

Speech audiometry in contrast to tonal, it allows one to determine the social suitability of hearing in a given patient. The method is especially valuable in the diagnosis of central hearing lesions.

Speech audiometry is based on determining speech intelligibility thresholds. Understandability is understood as a value defined as the ratio of the number of correctly understood words to the total number of words heard; it is expressed as a percentage. So, if out of 10 words presented for listening, the patient correctly understood all 10, this will be 100% intelligibility; if he correctly understood 8, 5 or 2 words, this will be 80, 50 or 20% intelligibility, respectively.

The study is carried out in a soundproofed room. The results of the study are recorded on special forms in the form of speech intelligibility curves, while the intensity of speech is marked on the abscissa axis, and the percentage of correct answers is marked on the ordinate axis. The intelligibility curves are different for different forms of hearing loss, which has differential diagnostic significance.

Objective audiometry. Objective methods of hearing research are based on unconditioned and conditioned reflexes. Such a study is important for assessing the state of hearing in cases of damage to the central parts of the sound analyzer, during labor and forensic examinations. With a strong sudden sound, unconditioned reflexes are reactions in the form of dilation of the pupils (cochlear-pupillary reflex, or auropupillar reflex), closing of the eyelids (auropalpebral, blink reflex).

Most often, galvanic skin and vascular reactions are used for objective audiometry. The galvanic skin reflex is expressed in a change in the potential difference between two areas of the skin under the influence, in particular, of sound stimulation. The vascular response consists of a change in vascular tone in response to sound stimulation, which is recorded, for example, using plethysmography.

In young children, the reaction most often recorded is when gaming audiometry, combining sound stimulation with the appearance of a picture at the moment the child presses a button. The initially loud sounds are replaced by quieter ones and determine the hearing thresholds.

The most modern method of objective hearing research is audiometry with recording auditory evoked potentials (AEPs). The method is based on recording potentials evoked in the cerebral cortex by sound signals on an electroencephalogram (EEG). It can be used in infants and young children, mentally disabled persons and persons with normal psyche. Since EEG responses to sound signals (usually short - up to 1 ms, called sound clicks) are very small - less than 1 μV, averaging using a computer is used to register them.

Registration is being used more widely short-latency auditory evoked potentials (SAEP), giving an idea of ​​the state of individual formations of the subcortical pathway of the auditory analyzer (vestibular-cochlear nerve, cochlear nuclei, olives, lateral lemniscus, quadrigeminal tuberosities). But CVEPs do not provide any complete picture of the response to a stimulus of a certain frequency, since the stimulus itself must be short. In this regard, more informative long-latency auditory evoked potentials (LAEPs). They record responses of the cerebral cortex for relatively long periods, i.e. sound having a certain frequency

signals and can be used to infer hearing sensitivity at different frequencies. This is especially important in pediatric practice, when conventional audiometry, based on the patient's conscious responses, is not applicable.

Impedance audiometry- one of the methods for objective assessment of hearing, based on measuring the acoustic resistance of a sound-conducting apparatus. In clinical practice, two types of acoustic impedance measurements are used - tympanometry and acoustic reflexometry.

Tympanometry consists of recording the acoustic resistance that a sound wave encounters as it propagates through the acoustic system of the outer, middle and inner ear, when the air pressure in the external auditory canal changes (usually from +200 to -400 mm water column). The curve reflecting the dependence of the resistance of the eardrum on pressure is called a tympanogram. Various types of tympanometric curves reflect the normal or pathological condition of the middle ear (Fig. 1.17).

Acoustic reflexometry is based on recording changes in the compliance of the sound-conducting system that occur during contraction of the stapedius muscle. Nerve impulses caused by a sound stimulus travel along the auditory pathways to the superior olivary nuclei, where they switch to the motor nucleus of the facial nerve and go to the stapedius muscle. Muscle contraction occurs on both sides. A sensor is inserted into the external auditory canal, which responds to changes in pressure (volume). In response to sound stimulation, an impulse is generated, passing through the above-described reflex-

Rice. 1.17. Types of tympanometric curves (according to Serger):

a - normal; b - with exudative otitis media; c - when the auditory circuit breaks

seeds

nal arch, as a result of which the stapedius muscle contracts and the eardrum begins to move, the pressure (volume) in the external auditory canal changes, which is recorded by the sensor. Normally, the threshold of the acoustic reflex of the stapes is about 80 dB above the individual sensitivity threshold. With sensorineural hearing loss accompanied by FUNG, reflex thresholds are significantly reduced. With conductive hearing loss, pathology of the nuclei or trunk of the facial nerve, the acoustic reflex of the stapes is absent on the affected side. For the differential diagnosis of retrolabyrinthine lesions of the auditory tract, the acoustic reflex decay test is of great importance.

Thus, existing methods of hearing research allow one to navigate the severity of hearing loss, its nature and the location of damage to the auditory analyzer. The accepted international classification of degrees of hearing loss is based on average values ​​of thresholds for the perception of sounds at speech frequencies (Table 1.2).

Table 1.2. International classification of hearing loss

1.4.2. Study of the functions of the vestibular analyzer

The examination of the patient always begins with finding out complaints and anamnesis life and illness. The most common complaints are dizziness, balance disorder, manifested by impaired gait and coordination, nausea, vomiting, fainting, sweating, discoloration of the skin, etc. These complaints may be constant or intermittent, fleeting or lasting several hours or days. They can occur spontaneously, for no apparent reason, or under the influence of

We take into account specific factors of the external environment and the body: in transport, surrounded by moving objects, overwork, physical stress, a certain position of the head, etc.

Usually, with vestibular genesis, there are specific complaints. For example, when dizzy, a patient feels an illusory displacement of objects or his body; when walking, such sensations lead to falling or staggering. Patients often call dizziness the darkening or appearance of spots in the eyes, especially when bending over and when moving from a horizontal to a vertical position. These phenomena are usually associated with various lesions of the vascular system, fatigue, general weakening of the body, etc.

Vestibulometry includes identifying spontaneous symptoms, conducting and evaluating vestibular tests, analyzing and summarizing the data obtained. Spontaneous vestibular symptoms include spontaneous nystagmus, changes in muscle tone of the limbs, gait disturbance.

Spontaneous nystagmus. The patient is examined in a sitting position or in a supine position, while the subject follows the doctor’s finger, which is 60 cm away from the eyes; the finger moves sequentially in horizontal, vertical and diagonal planes. Eye abduction should not exceed 40-45°, since overstrain of the eye muscles may be accompanied by twitching of the eyeballs. When observing nystagmus, it is advisable to use high-magnification glasses (+20 diopters) to eliminate the influence of gaze fixation. Otorhinolaryngologists use special Frenzel or Bartels glasses for this purpose; Spontaneous nystagmus is revealed even more clearly by electronystagmography.

When examining a patient in a supine position, the head and torso are given different positions, while in some patients the appearance of nystagmus, designated as positional nystagmus(positional nystagmus). Positional nystagmus can have a central genesis; in some cases it is associated with a dysfunction of otolith receptors, from which the smallest particles are torn off and enter the ampoules of the semicircular canals with pathological impulses from the cervical receptors.

In the clinic, nystagmus is characterized along the plane(horizontal, sagittal, rotatory), towards(right, left, up, down), by strength(I, II or III degrees), according to the speed of vibration -

body cycles(alive, lethargic), by amplitude(small-, medium- or large-scale), by rhythm(rhythmic or disrhythmic), by duration (in seconds).

The strength of nystagmus is considered I degree, if it occurs only when looking towards the fast component; II degree- when looking not only towards the fast component, but also directly; finally, nystagmus III degree observed not only in the first two eye positions, but also when looking towards the slow component. Vestibular nystagmus usually does not change its direction, i.e. in any position of the eyes, its fast component is directed in the same direction. The extralabyrinthine (central) origin of nystagmus is evidenced by its undulating nature, when it is impossible to distinguish fast and slow phases. Vertical, diagonal, multidirectional (changing direction when looking in different directions), converging, monocular, asymmetrical (not the same for both eyes) nystagmus is characteristic of disorders of central origin.

Tonic reactions of hand deviation. They are examined by performing index tests (finger-nose, finger-finger), Fischer-Wodak test.

Index samples. By doing finger-nose test the subject spreads his arms to the sides and, first with his eyes open and then with his eyes closed, tries to touch the tip of his nose with the index fingers of one and then the other hand. When the vestibular analyzer is in a normal state, it performs the task without difficulty. Stimulation of one of the labyrinths leads to swinging of both hands in the opposite direction (towards the slow component of nystagmus). When the lesion is localized in the posterior cranial fossa (for example, with pathology of the cerebellum), the patient swings with one hand (on the side of the disease) to the “sick” side.

At finger-finger test The patient, alternately with his right and left hand, should touch the doctor’s index finger, located in front of him at arm’s length. The test is performed first with eyes open, then with eyes closed. Normally, the subject confidently hits the doctor’s finger with both hands, both with open and closed eyes.

Fischer-Wodak test. It is performed by the subject sitting with his eyes closed and with his arms extended forward. Index fingers

extended, the rest clenched into a fist. The examiner places his index fingers opposite and in close proximity to the patient's index fingers and observes the deviation of the subject's hands. In a healthy person, deviation of the hands is not observed; when the labyrinth is damaged, both hands deviate towards the slow component of nystagmus (i.e. towards the labyrinth, the impulse from which is reduced).

Study of stability in the Romberg pose. The subject stands with his feet close together so that their toes and heels touch, his arms are extended forward at chest level, his fingers are spread, his eyes are closed (Fig. 1.18). In this position, the patient should be secured so that he does not fall. If the function of the labyrinth is impaired, the patient will deviate in the direction opposite to nystagmus. It should be taken into account that even with cerebellar pathology, there may be a deviation of the body in the direction of the lesion, therefore the study in the Romberg position is supplemented by turning the subject’s head to the right and left. With damage to the labyrinth, these turns are accompanied by a change in the direction of fall; with cerebellar damage, the direction of deviation remains unchanged and does not depend on the rotation of the head.

Gait in a straight line and flank:

1) when studying gait in a straight line, the patient with his eyes closed takes five steps forward in a straight line and then, without turning, 5 steps back. If the function of the vestibular analyzer is impaired, the patient deviates from a straight line in the direction opposite to nystagmus; in case of cerebellar disorders - in the direction of the lesion;

Rice. 1.18. Study of stability in the Romberg pose

2) flank gait is examined as follows. The subject puts his right leg to the right, then puts his left one in and takes 5 steps in this way, and then similarly takes 5 steps to the left. If the vestibular function is impaired, the subject performs the flank gait well in both directions; if the cerebellar function is impaired, he cannot perform it in the direction of the affected cerebellar lobe.

Also, for the differential diagnosis of cerebellar and vestibular lesions, test for adiadochokinesis. The subject performs it with his eyes closed, both arms extended forward, and quickly changes between pronation and supination. Adiadochokinesis - a sharp lag of the hand on the “sick” side due to impaired cerebellar function.

VESTIBULAR TESTS

Vestibular tests make it possible to determine not only the presence of dysfunctions of the analyzer, but also to give a qualitative and quantitative description of their features. The essence of these tests is to excite the vestibular receptors with the help of adequate or inadequate dosed influences.

Thus, for the ampullary receptors, angular accelerations are an adequate stimulus; a dosed rotational test on a rotating chair is based on this. An inadequate stimulus for the same receptors is the effect of a dosed caloric stimulus, when the infusion of water of different temperatures into the external auditory canal leads to cooling or heating of the liquid media of the inner ear and this causes, according to the law of convection, the movement of the endolymph in the horizontal semicircular canal, located closest to the middle ear. Also, exposure to galvanic current is an inadequate stimulus for vestibular receptors.

For otolith receptors, an adequate stimulus is rectilinear acceleration in the horizontal and vertical planes when performing a test on a four-bar swing.

Rotational test. The subject is seated in the Barani chair in such a way that his back fits tightly against the back of the chair, his legs are placed on the stand, and his hands are on the armrests. The patient's head tilts forward and down 30°, eyes should be closed. Rotation is carried out uniformly at speed

1/2 revolution (or 180°) per second, for a total of 10 revolutions in 20 s. At the beginning of rotation, the human body experiences positive acceleration, and at the end - negative acceleration. When rotating clockwise after stopping, the endolymph flow in the horizontal semicircular canals will continue to the right; therefore, the slow component of the nystagmus will also be to the right, and the direction of the nystagmus (fast component) will be to the left. When moving to the right at the moment the chair stops in the right ear, the movement of the endolymph will be ampulofugal, i.e. from the ampulla, and in the left - ampulopetal. Consequently, post-rotation nystagmus and other vestibular reactions (sensory and autonomic) will be caused by irritation of the left labyrinth, and the post-rotation reaction from the right ear will be observed when rotating counterclockwise, i.e. to the left. After the chair stops, the countdown begins. The subject fixes his gaze on the doctor's finger, while the degree of nystagmus is determined, then the nature of the amplitude and liveliness of the nystagmus, its duration when the eyes are positioned towards the fast component are determined.

If the functional state of the receptors of the anterior (frontal) semicircular canals is being studied, then the subject sits in a Barany chair with his head tilted back 60°; if the function of the posterior (sagittal) canals is being studied, the head is tilted 90° to the opposite shoulder.

Normally, the duration of nystagmus when studying the lateral (horizontal) semicircular canals is 25-35 s, when studying the posterior and anterior canals - 10-15 s. The nature of nystagmus when irritating the lateral canals is horizontal, the anterior canals are rotatory, the posterior canals are vertical; in amplitude it is small or medium in amplitude, grades I-II, lively, quickly fading.

Caloric test. During this test, a weaker artificial stimulation of the labyrinth, mainly of the receptors of the lateral semicircular canal, is achieved than during rotation. An important advantage of the caloric test is the ability to irritate ampullary receptors on one side in isolation.

Before performing a water caloric test, you should make sure that there is no dry perforation in the tympanic membrane of the ear being tested, since water entering the tympanic cavity can cause an exacerbation of the chronic inflammatory process. In this case, air calorization can be carried out.

The caloric test is performed as follows. The doctor draws 100 ml of water at a temperature of 20 ° C into the Janet syringe (with a thermal caloric test, the water temperature is +42 ° C). The subject sits with his head tilted back 60°; in this case, the lateral semicircular canal is located vertically. Pour 100 ml of water into the external auditory canal over 10 s, directing the stream of water along its posterior superior wall. The time from the end of the infusion of water into the ear until the appearance of nystagmus is determined - this is the latent period, normally equal to 25-30 s, then the duration of the nystagmus reaction is recorded, normally equal to 50-70 s. The characteristics of nystagmus after calorization are given according to the same parameters as after the rotational test. During cold exposure, nystagmus (its fast component) is directed in the direction opposite to the test ear, and during thermal calorization - towards the irritated ear (Fig. 1.19 a, b).

Rice. 1.19. Methodology for conducting a caloric test

Pressor (pneumatic, fistula) test. It is carried out to identify a fistula in the area of ​​the labyrinthine wall (most often in the area of ​​the ampulla of the lateral semicircular canal) in patients with chronic purulent otitis media. The test is performed by condensing and rarefying the air in the external auditory canal, or by applying pressure to the tragus, or using a rubber bulb. If nystagmus and other vestibular reactions occur in response to air thickening, then the pressor test is assessed as positive. This indicates the presence of a fistula. It should be noted, however, that a negative test does not allow one to completely deny the presence of a fistula. In case of extensive perforation in the eardrum, direct pressure can be applied with a probe with cotton wool wound onto it onto areas of the labyrinthine wall that are suspected of a fistula.

Study of the function of the otolithic apparatus. It is carried out mainly during professional selection; in clinical practice, methods of direct and indirect otolitometry are not widely used. Taking into account the interdependence and mutual influence of the otolithic and cupular sections of the analyzer V.I. Wojacek proposed a technique he called the “double experiment with rotation” and known in the literature as the “Otolith reaction according to Wojacek.”

Otolithic reaction (OR). The subject sits in a Barany chair and tilts his head and torso 90° forward and down. In this position, it is rotated 5 times for 10 s, then the chair is stopped and waited for 5 s, after which it is asked to open your eyes and straighten up. At this moment, a reaction occurs in the form of tilting the torso and head to the side. The functional state of the otolithic apparatus is assessed by the degrees of deviation of the head and torso from the midline in the direction of the last rotation. The severity of autonomic reactions is also taken into account.

Thus, a deviation by an angle from 0 to 5° is assessed as I degree of reaction (weak); deviation of 5-30° - II degree (medium strength). Finally, a deviation of more than 30° is grade III (strong), when the subject loses balance and falls. The angle of reflex inclination in this reaction depends on the degree of influence of otolith irritation during straightening of the body on the function of the anterior semicircular canals. In addition to the somatic reaction, this experience takes into account vegetative reactions, which can also be of three degrees: I degree - paleness of the face, change in pulse; II degree

(medium) - cold sweat, nausea; III degree - changes in cardiac and respiratory activity, vomiting, fainting. The double rotation experiment is widely used when examining healthy people for the purpose of professional selection.

When selecting in aviation and astronautics for studying the sensitivity of the subject to the cumulation of vestibular irritation, the proposal proposed by K.L. Khilov back in 1933. technique of motion sickness on a four-bar (two-bar) swing. The swing platform does not oscillate like a regular swing - in an arc, but remains constantly parallel to the floor. The subject is located on the swing platform, lying on his back or on his side, and tonic eye movements are recorded using the electrooculography technique. A modification of the method using small dosed amplitude swings and recording compensatory eye movements is called "direct otolitometry".

Stabilometry. Among the objective methods for assessing static equilibrium, the method stabilometry, or posturography (posture - pose). The method is based on recording fluctuations in the center of pressure (gravity) of the patient’s body installed on a special stabilometric platform

(Fig. 1.20). Body vibrations are recorded separately in the sagittal and frontal planes, and a number of indicators are calculated that objectively reflect the functional state of the balance system. The results are processed and summarized using a computer. In combination with a set of functional tests, computer stabilometry is

Rice. 1.20. Study of balance on a stabilometric platform

a highly sensitive method and is used to identify vestibular disorders at the earliest stage, when they are not yet subjectively manifested (Luchikhin L.A., 1997).

Stabilometry is used in the differential diagnosis of diseases accompanied by balance disorders. For example, a functional test with head rotation (Palchun V.T., Luchikhin L.A., 1990) makes it possible at an early stage to differentiate disorders caused by damage to the inner ear or vertebrobasilar insufficiency. The method makes it possible to control the dynamics of the development of the pathological process in case of balance function disorder, and to objectively evaluate the results of treatment.

1.5. ESOPHAGOSCOPY

Esophagoscopy is the main method for examining the esophagus. It is performed both in the provision of emergency medical care, for example, when removing foreign bodies of the esophagus, and for examining the walls of the esophagus in case of injuries to the esophagus, suspected tumor, etc.

Before esophagoscopy, a general and special examination is carried out. The patient’s condition and contraindications to esophagoscopy are clarified. A special examination involves an X-ray examination of the hypopharynx, esophagus and stomach with a contrast mass.

Tools. Brunings, Mesrin, Friedel bronchoscopes and fiber optics. In addition, the research room should have an electric suction, a set of forceps for removing foreign bodies and taking pieces of tissue for histological examination.

Preparing the patient. The manipulation is performed on an empty stomach or 5-6 hours after the last meal. 30 minutes before the start of esophagoscopy, an adult patient is injected subcutaneously with 1 ml of 0.1% atropine sulfate solution and 1 ml of 2% promedol solution. Removable dentures must be removed.

Anesthesia. Esophagoscopy for adults and older children can be performed under general anesthesia or local anesthesia; for young children - only under general anesthesia.

Local anesthesia used in cases where there are no local and general aggravating factors (perforation or injury

esophagus, general diseases, etc.). For pain relief in adults, use 10% cocaine solution or 2% dicaine solution with the addition of 0.1% adrenaline solution. After spraying the pharynx twice, the mucous membrane of the pharynx and larynx is sequentially lubricated with the same composition. Anesthesia occurs when the patient does not react by gagging and coughing to lubricate the laryngopharynx and the area at the entrance to the esophagus.

Anesthesia. Endotracheal anesthesia is always preferable; it is absolutely indicated in cases where esophagoscopy is performed in the presence of local or general aggravating factors. Local factors include a large foreign body, injury or inflammation of the wall of the esophagus, bleeding from the esophagus, a failed attempt to remove a foreign body under local anesthesia, etc. General factors include mental illness, deaf-muteness, dysfunction of the cardiovascular system, general diseases, disrupting certain vital functions of the body.

Rice. 1.21. Esophagoscopy technique

Position of the patient. If esophagoscopy is performed under local anesthesia, the patient sits on a special Brunings chair. An assistant stands behind the patient, holding his head and shoulders in the desired position if anesthesia is given, and also in children, esophagoscopy is performed with the patient lying on his back.

Esophagoscopy technique(Fig. 1.21). Before starting esophagoscopy, an appropriate size tube is selected (taking into account the level of damage to the esophagus or stuck foreign body). If esophagoscopy is performed under local anesthesia, the patient opens his mouth wide and sticks out his tongue. Breathing should be smooth. The doctor places a napkin on the protruding part of the tongue and grasps the tongue with the fingers of his left hand in the same way as during indirect laryngoscopy. With his right hand, the doctor inserts the esophagoscope tube from the corner of the mouth into the oropharynx, then transfers it to the laryngopharynx, the end of the tube should be strictly in the midline. At this point, the epiglottis fossae should be examined. By pushing the epiglottis anteriorly with the beak of the tube, the tube is advanced beyond the arytenoid cartilages. In this place, in the lumen of the tube, the entrance to the esophagus is visible in the form of a sphincter. Next, under visual control, the patient is asked to make a swallowing movement, which helps open the mouth of the esophagus. The tube moves lower. An indispensable condition for further advancement of the esophagoscope is the coincidence of the axis of the tube and the axis of the esophagus.

Upon examination, a pink mucous membrane is visible, collected in longitudinal folds. When properly performed esophagoscopy, the narrowing and expansion of the lumen of the esophagus is determined synchronously with respiratory movements. When the tube is immersed in the lower third of the esophagus, it is clear that its lumen becomes narrow, acquiring a slit-like shape as it passes the level of the diaphragm. Remove the tube slowly. At the same moment, directing the distal end along the mucous membrane in a circular motion, a thorough examination is performed.

Esophagoscopy under anesthesia has a number of features. First, the doctor uses the fingers of his left hand to open the mouth of the patient lying on his back wide. An esophagoscopic tube is passed through the corner of the mouth to the entrance to the esophagus. Absolutely effortlessly, the tube is inserted through the mouth of the esophagus into its lumen, but gaping of the lumen, as with esophagoscopy under local anesthesia, does not occur.

1.6. TRACHEOBRONCHOSCOPY

The trachea and bronchi are examined for diagnostic and therapeutic purposes using the same instruments used to examine the esophagus.

A diagnostic examination of the trachea and bronchi is indicated in cases of respiratory dysfunction in the presence of neoplasms; the occurrence of tracheoesophageal fistula, atelectasis (any localization), etc. For therapeutic purposes, tracheobronchoscopy is used in otorhinolaryngology mainly in the presence of foreign bodies and scleroma, when infiltrates or a membrane of scar tissue form in the subglottic cavity. In this case, the bronchoscopic tube is used as a bougie. In therapeutic and surgical practice, tracheobronchoscopy is one of the measures in the treatment of abscess pneumonia and lung abscess.

Instrumental examination of the lungs plays an equally important role in the practice of treating pulmonary tuberculosis. Depending on the level of tube insertion, upper and lower tracheobronchoscopy are distinguished. With upper tracheobronchoscopy, the tube is inserted through the mouth, pharynx and larynx, with lower tracheobronchoscopy, the tube is inserted through a pre-formed tracheotomy opening (tracheostomy). Lower tracheobronchoscopy is performed more often in children and people who already have a tracheostomy.

The anesthesia technique deserves special attention. Currently, preference should be given to general anesthesia (anesthesia), especially since the doctor is armed with special respiratory bronchoscopes (Friedel system). In children, examination of the trachea and bronchi is carried out only under anesthesia. In connection with the above, the introduction of anesthesia is carried out in the operating room with the patient lying on his back with his head thrown back. The advantages of general anesthesia over local anesthesia are the reliability of pain relief, the elimination of mental reactions in the subject, relaxation of the bronchial tree, etc.

Technique for introducing a tracheobronchoscopic tube. The patient is on the operating table in a supine position with the shoulder girdle raised and head thrown back. Holding the lower jaw with the fingers of the left hand with the mouth open, under visual control (through the bronchoscope tube) the bronchoscope is inserted through the corner of the mouth into its cavity. The distal end of the tube is

wives should be located strictly on the midline of the oropharynx. The tube is slowly advanced forward, pressing on the tongue and epiglottis. At the same time, the glottis becomes clearly visible. By rotating the handle, the distal end of the tube is turned 45° and inserted into the trachea through the glottis. The examination begins with the walls of the trachea, then the bifurcation area is examined. Under visual control, the tube is inserted alternately into the main and then into the lobar bronchi. Inspection of the tracheobronchial tree continues when the tube is removed. Foreign bodies are removed and pieces of tissue are taken for histological examination using a special set of forceps. Suction is used to remove mucus or pus from the bronchi. After this manipulation, the patient should be under medical supervision for 2 hours, since during this period laryngeal edema and stenotic breathing may occur.

For effective treatment of diseases of the ear, nose and throat, high-quality diagnostics is necessary. To identify the cause of the pathology, a full range of examinations is needed. At the beginning, the doctor interviews the patient, clarifies information about operations performed previously, diseases that occur in a chronic form. Next, the patient is examined using instruments, and if necessary, the doctor can additionally refer for instrumental examination methods.

Inspection methods

A consultation with an ENT doctor differs from other doctors in that the ENT learns surgical and conservative treatment. He does not need to “transfer” the patient to other specialists if surgical intervention in the upper respiratory tract or hearing organs is necessary. The doctor himself offers the best treatment option. The following methods are used for diagnosis:

Palpation

The doctor looks at the presence of defects, the color of the skin, and the symmetry of the face. Determines the condition of the lymph nodes (cervical and submandibular).

Endoscopic examination

From the Greek, the word “Endoscopy” is translated as looking from the inside. An endoscope is an optical tube based on a lens system. The drug is connected to an endovideo camera and a light source.

• If rigid optics are used, the otolaryngologist inserts the endoscope into the cavity of the ear, nose, or larynx. Multiple images of the organ being examined are transmitted to the monitor
• Fiber endoscopy allows assessing the condition of the throat, auditory tubes, and tonsils through the nasal cavity. Its advantage is that the airways are examined with one insertion of the endoscope

Laryngoscopy

Consultation with an otolaryngologist for examination of the larynx includes indirect (mirror) laryngoscopy. A round mirror is inserted into the oral cavity. The examination takes place while the patient pronounces the sounds “E”, “I”; on exhalation

People who have a pronounced gag reflex are given (superficial) anesthesia to the pharynx.

Oropharyngoscopy

When examining the oral cavity and pharynx, the specialist focuses on the condition of the tongue, cheeks, teeth, mucous membranes of the gums, and lips. Examining the throat to determine the tone and symmetry of the palate, he asks the patient to pronounce the sound “A”.

Otoscopy

The word is translated from Greek as “I examine the ear.” Using medical instruments (ear specula and frontal illuminator), the specialist examines the ear canal, eardrum, and skin.

Procedure for examining the nasal cavity:

• An otolaryngologist determines the condition of the nasal septum, the “vestibule” of the nose, by lifting the tip of the nose with a finger
• Using a speculum, examines the mucous membrane and nasal passages
• The posterior parts of the nasal cavity are examined using an endoscope

Microlaryngoscopy and microotoscopy

An ENT doctor is a specialist who treats diseases of the throat, ear, and nose. If necessary, for bacteriological examination, take a swab from the ear, nose, and throat.

Additional examination methods

An appointment with an ENT doctor is necessary to identify the causes, factors in the development of the disease and treatment. An otolaryngologist uses many research techniques.

• Puncture of the maxillary sinuses, treatment of sinusitis using the YAMIK-3 sinus catheter
• X-ray
• CT scan