Detailed Skill Performance Evaluation: Ears, Nose and Throat Examination

Directions: You will have 10 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps must be
performed or verbalized. Special tests (S) will be performed if requested by the examiner.
Start: End:
Performed Verbalized
Washes hands and dons appropriate personal protective equipment. C
Introduces self to patient using first and last name. Y/N
Notes general appearance and vital signs. Y/N
Inspection
1. Auricles: deformity, masses, skin lesions (Look anterior and behind auricles by pulling
Y/N Y/N
auricle forward.)
Palpation
1. Auricles/tragi/mastoids: tenderness, nodules, edema (Pull auricle up and down, press the
Y/N Y/N
tragus, palpate over mastoid.)
2. Gross auditory acuity test (Test cranial nerve VIII by one of two methods: Finger rub one
ear at a time with opposite ear occluded or stand 1–2’ in front or behind patient and ask
Y/N Y/N
patient to occlude one ear with finger then whisper two-syllable words and ask patient to
repeat the word.)
Ears

Otoscopic Exam
1. Holds auricle and otoscope correctly (Hold scope in a way that protects patient from
injury by using fingers or side of hand held against face. Pull auricle upward and back to Y/N
straighten the canal.)
2. Ear canals: discharge, foreign bodies, erythema, edema, cerumen, masses Y/N
3. Tympanic membranes: color, contour, malleus, cone of light, perforations Y/N
Special Tests
1. Mobility of tympanic membrane with pneumatic otoscope S Y/N
2. Conductive vs. sensorineural hearing loss (Weber test: Place tuning fork at middle of head
or bridge of nose and ask patient in which ear the sound is best heard or if it is equal. Rinne
S Y/N
test: Hold tuning fork over mastoid until patient cannot hear sound, then immediately hold
tuning fork, U facing forward, next to ear and ask patient if the sound is heard again.)
Inspection
1. External surface: asymmetry, lesions, or deformity Y/N Y/N
Palpation
1. Nose: tenderness, masses (Palpate bone and cartilage midline and lateral.) Y/N Y/N
2. Nares: patency (Occlude one nare at a time and ask patient to breath in through nose.) Y/N Y/N
3. Frontal sinuses and maxillary sinuses: tenderness (Palpate upward under bony ridge of
Y/N Y/N
eyebrows and upward on the maxillary sinuses.)
Nose

4. Examine internal nose using otoscope with nasal illuminator (Insert nasal speculum
without touching the septum, enough to get visualization of the inferior turbinate and septum, Y/N
using a light source.)
5. Mucosa: color, swelling, bleeding, exudate, ulcers, polyps Y/N
6. Septum: deviation, inflammation, perforation (Look midline at the septum bilaterally.) Y/N
7. Transillumination of the sinuses (This is a special test. Place light source upward under
each brow to illuminate frontal sinus. Place light source just below eye and point downward; S Y/N
look at roof of mouth for illumination.)
Inspection
Mouth and
Pharynx

1. Lips: color, moisture, lesions, cracking, scaliness Y/N Y/N

2. Oral mucosa: color, areas of pigmentation, ulcers, white patches, nodules (Use a light
Y/N Y/N
and tongue blade to inspect.)
3. Gums: color, swelling, ulceration, bleeding, retraction (Use a light and tongue blade to Y/N Y/N

Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical
Examination and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health
 Detailed Skill Performance Evaluation: Ears, Nose and Throat Examination

Directions: You will have 10 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps must be
performed or verbalized. Special tests (S) will be performed if requested by the examiner.
Start: End:
Performed Verbalized
inspect.)
4. Teeth: caries, abnormal position, missing (Use a light and tongue blade to inspect.) Y/N Y/N
5. Hard palate: color, lesions, masses (Use a light to inspect.) Y/N Y/N
6. Tongue: color, lesions, texture (Ask patient to stick out tongue and then move it to one
Y/N Y/N
side and then the other side to look for abnormalities.)
7. Pharynx: color, swelling, lesions, symmetry (Use a light and tongue blade to inspect.) Y/N Y/N
8. Soft palate: uvula (Use a light and tongue blade to inspect.) Y/N Y/N
9. Tonsils: color, ulcers, swelling, symmetry, exudate (Use a light and tongue blade to
Y/N Y/N
inspect.)
Palpation (Don gloves.)
1. Tongue and floor of mouth: induration (With gloves on, use a piece of gauze to hold the
tip of the tongue and distract the tongue outward and lateral to visualize the sides and
Y/N Y/N
underneath of the tongue for abnormalities; palpate base of mouth and sides of tongue for
induration.)
2. Gums/teeth: tenderness, loose teeth (Use gloves and palpate over upper and lower gums
Y/N Y/N
and teeth.)
Adequate exposure was maintained for all inspection steps. C
Evaluation: #Y = #C =
min. = 38/47 min. = 2
Comments on quality of performance: Needs remediation?

Y/N

Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical
Examination and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health