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Extra resources for Oxford American Handbook of Otolaryngology
33 34 CHAPTER 2 The ENT examination Cranial nerve examination Examination of the cranial nerves (CN) is a routine part of the head and neck examination. Thorough knowledge of the route and nature of each cranial nerve is one of the basic skills of the otolaryngologist and a major tool in the clinical armamentarium. Cranial nerve I—olfactory nerve Olfaction is tested by asking the patient to smell and describe a scent. Commonly used are cloves or spices kept in an air-tight container. Wipes with a lemon scent can also be used.
A decreased gag reflex suggests dysfunction. Throat pain and ear pain often occur together because of the common nerve fibers. CNIX often has dysfunction with other cranial nerves that exit the skull from the jugular foramen. The associated cranial neuropathies are referred to as jugular foramen syndrome and involve dysfunction on CNIX, X, XI, and XII. Cranial nerve X—vagus nerve The vagus nerve has motor, somatic sensory, and visceral sensory functions. CNX is widely dispersed throughout the body and has major regulatory functions outside the head and neck involving the respiratory, gastrointestinal, and cardiovascular systems.
Evidence of tremor or dystonia should also be noted. Any mucosal abnormalities should be carefully examined and documented. The patient should be asked to cough and clear their throat and to swallow, to assess these vegetative tasks. Special tests such as functional endoscopic evaluation of swallowing (FEES) and the Muller maneuver for obstructive sleep apnea can also be performed with the flexible laryngoscope. This page intentionally left blank 30 CHAPTER 2 The ENT examination Stroboscopy Fine movements of the vocal cords and mucosal wave require stroboscopic examination.