Physical examination in ENT

Weber and Rinne test
- Used to distinguish between conductive and sensorineural hearing loss
- Weber
  - Tuning fork placed on the forehead.
  - In case of no hearing loss, the tone is heard equally well on both sides.
  - In case of conductive hearing loss, the tone is lateralised to (louder on) the side with decreased hearing.
  - In case of sensorineural hearing loss, the tone is lateralised to the side opposite of the one with decreased hearing
- Rinne
  - Tuning fork placed in front of ear opening and on the mastoid process.
  - In case of conductive hearing loss, the tone is heard best on the mastoid process (called Rinne negative)
  - In case of no hearing loss or sensorineural hearing loss, the tone is heard best in front of the ear opening (called Rinne positive)
Spontaneous vestibular signs
- Head impulse test
- Romberg test
  - Stand with eyes closed for 30 seconds and observe for swaying to one side
- Unterberger stepping test
  - 50 steps with eyes closed
- Finger to nose test
- Walking with eyes closed
- Smooth eye tracking of objects
- Horizontal and vertical tracking test
- Dix-Hallpike manoeuvre
Examinations of the neck, lymph nodes, thyroid
Examinations of facial nerve
- Forehead wrinkling
- Closing eyes tightly
- Nose wrinkling
- Inflate cheeks
- Smiling
- Whistling
- Taste
Examinations of meningeal signs
- Triad
  - Nuchal rigidity (inability to flex neck forward)
  - Headache
  - Photophobia
- Kernig sign
  - Supine patient
  - Flexion of hip joint with knees in 90 degrees -> painful passive extension of the knee joint
- Brudzinski sign
  - Supine patient
  - Passive flexion of the neck -> patient involuntarily lifts legs‎