ENT History Taking: Approach to a Throat Case

ENT History Taking: Oral Cavity, Larynx, and Pharynx

✨ Patient Particulars

Start with the patient's basic information.

• Name: For identification, building rapport, and maintaining records.

• Age: Conditions vary with age.

  • Young Children/Infants
  • Adolescence
  • Elderly

Name some diseases common in different age groups - Infants, Adolescence and Adults.

• Sex: Some diseases are more common in a specific gender.

Name some diseases common in Males and Females.

• Address/Location: Geographical prevalence of certain conditions.

  • West Bengal, Bihar, UP (India): Laryngeal Tuberculosis.
  • Himalayan Region (India): Goiter (iodine deficiency).
  • Central/Southern India: Oral precancerous lesions (Leukoplakia, Erythroplakia - often related to chewing habits).
  • Gujarat (India): Plummer-Vinson Syndrome (associated with post-cricoid carcinoma).

• Occupation: Relevant for exposure to irritants, vocal strain, or specific habits.

  • Vocal Abuse
  • Trumpet Blowers, Glass Workers
  • Agricultural/Factory Workers
  • Welders, Construction Workers, Asbestos Exposure

Can you name some diseases common in the above occupations?

🗣️ Chief Complaints

Note the patient's main complaints in their own words and chronological order.

1. Change in voice (Hoarseness, etc.)
2. Difficulty in breathing (Dyspnea)
3. Noisy breathing (Stridor, Stertor)
4. Cough
5. Difficulty in swallowing (Dysphagia)
6. Pain while swallowing (Odynophagia)
7. Disturbance in taste
8. Altered speech
9. Associated Symptoms: Swelling, foreign body sensation, throat clearing, nasal regurgitation, disturbed salivation, ulceration, difficulty opening mouth (trismus), bad breath (halitosis), mouth breathing/snoring, hearing loss, lump in the throat, lump in the neck, paresthesia/anesthesia of cheek, swelling.

📚 History of Present Illness (HPI)

Elaborate on each chief complaint in detail.

1. Change in Voice

• Onset: Sudden vs. Gradual.
• Duration: How long?
• Progress:

Rapidly progressive vs Gradually progressive

Constant vs Intermittent.

• Character:
  • Hoarse
  • Husky / Breathy
  • Hot Potato Voice / Muffled
  • Whispering
  • Feeble (Asthenophonia)
  • Puberphonia
  • Aphonia

Name some causes of the above mentioned characters of voice.

• Continuity & Diurnal Variation: Constant vs Intermittent

Name a condition that worsens in morning.

Name a condition that worsens in evening.

Name a condition that worsens as day passes.

• Habits/Exposures:

Excessive talking/singing/loud talking (vocal abuse)

Excessive smoking (Rinki's Edema)

Alcohol consumption

Exposure to irritants (dust, fumes)

• Aggravating/Relieving Factors

What are causes of Change of voice?

2. Difficulty in Breathing (Dyspnea)

• Onset: Sudden vs Insidious

• Duration: How long?

• Progress: Gradually vs Rapidly progressive

• Variation: Throughout day/night? With activity vs at rest? With position (sitting, standing, supine)?

• Aggravating/Relieving Factors

Do you know what are the Grades of shortness of breath?

What are causes of Dyspnea?

3. Noisy Breathing

• Onset: Sudden vs Insidious

• Duration: How long?

• Progress: Gradually vs Rapidly progressive

• Variation: Throughout day, with activity, with posture.

• Aggravating/Relieving Factors:

• Character:

  • Stridor: High-pitched sound due to obstruction at larynx, trachea, or bronchi.
  • Stertor: Low-pitched sound due to obstruction above the larynx (vibration of pharynx, nasopharynx, soft palate).

What are causes of Stridor?

What are the differences between Stridor & Stertor?

4. Cough

• Onset: Sudden vs Insidious

• Duration: How long?

• Amount: Scanty, Moderate, Profuse

• Continuity: Continuous/Intermittent

• Type: Dry vs. Wet (with sputum). Blood-tinged?

• Characteristic Features:

Forced cough/throat clearing

Dry forced cough

Whooping cough

Nocturnal cough

Morning cough

Cough after meals

Relieved with sleep

Cough during fluid ingestion

Foul-smelling sputum

Paroxysmal/irritating cough

Suffocating cough

Blood-tinged sputum

What are causes of above mentioned types of Cough?

What are causes of Wet & Dry Cough?

5. Difficulty in Swallowing (Dysphagia)

• Onset: Sudden vs Insidious

• Duration: How long?

• Progress: Gradually vs Rapidly progressive

• Character:

Difficulty more with liquids than solids

Difficulty more with solids than liquids

Inability to swallow saliva

Intolerance to acidic food

What are causes of above mentioned characteristics of Dysphagia?

• Associated Symptoms:

Regurgitation/Heartburn (Hiatus Hernia)

Regurgitation of undigested food at night (Hypopharyngeal Diverticulum)

Aspiration into lungs (Laryngeal paralysis)

Aspiration into nose (Palatal paralysis)

Classify and name causes of Dysphagia.

6.Pain While Swallowing (Odynophagia)

• Onset: Sudden vs Insidious

• Duration: How long?

• Progress: Gradually vs Rapidly progressive

• Associated Features: Referred pain in the ear.

What are causes of Odynophagia?

7. Disturbance in Taste

• Types:
  • Ageusia
  • Hypogeusia
  • Hypergeusia
  • Dysgeusia

What is Ageusia, Hypogeusia, Hypergeusia and Dysgeusia?

Name causes of Ageusia, Hypogeusia, Hypergeusia and Dysgeusia.

8. Altered Speech (Dysarthria, Anarthria)

• Onset: Sudden vs Insidious

• Duration: How long?

• Character:

  • Delayed/Difficult Speech in Child

  • Rhinolalia Aperta - Hypernasality

  • Rhinolalia Clausa - Hyponasality

  • Muffled Voice (Hot Potato Speech)

  • Thick / Guttural Voice

  • Difficulty in Articulation (Dysarthria/Anarthria)

What are causes of above mentioned characteristics of Altered Speech?

📋 Associated Symptoms & Additional History

Ask about other relevant symptoms and past events.

• Foreign Body Sensation / Throat Clearing

• Nasal Regurgitation

• Disturbed Salivation

• Ulceration

• Difficulty Opening Mouth (Trismus)

What is the grading of Trismus?

• Bad Breath (Halitosis)

• Mouth Breathing / Snoring

• Hearing Loss

• Lump in the Throat

• Lump in the Neck

• Paresthesia / Anesthesia of Chin (lateral to midline)

• Swelling

• Earache (Referred Pain)

• Additional Complaints:

Fever (evening rise in TB), Night sweats, Weakness of voice (TB), Vocal abuse history, Neck trauma/surgery history, Surgery under general anesthesia history (intubation-related vocal cord trauma), Radiotherapy history, Chest pain, Choking episodes, Weight loss, Loss of appetite (suggests malignancy).

📘 In my detailed notes, I’ve broken down each of these symptoms and what they typically indicate — with clinical correlations, differentials, and quick-reference tables to help you save time in exams and clinics.

📋 Past History

• Similar Complaints in the Past: Recurrent Tonsillitis/Adenoiditis, Previous episodes of voice change, Previous head/neck masses, History of Carcinoma (recurrence).

• Systemic Diseases: Pulmonary TB, Syphilis, Diabetes Mellitus, Hypertension, Epilepsy (spasm causes), Bleeding disorders, Dental caries, Allergies.

• Surgical History: Any previous surgeries in the head, neck, or chest.

• Other Medical History.

• Allergic Drug History.

Family History

• Diabetes, Hypertension, TB in the family.
• Similar complaints in the family (e.g., history of malignancy, prominent snoring).

Treatment History

• Treatment for current or past complaints.
• Medications used (type, duration, relief).
  • Beta blockers: Nasal obstruction.
  • Anticoagulants: Epistaxis risk.
  • Nasal decongestant abuse: Rhinitis Medicamentosa.
• Radiotherapy history.
• Details of previous surgeries (e.g., type of tonsillectomy, nasal surgery).

Personal History

• Diet and Appetite.
• Sleep: Especially if snoring/OSA is a complaint.
• Weight Loss / Low Appetite: Important indicators for malignancy.
• Bladder and Bowel habits.
• Socioeconomic status.
• Addiction History (Crucial for Malignancy Risk):
  • Smoking: Quantify in pack-years (Packs per day * Years smoked). 1 pack-year = 20 cigarettes/day for 1 year.
  • Alcohol: Type, amount, duration.
  • Drug or Snuff Addiction: Cocaine sniffing can cause septal perforation. Tobacco chewing habits (oral cancer risk).
• For females: Menstrual history.