'Clinical Methods' have been defined as 'the set of skills medical personnel use to diagnose and treat diseases' by the most respected treatise on the subject, Hutchison's Clinical Methods. In the present times when hi-end technological advances have overwhelmed the medical fraternity systematic history taking and structured clinical examination continue to be the mainstay of understanding concerns of a patient (and his/her family) and arriving at a correct diagnosis efficiently and in least possible time. These skills are cultivated over the years and require diligence and keenly supervised clinical training. The present book 'Clinical Methods in Otology' builds upon these universal principles of examination of patients in a outdoor clinic or in an emergency ward.

The book follows a well-designed approach and familiarises the reader with art and science of building bridges with the patient, eliciting systematised history of aural complaints, performing a systematized clinical and functional examination of ears including other related areas. The book also reviews the principles of selecting appropriate hematological, biochemical, radiological, and audiological investigations based on clinical presentation. How to interpret the results and corelate them with the history and clinical findings is also discussed.

The book is intended to meet the training needs of ENT Residents pursuing post-graduate programs such as MS (ENT), DNB Otolaryngology, and other Board exams. Practicing ENT specialists and Audiologists will also find the book useful to refurbish their knowledge and further improve their clinical skills.

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Building Bridges with the Patient

Establishing lines of communications early on with a patient in a clinical setting is key to understanding his/her concerns, complaints, and expectations. When a patient arrives in a clinic, he/she has a degree of apprehension associated with symptoms and fear of the unknown related to management and outcome of the treatment. The Clinician must demonstrate empathy, pay undivided attention, and win over patient’s confidence. This requires acquisition of certain skills and traits.

Welcome and Breaking the Ice

As you approach a patient in your clinic you must welcome him/her with a warm and reassuring smile. Even if the patient is looking apparently unwell do not alarm him/her with a startled, or desperate look. In case the patient can sit make him/her comfortable in a patient chair or on a patient stool.

ENT clinics are frequently visited by infants, toddlers, and young children who are even more terrified and concerned. They must be handled tenderly avoiding unnecessary haste.

After seating the patient comfortably, the next step is to break the ice and begin the conversation. Questions such as, what brings you here; how I may help you; or how you are feeling today may go a long way in opening the communication channels between the Clinician and patient (and the accompanying persons).

Be a good listener

It is of paramount importance to be a good listener especially when the patient is narrating history of his/her symptoms. The Clinician must desist from interrupting the patient lest to disturb the flow of his/her thoughts. Questions if any, should be reserved till the patient has completed his/her part of the story. The only exception to the rule is when the patient tends to lose the track and the Clinician may have to guide the patient back to mainstream. Leading questions are reserved for the concluding part of the session. However, it must the Clinician’s endeavor to establish a cut-off date when patient was completely free of any symptoms and when did the first symptom appear. Did the patient himself noticed the symptom or someone else brought it to his/her notice. The Clinician must make sure that chronology of symptoms as they appeared is maintained.

Do not judge your patient

It is imperative that the Clinician approaches the patient with an open mind and devoid of any bias or pre-conceived notions. It is advisable to not to form any opinion based on appearance, religion, caste, color, social or personal habits, state of mind, or financial status of the patient.

Systematic plan of examination

I often used to tell my students “When you are examining a patient, the patient is examining you”. A Clinician must have a plan of action to follow while examining a patient. If you are methodical, follow a pre-determined protocol, and record your findings immediately, patient is reassured that he/she is in safe hands. This sense of security further supports the dialogue between the patient and the Clinician.

The final session

The final session comprises of two sections. In the first part the Clinician shares his observations and findings from history and clinical examination. What is the probable diagnosis and points in favor or against it. Are there any differential diagnoses. How does the Clinician plan to proceed further to manage the patient.

In the concluding part of the session the Clinician encourages patient to seek answers to any concerns or queries they have in their mind. Replies to these queries must be straightforward and devoid of any technical jargon. Do not bombard the patient with information and keep your replies short and pointed. The objective is to facilitate the patient and not to confuse him.