Dr. Hazenfield -- Ear, Nose, and Throat Doctor in Hawaii

 

 

Residents' Page

 

Hugh N. Hazenfield, M.D., F.A.C.S.

 

  • Although others are welcome, this page is for the Department of Family Practice residents from the University of Hawaii who have their Otolaryngology - Head and Neck Surgery rotation with me. 

  • You have chosen to enter one of the most exciting, rewarding - and demanding - vocations that exists.  Your spouse and children will also experience the demands placed upon you, your energy, and your time.  However, you will know you have chosen correctly when you awaken in the morning with the feeling that you can hardly wait to get to work.

  • Expectations:  

    After your rotation in Otolaryngology - Head and Neck Surgery, you are expected to know the following:

    • How to interpret audiograms

    • How to distinguish between normal and abnormal findings in the head and neck examination

    • Tuning fork test interpretation

    • The names and functions of the cranial nerves and how to test each of them in the physical examination

     

 

  • Patient privacy and respect for patient wishes:

    • As we enter the examination room, I always introduce you to the patient and ask his or her permission for you to be in the room. 

    • Patients rarely refuse permission.  However, if the patient refuses, you may wait in my private office and read any books available there.

     

 

  • Required Reading:

    • Before you begin your rotation, please read about testing the cranial nerves in a physical diagnosis textbook such as DeGowin and DeGowin: Bedside Diagnostic Examination.

     

 

  • Office Hours:

    • I have office hours all-day Monday, Wednesday mornings, half-days on Friday, Tuesday afternoons, and every-other Saturday morning.  You are welcome at any session.

    • Since the office hours in my two offices (Wahiawa and Pali Momi) vary on Mondays and Fridays, please call my office at 622-2626 to check the time and location. 

    • If I am not seeing patients or doing surgery during periods you are assigned to me, with his permission, you may wish to spend that time with Dr. Regala who works out of the same offices.  You may reach Dr. Regala at 622-2626.

    • I am in the Wahiawa office every Tuesday afternoon. 

    • Morning office hours are usually 8:40 A.M. - 1:00 P.M. and afternoon office hours are usually 2:00 - 6:30 P.M. 

    • Except in unusual circumstances due to your other patient care obligations, I expect you to arrive for each session promptly.  If you are going to be late, please call my office at 622-2626.

    • Please wear a lab coat with your name, or at least a name tag, so that the patients know you are a physician.  Scrubs are not appropriate attire in a private office setting.

    • If you feel that that you and I need extra time for pertinent discussion of patients, diseases, or review, I am willing to meet with you prior to my morning office hours.  Please arrange this with me personally in advance.

    • If you wish to spend extra time in Otolaryngology - Head and Neck Surgery, you are welcome to do so if you arrange it with me in advance.

 

  • Surgery:

    • You are welcome to assist me in the operating room on Tuesdays and Thursdays and some Saturdays.  Call my office for the schedule.

    • Also, I schedule minor outpatient surgical procedures in the Wahiawa office on Tuesday afternoons.

 

  • Now, on to the Cranial Nerves!

    • Hopefully, every time you perform a complete physical examination, you are testing the cranial nerves (perhaps with the exception of Cranial Nerve I).  Abnormalities of some of these can signify disease entities anywhere from the brain to the termination of the nerves, or even elsewhere, such as in the thorax.

    • What you see in this table is basic.  You will need to research some of the nerves on your own, especially the branches of cranial nerves V, VII, and X, what they innervate, whether they are sensory or motor, and how you test them.

(Remember:  "On old Olympus' towering tops a Finn and German viewed some hops.")

 

CN #

Name

Sensory

Motor

Testing

I

Olfactory

Yes

No

Have the patient smell known odors such as coffee, cloves, peppermint.  Do not use strong odors such as ammonia.

II

Optic

Yes

No

Use standard eye charts and examine the eye with an ophthalmoscope.

III

Oculomotor

No

Yes

Test with Cranial Nerves IV and VI by testing eye movements.  This nerve supplies all extrinsic eye muscles (including the levator palpebrae superioris) except the superior oblique and lateral rectus.

IV

Trochlear

No

Yes

Test with Cranial Nerves III and VI by testing eye movements.    This nerve supplies the superior oblique muscle.

(Remember:  LR6SO4)

V

Trigeminal

Yes

Yes

Observe for trismus, lip tremor, and involuntary chewing movements.  Palpate the temporalis muscles with the patient clenching teeth.  Test facial sensation in all branches and the corneal reflex.

VI

Abducens

No

Yes

Test with Cranial Nerves III and IV by testing eye movements.    This nerve supplies the lateral rectus muscle.

(Remember:  LR6SO4)

VII

Facial

Yes

Yes

Motor:  Observe the patient's face for involuntary tremor of the eyelids and/or lips.  Test the motor branches by facial movement. 

Sensory: Test sense of taste (chorda tympani nerve) and external auditory canal sensation (partly innervated). 

Further tests:  Stapedial reflex testing

VIII

Acoustic

(Vestibulo-cochlear)

Yes

No

Test hearing.  Use finger rub or whispering for gross testing of hearing.  Use Rinne, Weber, and Schwabach tuning fork testing. 

Test for nystagmus and perform positional testing.

Further tests:  Order complete audiometry, including air and bone conduction, speech audiometry, and if indicated, impedance audiometry.  Order electronystagmography if indicated for balance disorders.

IX

Glossopharyngeal

Yes

Yes

Test for gag reflex, elevation of the palate, and symmetry of the posterior tonsillar pillars.

X

Vagus

Yes

Yes

Motor:  Observe vocal cord motility with a mirror or a fiberoptic endoscope.  Observe the configuration of larynx.  (These may require referral to an otolaryngologist.)

Sensory:  External auditory canal (Arnold's nerve); history of aspiration. 

XI

Spinal Accessory

No

Yes

Check strength of the sternocleidomastoid and trapezius muscles.

XII

Hypoglossal

No

Yes

Check tongue motility on extrusion and the strength of the tongue tip in the cheek.  Ask the patient to repeat "Round the rugged rock the ragged rascal ran".

 

Now, was that spoon-feeding?

Also, look at the following website.  It is excellent (except for the Trigeminal and Vestibulocochlear Nerves):

Yale University - Cranial Nerves

 

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DISCLAIMER:  The purpose of this website is to provide general information and not medical advice.  This website is not a substitute for consultation with a physician.  Information contained herein is believed to be accurate, but no warranty is made as to accuracy or appropriateness.  Information contained herein may be outdated or incomplete.