Examination of the nose
Full nose examinations assess the function, airway resistance and occasionally sense of smell. It includes looking into the mouth and pharynx. Common symptoms of the nasal disease include:
- Airway obstruction.
- Rhinorrhoea (a runny nose).
- Loss of smell (anosmia).
- Facial pain caused by sinusitis.
- Snoring (associated with nasal obstruction).
Inspection of the nose
First look at the external nose. Ask the patient to remove any glasses. Look at the nose from the front and side for any signs of the following:
- Size and shape.
- Obvious bend or deformity: a deviated nose is often best looked at from above.
- Scars or abnormal creases.
- Redness (evidence of skin disease).
- Discharge or crusting.
- Offensive smell.
The nose can be inspected from the front to examine the anterior nares by lifting the tip of the nose up and looking inside without a speculum. Check patency of each side and ask the patient to sniff. To assess the nasal airway hold a cold metal tongue compressor under the nose while the patient exhales and note the condensation under both nostrils, or occlude one nostril whilst the patient sniffs to give a reasonable idea of airway patency. Most otolaryngologists use either a head mirror or illuminated spectacles with a Thudichum speculum to open up the nose, which allows examination of the nasal cavity.
Holding the instrument comfortably can take practice at first. Insert the Thudichum speculum gently, and identify the nasal septum medially; turbines laterally; inferior turbinate (nearly always possible to see); the middle turbinate is often difficult to see as it is small. Check for inflammation (rhinitis), the position of the septum, and presence of polyps (touch to check sensitivity; it should be insensitive to touch). A foreign body, usually accompanied by an offensive unilateral discharge, may be seen inside the nose of a child. A mirror and headlight or an endoscope instrument are used to view the nasopharynx (the postnasal space, which contains the Eustachian tube orifices and pharyngeal recess (of Rosenmüller) and may contain adenoids or nasopharyngeal cancer), but this is not always possible during a routine examination. Finally, examine the palate. Look for large nasal polyps and tumors arising from the soft palate.
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