EXAMINATION OF NOSE

ADIL MUHAMMED 13M004

INTRODUCTION• Full nose examinations assess the function, airway

resistance and occasionally sense of smell. It includes looking into the mouth and pharynx.

• Common symptoms of nasal disease include:• Airway obstruction.• Rhinorrhoea (runny nose).• Sneezing.• Loss of smell (anosmia).• Facial pain caused by sinusitis.• Snoring (associated with nasal obstruction).

Things to do……..

• Introduce yourself• Position patient• Examination of external nose• Inspect the nasal tip, vestibule, and nasal

airway• Anterior rhinoscopy• Posterior rhinoscopy• Post nasal examination• Neck examination

EXAMINATION OF

EXTERNAL NOSE

INSPECTION :

First look at the external nose. Ask the patient to remove anyglasses. Look at the nose from the front and side for any signs..

• Nasal bridge deformity- Saddle Nose/ Hump deformity• Swelling• Ulcers• Sinuses• Growths on skin• Scars• Broadening of nose• Inflammation/ cellulites

PALPATION :

• Crepitation• Tenderness

Inspect the nasal tip, vestibule, and nasal airway :

•Nasal tip•Nostrils and airflow.•Mist test•Condition of mucosa inside vestibule•Furuncle•Fissure•Dislocated Septum•Tumors

Anterior RhinoscopyThe nose is both the sense organ and a respiratory organ. Anterior rhinoscopy is an examination of the nasal cavities enabling to note Nasal secretions, Swelling of the turbinates,Properties of the mucosal surface, Position of the nasal septum, Ulcerations or presence of foreign bodies.

The students are usually capable to observe the position of nasal septum with possible nasal deformities, inferior nasal turbinate and the quality of nasal mucosa.

Material

Thudicum speculum . Light is focused at different sites in nose to examine nasal septum, roof, floor and lateral wall by tilting patient’s head in different directions.

• Nasal passage- Narrow (septal deviation or

hypertrophy of turbinates)- Wide (atrophic rhinitis)

• Septum- Position, spurs, deviation, colour of

mucosa, ulcers, crusting and perforations, swellings (haematoma or abscess)

• Floor of the nose- Defects (cleft palate or fistula)- Swelling (dental cyst)- Neoplasm (haemangioma)- Granulations (foreign body or osteitis)

• Roof: only seen in case of atrophic rhinitis

Lateral wall:

- Colour of mucosa (congested in inflammation and pale in allergy)

- Size of turbinate's (during rhinitis)

- Discharge (infection of maxillary, frontal or anterior ethmoidal sinuses)

- Mass (polyp, rhinosporidiosis and carcinoma)

If any growth or polyp is suspected confirm by the probe test.

Probe Test: It is carried out by spraying the nose with 4% Lignocaine with 1:100000 adrenaline or 10% cocaine. The lesion or area is palpated to determine its character and mobility.

Posterior RhinoscopyTechnique:

Patient sits facing examiner opens his mouth breathes quietly from mouth.

Examiner depresses tongue with tongue depressor and introduces posterior rhinoscopic mirror warmed and tested on back of hand.

Mirror is held like a pen and carried behind soft palate. Without touching posterior third of tongue to avoid gag reflex .

Light from head mirror is focused on rhinoscopic mirror which further illuminates part to be examined.

St. Clair Thompson post-nasal mirror

Posterior Rhinoscopy

Structures seen

• Posterior margin of bony septum• Posterior end of inferior, middle and superior

turbinate• Posterior nares/ choanae• ET openings• Fossa of Rosenmuller• Roof of Nasopharynx• Adenoids• Nasal surface of soft palate and uvula

Functional Examination of Nose

• Patency of nose: - Spatula test: By placing a cold tongue depressor below the nostril to look for the area of mist formation. Compare the two sides always.

- Cotton wool wisp test: Fluff of cotton is held against each nostril and its movements are noticed when patient inhales and exhales.

Spatula test

Sense of smell:

Ask the patient to identify the smell of the solutions held before the nostril while keeping the eyes closed. Each nostril is tested separately.

Common substances used: Clove oil, peppermint, coffee and essence of rose.

EXAMINATION OF PNS

It includes both inspection and palpation ofanterior group of PNS, i.e., Maxillary,Frontal,Anterior ethmoidal.

Look for any redness,swelling,mass,sinus in the area of PNS.

Examination of the nose Neck examination

Anterior nose drains to submandibular region Posterior drains to middle deep cervical