Nose examination template

Introduction  Wash hand

 Introduce yourself
 Explain procedure & gain consent
 Position: Sitting
 Ask any pain
Inspection External nose Skin  Sign of inflammation [redness, swelling,
discoloration]
 Cancer – Basal cell ca, Melanoma
 Scar – Trauma, Surgical scar
Discharge  No discharge
 Clear – Viral infection, rhinitis
 Yellowish – Bacterial infection, sinusitis
 Yellow-Greenish – Pseudomonas infection
 Blood stained
 Watery
 Foul smelling
Obvious deviation  Present – Post-trauma, Congenital
 Absent – Normal
Mucosal ulceration  Present – Nasopharyngeal cancer, Infection
 Absent – Normal
Saddle-shaped  Present – Trauma, Granulomatosis with
polyangiitis
 Absent – Normal
Anterior Inspect nasal septum, inferior, middle turbinates, mucosa
rhinoscopy Nasal vestibule Nasal septum Color of mucosa
[Thudicum’s]  Foreign body  Perforation  Pink – Normal
 Nasal polyp  Septal hematoma  Bright red –
 Fissure  Mass Infection
 Furuncle  Epistaxis  Bluish, wet – Nasal
 Infection allergy
 Ulceration
Inferior turbinate Nasal floor Common abnormality
 Hypertrophy –  Secretion in anterior
Rhinitis, Sinusitis  Foreign body rhinoscopy
 Hypertrophy, wet,  Polyp  Nasal secretion
bluish – Allergic  Nasal mass
rhinitis  Foreign body
 Hypertrophy
turbinates
Palpation Tenderness  Palpate swelling area
 Tenderness & crepitus at nasal pyramid – Nasal bone fracture

Sinus tenderness
 Maxillary sinus – Over canine fossa
 Ethmoid sinus – Medial to medial canthus
 Frontal sinus – Roof of orbit, above medial canthus
Special Alar collapse • Ask patient to inhale deeply through nose
test • Note any nostril collapse
Nasal patency • Ask patient to exhale through nose over cold metal tongue depressor
[Cold spatula • Result: Condensation form on blade from both nostril – Patent nostril
test]
Sense of smell • Test sense of smell

Regarding rhinitis
a) How to classify rhinitis ?
• Allergic
• Atrophic
• Infective
• Non-allergic Non-infective

b) What are the typical history of rhinitis ?

• Watery nasal discharge [rhinorrhea]
• Sneezing
• Itchy eyes
• Medical history of asthma, eczema
• Family history of atopy

c) What is the most common causes in infective rhinitis ?

• Virus

d) What are the typical history for infective rhinitis caused by bacteria ?
• Purulent nasal discharge
• Headache
• Facial pain [sinusitis]

Regarding Loss of smell sensation

a) What cause unilateral loss of smell ?
• Nasal polyp
• Tumor

b) What cause bilateral loss of smell

• Congenital – Kallmann syndrome
• Acquired
» Common cold (Most common)
» Trauma [damage to cribriform plate]
» Parkinson’s disease

Regarding nasal septum

a) What is the normal nasal septum ?
• Mildly deviated

b) When does need to repair nasal septum ?

• Symptomatic – Chronic unilateral nasal blockage

c) Most common causes of obvious deviation of nasal septum ?

• Trauma

Regarding nasal polyps

a) What is the most common cause of space occupying lesions of nose ?
• Nasal polyp

b) Nasal polyp commonly bilateral or unilateral ?

• Bilateral
c) State the most common site of nasal polyp
• Lining of paranasal sinuses of nose

d) What is the investigation of choice for unilateral nasal polyps ?

• Biopsy – To rule out cancer

e) Nasal polyps usually associated with what disease ?

• Infection & allergy

Regarding Nasopharyngeal Carcinoma

Mnemonic [NOSE]
• N – Neck mass
• O – Obstructed nasal passage
• S – Serous otitis media, externa
• E – Epistaxis or discharge