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M10.05.07 Examination of the Nose
The examination of the nose is a crucial component of the head and neck assessment. It helps diagnose a variety of conditions affecting the nasal passages and sinuses. This section provides a comprehensive guide to the techniques, key points, and related abnormal conditions in nasal examination for medical students.
Anatomy of the Nose
- External Nose: Consists of the nasal root, bridge, dorsum, apex, and alae.
- Nasal Cavity: Divided by the nasal septum, lined with mucosa, and contains the nasal turbinates.
- Paranasal Sinuses: Air-filled spaces including the maxillary, frontal, ethmoid, and sphenoid sinuses.
Examination Techniques
- Inspection
- External Nose: Look for symmetry, deformities, swelling, redness, or lesions.
- Nasal Patency: Check for obstruction by asking the patient to occlude one nostril and breathe through the other.
- Palpation
- External Nose: Gently palpate for tenderness, masses, or irregularities.
- Sinuses: Palpate the frontal and maxillary sinuses for tenderness indicating sinusitis.
- Internal Examination
- Use of Otoscope/Nasal Speculum: Visualize the nasal septum, turbinates, and mucosa.
- Mucosal Inspection: Look for color, swelling, discharge, polyps, or bleeding.
- Percussion
- Not commonly performed, but can be used to assess sinus tenderness.
Key Points to Remember
- Always ensure proper lighting and patient comfort during the examination.
- Systematically assess both the external and internal structures of the nose.
- Be gentle, especially when using instruments, to avoid causing discomfort or injury.
- Compare findings between both nostrils for symmetry.
Related Abnormal Conditions
| Condition | Description |
|---|---|
| Allergic Rhinitis | Inflammation of nasal mucosa due to allergens, characterized by itching and sneezing. |
| Sinusitis | Infection or inflammation of the sinuses, often causing facial pain and pressure. |
| Nasal Polyps | Non-cancerous growths on the lining of nasal passages or sinuses. |
| Deviated Septum | Displacement of the nasal septum, leading to breathing difficulties. |
| Epistaxis | Nosebleed, can be due to trauma, dryness, or underlying conditions. |
| Nasal Fracture | Break in the bone or cartilage of the nose, often due to trauma. |
| Foreign Body | Presence of an object in the nasal cavity, common in children. |
| Acute Viral Rhinitis | Common cold, characterized by a runny nose, congestion, and sneezing. |
Table: Sinus Palpation Findings
| Sinus | Location for Palpation | Normal Finding | Abnormal Finding (Tenderness) |
|---|---|---|---|
| Frontal | Above the eyebrows | No tenderness | Indicates frontal sinusitis |
| Maxillary | Below the eyes, on the cheeks | No tenderness | Indicates maxillary sinusitis |
Key Points to Remember
- A thorough nasal examination is critical for diagnosing various nasal and sinus conditions.
- Proper technique and gentle handling are essential for patient comfort and accurate assessment.
- Be familiar with common abnormal findings and their clinical significance.
Bibliography
- Bickley, L. S., & Szilagyi, P. G. (2017). Bates’ Guide to Physical Examination and History Taking. Wolters Kluwer.
- Kern, E. B., & Merritt, J. A. (2015). Rhinology: A Practical Guide. Springer.
- Swartz, M. H. (2019). Textbook of Physical Diagnosis: History and Examination. Elsevier.
- Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Seidel’s Guide to Physical Examination. Elsevier.