Introduction
- Introduce yourself to the patient
- Wash your hands
- Briefly explain to the patient what the examination involves
- Ask the patient to remove any spectacles.
Approach the examination in a systematic way, but be prepared to be instructed to move on quickly to certain sections by any examiner.
External Nose
Inspect the external nose, both anteriorly and laterally for:
- Size and shape
- Obvious swellings or deformity
- Scars or skin changes
- Including for skin malignancies
- Redness or discharge
Ask the patient to tilt their head back (or gently tip the end of the nose up) and inspect the anterior nares; use a pen torch or otoscope if necessary. Check for the same characteristics as listed above.
Nasal Cavity
Use a head lamp with a nasal speculum to gently open up the nose
- Place the index finger in the middle of the speculum
- Use your middle and ring finger to support the speculum on each side
Fig. 2 – How to Hold a Nasal Thudichum
Examine the nasal cavity
- Nasal septum (medially), checking for
- Perforations
- Septal deviation or haematoma
- Superficial vessels or potential bleeding sites
- Turbinates (laterally), checking the
- Inferior terbinate (commonly visible)
- Middle turbinate (less commonly visible)
- Entire nasal cavity
- Rhinitis
- Oedematous and inflammaed mucosa
- Polyps (typically bilateral*)
- Rhinitis
*A unilateral polyp warrants biopsy for histology, due to possible malignant cause
- Foreign bodies
Fig. 3 – Nasal polyp, located in the right nasal cavity. Unilateral polyps warrant biopsy and histological examination.
Completing the Examination
Remember, if you have forgotten something important, you can go back and complete this.
To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform:
- Examination of palate
- Nasoendoscopy