Examination of the nasal cavity
The examination is the key for the examination of the nose and it is often conducted with the help of a nasoscope.
The usage of a nasoscope: Hold the nasoscope with the left hand and put the thumb on the juncture of the two lobes of the nasoscope. Then place one handle in the palm and hold the other one between the other four fingers. The two dilating lobes run parallel with the line of the floor of nose. At this time, place the nasoscope gently into the nasal vestibule and then open the two lobes of the nasoscope slowly. Do not put the nasoscope too deep, without surpassing the threshold of nose. This can prevent pain or bleeding due to injury of the nasal septum. When taking out the nasoscope, do not make the two lobes completely closed. This can avoid adding pain to the examinee by preventing rhinothrix from being pulled.
Generally, examine the nasal cavity from the lower part to the upper part, from the front part to the back part, from the inner wall to the outer wall. This order can prevent possible omission.
When the examinee bends his head slightly forward, the examiner can see the floor of nose, the anterior and inferior parts of the nasal septum, inferior part of inferior nasal concha, and inferior nasal meatus; when the examinee bends his head backwards at the angle of 30 to 60 ,the examiner can see the superior and posterior parts of the nasal septum, agger nasi, superior part of inferior nasal concha, middle nasal concha, and middle nasal meatus. In a small number of patients, the examiner may see the superior nasal meatus as well. In the case of swelling of the nasal mucosa, spray or daub 1% to 2% ephedrine solution on the nasal mucosa to make the mucosa of inferior nasal concha, etc. contracted and then observe the change.
The normal nasal mucosa is reddish, moist, slippery, without retention of secretion in floor of nose and every nasal meatus.
Palpation of the concah: the normal mucosa of concha is soft and elastic. In the case of hypertrophic rhinitis, the mucosa of concha is harder without elasticity.
During the examination, pay attention to the observation of the following conditions:
1. Nasal mucosa
Colour, swelling, pachynsis, atrophy, moist or dry surface, with or without adhesion.
2. Common nasal meatus
Broadening or narrowing.
Amout, colour, property, shape and location. The property and shape of secretion can be divided into serous, mucous, purulent, bloody and mixed.
Amount, colour, property and shape.
5. Nasal septum
Degree and location of deviation, with or without bleeding, ulcer, or perforation.
Whether there exists tumor or not, and its shape, size, location as well as colour, etc.