Examination of external nose
Mainly observe whether or not there exist changes in the form, colour and lustre as well as injury. Press the nose to see if there exists swelling in the external nose or not, if there exists collapse and fracture on the nose bridge or not.
Examination of nasal vestibule
Ask the examinee to bend his head slightly backwards. Then the examiner uses his thumb to raise the examinee's apex of nose for the examination. Notice if there exist swelling, ulcer, scab, rugous fissure, and purulent sore, etc. or not in the nasal vestibular skin. If anterior naris is obstructed by the scab, hydrogen dioxide
solution may be used to soften and remove the scab before the examination.
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 300to 600, the examiner can see the 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 concha. 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.
Colour, swelling, pachynsis, atrophy, moist or dry surface, with or without adhesion.
Common nasal meatus
Broadening or narrowing.
Amount, 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.
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.
Posterior pharyngeal cavity of the nasal cavity can be examined by this method. The examinee bends his head slightly forwards, opens his mouth, relaxes the pharyngeal cavity completely and breathes through the nose.
Place the posterior rhinoscope over an alcohol lamp to be heated. This can prevent the vapour breathed out by the examinee from coagulating on the rhinoscope surface.Before stretching the posterior rhinoscope into the oral cavity, feel the rhinoscope with the back of the hand to see if the temperature is proper or not. This can prevent pharyngeal part from being scalded if the back of the rhinoscope is too hot.
The examiner holds the spatula with the left hand,presses 2/3 of posterior dorsum of tongue towards the anteroinferior direction, holds the posterior rhinoscope with the right hand to place it into the back of the soft palate between the uvula and the retropharyngeal wall, with the rhinoscope surface facing upperwards. Take care not to make the rhinoscope in touch with the retropharyngeal
wall or the soft palate. This can prevent nauseous reflex (In case of reflex allergy in the examinee, the examiner may spray 1% dicaine or 4 % cocaine to anesthetize the pharyngeal part. ). When turning the rhinoscope surface around, the examiner can see the top of the nasopharyngeal cavity, tubal prominence and opening, pharyngeal recess, posterior margin of the nasal septum, posterior end of each concha. Take care to see whether there exist inflammation, pus, tumour, etc. or not.
Examination of nasal sinuses
Palpation of nasal sinuses
According to the position of tenderness, the examiner may determine to which sinus the acute inflammation pertain. For instance, the tenderness of frontal sinusitis lies in the superior part of the inner orbit; the tenderness of ethmoid sinusitis in the inner wall of orbit; the tenderness of maxillary sinusitis in canine fossa, often with hyperesthesia of molar teeth; the tenderness of severe sphenoiditis and sinus ethmoidei posteriores in eyeballs.
Application of a rhinoscope during examination
The examiner mainly uses the change of nasal mucosa and drainage of nasal meatus to help diagnosis of sinusitis.For example, the drainage of nasal sinusitis of anterior sinuses is in the middle nasal meatus; the drainage of nasal sinusitis of posterior sinuses in the superior nasal meatus and the olfactory sulcus.
Transillumination test of nasal sinuses
The nasal sinus transilluminator is a long and thin tube, on which a small bulb is installed on one end and power source is attached on the other one. The test
should be conducted in a dark room. Place the transilluminator over the superior part of orbit, making the light shining upwards. At this time, the examiner can see a bright red highlight on the forehead. If the examiner places the sterilized transilluminator into the examinee's mouth to push up the middle and posterior parts of the hard palate, a red crescent-shaped highlight will appear on the lower eyelid. Simultaneously, the homolateral pupil will give out red light. When closing his eyes, the patient will feel that there exists light in his eyes as well. If the transparent area is dark, it often shows there exist pathological changes in nasal sinuses like hyperplasia and pachynsis of mucosa, tumor, mucus, pus, or maldevelopment of nasal sinuses.
Examination of osphresis
Use a small bottle to contain liquids with various smells, such as vinegar, soysauce, sesame oil, alcohol,perfume and petrol. Ask the examinee to distinguish them with osphresis. This method can only determine whether the examinee has osphresis or not and is suitable for general clinical application.