Nose

There are different ways to perform an examination of the nose. This is one example of a structured examination.

 

Introduction

 

  • Wash hands with alcohol gel

  • Introduce yourself to the patient

  • Confirm patient’s name and date of birth

  • Obtain consent to examine the patient and explain what this will involve

  • Ask for a chaperone if required

  • Position patient – sit in chair

  • Ask the patient if they have any pain

  • Gather equipment 

  • Headlight

  • Thudicum Speculum

  • Metal tongue depressor

 

Inspection

 

  • External nose – from in front and profile

  • Deformity e.g. deviation

  • Skin changes e.g. skin lesions, scars, erythema, swelling e.g. rhinophyma

  • Internal nose – use Thudicum speculum if available, otherwise elevate nasal tip

  • Columellar – straight, dislocated

  • Septum – straight, deviated, septal haematoma, perforation

  • Mucosa

  • Nasal vestibule 

  • Nasal cavity including inferior turbinates

 

Palpation

 

  • Nasal bones for alignment, step deformity, tenderness

  • Nasal airflow

  • Occlude each nostril in turn and ask patient to breathe through their nose

  • Use metal tongue depressor to look for misting

 

To complete examination 

 

  • Suggest further examinations

    • Full head and neck examination

    • Flexible naso-endoscopy

  • Thank patient for examination

  • Wash your hands

  • Present findings

  • Suggest that you would document your findings in the patient’s notes

 

Possible investigations that may subsequently be requested

 

  1. CT sinus

  2. MRI head – anterior cranial fossa for olfactory neuroblastoma

  3. UPSIT – smell test

  4. Allergy testing – skin prick, RAST test

 

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