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Nose Exam

Terms in this set (64)

What part and portion of the nose is supported by bone? Cartilage?
*The upper 1/3 supported by bone.

*The lower 2/3 supported by cartilage
Air enters the nasal cavity by way of what?
The right and left anterior nares
After air enter the nasal cavity, where does it travel?
Into the vestibule, through the narrow nasal passage, to the nasopharynx
What is the name of the medial wall of each nasal cavity?
The nasal septum
Is the nasal septum bony or cartilaginous?
Anterior portion is cartilaginous, posterior portion is bony.
What lines the nasal septum?
Vascularlized mucous membrane
Unlike the rest of the nasal cavity, what lines the vestibule?
Hair-bearing skin
Turbinates are found where in the nasal cavity?
Protruding into the nasal cavity from the lateral walls
What are turbinates structurally?
Curving bony structures
What is the groove below each turbinate called
Meatus
What covers the turbinates?
Vascularized mucous membranes
How many turbinates are there in each nasal cavity?
3: superior, medial, and inferior
Where does the nasolacrimal duct drain?
Into the inferior meatus
Where do most of the paranasal sinuses drain?
Into the middle meatus
What 3 principle functions of the nasal cavity do the turbinates aid in? What about their structure contirbutes to this?
Increased surface area of these structures and their mucosa aids in:

1. Cleansing
2. Humidification
3. Temperature control of inspired air
What are paranasal sinusues?
Air filled cavities within the bones of the skull that are lined by mucous membranes
What are the 3 paranasal sinuses?
1. Frontal sinus
2. Maxillary sinus
3. Ethmoid sinus
What are the only 2 paranasal sinuses that are readily accessible to clinical examination?
1. Frontal sinus
2. Maxillary sinus
What are the 4 main things to ask about in a nose examination?
1. Pain
2. Discharge
3. Patency
4. Associated symptoms
6 characteristics about nasal discharge to ascertain in the HPI
1. Color
2. Consistency
3. Odor
4. Amount
5. Timing
6. Bilateral/unilateral
Define rhinorrhea
Drainage from the nose
Rhinorrhea is often associated with what?
Nasal congestion
Rhinorrhea and nasal congestion are often accompanied by what 4 associated symptoms?
1. Sneezing
2. Watery eyes
3. Throat discomfort
4. Itching in the eyes, nose, and throat
Itching as an associated symptom of rhinorrhea and congestion favors what cause?
An allergic cause
Seasonal onset or environmental triggers suggest what cause for rhinitis?
Allergic cause
When does drug-induced rhinitis occur?
With excessive use of decongestants or use of cocaine

**This is one reason to ask about what remedies the patient has been using and for how long [eg. Afrin]
With rhinitis, acute bacterial sinusitis is unlikely until when?
Until viral URI symptoms have persisted more than 7 days and both purulent drainage and facial pain are present.
What are 5 drugs that may induce nasal congestion?
1. Oral contraceptives
2. Reserpine
3. Guanethidine
4. Alcohol
5. Cocaine
5 conditions to consider if nasal congestion is unilateral
1. Deviated nasal septum
2. Nasal polyp
3. Foreign body
4. Granuloma
5. Carcinoma
Define patency
Condition of being open, expanded, or unobstructed
Define epistaxis
Bleeding from nasal passages, paranasal sinuses, or nasopharynx
When assessing for patency of nasal passages, what are the 3 things you need to ask about?
1. Congestion
2. Timing
3. Unilateral or bilateral
If the patient reports epistaxis, what must you clarify?
Make sure that the blood is from the nose and not from hematemesis or hemoptysis
Define hematemeis
Vomiting blood
Define hemoptysis
Coughing up blood
What are 3 drugs that can contribute to epistaxis?
1. Anticoagulants
2. NSAIDs
3. Coagulopathies
If the patient has epistaxis, what do you need to ask about more systemically?
You need to ascertain if there is bruising or bleeding elsewhere in the body to differentiate from a systemic bleeding disorder.
What are the first 2 steps of the nose examination?
Observe and palpate the external nose
What 3 things are you looking for when observing the external nose?
1. Swelling
2. Deformity
3. Erythema
What 3 things are you looking for when palpating the external nose?
1. Tenderness
2. Crepitus
3. Warmth
Tenderness of the nasal tip or alae suggest what?
Local infection [eg. furuncle]
What is crepitus?
A grating sound or sensation produced by friction between bone and cartilage
How do you test for nasal patency?
Press on each ala nasi in turn ask the patient to breath in.
Steps to inspecting the inside of the nose
1. Tilt patient's head back
2. Hold the patient's nose up with your thumb
3. Insert the tip of the speculum into the vetibule
4. Direct the speculum posteriorly then upwards step by step
What should you observe when inspecting inside the nose?
1. Inferior turbinate
2. Nasal septum
3. Mucosa
4. Discharge
When does a deviated septum become pathalogical?
When it impedes airflow through the nose.
How might a deviated septum affect trubinate growth?
The inferior turbinate will often grow to fill the space where the nasal septum was before deviation
How might the nasal mucosa be different in viral rhinitis versus allergic rhinitis?
Viral rhinitis - mucosa is reddened and swollen

Allergic rhinitis - mucosa may be pale, bluish, or red
After inspecting the nasal cavity, what is the next step in the physical examination?
Palpate the facial sinuses [maxillary and frontal]
What 2 things are you assessing for by palpation of the facial sinuses?
1. Tenderness
2. Bony abnormalities
What else should you do when examining the sinuses besides palpation? What is the purpose of this?
You should percuss the sinuses to assess for tenderness
After palpating and percussing the sinuses, what might be another useful diagnostic technique to identify fluid in the sinuses?
Transillumination
How is transillumination performed and interpreted
1. Darkened room
2. Place a bright light to the skin in the area of maxillary sinus [close to nose]
3. If light shines through and can be seen on the palate, then there is probably no fluid in the sinus
What is the specificity and sensitivity of transillumination?
Low specificity and low sensitivity
Describe nasal polyps
Pale, sac-like growths of inflamed tissue
If large, what effects might nasal polyps have on air flow and the sinuses?
May obstruct air passage or sinuses
5 conditions conducive to the development of nasal polyps
1. Allergic rhinitis
2. Aspirin sensitivity
3. Asthma
4. Chronic sinus infections
5. Cystic Fibrosis
What does a deviated septum look like on inspection?
The septum will be bowed
What is the risk of trying to remove a foreign body in the nasal passage with an instrument?
You might push the object further back into the canal
If possible, what is the best way to try and remove a foreign body from the nasal passage?
Have the patient close the opposing nares and blow
Describe nasal vestibulitis
The tip of the nose and nares are generally red
What organ system is usually the cause of nasal vestibulitis?
Dermatological problems
If nasal vestibulitis is recurrent, what might be the cause and what would test should you order?
It might be a bacterial infection and you should obtain a culture
What is the turbinate cycle?
The right and left turnbinates alternate between being enlarged and less so throughout the day.
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