Clinical Exammination Of Nose and Nasopharynx

Clinical Examination of the Nose and Nasopharynx


Most students are unaware of the interior dimensions of the nose, which extends horizontally backwards for 65–76mm to the posterior choanae. The inside of the nose may be obscured by mucosal oedema,septal devia- tions or polyps and only with practice is adequate visualization possible. The first requirement is adequate lighting. Ideally this is obtained with a head-mirror, but a bright torch or auriscope provide reasonable alternatives.


Anterior rhinoscopy


Anterior rhinoscopy is carried out with Thudichum’s speculum, which is introduced gently into the nose.The nasal mucosa is very sensitive! In children, a speculum is often not necessary as an adequate view can be obtained by lifting the nasal tip with the thumb. On looking into the nose the anterior septum and inferior turbinates are easily seen. It is a common error to mistake the turbinates for a nasal polyp.If you examine enough noses,you will not make that mistake.

 

Nasal endoscope


Rigid or fibre-optic endoscopes have made examination of the nasophar- ynx much easier.The instrument is introduced through the nose and the postnasal space can be inspected at leisure.It has the advantage of allowing photography and simultaneous viewing by an observer.It also allows minute inspection of the nasal cavity.


Assessment of the nasal airway


Assessment of the nasal airway can be made easily by holding a cool polished surface, such as a metal tongue depressor, below the nostrils.The area of condensation from each side of the nose can be compared.