👃 Flashcards
Technique of external nose inspection :
Sit in front of patient.
Assess skin : color, swelling, wound, scars, pustule
Pressure on tip to widen nostrils : shape, size, symmetry
- tenderness of tip => local infection
Use penlight / otoscope to view nasal vestibule
Technique of internal nose inspection ?
Patient sit straight holding head up
Push tip of nose to clear the view. Use headlamp / penlight.
Assess : patency, appearance of mucous, discharge, scabs, polyps, swellings
Test for nasal obstruction / patency ?
Watch for swellings, tenderness, abnormal mobility, irregularities
Use thumb to close of nostrils, listen to inspiration flow : almost always physiological difference in patency of both nostrils.
What can you find on the nasal septum ?
Fresh blood / crusting => septal perforation due to surgery or use of intranasal drugs
Nasal polyps : pale sac like growth => allergic rhinitis, aspirin, asthma, cystic fibrosis,…
Malignant tumor => tobacco, toxins
Deviation : common seldom obstruct airflow
Hematoma => after trauma takes long time to reverse => can lead to collapse of septum => saddle nose
Nasal mucosa : red/swollen (viral rhinitis), pale, bluish, red (allergic rhinitis)
Palpation of sinuses ?
To feel tenderness, pressure, fullness
Press up the frontal sinuses under the bony brow
Press up maxillary sinuses
- acute bacterial rhinosinusitis : tenderness and facial pain, pressure, fullness, nasal discharge/obstruction
Examination on indication of the nose ?
Anterior rhinoscopy : observe interior of nose
Palpation and patency of nose : especially following trauma
Examination of nasal sinuses
Sense of smell test
Technique of anterior rhinoscopy ?
In front of patient with non sterile gloves. Inspect with headlamp and speculum.
Tilt patient’s head back and insert speculum halfway with blades parallel to nasal floor into vestibule of nostrils. Avoid contact with nasal septum.
Open speculum, place finger on nose tip for support. Inspect.
While pulling out beware of not trapping a hair : do not close the blade fully unless you are out.
What can you inspect in an anterior rhinoscopy ?
Nasal septum : shape, spine, crest, alignment, ulceration, Kiesselbach’s plexus, appearance of mucous, perforation
Inferior turbinates and middle turbinates : shape, size, appearance of mucous
Inferior meatus and middle meats : patency, secretion
Polyps, tumor, foreign bodies
Examination of nasal sinuses ?
Test for percussion/palpation pain
Test for diaphane / translucency : hold lamp against underside of cheekbone in dark room
- compare both cheeks
- if mucous membrane swollen or presence of pus => less light
Cause of misalignment of the nose ?
Sometimes visible externally and may exhibit abnormal mobility.
Nasal fracture : rapid swelling, very painful
Boxer’s nose : bridge has collapse, narrowing nostrils
External examination findings of nose :
Furoncles on the tip : may be dangerous because of the link between those blood vessels and the brain.
- lead to meningitis / cavernous sinus thrombosis
External nasal valve problem
- nostrils drawn in when inspiration
Rash around nose : impetigo
- yellow pus that crusting
- can also occur near the mouth
Cause of bilateral nasal blockage ?
Swelling of mucous membrane caused by infection
Allergic rhinitis with turbinate hypertrophic
Nasal septal deviation
Nasal polyps
Cause of unilateral obstruction ?
Foreign body/nasal tumor
Cause and signs of sinusitis ?
Nasal blockage, painful maxillary and frontal sinuses, cold, ill health.
Headache when bending forward
Odontogenic sinusitis : caused by dental pathology
Diagnosis require : endoscopy, CT scan
Enlarged adenoid ?
Common cause of blockage for children.
Snoring, apnea
Can occlude Eustachian tube ==> prevent aeration and drainage of middle ear => glue ear
