Examination of the Nose

Anterior Nose Examination
Fig. 1.44 Examining a child. Instruments are best avoided in children. A good anterior view of the nose can be obtained simply by pressing on the tip of the nose. In this case, a clear view is obtained of a pedunculated papilloma of the nasal vestibule (arrow).
Nasal Speculum Exam

Fig. 1.45a Speculum examination shows the nasal vestibule, the septum anteriorly (particularly Little's area—see Fig. 3.80), and the inferior and middle turbinates anteriorly. b There are several different types of nasal speculum used throughout the world. The ones demonstrated here are Thudicum (left) and the Killian (right) speculums.

Fig. 1.45a Speculum examination shows the nasal vestibule, the septum anteriorly (particularly Little's area—see Fig. 3.80), and the inferior and middle turbinates anteriorly. b There are several different types of nasal speculum used throughout the world. The ones demonstrated here are Thudicum (left) and the Killian (right) speculums.

Thudicum Nasal Speculum
Fig. 1.46 Nasal speculum examination.
Nasal Speculum Exam
Fig. 1.47 A nasal endoscope is necessary for a thorough examination of the nasal cavities, the mucosa having been sprayed with surface anesthetic.
Speculum Examination

Fig. 1.48 Mirror examination of the postnasal space. This is not easy, particularly in children. With a patient who gags easily, or whose soft palate is close to the posterior wall of the oropharynx, a view may be impossible. With a fiberoptic endoscope (Fig. 1.47), however, a clear view of the postnasal space is obtained, and instrumentations for biopsies of the postnasal space via the fiberoptic endoscope are available.

With the endoscope, however, the postnasal space may be seen more clearly, and a soft tissue lateral x-ray shows the adenoids or other pathology in this region.

Fig. 1.48 Mirror examination of the postnasal space. This is not easy, particularly in children. With a patient who gags easily, or whose soft palate is close to the posterior wall of the oropharynx, a view may be impossible. With a fiberoptic endoscope (Fig. 1.47), however, a clear view of the postnasal space is obtained, and instrumentations for biopsies of the postnasal space via the fiberoptic endoscope are available.

With the endoscope, however, the postnasal space may be seen more clearly, and a soft tissue lateral x-ray shows the adenoids or other pathology in this region.

Rhinometry

Fig. 1.49 Rhinometry techniques gives a quantitative measurement of nasal airways. Many methods have been employed, but the anterior active method has gained most acceptance. The pressure is measured through one nostril, while the flow is measured through the opposite side using a face mask and pneumotach. Rhinometry has yet to become of sufficient clinical value to be of routine use in the assessment of nasal obstruction, as the threshold of nasal obstruction or "congestion" of which the patient complains correlates poorly with air pressure measurements.

Fig. 1.49 Rhinometry techniques gives a quantitative measurement of nasal airways. Many methods have been employed, but the anterior active method has gained most acceptance. The pressure is measured through one nostril, while the flow is measured through the opposite side using a face mask and pneumotach. Rhinometry has yet to become of sufficient clinical value to be of routine use in the assessment of nasal obstruction, as the threshold of nasal obstruction or "congestion" of which the patient complains correlates poorly with air pressure measurements.

Acoustic Rhinometry Graph Images

Fig. 1.50 Acoustic rhinometry. Noise introduced into the nasal vestibule is reflected from the interior of the nose. With a widely patent nasal airway, the reflection of sound is delayed and less intense than with nasal obstruction. Hence, a graph of normality can be made, and acoustic rhinometry is one recent objective measurement for nasal airway.

Fig. 1.50 Acoustic rhinometry. Noise introduced into the nasal vestibule is reflected from the interior of the nose. With a widely patent nasal airway, the reflection of sound is delayed and less intense than with nasal obstruction. Hence, a graph of normality can be made, and acoustic rhinometry is one recent objective measurement for nasal airway.

Noisy Sinus Radiographs

Fig. 1.51 Sinus radiographs have largely been displaced by CT scans for the investigation of sinus disease.

Plain radiographs are, however, helpful in diagnosis, showing opacity, indicating infection or polyposis and bone expansion or erosion, suggestive of neoplasm. Plain radiographs are also inexpensive and involve minimal radiation compared to CT scans.

Fig. 1.51 Sinus radiographs have largely been displaced by CT scans for the investigation of sinus disease.

Plain radiographs are, however, helpful in diagnosis, showing opacity, indicating infection or polyposis and bone expansion or erosion, suggestive of neoplasm. Plain radiographs are also inexpensive and involve minimal radiation compared to CT scans.

Ethmoid sinus

Nasal septum

Ethmoid sinus iddle turbinate

Ethmoid sinus

Ethmoid sinus

Nasal septum

Scan Ethmoid Sinus

iddle turbinate

Fig. 1.52 A CT scan of the sinuses gives precise detail, particularly of the eth-moids, which are not well seen on the plain radiograph. The CT scan is important prior to sinus surgery. The left maxillary antrum is seen to be opaque on this radiograph from infection, but the left ethmoids are clear. Some minimal mucosal thickening (which would not be detected on plain radiographs) is seen in the right ethmoid sinus.

Fig. 1.53 Transillumination. A bright light held inside the mouth in a dark room is an investigation very rarely used. A dull antrum is, however, an additional sign in the diagnosis of maxillary sinus disease. Transillumination is useful to assess whether a sinusitis is settling. Dental cysts involving the antrum tran-silluminate brightly.

Transillumination Sinuses

Fig. 1.54 Sinus endoscopy (antroscopy). A narrow endoscope inserted into the maxillary antrum, either through the thin bony wall of the canine fossa intraorally or via the inferior meatus of the nasal fossa under the inferior turbinate, gives a good view of the interior of the maxillary sinus, and is helpful in diagnosis.

Transillumination Maxillary Sinus

Fig. 1.53 Transillumination. A bright light held inside the mouth in a dark room is an investigation very rarely used. A dull antrum is, however, an additional sign in the diagnosis of maxillary sinus disease. Transillumination is useful to assess whether a sinusitis is settling. Dental cysts involving the antrum tran-silluminate brightly.

Dental CystPostnasal Space

Fig. 1.56 The postnasal space seen with a fiberoptic endoscope. A panoramic Fig. 1.55 The ostium of the maxillary view showing most of the anatomical fea-sinus seen through the endoscope. turees photographed through the fiberoptic endoscope (see Figs. 1.3, 1.47). (Left arrow: Eustachian orifice; middle arrow: posterior end of inferior turbinate; right arrow: posterior border of septum.)

Fig. 1.56 The postnasal space seen with a fiberoptic endoscope. A panoramic Fig. 1.55 The ostium of the maxillary view showing most of the anatomical fea-sinus seen through the endoscope. turees photographed through the fiberoptic endoscope (see Figs. 1.3, 1.47). (Left arrow: Eustachian orifice; middle arrow: posterior end of inferior turbinate; right arrow: posterior border of septum.)

Normal Postnasal Space

Fig. 1.58 A postnasal cyst (Thorn-valdts, arrow) demonstrated with a fiberoptic photograph of the postnasal space.

Fig. 1.57 The postnasal space.

Enlarged view of Fig. 1.56 to show the eustachian orifice (1) and posterior ends of the middle (2) and inferior (3) turbinate.

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Responses

  • Erik
    Why thudicum nasal speculum is not used in children?
    4 years ago
  • felix
    How to use nasal speculum during nose examination?
    2 years ago
  • david
    What is the purpose of the speculum to evaluate the nasal mucosa?
    23 days ago

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