Examination of the nose

Comprehensive examination of the nose without specialist ENT equipment is difficult. Some quick basic steps can give you useful information.

Straightness

If the tip of the nose or the bridge of the nose is significantly deviated then it is likely that the septal cartilage will also be bent, if a patient is complaining of asymmetrical nasal obstruction in this instance it is possible that surgery may help.

Tip/Profile

A dorsal hump does not always mean that the nose has been broken in the past. A lot of patients, especially men, will naturally have a dorsal hump. A dip in the nose just above the tip is usually abnormal (supra-tip depression, and might result from cartilage loss secondary to infection, trauma or previous surgery (particularly aggressive sub mucous resection of the septum)

Anterior Nares

In children, lifting the tip of the nose with the thumb allows quite a good view of the nasal cavity with a torch or otoscope. In adults, the view is not as good but it is worth doing this anyway as anterior septal deviations, vestibulitis, alar collapse and other conditions may be seen and can be missed by passing an otoscope too far into the nose.

Palpation

Palpation of the lower third of the nose (squeezing gently between finger and thumb) can give you an idea whether the anterior septum is in the midline or is significantly deviated to one side. Anterior septal deviation are generally more symptomatic than posterior ones so an asymmetry picked up this way is usually a significant cause of obstruction.

Assessment of Airflow

The sensation of nasal airflow is very subjective. Scientific methods of measuring nasal resistance have found little use in clinical practice. To quickly assess airflow you can obstruct each side at a time with a finger or thumb and ask the patient to sniff or inhale, significant nasal obstruction can be picked up fairly easily.

Rhinoscopy 

Outside an ENT clinic, an otoscope with a large speculum is the best instrument to use to examine the nose. In most cases it should be possible to see the nasal septum and inferior turbinate, and in some cases the middle turbinate. Using a decongestant spray will allow you a better view of the nasal cavity if the mucosa is very swollen.