• Position and expose as for ear examination. Perform with headlight.
General inspection (from the front)
• Listen to the voice and breathing.
• Inspect face, eyes, lips and mouth.
External examination of the nose
• symmetry: height, width, bony deformity, septal deviation
• scars: columella, lateral rhinotomy, Lynch-Howarth, bicoronal
• skin: erythema, rash, swelling, ulcer
• alar collapse
• profile: dorsal hump, saddling, tip ptosis
• narrowing of external nasal valve
• Skin: quality
• Nasal bones: steps, fractures
• Nasal tip support and recoil
• Misting test/nostril occlusion
• Cottle's manoeuvre
Internal examination of the nose
• Elevate tip.
• Inspect position of the caudal septum: dislocation/deviation.
• Inspect the external nasal valve.
• Anterior rhinoscopy with Thudicum's speculum: nasal vestibule, septal deviation, septal perforation, mucosa (rhinitic), turbinates (congested), polyps, papillomas, granulomas, tumours, ulcers, crusting, Little's area (prominent vessels), telangiectasia.
• Rigid nasendoscopy.
• Inspect and percuss the upper teeth for dental disease.
To complete the examination…
• Regional lymphadenopathy.
• Cranial nerve examination and ear examination if evidence of postnasal space lesion.
Full aesthetic assessment of the nose is beyond the scope of this chapter. Start by examining from the front.