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Examination of the nose and throat

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Principal Nasal Symptoms

airway obstruction runny nose (rhinorrhoea) sneezing loss of smell (anosmia) facial pain due to sinusitis snoring associated with nasal obstruction

05/01/23 © Clinical Skills Resource Centre, University of Liverpool, UK

Inspection Nose

Shape- Deviation. Look from the sides & from above.

Deformities – Abnormal Nasal Creases Scars Discharge or crusting Redness or evidence

of skin disease Offensive odour (From the Patient) Rhinorrhoea

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Inspection Inspect the front of the nose first

by tipping the nose up and inspecting without a speculum.

Insert a Thudicum speculum into the appropriate nostril. A light source is required to visualise the internal structures.

You should be able to identify the septum medially, the turbinates laterally. The inferior turbinates should be easy to visualise.

Thudicum Speculum

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Inspection Inspect for

inflammation (Rhinitis)

Comment on the septum. Is it straight or deviated.

Look in the mouth. Occasionally large polyps or tumours may be visible from arising behind the soft palate.

Polyp right nostril

TURBINATE

SEPTUM

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Palpation If you see what you believe is a polyp then

it is useful to assess sensitivity. Polypsare not sensitive to touch whereas turbinates are tender to touch.

Polyps are grey / yellow whereas turbinates are pink.

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Nasal Airway Assessment Hold a cold metal tongue depressor under the

patient’s nose whilst they breath in and out through their nose. Condensation should be visible as air passes over the metal.

To assess nasal airway efficiency. Occlude one nostril and ask the patient to sniff. This gives a reasonable idea on nasal airway efficiency.

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Throat Examination

History.Enquire on general history.

Sore throat, feeling run down, visible lesions & causing pain.

Ask about alcohol & tobacco habits.

Ask about their general dental history.

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Inspection 1Ask the patient to remove any dentures. Inspect the lips. Note the Vermillion border

& the corners of the mouth for any deviation.Retract the upper lip with the front teeth

closed together. Note the maxillary labial frenum, gingivae, mucogingival line with teeth.

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Vermillion border

maxillary labial frenum

gingivae

mucogingival line

Inspection 2

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Inspection 3 Note oral hydration Halitosis? Note any varicosities,

missing teeth, dental carries, ulceration or haemangiomas.

Use a bright light & a tongue depressor, inspect the tonsils, uvula and the soft palate. Ask the patient to tilt their head upwards to inspect the hard palate.

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Inspection 4 Note the mucosal lining of the cheeks, noting

Stensen’s glands. (See slide 13.) Located behind the 2nd molar. It carries saliva from the Parotid gland.

Any blockage can render the mouth dry.

Note the frenum. Note any ulceration / discharge.

Ask the patient to lift their tongue upwards to inspect the floor of the mouth. Note if the tip of the tongue can touch the roof of the mouth. Failure to do so may indicated tongue tie. (Ankyloglosia.)

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Parotid The parotid salivary gland is

located over the mandibular ramus, anteriorly and inferiorly to the ears.

Inspection of stensen’s duct may require inspection if the mouth is dry or if any parotid swelling is detected upon external palpation.

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Parotid Palpation Palpated bilaterally

Start palpating anterior to the ears and move towards the cheek and then inferiorly towards the angle of the mandible.

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Inspection 4Any further examination of the larynx

requires specialised equipment.

Inspection of the oral cavity may also have a neurological element. C.N’s 7.9 &12