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Anterior Rhinoscopy: Types, Examination and Methods

It consists of the following steps

• Examination of the vestibule (Skin lined part of the nares)
• Examination of the nasal cavity using the Thudichum's speculum
• Patency tests
• Probe test

Examination of the vestibule

• This is carried out by tilting the tip of The lining which is skin and has all the dermal appendages (Hair, sebaceous glands etc.). All the diseases affecting these adnexa can occur in the vestibule.
• Boil causes swelling in the roof and lateral wall.
• Ulceration may be neoplastic, infective.
• Excoriation because of discharge.

Examination of the nasal cavity using a speculum

Nasal speculum

It is an inverted 'U' shaped instrument. It has two blades at the lower end.

Method of holding the instrument

• Hold it in the left hand keeping the right hand free for other instruments. Pick the instrument with the thumb and the index finger of the L hand with the blades directed towards the elbow.
• The loop is directed downwards.
• Pronate the forearm and flex the wrist there by aligning the blades with the nares.
• The legs of the speculum are controlled by the middle and the ring fingers.

Use of the speculum

• The axis of the anterior nares is upwards and backwards, whereas that of the posterior nares is horizontally backwards. Lift the tip of the nose with the blades so that the two axes are in straight line Introduce the speculum with the blades closed..
• Introduce the speculum in an upwards and backwards direction.
• Once inside the nose, gradually open the blades avoiding discomfort to the patient.
• Look at roof, floor, lateral and medial walls of the nose.
• Septum: Position, spurs, deviation, colour of mucosa, ulcers, crusting, vessels, and perforations.
• Lateral wall: Inferior and middle turbinates, size ,colour, shape.
• Meatii for pus and discharge, and polyps.
• Middle meatus is situated higher up so tilt the head backwards at an angle of 45. If any growth or polyp is suspected confirm by the probe test.

Probe test

It is carried out by spraying the nose with 4% Lignocaine with 1:100000 adrenaline or 10% cocaine. The lesion or area is palpated to determine its character and mobility.

Patency test

By placing a cold tongue depressor or a wick of cotton below the nostril, nasal patency can be assessed. Compare the two sides always.

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