{"id":1540,"date":"2010-12-06T11:26:05","date_gmt":"2010-12-06T11:26:05","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/anterior-rhinoscopy\/"},"modified":"2023-10-25T11:58:33","modified_gmt":"2023-10-25T10:58:33","slug":"anterior-rhinoscopy","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-ear-nose-mouth-throat-and-neck\/the-nose\/anterior-rhinoscopy\/","title":{"rendered":"Anterior Rhinoscopy"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Required Instruments<\/strong>\u00a0<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Head light <em><strong>[Figure 21]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Hartmann nasal speculum.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1535\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-21b.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-21b.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-21b-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 21<\/span><\/strong><\/span><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Examination Technique<\/strong><\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">For all examinations of the <span style=\"color: #33cccc;\"><strong>nose<\/strong><\/span>, the patient sits on a chair which provides adequate back support. <\/span><\/li>\n<li><span style=\"color: #003366;\">Sit on a height-adjustable stool beside or in front of the patient. <\/span><\/li>\n<li><span style=\"color: #003366;\">Your eyes should be at the <span style=\"text-decoration: underline;\">same height<\/span> as the patient\u2019s nose.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/122523024?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to hold their head slightly backwards so that the <span style=\"color: #33cccc;\"><strong>nostrils<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>columella<\/strong><\/span> become visible. <\/span><\/li>\n<li><span style=\"color: #003366;\">Aim the light from the head lamp in the nostril that is to be examined.<\/span><\/li>\n<li><span style=\"color: #003366;\">Hold the <span style=\"text-decoration: underline;\">nasal speculum<\/span> with your hand in a neutral position, between pronation and supination. <\/span><\/li>\n<li><span style=\"color: #003366;\">One leg of the speculum should lie in the palm of your hand in the groove between the thenar and hypothenar eminences <em><strong>[Figure 28]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Place your middle, ring, and little fingers against the other leg of the speculum. <\/span><\/li>\n<li><span style=\"color: #003366;\">The index finger should lie against the speculum blade <em><strong>[Figure 29]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1536\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-28.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-28.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-28-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 28<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1537\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-29.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-29.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-29-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 29<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Place the four fingers of your other hand on the patient\u2019s forehead and press the nasal tip slightly upwards using the thumb <em><strong>[Figure 30]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">This allows you to properly assess the position of the <span style=\"text-decoration: underline;\">columella<\/span> and the <span style=\"text-decoration: underline;\">frontal part<\/span> of the <span style=\"text-decoration: underline;\">nasal septum<\/span>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1538\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-30.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-30.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-30-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 30<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Insert the <span style=\"text-decoration: underline;\">closed<\/span> nasal speculum with the blade parallel to the nasal floor or with the opening at a <span style=\"text-decoration: underline;\">45\u00b0 angle<\/span> relative to the nasal floor <em><strong>[Figure 31]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">If necessary, use the thumb of your other hand to guide the speculum, to avoid touching the blood vessels of the <span style=\"color: #33cccc;\"><strong>Kiesselbach plexus<\/strong><\/span> or the <span style=\"color: #33cccc;\"><strong>nasal septum<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">If the tip of the nasal speculum has passed the <span style=\"color: #33cccc;\"><strong>nasal valve area<\/strong><\/span>, carefully <span style=\"text-decoration: underline;\">open<\/span> the speculum.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1539\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-31.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-31.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-31-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 31<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">The inferior, and occasionally the middle, turbinate are now visible. <\/span><\/li>\n<li><span style=\"color: #003366;\">Describe the <span style=\"color: #33cccc;\"><strong>mucosa<\/strong><\/span> covering these structures (<em>smoothness, colour, swelling<\/em>), plus the presence of any <span style=\"text-decoration: underline;\">pus<\/span>, <span style=\"text-decoration: underline;\">mucus<\/span> or <span style=\"text-decoration: underline;\">blood<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">The <span style=\"color: #33cccc;\"><strong>inferior<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>middle meatus<\/strong><\/span> should also be visible now and can be assessed for the presence of <span style=\"text-decoration: underline;\">pus<\/span>, <span style=\"text-decoration: underline;\">mucus<\/span>, <span style=\"text-decoration: underline;\">blood<\/span> or a <span style=\"text-decoration: underline;\">foreign object<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">If the <span style=\"color: #33cccc;\"><strong>nasal mucosa<\/strong><\/span> are <span style=\"text-decoration: underline;\">swollen<\/span> to such an extent that the middle turbinate and meatus cannot be inspected, repeat the examination once you have decongested the nasal mucosa.<\/span><\/li>\n<li><span style=\"color: #003366;\">Once you have finished the examination, remove the nasal speculum in a slightly open position from the patient\u2019s nose. <\/span><\/li>\n<li><span style=\"color: #003366;\">In this manner, you avoid trapping and removing any nasal hairs, which can be painful. <\/span><\/li>\n<li><span style=\"color: #003366;\">Clean the speculum with soap and water.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p style=\"padding-left: 30px;\"><span style=\"color: #003366;\"><em>In very young children, anterior rhinoscopy can be carried out more easily using an <span style=\"text-decoration: underline;\">otoscope<\/span> with a 6mm ear speculum attached.<\/em><\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Required Instruments\u00a0 Head light [Figure 21]. Hartmann nasal speculum. Figure 21 Examination Technique For all examinations of the nose, the patient sits on a chair which provides adequate back support. Sit on a height-adjustable stool beside or in front of the patient. Your eyes should be at the same height as the patient\u2019s nose. Procedure [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[39],"tags":[132],"class_list":["post-1540","post","type-post","status-publish","format-standard","hentry","category-the-nose","tag-the-examination-of-the-ear-nose-mouth-throat-and-neck"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Anterior Rhinoscopy - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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