External Inspection & Palpation

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’s nose.

Ask the patient to hold their head up straight and aim the light of the examination lamp or head light onto the patient’s nose.
Describe the colour and smoothness of the covering skin.
Assess the position of the nose and look for any visible swellings.
Ask the patient to hold the head slightly backwards so that the nostrils and the columella become visible.
Check whether the nasal columella is straight.
Press the tip of the nose slightly upwards with your thumb [Figure 22].
The frontal part of the nasal vestibulum will now become visible.

Figure 22

Check if there is any pus, mucus, blood or possibly a foreign object visible in the nose.
In this position, occasionally the inferior turbinate and nasal cavity will be visible.
Assess the colour and any swelling of the turbinate mucosa and accessibility of the nasal cavity.
Again, check for the presence of pus, mucus, blood, or a foreign object.
Take hold of the nasal bone between thumb and index finger [Figure 23] and move the covering skin carefully over the bony part of the nasal skeleton.
Note any swellings and other irregularities on the surface that may indicate recent or old damage to the nasal bone.
Ask the patient whether this is painful.
Whilst feeling the nose with your fingers in this manner, palpate towards the nasal tip.
For any swellings that you may come across, describe the size, perimeters, surface, consistency, and mobility in relation to the surrounding structures.

Figure 23

Finally, assess the accessibility of the nose.
To do this, first close off one nostril and then the other by placing a finger on the underside of the nostril [Figure 24].
Make sure to wear a glove.
Then ask the patient to inhale and exhale through the opened nostril.

Figure 24