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Respiratory Exam
 
 

The Nasal Cavity

 
 
 
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Overview

The nasal cavity warms, filters and adds moisture to inhaled air. By inspecting the nasal cavity it may be possible to assess for obstruction impeding respiration, inflammation or other pathology.
  • How to Perform

  • Use an otoscope to inspect straight backward into the nasal cavity.
  • Look For

  • Nasal mucosa - swelling / erythema, ulcers, polyps, irregular masses, foreign bodies
  • Nasal septum - deviation, perforation
  • Nasal discharge - mucus or blood

Nasal Septal Deviation

  • Look For

  • Deviation of the nasal septum to one side.
  • Causes of Nasal Septal Deviation

  • Congenital deviation
  • Trauma

Nasal Septal Perforation

  • Look For

  • A hole or fissure within the nasal septum.
  • Causes of Nasal Septal Perforation

  • Trauma
  • Previous septal surgery
  • Cocaine inhalation
  • Chronic intranasal steroid use
  • Infection - syphilis, HIV, tuberculosis, mucormycosis
  • Autoimmune disorders - granulomatosis with polyangiitis (Wegener's), SLE
  • Sarcoidosis
  • Malignancy

Nasal Discharge

  • Interpretation

  • Clear discharge - suggestive of allergic rhinitis, viral URTI or CSF leak
  • Purulent discharge - suggestive of URTI or sinusitis
  • Causes of Nasal Discharge

  • Infection - URTI, sinusitis
  • Hypersensitivity - allergic rhinitis
  • CSF leak - due to base of skull fracture
  • Epistaxis - physiological, traumatic, coagulopathy
  • Tip

  • In patients with clear nasal discharge and no symptoms of URTI, suspect a CSF leak. Look for raccoon eyes and battle sign as an indicator of base of skull fracture.
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