Components of the Nasal Examination

Abstract

Along with patient history, the physical examination is the key component for any patient encounter. Determining what should be included in the nasal examination is critical. Practicing evidenced-based medicine calls for an integration of the clinical/surgical expertise of the provider, the individual patient's needs and preferences, and the application of the current best medical knowledge found in the literature, so the results of a survey on current practices can help physicians place their own practice in context. The author presents the results of a survey on current practices in nasal examination and gives an evidence-based review of those practices. The attendees of the 2011 Rhinoplasty Society meeting in Boston, Massachusetts, were asked to complete a questionnaire concerning components of the nasal examination in functional cases. The questionnaire was completed by 49 of 60 attendees. Results showed that anterior rhinoscopy is routinely part of the exam to assess for nasal function. The majority of respondents use a patient questionnaire to assess function, followed in decreasing frequency by response to decongestant spray to confirm evidence of turbinate hypertrophy, nasal endoscopy, computed tomography scan, rhinomanometry, acoustic rhinometry, Cottle maneuver, and response to nasal strips to assess for internal and/or external nasal valve compromise. The results of this physician survey and literature review supports the inclusion of anterior rhinoscopy, patient questionnaire, endoscopy, decongestant spray rhinomanometry, and nasal strips as important components of a nasal examination.