Patients with complaints of nasal dysfunction quite often turn to doctors of various specialties. Starting from allergic rhinitis and ending with complex surgical pathology – complaints about a nose disease can be very similar, and every practicing doctor, and especially such narrow specialists as otorhinolaryngologists, must be able to properly examine the nose and paranasal sinuses, and suspect this or that disease in time.
The nose diagnostic technique includes several main steps, the sequential implementation of which will help in making the correct diagnosis.
First stage: inspection and palpation of the nose and sinuses
The primary stage in the diagnosis of the nose is its external examination and palpation. The external nose and sinus projection sites are examined for swelling, hyperemia, violations of the integrity of the skin, and so on. Palpation of the external nose is carried out as follows: the index fingers are located along the back of the nose and all its parts are felt: root, back, tip and wings.
To palpate the walls of the frontal nasal sinuses, the thumbs are placed on the patient's forehead under the eyebrows, and moved to the inner corner of the eye with soft pressure movements. During palpation of the maxillary sinuses, the thumbs are pressed in the region of the canine fossa of the maxillary bone.
Normally, palpation is painless. They complete the general examination of the nose with palpation of the submandibular and cervical lymph nodes, the increase and soreness of which indicates the presence of pathology.
Second stage of nose diagnostics: rhinoscopy
The second stage in the diagnosis of the nose is rhinoscopy – inspection of the nasal cavity. Rhinoscopy should be carried out under special artificial lighting, which is created using a frontal reflector or an autonomous light source. To examine the nasal cavity, use & nbsp; a special nasal speculum-nasodilator. First, the vestibule of the nose is examined by lifting the tip of the nose with a finger.
Normally, it should be free and have hair. Then, one by one, a nasal speculum-nasal dilator is inserted into each nostril of the patient by 0.5 cm and the nasal cavity is examined. Normally, the nasal concha should not be dilated, the nasal passages are free, the mucous membranes are pink, smooth and moist, the nasal septum is located along its midline.
Third stage of nose diagnosis: assessment of nasal functions
The next step in diagnosing the nose is to assess its respiratory and olfactory functions. To assess the respiratory function of the nose, the doctor pinches each nostril in turn with the finger of one hand, and brings a small piece of ordinary cotton wool to the second nostril and asks the patient to take a short breath and exhale. The respiratory function of the nose is assessed by the vibrational movements of vata. Respiratory function of the nose may be normal, difficult or absent.
To assess the olfactory function of the nose, a special ophthalmic kit with odorous substances or an olfactometer device is used. An odorous substance is brought to each nostril of the patient, with the second nostril closed, and the patient is asked to rate the odor. The olfactory function of the nose may be normal (normosmia), reduced (hyposmia), perverted (kakosmia) or completely absent (anosmia).
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Fourth stage of nose diagnosis: X-ray of the sinuses
X-rays for nasal pathology are performed primarily to assess the condition of the sinuses. There are several main methods of x-rays of the sinuses:
- X-ray of the nasal sinuses in the occipital-frontal projection helps to visualize the frontal, and to a lesser extent the ethmoid and maxillary sinuses;
- X-ray of the nasal sinuses in the naso-chin projection provides maximum information about the state of the frontal and maxillary sinuses;
- radiography of the nasal sinuses in the lateral or profile projection allows you to assess the condition of the frontal, sphenoid and ethmoid sinuses in their lateral image;
- X-ray of the nasal sinuses in the axial projection allows a good differentiation of the sphenoid sinuses from each other and the most accurate assessment of their condition.
Fifth stage of nasal diagnostics: endoscopy of the nasal cavity and sinuses
The most informative modern methods of nose diagnostics are endoscopic methods. For endomicroscopy of the nasal cavity and sinuses, special optical systems and rigid and flexible endoscopes with different viewing angles are used, which help to see and assess the condition of the nasal cavity and sinuses as accurately as possible. Endoscopic methods for diagnosing the nose are almost completely painless and can be used not only for diagnostic purposes, but also for therapeutic purposes.
A complete step-by-step examination of the condition of the nose and evaluation of its functions help to assess the condition of the nose as accurately as possible and complete the process of diagnosing the nose with a reliable diagnosis.
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