Anterior rhinoscopy

The nose is both the sense organ and a respiratory organ. Anterior rhinoscopy is an examination of the nasal cavities enabling to note 1. nasal secretions, 2. swelling of the turbinates, 3. properties of the mucosal surface, 4. position of the nasal septum, 5. ulcerations or 6. presence of foreign bodies. The students are usually capable to observe o the position of nasal septum with possible nasal deformities, o inferior nasal turbinate and o the quality of nasal mucosa. The nasal cavity can be examined in vivo either through a nostril or through the pharynx. A nasal speculum in a nostril is used in anterior rhinoscopy. A postnasal mirror inserted into the pharynx through the mouth enables the choanae to be inspected in posterior rhinoscopy (figs. 52-4 and 53-11B).

Posterior rhinoscopy. A shows the placement of the mirror, and B the structures seen

Figure 53-11. Ear, nose, and throat in vivo. A, The right tympanic membrane, showing the handle of the malleus. Ct. fig. 44-2. B, The nasopharynx and nasal cavities as seen in a mirror placed on the posterior pharyngeal wall. Note the posterior edge of the nasal septum, inferior nasal concha, and (on the right side of the illustration) the opening of the auditory tube. Ct. fig. 52-4. C, The larynx on inspiration, as seen in a mirror placed on the posterior pharyngeal wall. Note the epiglottis, ary-epiglottic folds, and (on the left side of the illustration) cuneiform cartilage, vestibular and vocal folds, and trachea. Cf. fig. 53-2. D, The larynx on phonation, as seen in a mirror. Note the vestibular and vocal folds: the latter are now approximated. (All photographs courtesy of Paul H. Holinger, M.D., Chicago, Illinois.)

Right tympanic membrane, lateral aspect. The interrupted lines delimit the quadrants. The umbo is approximately opposite the promontory of the middle ear. The head of the malleus and the body and short crus of the incus are in the epitympanic recess, above the level of the tympanic membrane. Cf. fig. 53-11A

Scheme of respiratory and digestive cavities in the head and neck. Note that the pharynx acts as a common channel for both respiration and deglutition and that the air and food passages cross each other.

Method Anterior rhinoscopy is only carried out after inspection without instruments. The observer should note o properties of the overlying skin, o externally visible changes in shape of the cartilaginous or bony structures,

o nasal vestibule, e.c. Then, the speculum is introduced into the nasal vestibule with its blades together. The point of the speculum is directed somewhat laterally in the nasal vestibule and the speculum is then opened out. The patients head is initially in vertical position, allowing the examiner to observe inferior turbinate and the inferior meatus. The patients head is then tilted slightly backward to allow the upper part of the nasal cavity to be examined. The instrument is held slightly open while removing it to prevent pain due to avulsion of vibrissae.