NOSE & SINUSES

• External Nosenormal findings

  • Note size, shape, and symmetry
  • Midline placement
  • Shape symmetrical and consistent with age, gender, and race/ethnic group
  • No nasal flaring
  • No drainage
• Deviations from normal external nose

  • Misalignment of nose or shape inconsistent with patient's biographical information
  • Previous trauma
  • Congenital deformity
  • Surgical alteration
  • Mass
  • Acromegaly
  • Down syndrome
• Nasal flaring


  • Suggests respiratory distress, especially in infants, who are obligatory nose breathers
• Types of nasal drainage

  • Clear, bilateral drainage (Cerebrospinal fluid leak, Allergic rhinitis)
  • Clear, unilateral drainage (Head trauma or fracture)
  • Clear, mucoid drainage (Viral Rhinitis)
  • Yellow or green drainage (Upper Respiratory Infection)
  • Bloody drainage (Trauma, Hypertension, Bleeding disorders)
• Internal Nosenormal findings

  • Pink, variations consistent with ethnic group/race and with oral mucosa
  • Moist, with only clear, scant mucus present
  • Intact, with no lesions or perforations
  • No crusting or polyps
  • Septum located midline
• Deviated septum


  May appear to be an overgrowth of tissue, but is a normal finding as long as breathing is not obstructed
• Turbinates


  • Cleanses and humidifies air that goes into the lungs
  • Middle turbinate is located more medially
  • Inferior turbinate is more lateral
  • Superior turbinate is not visible
  • Medial and inferior turbinates visible, symmetrical and shape/size consistent with general features of patient
  • Overlying mucosa coloring consistent with other mucous membranes
• Deviations from normal turbinates

  • Enlarged, boggy turbinates (Allergic disorder)
  • Bright red mucosa (Inflammation from rhinitis or sinusitis, Cocaine abuse)
  • Pale or gray (Allergic rhinitis)
  • Copious or colored discharge (Allergic or infectious disorder, Epistaxis, Head or nose trauma)
  • Clustered vesicles (Herpes infection)
  • Ulcers or perforations (Chronic infection, Trauma, Cocaine use)
  • Dried crusted blood (Previous epistaxis)
  • Polyps (Allergies, Irritation, Chronic infections)
  • Deviated septum (Trauma)
• Palpation of the Nose

  • Cartilaginous portion is slightly mobile
  • Nontender, no masses
  • Nares patent
• Deviations from normal palpation

  • Deviations or masses
  • Previous trauma or infection
  • Septal Deviation (Treatment: Septoplasty)
• Nasal flaring occurs when your nostrils widen while breathing. It may be a sign that you're having difficulty breathing. It's most commonly seen in children and infants. In some cases, it can indicate respiratory distress.