Method of examination of the sinus nose

2021-01-31 12:00 AM

People also use the nasal gas meter (Rhinometries) to measure the breathing pressure of each nasal cavity is more specific or can be recorded on paper for evidence.

Asked the disease

Patients when examining the nose and sinuses have many reasons: stuffy nose, runny nose, sneezing or not being able to smell, cough up sputum or have a headache, blurred vision, tired neck ...

To know about the disease: to determine the time of onset, progress and status of the disease, what drug was treated? Besides, it is necessary to ask about the professional and family status to see the causes and related to the disease.

The main symptoms: 

Nasal congestion: is the main symptom of nasal congestion, duration and degree of nasal congestion, one or two sides, related to weather, head position and other symptoms.

Nasal discharge: evaluating the nature, severity and duration of the run, its course and its relevance to the weather, to other factors and symptoms.

Loss of smell: changes in smell, duration, degree, and relevance to other symptoms.

Pain: also, common, spontaneous or induced, nature, location, severity and duration of pain, relative to other symptoms, diffuse, in association with other symptoms.

Sneezing: the wall of the colon elongated or just a few times?

Physical examination of the nose

Nasal exam tools

Clar lights.

Frontal mirror.

Sticky tongue.

Dome mirror.

Speculum sizes.

Elbow.

Alcohol lamp.

Probes.

External examination

Look and touch the base of the nose, bridge of the nose, wings of the nose, press the front of the sinuses to detect deformities, deformations, changes and pain points.

Internal examination

Nasal vestibule: lift the top of the nose with your finger to observe the vestibular area of ​​the nose for boils, ulcers ...

Nasoscope first: use to open the nose, examine the nasal cavity which holds the tool with that hand. Gently open the nose into the nasal cavity in a closed position, when entering the nasal cavity, open the nose open to wide. Look at the horizontal and vertical axes. Usually, the lower nose is swollen, covering the nasal passages, then put a small piece of cotton soaked in a vasoconstrictive solution such as: Ephedrine, Naphazoline, Xylocaine 1-2 minutes, after causing nasal constriction, check again to observe More thoroughly and completely, evaluate the response of nasal aspiration to vasoconstrictor drugs.

Nasal septum: straight, legs slightly bulging into ridges, mucous membranes pale pink, smooth, wet.

Lower nasal roll: smooth, pink or light red, wet with good elasticity when the drug is placed.

Middle nose roll: smooth, pink white.

Medial, lower, and nasal passages: clean, free from fluid, pus stasis, pale pink smooth mucosa.

Postnasal examination: to observe indirectly (through the mirror) of the nasopharynx, posterior nasal door, speaker and mouth of the eardrum. Use tongue pressure and rear-view mirror.

Scanning method:

Patient: sit upright, back away from the chair rest.

Physician: the left-hand holds the tongue like when examining the throat, the right-hand holds the mirror. First, quickly turn the mirror over an alcohol lamp flame (check that it is not too hot) so that the condensation does not blur the mirror. Gently bring the mirror to the throat, spleen through the tongue, then turn the mirror face up, rolling the mirror horizontally. When you put the mirror in, tell the patient to breathe through the nose so that the dome does not shrink, if there is saliva covering the dome, tell the patient to say a, a, a ... it will be lost.

Note: during the procedure, try not to let the mirror-touch the throat wall to cause nausea reflex. If the patient has a lot of reflexes, throat and tongue area should be anaesthetized with 3-6% Xylocaine (spray or topical).

In addition, it is necessary to check the nasopharynx by touching the arch with the index finger to detect tumours, VA Remember to touch the palate only when there is no acute inflammation in the nasopharynx.

Physical examination of the sinuses

Look

Is the front of sinuses, fangs, nasal-cheek grooves, nasal-eye grooves, nasal bases, angle in eye sockets see swelling, swelling, changes?

Touch

Find distortions on the front of the sinuses.

Gently press the thumb on the area to find the pain point, to compare the two sides to get the exact pain sensation.

Shading

Use a dim light bulb (like a flashlight) in a dark room, so that the patient keeps the lamp in the mouth, directing the light source towards the face. With normal jaw sinuses, the light source passes through forming a triangular shiny under the orbital socket. Let the light source apply to the upper orbital wall to direct the light source to the forehead if the frontal sinus is normal there will be a shiny area in the arch of the eyebrow. The ghosting method does not give clear and accurate results, so it is rarely applied at present.

Sinus puncture

The jaw sinus has a hole with the middle nasal passages, using a needle to pierce the sinus septum in the lower nasal passages to enter the jaw sinus. Thereby we can suck to observe the stagnant substance in the sinuses, try to find bacteria or cytology. You can also pump warm water or normal saline solution into your sinuses so that water can flow through the nostrils and sinuses in the middle nasal passages. In the case of sinusitis, there is pus or pus oozing with water.

This simple method, for confirmation in combination with treatment, is often used. Keep in mind that this should not be performed during acute inflammation.

 Endoscopic examination of the nose-sinuses

Nowadays, endoscopy has developed rapidly and become an indispensable means in the diagnosis and treatment of diseases of the nose and sinuses. With a cold light source, the small, magnifying-lens endoscope with different inclinations has shown direct, detailed, deep images that complement the previous examination.

Functional examination

Functional breathing exam

The simplest way is to breathe on the mirror. Using a Gladen mirror is a shiny nickel-plated metal sheet with concentric semi-circular lines and a straight line bisecting the centre. Let the mirror fit in front of the patient's nose, the straight line corresponds to the cylinder, the mirror is horizontal. When exhaled, the vapour will blur the mirror. According to the degree of blurry mirrors to assess breathing function. If the mirror is not blurred, the nose is completely covered. An ordinary mirror can also be used for testing.

People also use the nasal gas meter (Rhinometries) to measure the breathing pressure of each nasal cavity is more specific or can be recorded on paper for evidence.

Smell function examination

Often use a sniffer by injecting a volume of air into each nostril with a certain concentration of an odorant substance to find the smell threshold of each substance. Perform with a number of substances with different odours and compare with normal thresholds to get a sense of the patient's smell level.

It is necessary to distinguish odorous substances and stimulants such as: Ethers, Ammonia ... there are people who still know stimulation but may lose their smell. Often use substances with familiar odours such as: fragrance, sour, food.

X-ray

Blondeau pose (film nose - chin film)

Consider the lesions of the jaw sinuses, frontal sinuses and nasal passages.

Patient posture

Lie on your stomach, mouth fully open, nose and chin touching the film. Tia went from the occipital to the front.

Standard

Clearly see the eye sockets on both sides.

The upper margins of the stony bone do not exceed the base of the jaw sinuses.

The nasal septum is projected straight between 2 teeth of the upper jaw.

Result

Compare with eye socket brightness.

Normal:

Nasal cavity clearly clear airway.

The jaw sinuses, frontal sinuses are bright, and the sinus walls are clear.

Pathological:

The nasal cavity is lost, narrowed due to tumour or excessive nasal curl.

The jaw sinuses and forehead are blurred due to the oedema of the mucosa, thick translucency due to pus in the sinuses, thick, irregular margins due to thick, degenerative mucosa.

Sinus wall has lost place, unknown: mucus or malignant tumour is suspected.

Note:

When there is a suspicion of an object in the sinus: it is necessary to take an additional cranial position to determine a specific position.

When a tumour is suspected, a polyp in the jaw sinus: need to pump contrast into the sinus to detect and clarify.

Hirtz (chin-top position in the film)

Clearly show all the anterior sieve, the posterior sinus and the parietal sinus. In addition, a detailed assessment of the anterior cranial base, the butterfly wing region is provided.

Patient posture

On the back of the head, the head drops off the wall of the table, the top of the head hits the film, the rays go from the chin to the top.

Standard

Clearly see the oral cavity and occipital cavity.

The septum is straight between 2 teeth number 1.

The upper and lower molars coincide in an arc.

The demarcation of the anterior and posterior sieve is the seam connecting the two molars 6 and 7.

Result

Compare with oral cavity brightness.

Normal: the sieve sinuses before and after morning are even, the septum of the cells clears.

Pathological:

The cells are fuzzy or dense opaque due to pus, thick mucosa, polyps in the sinus.

The sieve cell septum’s are unknown or are lost or destroyed: mucous tumour or suspected malignant tumour.

When in doubt there is an object

Need to take an additional cranial position to determine the specific position of the object.

When cysts or polyps are suspected

In the jaw sinuses, inject a contrast agent into the sinuses for a detection scan.

CT Scan in the sinus area

To assess the disease clearly and accurately, for diagnosis and treatment.

Posture:

Coronal.

Axial.