Rhinologic History and Physical Examination

• Ear symptoms need to be elicited, as this is often concurrent; unilateral serous otitis media can be a sign of a nasal or nasopharyngeal tumor.

• Throat symptoms are common due to post-nasal drip; always ask about reflux as this is thought to possibly be a factor in nasopharyngitis, and possibly rhinosinusitis, in some patients.

• Orbital symptoms such as restriction of gaze and epiphora can be a sign of a nasal tumor; numbness, particularly in the distribution of the second branch of the trigeminal nerve, can similarly be a sign of malignancy.

• Ask about prior imaging including sinus CTs, plain films, head CTs, and MRIs.

• Discuss any history of nasal trauma, although patients often claim they broke their nose at one point without actual evidence of a previous fracture.

• Smoking and drug use, particularly intranasal drug use, is relevant; smoking decreases mucus transit and increases viscosity of the mucus; intranasal drug use can destroy the nasal cavity—specifically cocaine and crushed pain killers such as oxycodone can cause extensive necrosis.

• Inquire about prior efforts the patient has made to treat this problem:

1. Topical nasal sprays: decongestants, nasal corticosteroids, nasal antihistamines and saline

2. Previous courses of antibiotics, including type of antibiotic and length of treatment and degree of improvement; documentation here is important, especially if imaging is to be obtained; often insurance companies will look for duration of antibiotic treatment for preauthorization for imaging

3. Previous courses of systemic steroids and degree of improvement

Past Medical History

• The Unified Airway Theory stresses the concept that both the upper and lower respiratory tract act as one functional unit; conditions that impact one may impact the other; questioning regarding respiratory disease is thus of paramount importance; asthmatics with sinus disease often note a correlation between the severity of their sinonasal symptoms and the severity of their asthma.

• Allergic disorders can similarly have both upper and lower airway manifestations; a full allergic history including reaction to seasonal allergens as well as flare-ups with certain foods is important; Samter’s patients often react to certain foods and beverages, particularly alcohol.

• Several rheumatologic diseases can manifest in the nasal cavity including sarcoidosis, Wegener’s granulomatosis (granulomatosis with polyangiitis GPA), Churg-Strauss syndrome, and relapsing polychondritis.

• Particularly for epistaxis, knowledge of hypertension as well as an existing bleeding diathesis is important.

• Certain disorders can have an impact on methods of treatment, particularly diabetes mellitus, which will limit the ability to use oral steroids, and glaucoma that might limit nasal steroid usage.

Past Surgical History

• A full surgical history should be elicited.

• Focus on ENT surgeries including adenoidectomy, myringotomy tube placement, and any previous nasal surgery.

• Patients often leave out cosmetic surgeries and knowledge of a previous rhinoplasty is critical.

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Jul 20, 2019 | Posted by in OTOLARYNGOLOGY | Comments Off on Rhinologic History and Physical Examination

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