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ENT
15.Examining the Nose, Paranasal Sinuses, and Face
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
10 sections · 63 slides
Overview
- What you will learn
External Inspection and Palpation
Start with the naked eye and the fingertips
- Looking at the outside of the nose
- Feeling the framework and its neighbors
- Where the facial and occipital nerves exit
Anterior Rhinoscopy
The first look inside the front of the nose
- What it is and what you need
- Technique step by step
- Head mirror versus modern headlamp
- Two head positions for anterior rhinoscopy
- What to record, and a decongestant tip
Posterior Rhinoscopy
A mirror view of the back of the nose and nasopharynx
- What it examines
- Technique and getting past the gag reflex
- Mirror technique and the composite nasopharyngeal view
- What to note
Nasal Endoscopy
The modern gold standard for seeing inside the nose
- The rod lens: how the modern scope was born
- From invention to a new era of ENT
- Setting up for nasal endoscopy
- When to reach for the endoscope
- Reading the mucosa: normal versus warning signs
- Anatomy that predisposes to recurrent sinusitis
- What normal and diseased noses look like on endoscopy
- Preparing and choosing the scope
- Systematic examination: steps 1 and 2
- Systematic examination: steps 3 and 4
- The four regions of a systematic nasal endoscopy
Assessing Nasal Patency
Measuring how freely air moves through the nose
- Rhinomanometry: the gold standard
- Law 1 — Hagen–Poiseuille: why radius rules
- Law 2 — Weber–Fechner: sensation is logarithmic
- Four-phase rhinomanometry
- Rhinomanometry curves and the nasal-valve loop
- Airflow speed mapped inside the nose (CFD)
- Simpler and complementary patency tests
- Quick qualitative checks and the future
Olfactometry
Testing the sense of smell
- Start with history, then test with a validated scale
- More smell tests, and how to catch faking
- Evoked response olfactometry (ERO): the objective test
- The language of smell disorders
Diagnostic Imaging
Seeing what the endoscope cannot reach
- Conventional radiology: plain films
- Landmarks on a plain sinus radiograph
- Computed tomography (CT): the modality of choice
- Coronal CT contrasting a normal side with pansinusitis
- 3-D imaging and MRI
- Coronal MRI: soft tissue and a vascular tumor
- Vascular imaging and ultrasound
Lavage of the Sinuses
Washing out and sampling the sinus cavities
- Why irrigate, and which sinuses can be washed
- Lavage of the maxillary antrum
- A modern maxillary sinus lavage system
- Frontal and sphenoid lavage, and a fatal pitfall
- The Kümmel–Beck frontal sinus trephine
Specific Diagnostic Methods
Sampling cells, testing for allergy, and finding CSF leaks
- Cytology and allergy studies
- Biopsy and detecting a CSF leak
- Putting it together: matching tool to question
- Named methods and pioneers cited in the text
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery