Checklist

WIPER

• Position and expose as for ear examination. Perform with headlight.

Physiological parameters

General inspection (from the front)

• Listen to the voice and breathing.

• Inspect face, eyes, lips and mouth.

External examination of the nose

Inspection:

• Front:

• symmetry: height, width, bony deformity, septal deviation

• scars: columella, lateral rhinotomy, Lynch-Howarth, bicoronal

• skin: erythema, rash, swelling, ulcer

• alar collapse

• Sides:

• profile: dorsal hump, saddling, tip ptosis

• Below:

• narrowing of external nasal valve

• triangularity

Palpate:

• Skin: quality

• Nasal bones: steps, fractures

• Nasal tip support and recoil

Patency:

• Misting test/nostril occlusion

• Cottle's manoeuvre

Internal examination of the nose

• Elevate tip.

• Inspect position of the caudal septum: dislocation/deviation.

• Inspect the external nasal valve.

• Anterior rhinoscopy with Thudicum's speculum: nasal vestibule, septal deviation, septal perforation, mucosa (rhinitic), turbinates (congested), polyps, papillomas, granulomas, tumours, ulcers, crusting, Little's area (prominent vessels), telangiectasia.

• Rigid nasendoscopy.

Oral examination

• Inspect and percuss the upper teeth for dental disease.

To complete the examination…

• Regional lymphadenopathy.

• Cranial nerve examination and ear examination if evidence of postnasal space lesion.