1. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Examination of the nose and
throat

2. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Principal Nasal Symptoms
airway obstruction
runny nose (rhinorrhoea)
sneezing
loss of smell (anosmia)
facial pain due to sinusitis
snoring associated with nasal obstruction

3. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection
 Nose
 Shape - Deviation. Look from the sides &
from above.
 Deformities – Abnormal Nasal Creases
 Scars
 Discharge or crusting
 Redness or evidence
of skin disease
 Offensive odour (From the Patient)
 Rhinorrhoea

4. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection
 Inspect the front of the nose first
by tipping the nose up and
inspecting without a speculum.
 Insert a Thudicum speculum into
the appropriate nostril. A light
source is required to visualise
the internal structures.
 You should be able to identify
the septum medially, the
turbinates laterally. The inferior
turbinates should be easy to
visualise.
Thudicum Speculum

5. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection
 Inspect for
inflammation (Rhinitis)
 Comment on the
septum. Is it straight or
deviated.
 Look in the mouth.
Occasionally large
polyps or tumours may
be visible from arising
behind the soft palate.
Polyp right nostril
TURBINATE
SEPTUM

6. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Palpation
If you see what you believe is a polyp then
it is useful to assess sensitivity. Polyps
are not sensitive to touch whereas turbinates
are tender to touch.
Polyps are grey / yellow whereas turbinates
are pink.

7. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Nasal Airway Assessment
 Hold a cold metal tongue depressor under the
patient’s nose whilst they breath in and out through
their nose. Condensation should be visible as air
passes over the metal.
 To assess nasal airway efficiency. Occlude one
nostril and ask the patient to sniff. This gives a
reasonable idea on nasal airway efficiency.

8. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Throat Examination
History.
Enquire on general history.
Sore throat, feeling run down, visible lesions & causing pain.
Ask about alcohol & tobacco habits.
Ask about their general dental history.

9. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection 1
Ask the patient to remove any dentures.
Inspect the lips. Note the Vermillion border
& the corners of the mouth for any deviation.
Retract the upper lip with the front teeth
closed together. Note the maxillary labial
frenum, gingivae, mucogingival line with
teeth.

10. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Vermillion border
maxillary labial frenum
gingivae
mucogingival line
Inspection 2

11. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection 3
 Note oral hydration
 Halitosis?
 Note any varicosities,
missing teeth, dental
carries, ulceration or
haemangiomas.
 Use a bright light & a
tongue depressor, inspect
the tonsils, uvula and the
soft palate. Ask the patient
to tilt their head upwards to
inspect the hard palate.

12. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection 4
 Note the mucosal lining of the cheeks, noting
Stensen’s glands. (See slide 13.) Located behind the 2nd
molar. It carries saliva from the Parotid gland.
Any blockage can render the mouth dry.
 Note the frenum. Note any ulceration / discharge.
 Ask the patient to lift their tongue upwards to
inspect the floor of the mouth. Note if the tip of the
tongue can touch the roof of the mouth. Failure to
do so may indicated tongue tie. (Ankyloglosia.)

13. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Parotid
 The parotid salivary gland is
located over the mandibular
ramus, anteriorly and
inferiorly to the ears.
 Inspection of stensen’s duct
may require inspection if the
mouth is dry or if any parotid
swelling is detected upon
external palpation.

14. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Parotid Palpation
 Palpated bilaterally
 Start palpating anterior
to the ears and move
towards the cheek and
then inferiorly towards
the angle of the
mandible.

15. 01/21/16 © Clinical Skills Resource Centre, University of Liverpool, UK
Inspection 4
Any further examination of the larynx
requires specialised equipment.
Inspection of the oral cavity may also have a
neurological element. C.N’s 7.9 &12