Anterior rhnoscopy implies examination of the anterior part of the nose. Classically, Bull's lamp and reflecting mirror being used to achieved examination of this area. Nowadays, headlight supplied by battery or electrical source are used more commonly. The depth of examination is usually good up to mid-nasal cavity; the vestibular area, nasal valve, anterior nasal septum and inferior turbinate are visualized well.
Figure shows clinical assessment of nasal passage patency by using a shiny metal rod. Metal tongue depressor or indirect laryngoscopy mirror can also be used for similar purpose. Asymmetric, reduced, or absent misting either unilateral or bilaterally need to be documented and followed by anterior rhinoscopy and endoscopy to rule out internal obstruction of any cause.
The "Cold Spatula" Test
Nasal valve is the narrowest region of the nasal cavity and contribute significantly to airway resistance. Cottle's manoeuvre is a simple clinical test that give clue to this segmental airway narrowing. With few finger the skin close to the nasolabial fold of the side of nasal cavity to be examined in gently pulled in an upward and outward direction (towards ipsilateral zygoma). Subjective and objective improvement in breathing or nasal patency observed (positive response).
Figures show widening of nasal valve area on right Cottle's manoveure in a patient with deviated nasal septum. Similar action improves delivery of intranasal spray application of medication in the presence of such narrowing e.g. intranasal corticosteroid spray therapy in allergic or vasomotor rhinitis.
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