Rhinitis physical examination: Difference between revisions
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===HEENT=== | ===HEENT=== | ||
Ocular findings | Ocular findings | ||
* | * Bilateral conjunctival injection, with corneal involvement in severe cases of coexisting allergic eye disease(atopic and vernal keratoconjunctivitis. | ||
* Rubbing of the eyes, irritability and lacrimation | * Rubbing of the eyes, irritability and lacrimation | ||
* Periorbital edema | * Periorbital edema | ||
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* Swollen turbinates | * Swollen turbinates | ||
* Pale, bluish or erythematous mucosa. The mucosa is often pale/bluish in allergic rhinitis. Beefy red mucosa can be seen in rhinitis medicamentosa.<ref name="pmid20210811">{{cite journal| author=Varghese M, Glaum MC, Lockey RF| title=Drug-induced rhinitis. | journal=Clin Exp Allergy | year= 2010 | volume= 40 | issue= 3 | pages= 381-4 | pmid=20210811 | doi=10.1111/j.1365-2222.2009.03450.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20210811 }} </ref> | * Pale, bluish or erythematous mucosa. The mucosa is often pale/bluish in allergic rhinitis. Beefy red mucosa can be seen in rhinitis medicamentosa.<ref name="pmid20210811">{{cite journal| author=Varghese M, Glaum MC, Lockey RF| title=Drug-induced rhinitis. | journal=Clin Exp Allergy | year= 2010 | volume= 40 | issue= 3 | pages= 381-4 | pmid=20210811 | doi=10.1111/j.1365-2222.2009.03450.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20210811 }} </ref> | ||
Ear findings- Otoscopic examination of the ears may reveal symptoms suggestive of associated comorbidities such as: | |||
* Otitis media with effusion | |||
* Acute otitis media | |||
Face | Face | ||
* Facial tenderness/discomfort on palpation of the sinuses. This often occurs when the inflammation extends into the sinuses (rhinosinusitis), and it can be as a result of infection or allergy | * Facial tenderness/discomfort on palpation of the sinuses. This often occurs when the inflammation extends into the sinuses (rhinosinusitis), and it can be as a result of infection or allergy | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Physical Examination
The examination of a patient with rhinitis should include an examination of the nose and the nasal cavity, and assessment for possible comorbidities and complications. The physical examination of a patient with rhinitis may reveal the following:[1][2]
General Appearance
- Rhinorrhea may be seen
- Mouth breathing from nasal congestion
- Sniffing
- Allergic shiners- dark eye shadows beneath the lower eye lid due to blood/fluid accumulation in the infraorbital groove as a result of congestion of the nose/sinuses. It is commonly seen in childhood allergic rhinitis, and the degree of darkness is associated with the chronicity and severity of disease. It can also be seen in nonallergic rhinitis.
- Dennie–Morgan lines- These are wrinkles/ extra skin fold underneath the lower eyelids. It is seen in children with allergic diseases such as allergic rhinitis.
- Allergic salute- A habitual gesture of rubbing the nose upward because of nasal discomfort and pruritus. It sometimes produces a persistent horizontal crease across the nose.
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Vital signs
Increased temperature may be seen especially when there is an infectious etiology (infectious rhinitis/rhinosinusitis)
HEENT
Ocular findings
- Bilateral conjunctival injection, with corneal involvement in severe cases of coexisting allergic eye disease(atopic and vernal keratoconjunctivitis.
- Rubbing of the eyes, irritability and lacrimation
- Periorbital edema
Nasal findings- Examination of the nasal cavity with a speculum or otoscope may reveal the following:
- Swollen turbinates
- Pale, bluish or erythematous mucosa. The mucosa is often pale/bluish in allergic rhinitis. Beefy red mucosa can be seen in rhinitis medicamentosa.[3]
Ear findings- Otoscopic examination of the ears may reveal symptoms suggestive of associated comorbidities such as:
- Otitis media with effusion
- Acute otitis media
Face
- Facial tenderness/discomfort on palpation of the sinuses. This often occurs when the inflammation extends into the sinuses (rhinosinusitis), and it can be as a result of infection or allergy
- Abnormal facial development may be seen especially in chronic mouth breathers.[4]
Throat
- Coexisting conditions like hypertrophied adenoids may be seen
- Dental malocclusion frequently occurs in chronic mouth breathers.[4]
References
- ↑ Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
- ↑ Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255.
- ↑ Varghese M, Glaum MC, Lockey RF (2010). "Drug-induced rhinitis". Clin Exp Allergy. 40 (3): 381–4. doi:10.1111/j.1365-2222.2009.03450.x. PMID 20210811.
- ↑ 4.0 4.1 Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.