Rhinitis physical examination: Difference between revisions
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* [[Mouth breathing]] from [[nasal congestion]] | * [[Mouth breathing]] from [[nasal congestion]] | ||
* Sniffing | * Sniffing | ||
* Allergic shiners | * 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 | * 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. | * 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. | ||
{{#ev:youtube|Jfd04SBQjmk}} | {{#ev:youtube|Jfd04SBQjmk}} | ||
===Vital signs=== | ===Vital signs=== | ||
Increased temperature may be seen especially when there is an infectious etiology (infectious rhinitis/[[rhinosinusitis]]) | Increased [[temperature]] may be seen especially when there is an infectious etiology (infectious rhinitis/[[rhinosinusitis]]) | ||
===HEENT=== | ===HEENT=== | ||
'''Ocular findings''' | '''Ocular findings''': Commonly seen in patients with allergic rhinitis. Some of the ocular findings include:<ref name="pmid 27490123">{{cite journal| author=Shaker M, Salcone E| title=An update on ocular allergy. | journal=Curr Opin Allergy Clin Immunol | year= 2016 | volume= 16 | issue= 5 | pages= 505-10 | pmid= 27490123 | doi=10.1097/ACI.0000000000000299 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27490123 }} </ref> | ||
* Bilateral [[conjunctival injection]], papillae and cobblestones. | * Bilateral [[conjunctival injection]], papillae and cobblestones. | ||
* Corneal involvement in severe cases (atopic and [[vernal keratoconjunctivitis]]). | * [[Cornea|Corneal]] involvement in severe cases (atopic and [[vernal keratoconjunctivitis]]). | ||
* Frequent rubbing of the eyes, irritability, lacrimation, mucus discharge. | * Frequent rubbing of the eyes, irritability, [[lacrimation]], mucus discharge. | ||
* [[Blepharospasm]] | * [[Blepharospasm]] | ||
* [[Periorbital edema]] | * [[Periorbital edema]] | ||
'''Nasal findings''' | '''Nasal findings''': Examination of the nasal cavity with a [[speculum]] or [[otoscope]] may reveal the following: | ||
* Swollen/edematous turbinates | * Swollen/edematous [[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''' | '''Ear findings''': Otoscopic examination of the ears may reveal signs suggestive of associated co-morbidities such as: | ||
* [[Otitis media with effusion]]- common in patients with allergic rhinitis. | * [[Otitis media with effusion]]- common in patients with allergic rhinitis. | ||
* [[Acute otitis media]] | * [[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 [[Paranasal sinus|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 such as elongated facies may be seen, especially in chronic mouth breathers.<ref name="pmid11449200">{{cite journal| author=Skoner DP| title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. | journal=J Allergy Clin Immunol | year= 2001 | volume= 108 | issue= 1 Suppl | pages= S2-8 | pmid=11449200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11449200 }} </ref> | * Abnormal facial development such as elongated facies may be seen, especially in chronic mouth breathers.<ref name="pmid11449200">{{cite journal| author=Skoner DP| title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. | journal=J Allergy Clin Immunol | year= 2001 | volume= 108 | issue= 1 Suppl | pages= S2-8 | pmid=11449200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11449200 }} </ref> | ||
'''Mouth and Throat''' | '''Mouth and Throat''' | ||
* Coexisting conditions like hypertrophied adenoids may be seen. | * Coexisting conditions like hypertrophied adenoids may be seen. | ||
* Dental malocclusion frequently occurs in children who are chronic mouth breathers.<ref name="pmid11449200">{{cite journal| author=Skoner DP| title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. | journal=J Allergy Clin Immunol | year= 2001 | volume= 108 | issue= 1 Suppl | pages= S2-8 | pmid=11449200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11449200 }} </ref> | * Dental malocclusion frequently occurs in children who are chronic mouth breathers.<ref name="pmid11449200">{{cite journal| author=Skoner DP| title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. | journal=J Allergy Clin Immunol | year= 2001 | volume= 108 | issue= 1 Suppl | pages= S2-8 | pmid=11449200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11449200 }} </ref> | ||
* High arch in the palate | * High arch in the [[palate]] | ||
* Cobblestoning of the [[oropharynx]] | * Cobblestoning of the [[oropharynx]] | ||
* Posterior drainage of nasal secretions | * Posterior drainage of nasal secretions | ||
| Line 46: | Line 46: | ||
* [[Eczema]] may be seen in patients with allergic rhinitis if there is coexisting [[atopic dermatitis]]. | * [[Eczema]] may be seen in patients with allergic rhinitis if there is coexisting [[atopic dermatitis]]. | ||
===Chest=== | ===Chest=== | ||
* A thorough chest examination is essential, as it may reveal abnormalities suggestive of other pathological conditions or | * A thorough chest examination is essential, as it may reveal abnormalities suggestive of other pathological conditions or co-morbidities such as [[respiratory tract infections]], [[asthma]]. | ||
==References== | ==References== | ||
Revision as of 18:57, 6 April 2017
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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
Rhinitis is one of the most common conditions presenting for medical care in several countries.[1] It is a heterogenous disorder which is sometimes mistakenly treated with triviality.[2] Rhinitis significantly affects the quality of life of affected individuals, and also constitute a huge financial burden to the society.[3] A careful history and physical examination is essential for accurate diagnosis, treatment, and prevention of the potential complications associated with chronic rhinitis.[4][5] It is essential to examine all the organ systems that are potentially affected by allergies.[2] A detailed examination of the upper respiratory tract should be done in all patients presenting with rhinitis.[2]
Physical Examination
The examination of patients with rhinitis should include an examination of the nose, and assessment for possible comorbidities and complications. The physical examination of a patient with rhinitis may reveal the following:[6][7]
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.
{{#ev:youtube|Jfd04SBQjmk}}
Vital signs
Increased temperature may be seen especially when there is an infectious etiology (infectious rhinitis/rhinosinusitis)
HEENT
Ocular findings: Commonly seen in patients with allergic rhinitis. Some of the ocular findings include:[8]
- Bilateral conjunctival injection, papillae and cobblestones.
- Corneal involvement in severe cases (atopic and vernal keratoconjunctivitis).
- Frequent rubbing of the eyes, irritability, lacrimation, mucus discharge.
- Blepharospasm
- Periorbital edema
Nasal findings: Examination of the nasal cavity with a speculum or otoscope may reveal the following:
- Swollen/edematous turbinates
- Pale, bluish or erythematous mucosa. The mucosa is often pale/bluish in allergic rhinitis. Beefy red mucosa can be seen in rhinitis medicamentosa.[9]
Ear findings: Otoscopic examination of the ears may reveal signs suggestive of associated co-morbidities such as:
- Otitis media with effusion- common in patients with allergic rhinitis.
- 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 such as elongated facies may be seen, especially in chronic mouth breathers.[4]
Mouth and Throat
- Coexisting conditions like hypertrophied adenoids may be seen.
- Dental malocclusion frequently occurs in children who are chronic mouth breathers.[4]
- High arch in the palate
- Cobblestoning of the oropharynx
- Posterior drainage of nasal secretions
Neck
- Swollen lymph nodes may be seen in infectious rhinitis secondary to upper respiratory tract infections.
Skin
- Eczema may be seen in patients with allergic rhinitis if there is coexisting atopic dermatitis.
Chest
- A thorough chest examination is essential, as it may reveal abnormalities suggestive of other pathological conditions or co-morbidities such as respiratory tract infections, asthma.
References
- ↑ Romeo, Jonathan; Dykewicz, Mark (2014). "Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis". Diseases of the Sinuses. Springer New York. pp. 133–152. ISBN 978-1-4939-0265-1.
- ↑ 2.0 2.1 2.2 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S1–84. doi:10.1016/j.jaci.2008.06.003. PMID 18662584.
- ↑ Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL (2004). "Economic impact and quality-of-life burden of allergic rhinitis". Curr Med Res Opin. 20 (3): 305–17. doi:10.1185/030079903125003053. PMID 15025839.
- ↑ 4.0 4.1 4.2 Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
- ↑ Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
- ↑ 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.
- ↑ Shaker M, Salcone E (2016). "An update on ocular allergy". Curr Opin Allergy Clin Immunol. 16 (5): 505–10. doi:10.1097/ACI.0000000000000299. PMID 27490123 27490123 Check
|pmid=value (help). - ↑ 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.