Physical Exam

Nose Inspection

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Video coming September 2026

How to Perform

Inspect the external nose for shape, symmetry, swelling, deformity, or lesions. Ask the patient to tilt the head back slightly and breathe through the mouth. Using an otoscope with a large speculum, gently insert the speculum just inside the nasal vestibule, taking care not to press against the septum. Direct the instrument posteriorly along the floor of the nasal cavity and inspect each side in turn. Examine the nasal mucosa, septum, and the visible inferior and middle turbinates. Note the color and moisture of the mucosa and any discharge, crusting, swelling, bleeding, septal deviation or perforation, foreign body, or mass such as a polyp.

How to Interpret

Acute Rhinosinusitis

Purulent (mucopurulent) secretions in the nasal cavity, especially from the middle meatus

Rule in

Somewhat helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Strong

Chronic Rhinosinusitis with Nasal Polyps

One or more nasal polyps visible in the nasal cavity

Rule in

—

Rule out

Somewhat helpfulDerived CI

Evidence:Limited

Herpes Zoster Ophthalmicus

Hutchinson sign — zoster vesicles on the tip or side of the nose in established herpes zoster ophthalmicus

Rule in

Somewhat helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Limited

References

Ebell MH, McKay B, Dale A, Guilbault R, Ermias Y. Accuracy of signs and symptoms for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis. Ann Fam Med. 2019;17(2):164-172. doi:10.1370/afm.2354. PMID 30858261.
Williams JW Jr, Simel DL. Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination. JAMA. 1993;270(10):1242-6. PMID: 8355389. (Closest candidate only — does not anchor a tier for this finding.)
Chainansamit S, Chit-uea-ophat C, Reechaipichitkul W, Piromchai P. The diagnostic value of traditional nasal examination tools in an endoscopic era. Ear Nose Throat J. 2021;100:167-171. doi:10.1177/0145561319875711. PMID: 31547699.
Hamizan AW, Christensen JM, Ebenezer J, Oakley G, Tattersall J, Sacks R, Harvey RJ. Middle turbinate edema as a diagnostic marker of inhalant allergy. Int Forum Allergy Rhinol. 2017;7(1):37-42. doi:10.1002/alr.21835. PMID 27530103.
Gill C, Sturman J, Ozbek L, Henderson SR, Burns A, Hamour S, Pepper RJ, McClelland L, Chanouzas D, Gane S, Salama AD, Harper L. Cocaine-induced granulomatosis with polyangiitis-an under-recognized condition. Rheumatol Adv Pract. 2023;7(1):rkad027. doi:10.1093/rap/rkad027. PMID 37026037.
Gharehdaghi J, Samadi Rad B, Ghatreh Samani V, Kolahi F, Khatami Zonoozian A, Marashian SM. Comparison of physical examination and conventional radiography in diagnosis of nasal fracture. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2). doi:10.1007/s12070-011-0453-x. PMID 24427666.
Mihalache A, Yu P, Tao BK, Xie JS, Margolin EA, Micieli JA. Hutchinson's sign in herpes zoster ophthalmicus: a systematic review and meta-analysis. Ophthalmology. 2026;133:411-422. doi:10.1016/j.ophtha.2025.10.019. PMID: 41223901.
Hira İ, Tofar M, Bayram A, Yaşar M, Mutlu C, Özcan İ. Childhood Nasal Foreign Bodies: Analysis of 1724 Cases. Turk Arch Otorhinolaryngol. 2019;57(4):187-190. PMID: 32128516.
Andrades P, Cuevas P, Danilla S, Bernales J, Longton C, Borel C, Hernandez R, Villalobos R. The accuracy of different methods for diagnosing septal deviation in patients undergoing septorhinoplasty: a prospective study. J Plast Reconstr Aesthet Surg. 2016;69(6):848-855. PMID: 27085612. Free full text: repositorio.uchile.cl bitstream 2250/141972.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.