Rhinitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D.  Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S 
Rhinitis is one of the most common conditions presenting for medical care in several countries. It is a heterogenous disorder which is sometimes mistakenly treated with triviality. Rhinitis significantly affects the quality of life of affected individuals, and also constitute a huge financial burden to the society. A careful history and physical examination is essential for accurate diagnosis, treatment, and prevention of the potential complications associated with chronic rhinitis. It is essential to examine all the organ systems that are potentially affected by allergies. A detailed examination of the upper respiratory tract should be done in all patients presenting with rhinitis.
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:
- Rhinorrhea may be seen
- Mouth breathing from nasal congestion
- 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.
Increased temperature may be seen especially when there is an infectious etiology (infectious rhinitis/rhinosinusitis)
Ocular findings: Commonly seen in patients with allergic rhinitis. Some of the ocular findings include:
- Bilateral conjunctival injection, papillae and cobblestones.
- Corneal involvement in severe cases (atopic and vernal keratoconjunctivitis).
- Frequent rubbing of the eyes, irritability, lacrimation, mucus discharge.
- 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.
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
- 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.
Mouth and Throat
- Coexisting conditions like hypertrophied adenoids may be seen.
- Dental malocclusion frequently occurs in children who are chronic mouth breathers.
- High arch in the palate
- Cobblestoning of the oropharynx
- Posterior drainage of nasal secretions
- Swollen lymph nodes may be seen in infectious rhinitis secondary to upper respiratory tract infections.
- Eczema may be seen in patients with allergic rhinitis if there is coexisting atopic dermatitis.
- 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.
- ↑ 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
- ↑ 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.