Rhinitis physical examination
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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.
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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.