Physical Examination
ÎThe physical examination of all organ systems potentially affected by allergies should be performed in all patients with a history of rhinitis (refer to Table 2).1
ÎEmphasis should be on the upper respiratory tract, but the examiner should carefully look for accompanying otitis or eustachian tube dysfunction, chronic sinusitis, nasal polyps, conjunctivitis, asthma, and atopic dermatitis.1
Table 2. Physical Examination of Patient Presenting With Symptoms Compatible With Rhinitis1
Vital signs
General observations
Eyes Nose > Weight and height should be recorded in all patients
> Facial pallor, elongated facies, preferred mouth breathing, and any evidence of systemic disease
> Excessive lacrimation, erythema and swelling of the bulbar and/or palpebral conjunctiva, cobblestoning of the tarsal conjunctiva, swelling or dermatitis of outer eyelids, Dennie-Morgan lines, or venous stasis below the lower eyelids (''allergic shiners'')
> Reduced patency of nasal valve; alar collapse; transverse external crease; external deformity such as saddle nose; sepal deviation or perforation, spurs, ulcers, perforation, prominent vessels, or excoriation; nasal turbinate hypertrophy, edema, pallor or erythema, and crusting; discharge (amount, color, consistency), and nasal polyps > Presence of tumors or foreign bodies should be noted
Ears Oropharynx
> Tympanic membrane dullness, erythema, retraction, perforation, reduced or increased mobility, and air-fluid levels
> Halitosis, dental malocclusion, high arched palate, tonsillar or adenoidal hypertrophy
> Observe for malocclusion or high arched palate associated with chronic mouth breathing, tonsillar hypertrophy, cobblestoning of the oropharyngeal wall, pharyngeal postnasal discharge, temporomandibular joint pain or clicking with occlusion, furrowing, coating, or ulceration of tongue or buccal mucosa
Neck Chest
Abdomen Skin
Other organ systems
> Lymphadenopathy, thyroid enlargement, or tenderness
> Signs of asthma > Chest wall deformity or tenderness, abnormal percussion, egophony, audible wheezing, abnormal or diminished sounds by auscultation
> Tenderness, distension, masses, or enlargement of liver or spleen
> Rashes, especially eczematous or urticarial (distribution and description), or dermatographism
> When history or general observation indicate these should be included
Note: This list is not intended to be totally inclusive. Elements of the examination that will assist in the differential diagnosis of rhinitis or that may indicate complications of treatment are included. Documentation of presence or absence of these elements should be considered.
FOR INTERNAL USE ONLY
