--- title: "ENT History Taking: Approach to a Nose Case" description: "A comprehensive guide on taking a detailed history for nose related complaints, covering chief complaints, history of present illness, and relevant past/personal history - perfect for MBBS and ENT students." source: "The ENT Resident" canonical_url: "https://www.theentresident.com/ent-notes-lectures/history-taking-nose" categories: ["History and Clinical Examination"] video: "https://www.youtube.com/watch?v=csUvdtmmpEU" image: "https://media.theentresident.com/og-images/history-taking-nose.png" --- # ENT History Taking: Approach to a Nose Case A comprehensive guide on taking a detailed history for nose related complaints, covering chief complaints, history of present illness, and relevant past/personal history - perfect for MBBS and ENT students. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=csUvdtmmpEU Today, we'll be learning about **history taking in a nose case**. Taking a thorough history in a nose case is vital. Every detail helps us understand the patient's condition and guides us towards a diagnosis. --- ### ✨ Patient Particulars Beginning with the patient's basic information: - **Name:** For identification, building rapport, maintaining records, and sometimes indicates cultural background (relevant for certain conditions). - **Age:** Different nasal conditions are more common in specific age groups. >What are some diseases of nose seen in children, adults and elderly? - **Gender:** Some conditions show gender preference. >What are some diseases of nose seen in males and females? - **Address/Location:** Geographical prevalence of certain diseases. - **Coastal/Tropical Areas (India, Bangladesh, Sri Lanka):** Rhinosporidiosis. - **North India, South Africa, Europe:** Rhinoscleroma. - **Occupation:** Environmental exposures can be relevant. - **Farmers:** Rhinosporidiosis - **Dusty Environment:** Vasomotor Rhinitis - **Smoke/Air Pollution Exposure:** Asthma --- ### πŸ—£οΈ Chief Complaints Note down the main reasons the patient is seeking consultation, in chronological order. Common nose-related chief complaints: 1. **Rhinorrhea / Nasal Discharge** 2. **Nasal Obstruction** 3. **Headache or Facial Pain** 4. **Bleeding from the Nose (Epistaxis)** 5. **Change in Smell** 6. **Swelling or Deformity** 7. **Change in Voice** (Hyponasality or Hypernasality) 8. **Associated Factors:** Sneezing, Post Nasal Drip, Snoring, Dryness of nose/throat. --- ### πŸ“š History of Present Illness (HPI) Delve into the details of each chief complaint. #### **1. Nasal Discharge (Rhinorrhea)** - **Onset:** Sudden vs Gradual - **Progress:** Rapidly progressive vs Slowly progressive - **Type:** - **Watery** - **Purulent** - **Blood-Stained** - **Mucoid** >Can you name causes of each type? - **Quantity:** Profuse, Moderate, Small - **Smell:** Foul smelling (Foreign Body, Atrophic Rhinitis). _**Clinical Pearl:** Unilateral foul-smelling nasal discharge in a child: **Always suspect a Foreign Body!**_ - **Side:** - **Unilateral:** Foreign Body - **Bilateral:** Ethmoidal Polyp #### **2. Nasal Obstruction** - **Onset:** Sudden vs Gradual - **Progress:** Rapidly progressive vs Slowly progressive - **Side:** - **Unilateral:** DNS (most common cause) - **Bilateral:** Ethmoidal Polyp - **Continuity:** Continuous (Mechanical/Structural cause like DNS) vs Intermittent (Mucosal cause like Allergic Rhinitis). #### **3. Headache or Facial Pain** - **Onset & Progress:** Sudden/Gradual onset, Rapid/Slow progress. - **Site:** Often related to the affected sinus. >What is the site of pain in different sinuses? >What is **Sluder's Neuralgia?** - **Radiation:** Pain radiating to teeth (Acute Maxillary Sinusitis) - **Character:** Dull aching, throbbing, constant - **Aggravating/Relieving Factors:** Bending forward (Frontal Sinusitis) - **Associated Symptoms** #### **4. Epistaxis (Bleeding from the Nose)** - **Common Sites/Causes:** >What is the Most Common Site of Bleeding? >What is the Most Common Site of Bleeding in Children? >What is the Most Common Site of Bleeding in Adults? >What is the Most Common cause of Bleeding in Children? >What is the Most Common cause of Bleeding in Adults? - **Types:** - Anterior Epistaxis - Posterior Epistaxis - **History Points to Ask:** Onset, Quantity, Frequency, Duration, Previous episodes, Unilateral/Bilateral, Frank blood/clots, Anterior/Posterior type, Spontaneous/Provoked (fingernail trauma?), History of trauma, Exanthematous fever, Foreign body, Bleeding disorders, Hypertension, Drug intake, Family history of hypertension/blood disorders. _**Clinical Pearl:** Recurrent, unprovoked, painless, profuse nasal bleed in an adolescent male: **Highly suspicious of Juvenile Nasopharyngeal Angiofibroma.**_ #### **5. Disturbance in Smell** - **History Points:** Onset, Duration, Perceived by patient or someone else? (Merciful Anosmia), Constant/Intermittent, Unilateral/Bilateral, Foul smell? Loss for particular odors or generalized? Associated symptoms (crusts, discharge, loss of taste, headache). > What are the different **types of Smell Disorder**? #### **6. Swelling or Deformity** - **History Points:** Onset, Duration, Progress, Side, Site. Describe the swelling (size, shape, consistency, tenderness). - **Associated Symptoms:** - Loosening of teeth - Ill-fitting dentures - Visual symptoms (diplopia, blurring) - Loss of nasolabial fold, Intranasal mass - **Specific Deformities:** Frog Face Deformity, Telecanthus, Saddle Nose Deformity, Crooked Nose. #### **6. Change in Voice** - **History Points:** Onset (congenital or secondary), Associated symptoms (palate). - **Types:** - **Hyponasality (Rhinolalia Clausa)** - **Hypernasality (Rhinolalia Aperta)** >What is Hyponasality & Hypernasality? >What are some causes of Hyponasality & Hypernasality? ### Other Associated Symptoms - **Sneezing:** - Allergic symptom. - Ask if in paroxysms, persistent, associated with watering eyes, occurs with face washing/waking up, exposure to dust/pollen/animals, associated itching (eyes, nose, throat). - **Post Nasal Drip (PND):** - Hawking sensation, feeling something stuck at back of throat, sometimes foul smell/taste or sensation of blood. - Ask about discharge color. - **Snoring:** - Rule out nasal pathology (DNS, polyps, turbinate hypertrophy). - Ask age, loudness, sleep disturbance (Obstructive Sleep Apnea?), mouth breathing history (especially in children with Adenoid Hypertrophy). - **Dryness of Nose and Throat:** Seen in Atrophic Rhinitis, Cocaine abuse, early Acute Rhinitis. ### Additional Relevant Histories When taking a patient's history in ENT, especially for nasal complaints, it's important to consider specific associated symptoms that can help narrow down your diagnosis. These include: - Fever with swelling/redness – often a clue toward infections like acute rhinitis or vestibulitis. - History of trauma or habitual nose picking – commonly linked to conditions like epistaxis or nasal fractures. - Use of nasal packs or instrumentation – which can affect bleeding, drainage, or even vision in rare cases. - Eye symptoms like watering or vision changes - Ear symptoms and referred pain - Recurrent upper respiratory infections - Sensory loss or numbness on the cheek πŸ‘‰ These histories can point towards common and serious conditions ranging from chronic sinusitis and nasal polyps to malignancies with orbital invasion. >πŸ“˜ In my detailed notes, I’ve broken down each of these symptoms and what they typically indicate β€” with clinical correlations, differentials, and quick-reference tables to help you save time in exams and clinics. --- ### πŸ“‹ Past History Systemic diseases and previous conditions can impact nasal health. - **Systemic Diseases** - **History of Surgery:** Any previous nasal or sinus surgery (can cause synechiae, atrophic rhinitis, septal perforation). ### Family History - Similar complaints in the family. - Bleeding disorders, Hypertension, Diabetes Mellitus, TB in the family. - Consanguinity (rarely relevant for nasal conditions, but generally good to ask in ENT history). ### Treatment History - Any treatment for current or past nasal/sinus complaints. - Medications used (type, duration, relief/aggravation). - Beta blockers: Nasal Obstruction. - Anticoagulants: Epistaxis. - Long-standing nasal decongestants: Rhinitis Medicamentosa. - Extensive nasal surgeries in the past (predisposition to Atrophic Rhinitis, Septal Perforation). ### Personal History - **Diet/Appetite.** - **Sleep:** Important if snoring/OSA is a complaint. - **Weight Loss:** Relevant if malignancy is suspected. - **Bladder and Bowel habits.** - **Socioeconomic status.** - **Addiction History:** Smoking, Alcohol, Drug/Snuff addiction (**Cocaine sniffing: Septal perforation**). - Hygiene (Myiasis). - Occupation (already covered). - For females: Menstrual history. --- ## About This Note This note on ENT History Taking: Approach to a Nose Case is one of the free ENT study notes published by The ENT Resident. It is free to read on the website, and it is paired with a full video lecture on YouTube. This note is categorized under [History and Clinical Examination](https://www.theentresident.com/ent-notes-lectures/category/history-and-clinical-examination.md). The category page lists all the free ENT notes on that topic. Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/history-taking-nose When citing or referencing this content, please credit The ENT Resident and link to the canonical page above. ## About The ENT Resident The ENT Resident is a free library of ENT notes and video lectures created by Dr. Mausumi Das (MS ENT), the ENT doctor and educator behind The ENT Resident YouTube channel (https://www.youtube.com/c/TheENTResident). These notes are written for ENT residents, ENT postgraduates preparing for exams, and MBBS students, to help them learn ENT clearly and score well. 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Other contact options are on the contact page: https://www.theentresident.com/contact.md ## Related ENT Notes & Lectures #### History and Clinical Examination - [Cottle’s Test](https://www.theentresident.com/ent-notes-lectures/cottle-test.md) - [ENT History Taking: Approach to a Throat Case](https://www.theentresident.com/ent-notes-lectures/history-taking-throat.md) - [ENT History Taking: Approach to an Ear Case](https://www.theentresident.com/ent-notes-lectures/history-taking-ear.md) - [Posterior Rhinoscopy](https://www.theentresident.com/ent-notes-lectures/posterior-rhinoscopy.md)