---
title: "Posterior Rhinoscopy"
description: "Learn how to perform Posterior Rhinoscopy, identify normal anatomical landmarks, recognize common abnormalities, and understand the practical difficulties faced during this ENT clinical examination."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/posterior-rhinoscopy"
categories: ["Rhinology", "History and Clinical Examination"]
video: "https://www.youtube.com/watch?v=p1owtH8ksBI"
image: "https://media.theentresident.com/og-images/posterior-rhinoscopy.png"
---

# Posterior Rhinoscopy

Learn how to perform Posterior Rhinoscopy, identify normal anatomical landmarks, recognize common abnormalities, and understand the practical difficulties faced during this ENT clinical examination. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=p1owtH8ksBI

## 👃 Posterior Rhinoscopy 

**Posterior rhinoscopy** is an essential part of the ENT clinical examination. 

It allows visualization of the **posterior nares (choanae)** and **nasopharynx** using a mirror, helping detect important pathologies in this region.

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### 🔍 What is Posterior Rhinoscopy?

It is the **visual examination of the posterior nasal cavity and nasopharynx** using a **posterior rhinoscopy mirror**. 

This mirror typically ranges from **8 to 15 mm in diameter**, with a **10 mm mirror** being most commonly used.

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### 🧪 Procedure of Posterior Rhinoscopy

Here is a step-by-step guide to performing posterior rhinoscopy:

**🔸 Preparation**

- **Prevent mirror fogging** by:
  - Dipping the mirror in **warm water**
  - **Warming** it over a **spirit lamp**
  - **Rubbing** it on the **buccal mucosa** (frictional heating)
  - Using **defogging agents** like *Cetramide*

- **Test mirror temperature** on the **flexor surface of your wrist** before use.

**🔸 Anesthetize the Pharynx**

- Use **10% lignocaine spray** on the **posterior pharyngeal wall**
- **Wait 2 minutes** for the anesthesia to take effect

**🔸 Examination Technique**

1. **Depress the tongue** using a **tongue depressor** with your left hand.
2. **Hold the mirror** like a pen in your **right hand**.
3. **Insert the mirror** behind the **soft palate**, **without touching the uvula** or surrounding structures to minimize gagging.
4. Ask the patient to **breathe through the nose** to move the **soft palate forward**.
5. **Visualize the posterior nasal cavity** and nasopharynx.

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### 🧠 Structures Seen in Posterior Rhinoscopy

✅ **Midline Structures**
- **Posterior end of the nasal septum** (first structure to be identified)

✅ **Turbinates and Meatuses**
- **Posterior ends** of:
  - **Inferior turbinate**
  - **Middle turbinate**
  - **Superior turbinate** (may or may not be visible)
- **Posterior parts** of:
  - **Superior meatus**
  - **Middle meatus**

✅ **Nasopharyngeal and Soft Palate Structures**
- **Nasal surface** of the **uvula** and **soft palate** (if the mirror is tilted anteriorly)

✅ **Lateral Structures**
- **Eustachian tube orifices** and **tubal elevations**
- **Fossa of Rosenmüller** (behind Eustachian tube)

✅ **Superior and Posterior Structures**
- **Roof of the nasopharynx**
- **Adenoids** (in children, at junction of roof and posterior wall)
- **Posterior pharyngeal wall**

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### ⚠️ Abnormalities Seen in Posterior Rhinoscopy

While examining, you must look for:

- **Polyps** (e.g., *antrochonal polyp*)
- **Cysts**
- **Secretions**
- **Foreign bodies**
- **Ulcers**
- **Tumors**
  - *Juvenile nasopharyngeal angiofibroma (JNA)*
  - *Nasopharyngeal carcinoma*

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### ⚠️ Common Difficulties in Performing Posterior Rhinoscopy

| Challenge | Solution |
| --- | --- |
| Uncooperative patients (e.g., children, mentally challenged) | May not be possible to perform |
| Gag reflex | Use 10% lignocaine spray |
| Fogging of mirror | Use warming or defogging techniques |

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### 📌 Conclusion

Posterior rhinoscopy is a **crucial diagnostic tool** in ENT, though technically demanding. With proper technique and patient preparation, it can reveal important findings in the **nasopharynx** and **posterior nasal cavity**.

---

## About This Note

This free ENT note on Posterior Rhinoscopy was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/posterior-rhinoscopy

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Rhinology: https://www.theentresident.com/ent-notes-lectures/category/rhinology.md
- History and Clinical Examination: https://www.theentresident.com/ent-notes-lectures/category/history-and-clinical-examination.md

## About The ENT Resident

The ENT Resident is an educational website and resource library created by Dr. Mausumi Das (MS ENT) for ENT residents, ENT postgraduates preparing for exams, and MBBS students.

Dr. Mausumi Das writes the notes, draws the diagrams, and records the lectures herself.

Browse all ENT notes and lectures on The ENT Resident: https://www.theentresident.com/ent-notes-lectures.md

## Medical-use Boundary

The ENT Resident provides educational material for medical learning and revision. It does not provide patient-specific medical advice, diagnosis, or emergency care, and it is not a substitute for evaluation by a qualified healthcare professional.

## More Resources

- Learn about the Premium ENT Notes, preview a complete sample, and find purchase options: https://www.theentresident.com/premium.md
- Premium note for this topic, Posterior Rhinoscopy: https://theentresident.gumroad.com/l/ctttd
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- Read student testimonials: https://www.theentresident.com/testimonials.md
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