EXAMINATION OF NASOPHARYNX

Examination of Nasopharynx

Symptomatology

Common Presenting Symptoms:
  • Nasal obstruction.
  • Postnasal discharge.
  • Epistaxis.
  • Hearing impairment (Tubal block).
  • Cranial nerve palsies.
  • Enlargement of lymph nodes in the neck.

Methods of Examination

1. Anterior Rhinoscopy

  • Only a small part of nasopharynx is visible.
  • Facilitation: Use vasoconstrictors to decongest nasal/turbinal mucosa.

2. Posterior Rhinoscopy

Technique: Mirror tilted in different directions; examiner mentally reconstitutes the entire picture.

Wall Structures to Examine
Anterior Post. border of septum, Choanae, Post. ends of turbinates & meatuses.
Lateral Torus tubarius, Eustachian tube opening, Pharyngeal recess.
Floor Upper surface of soft palate.
Roof/Post. Roof and posterior wall.
Abnormal Findings (Differential Diagnosis of Mass):
  • Smooth Pale Mass: Antrochoanal Polyp.
  • Pink Lobulated Mass: Angiofibroma.
  • Irregular Bleeding Mass: Carcinoma.
  • Smooth Roof Swelling: Thornwaldt’s cyst or abscess.
  • Irregular Mass (Radiating Folds): Adenoids.
  • Irregular Mass (Lower Choana): Mulberry hypertrophy of inferior turbinate.

Other Findings:

  • Discharge: Below middle turbinate (Anterior sinuses) vs Above (Posterior sinuses).
  • Crusting: Atrophic rhinitis or nasopharyngitis.

3. Digital Examination (Palpation)

Method: Examiner stands behind/right of patient → Invaginates cheek with left finger → Inserts right index finger behind soft palate.

  • Sequence: Septum → Choana → Lateral wall → Posterior wall.
  • Use: Quick method to feel adenoids/polyps.
⚠ CONTRAINDICATION:
Avoid Digital Examination if Angiofibroma is suspected (Risk of bleeding).

4. Endoscopy

  • Rigid Endoscope: (0° or 4 mm). Passed after local anaesthesia + decongestion. Gives bright, magnified view.
  • Flexible Nasopharyngoscope: Also passed through nose; magnified view.

5. Retraction of Soft Palate

  • Indication: Difficult cases where view is not obtained by other methods.
  • Method: Soft rubber catheter passed through each nostril → ends recovered from oropharynx and clamped together → Palate retracted forward → Mirror used.

Neurological & Neck Exam

Cranial Nerves

  • Malignancy can involve CN II to XII.
  • Most Common: CN IX, X, XI.

Cervical Lymph Nodes

  • Malignancy may present primarily as a neck mass.
  • Sites: Upper internal jugular & Posterior triangle nodes (along accessory nerve).
📚 Source: ENT Dhingra

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