# Nose & Sinus Assessment --- The **nose and sinus assessment** is the [[assessment]] of the [[nose]] and [[paranasal sinuses]], usually done during a HEENT exam. >[!tip] Considerations of the Older Adult The nose may appear more prominent on face from loss of subcutaneous fat. Changes in taste and smell are not unexpected. ## Subjective In addition to the standard subjective questions - any loss of smell - do you have a deviated septum - any discharge - frequent colds - sinus pain - trauma - epistaxis (nosebleeds) - allergies ## Objective You're going to need gloves, a penlight, a cotton 4x4. An otoscope is useful but not necessary. ### Inspection - External structure - Is the nose symmetrical - any deformities - any lesions - Internal structure - you're looking at the turbinates - inspect the nasal mucosa, normally it's red and smooth and moist - note any swelling, discharge, bleeding, foreign body - the septum - is it deviated or midline - is there a hole in it - with an otoscope - you can see the **Kiesselbach area** which is really rich with blood. - you can really see the turbinates - you can see the cilia ### Palpation - test for patency of each nare (nostril) - palpate the sinus areas - gently press with your thumbs above the eyebrows - then on the cheek bones - these will be very painful if there is an infection - if an injury is suspected, palpate the contours for any breaks ## Cranial Nerves Associated with the Nose [[cranial nerves|CN I]] the olfactory nerve, tests the sense of smell ___