Why the Doctor Looks in Your Nose

When patients come into my office with a runny nose or congestion, I want to get a good look at the source of their problem.

Doctors usually don't look inside your nose unless they have a specific reason. Usually, we're looking for an infection or allergy. Sometimes, we're looking for other sources of your breathing problem, such as a deviated septum, the term doctors use to describe a misalignment of the cartilage that runs down the center of your nose.

I use a lighted scope, called an otoscope, to get a clear view. I hold this scope at the tip of your nose and shine my light inside. It doesn't take long, maybe 30 seconds or so, for me to get a good look inside your nose. If there isn't too much congestion, I can see the opening of the sinuses, about 1 1/2 to 2 inches inside.

One of the first things I notice is color. The color of your nasal membranes should be pink, the same color as healthy gums.

If your nasal membranes are bluish or pale and appear swollen, I'll suspect you have allergic rhinitis, an inflammation caused by a nasal allergy. If this is the case, you might have a clear-to-white nasal discharge, and I might prescribe antihistamines or a nasal steroid to reduce the swelling.

If your nasal membranes are more red than pale and the discharge is thick and yellow, I'll suspect an infection. If your infection involves the nose, throat and ears and you have no fever or only a slight one, I'll suspect a cold virus. Viruses often move around in the body. Many patients will ask for an antibiotic when they have a cold, and I explain that antibiotics may work against bacteria but are powerless against a virus. For a viral infection in the nose, I'll usually prescribe decongestants to treat the symptoms.

If you have a fever, with tenderness around the bridge of your nose and at the top of your cheeks, I'll suspect a bacterial infection that has invaded your sinuses. Usually, I can see dark yellow, thicker mucus draining from the sinus opening when bacteria are causing your illness. If I do suspect a bacterial infection, I'll prescribe an antibiotic.

Not all nasal problems are caused by allergy and infection. You can be born with a deviated septum or develop one from a broken nose. In both cases, nasal breathing can be difficult. Sometimes surgery is necessary.

When I look inside your nose, I may notice a nasal polyp, a growth on the mucous membrane. Sometimes, these must be removed. Incidentally, 70 percent of people with polyps also have asthma.

Source: Kenneth R. Epstein, M.D.