As with all specialities a concise yet thorough history is paramount to ensure no important information is missed. The format you have learned from day one enables this, however, taking a focused speciality history  requires specific closed questions.

 

There are six main nasal symptoms to consider when taking a focused nasal history:

 

1. Facial pain

 

A complex topic to which we have a dedicated facial pain tutorial.

However, in order to establish the nature of the facial pain and its relation to the nasal cavity or paranasal sinus, we can use the following mnemonic 

 

 

S ite (Where does the pain originate? Is it definitely nasal / sinus pain? Consider other causes)

O nset (When did the pain start? Gradual or sudden)

C haracter (What is the pain like? Sharp, dull, stabbing, electric shock)

R adiation (Does the pain radiate anywhere?)

A ssociations (Any other signs associated with the pain – e.g. headaches?)

T ime course (Does the pain follow a pattern?)

E xacerbating/relieving factors

S everity         

 

2. Sense of smell

 

• Hyposmia (reduced or altered)

• Anosmia (complete loss)

   

3. Nasal obstruction

 

• Duration

• Side

• Fluctuation 

• Positional changes

• Timing with other symptoms

 

4. Rhinorrhoea

 

• Side

• Volume

• Nature (Colour, thickness, blood stained)

• Front of nose, post nasal drip or both?

 

5. Epistaxis

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• Side

• Duration

• Volume

• Post nasal (posterior bleeding)

• Presence of clots

• Anticoagulants

 

For a more in-depth look at epistaxis, please visit our epistaxis tutorial.

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6. Sneezing