Unilateral hearing loss due to serous otitis in an adult may be the presenting symptom of cancer of the nasopharynx, due to occlusion of the eustachian tube. All such patients should have a thorough nasopharyngeal exam, and careful palpation of the neck to detect possible metastasis from an occult tumor. Complete evaluation of the ear includes assessment of the facial nerve and vestibular function. The nose is a very narrow space, and it is impossible to completely examine the inner surface in the intact patient. Anterior rhinoscopy with a bivalve speculum usually discloses the anterior ends of the inferior turbinates and the septum.
Topical vasoconstriction permits a somewhat more thorough examination.
Nasal patency may be compromised by swollen turbinates, septal deviation, or intranasal masses, such as tumors, or nasal polyps. A perforation of the nasal septum can cause symptoms such as a whistling noise during breathing, epistaxis, and excessive crusting of the nose. An adequate light and tongue blade are necessary for examining the mouth. The blade should be used to systematically expose all teeth and mucosal surfaces, including those recesses inferior and posterior to the tongue, and the gingivobuccal sulci. Dentures should always be removed to permit a complete examination.