If a nasal speculum is used, the instrument is held in the examiner's left hand, and the speculum is introduced into the patient's nostril in a vertical position (blades facing up and down). The speculum should not rest on the nasal septum. The blades are inserted about 1 cm into the vestibule, and the patient's neck should be slightly extended. The examiner's left index finger is placed on the ala of the patient's nose to anchor the upper blade of the speculum while the examiner's right hand steadies the patient's head. The right hand is used to change the head position for better visibility of the internal structures. After one nostril has been examined, the speculum, still being held in the examiner's left hand, is introduced into the patient's other nostril. The technique of holding the speculum is shown in Figure 11-23. Although the nasal speculum provides the best method of inspection, internists rarely use this instrument. Figure 11-24 shows a patient with nasal polyps, visible by means of the nasal speculum.
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