1. Nose 43. Otoscope used with nasal speculum to inspect nasal vault or may use otoscope ear speculum 44. Nasal speculum examination done without causing pain 45. Palpate frontal sinus for tenderness (medial brow left and right, be sure not too high) 46. Palpate maxillary sinus for tenderness (correct position) 47. Palpate ethmoid sinus (bridge of nose) for tenderness

2. 43, 44 The otoscope with a nasal speculum can be used to inspect the nasal vault. If a nasal speculum is not available use the largest ear speculum available. Visualize the opening before and while advancing the speculum. Placing the finger on the tip of the nose and lightly push on the tip and having the patient extend their neck will help facilitate the exam.

3. Palpation of Frontal Sinuses

4. Palpation of Maxillary Sinuses

5. Palpation of the Ethmoid Sinuses Place your fingers at the bridge of the nose Direct pressure down (inferiorly) and towards the nose (centrally)