INTRODUCTION: Nasal septal deviation, inferior turbinate hypertrophy, and nasal valve compromise are among the most common etiologies of NAO seen by facial plastic surgeons and otolaryngologists. DISCUSSION: While both validated and non-validated scales and grading systems exist, they are inconsistently used. Further, anecdotally useful tools such as the Cottle maneuver have been adapted for purposes outside of patient care, such as billing. Although these NAO assessment systems have great utility in the diagnosis of nasal pathology, in isolation, they are not robust enough to influence surgical decision-making. CONCLUSION: In this study, we summarize the existing literature surrounding the nasal exam in cases of obstruction and offer a standardized nasal exam protocol based on grading systems and physical exam maneuvers. LEVEL OF EVIDENCE: N/A.