Index
Also called nasal endoscopy, it involves an evaluation of the nasal and sinus pits through direct vision when using an enlarged view of high quality.
It represents a minimally invasive technique that allows direct visualization of some of the nose’s internal organs and other structures.
This technique is performed using an endoscope, which can be rigid or flexible, and is connected to a fiber optic light cable.
objective
It is a procedure used as a diagnostic tool to evaluate nasal mucous membranes, sinonasal anatomy, and any nasal pathology.
The main objectives of a rhinoscopy are:
- Visually inspect nasal passages, paranasal sinuses, septum or wall of tissue that divides the nasal cavity, and vocal folds by examining the larynx and nearby structures to detect abnormalities such as structural defects and nasal polyps, a blockage or laryngeal injury.
- Diagnose recurrent and resistant sinus infections in the case of sinusitis.
- They are draining the sinuses, administering antibiotics, and removing polyps in the nose and throat.
- Determine the cause of the discharge of the nose, including nosebleeds, sneezing, snoring, or noises when breathing or wheezing.
Direct examination of the nasal cavities through rhinoscopy or nasal endoscopy has proven very efficient.
This technique is being used for the differential diagnosis of infectious, inflammatory diseases, and neoplastic disorders of the nose.
Methodology
The minimum requirements for basic nasal rhinoscopy include:
Using an endoscope, a microscopic lamp as a high-quality light source coupled to a light cable, a suction device to extract the present secretions, sinus instruments such as a Freer lift, a Blakesley forceps, and a cross-sectional instrument to obtain biopsy samples.
Preparation of the patient
- Patient preparation includes local anesthesia.
- Before performing nasal endoscopy, the nasal cavities are often sprayed with a nasal decongestant, such as oxymetazoline. However, it is sometimes necessary to perform endoscopy without decongestion, especially in patients with presumed turbinate hypertrophy.
- Also, anesthetics should be avoided when cultures are indicated to provide better samples with greater possibilities of bacterial growth in the medium.
- Drugs are usually used with a spray atomizer or directly with the help of a cotton dressing.
- Before the application, you must have patient information about the allergies that it presents to the medications.
- The topical anesthetic should be applied on the inferolateral surface of the middle turbinate, on the surface of the inferior turbinate, and in any other place where pressure could be exerted by inserting the endoscope.
- The use of anesthesia is performed in the cases of those patients who will undergo a surgical procedure.
- Local anesthesia is used as 4% lidocaine, a common topical anesthetic in these cases.
- While the endoscopic examination is performed, the patient must be sitting upright in the exam chair.
- The doctor will manipulate the patient’s head to visualize the nasopharynx better.
- After applying the nasal decongestant or the local anesthetic to the nasal cavities, the endoscope is inserted as the case may be.
- Usually, a 3 mm or 4 mm endoscope of 0º or 30º is selected, to which an antifog solution is applied before introducing it into the nasal cavity.
- Then, it is examined in 3 separate passes of the endoscope for each nasal cavity.
- In each pass, the appearance of the nasal mucosa and the structures present in the nasal cavity are examined.
- The color of the nasal mucosa, the inflamed or hypertrophic mucosa, and the presence of nasal polyps or purulent, thick, or thin secretions should be observed.
- Any other anatomical anomaly is visible as a septal deviation or the presence of a spur.
Complications of the procedure
The rhinoscopy procedure performed is low risk, very safe, and minimally invasive.
Possible complications associated with the procedure include an adverse reaction to topical decongestant or anesthesia.
The patient’s allergies must be verified before administering topical medications.
After rhinoscopy, you may experience pain or discomfort, epistaxis (bleeding or nasal bleeding), and vasovagal episodes (a few seconds of loss of consciousness).
In patients with a higher risk of bleeding, such as those with a family history or personal history of bleeding disorders and those who currently receive anticoagulants, caution should be exercised.
As nasal bleeding may occur secondary to trauma to the mucosa during treatment.
In addition to the fact that nasal biopsies obtained in these patients can cause significant bleeding.
Findings
During the procedure, the following findings should be taken into account:
Any deformity in the nasal structure, such as septal deviations: in case of occurrence, the site where the deformation is observed should be specified, and the presence of polyps should be recorded.
The amount and state of the liquids on the nasal surface define if they are aqueous, mucoid, or purulent. This finding may help perform a differential diagnosis of the pathology of an infection or any other condition.
The experimental condition of the mucous membranes: the color, the texture, and the signs of scars and lesions.
These must be precisely evaluated; for example, traditional bluish staining may reveal an allergic condition.
