Diagnostic Nasal Endoscopy

Like anterior and posterior rhinoscopy, endoscopy of nose
and nasopharynx helps in the diagnosis of diseases of
nose, paranasal sinuses (PNS) and the nasopharynx.
Because of the brighter illumination, magnification and
angled view provided by the endoscopes, it is possible to
examine all clefts and crevices of the nose and nasopharynx.
It is an important part of examination of nose and
nasopharynx.
Indications
1. To diagnose any disease of the nose and PNS.
2. To diagnose source of bleeding in epistaxis.
3. To assess response to medical or surgical treatment
of the nose and PNS disease.
4. To take a precise biopsy from nose and nasopharynx.
Anaesthesia
Topical anaesthesia with 4% xylocaine and a vasoconstrictor
(oxymetazoline), first as a nasal spray and then
nasal packs.
Position
Sitting or supine.
Instruments
1. 4 mm 30° endoscope
2.7 mm 30° endoscope } Required when nasal
2.7 mm 70° endoscope passages are narrow
2. Freer's elevator or elevator with a suction channel
3. Suction tips
4. Biopsy forceps
5. Antifog solution or savlon to prevent fogging of the
endoscopic lens.
Technique
After nasal packs are removed, endoscopy is performed by
three passes:
First Pass (Examination of nasopharynx and
inferior meatus)
1. First obtain a general view of the nasal cavity. Look
for any septal deviation or spurs and their size,
mucous or purulent discharge in the nasal cavity and
colour of the nasal mucous membrane.
2. Pass the endoscope along the floor of nose into the
nasopharynx and examine: (i) opening of eustachian
tube, (ii) walls of nasopharynx, (iii) upper surface of
soft palate and uvula, and (iv) opening of eustachian
tube of opposite side. To see these structures endoscope
is rotated.
3. Withdraw the endoscope slightly and examine the
margins of choana and posterior ends of turbinates.
4. Withdraw endoscope slowly and at the same time
examine inferior meatus for opening of nasolacrimal
duct and Hasner's valve. Slight pressure over the
lacrimal sac may express a drop or two of lacrimal
fluid through the nasolacrimal opening.
Second Pass (Examination of the
sphenoethmoidal recess, superior meatus
and openings of sphenoid sinus and
posterior ethmoidal cells)
Endoscope is passed medial to middle turbinate to examine
posterior part of middle turbinate, sphenoethmoidal
recess, superior turbinate and meatus, opening of posterior
ethmoid cells (in the superior meatus) and opening of
sphenoid sinus in the posterior wall of sphenoethmoidal
recess between the nasal septum and superior turbinate.
Third Pass (Examination of the
middle meatus in detail)
Endoscope is passed from the front into the middle meatus.
Sometimes middle turbinate needs to be displaced medially
or 2.7 mm 30° endoscope have to be used. Examine
uncinate process, bulla ethmoidalis, hiatus semilunaris,
sinus of the turbinate (cavity on lateral side of middle
turbinate) and the frontal recess.
Sometimes middle meatus is better entered from
behind where the space is wider than from the front and
structures are seen from behind forward, e.g. basal lamina,
bulla ethmoidalis, hiatus semilunaris, sinus of the turbinate
and uncinate process and the frontal recess.
Complications
Sometimes bleeding can occur due to suction or manipulation
of instruments. It is usually mild and easily controlled
by vasoconstrictor nasal drops.