Endoscopy is a minimally invasive, diagnostic medical procedure. It is used to examine the interior surfaces of an organ or tissue and allows visualization of body cavities not possible by standard examination. The nasal endoscope is a medical device consisting of a thin, rigid tube with fiberoptic cables for bringing in light. The endoscope is then connected to a light source and the doctor can see the image either through the eye piece on the scope, or on the computer screen.
Because the endoscope is slender (only 2.7-4.0 mm in width), it may be passed through the nostril to examine the nasal passages, structures and sinus cavities. While the traditional nasal examination with a speculum and a flashlight (called anterior rhinoscopy) allows a limited “key-hole” view of the front part of the nose, nasal endoscopy, with its superior light and magnification, provides a superior detailed look at the deeper internal nasal anatomy, central airway and posterior aspects of the nose and sinuses. In addition, maximal visualization of the nasal and sinus cavities is provided by the various types of nasal endoscopes. The zero degree nasal endoscope allows a straight view from the tip of the instrument into the nose. The “angled” (30/45/70 degree) endoscopes, in which the view is at an angle from the tip of the endoscope, provide an “around the corner” view, deep into the sinus cavities. These superior visualization capabilities enabled by nasal endoscopy, have turned this procedure into the “work horse” in the diagnosis and management of nasal and sinus conditions.
OFFICE NASAL ENDOSCOPY
Office nasal endoscopy allows a detailed examination of the nasal and sinus cavities in the outpatient clinics. This examination is typically performed by Otolaryngologists (Ear Nose Throat doctors). It is currently the preferred initial method of evaluating medical problems such as nasal stuffiness and obstruction, sinusitis, nasal polyps, nasal tumors, and epistaxis (nose bleeds). During the endoscopy, the patient is seated and the physician searches for: areas of swelling in the mucosal membranes, presence of purulent secretions (pus) draining from the sinus openings, enlargement of the nasal turbinates (internal nasal structures that humidify the nose), crookedness of the nasal septum (the wall that separates the two sides of your nose), presence of polyps, sites of nasal bleeding, and the presence of tumors within the nasal and sinus cavities. If pus is observed, it may be sampled and cultured with a small swab to determine what organism is causing the infection.
Typically, nasal endoscopy is performed with a zero degree endoscope using the “three pass” technique, visualizing three main areas in the nasal and sinus cavities. In the first pass the nasal floor and the back of the nose (nasopharynx) are viewed. The endoscope is then brought out and turned upwards and sideways in order to view the drainage areas of the nasal sinuses (middle and superior meati and the spheno-ethmoidal recess). In the third pass the endoscope is used to view the roof of the nose and the area of the olfactory cleft (smell region).
In order to make this procedure easier and minimize patient discomfort, just before nasal endoscopy the nose will be sprayed with: 1) a nasal decongestant, to gently reduce the swelling in the nasal membranes to permit an easy passage of the endoscope, and 2) a local anesthetic, which temporarily numbs the nose and helps to decrease the chances of sneezing from sensitivity. The procedure is rarely painful, but some patients may experience discomfort if the nasal cavity is unusually narrow or the nasal lining is very swollen.
Overall, nasal endoscopy is a safe and low risk procedure. Nonetheless, potential complications such as mucosal trauma and bleeding may occur, particularly in susceptible patients with increased risk of bleeding, such as those receiving aspirin or other anticoagulant medications (i.e. Plavix, Coumadin, etc.). In addition, adverse reactions to the topical decongestants or anesthetic provided prior to the procedure may occur. Thus before administering these topical medications, patients’ allergies should be verified.
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