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Nasal Evaluation

1. Anterior rhinoscopy

Anterior rhinoscopy is the basic tool of the physical examination that most specifically relates to determining the existence of pathology in the sino-nasal passages. It is best to evaluate the patient before and after decongestion with a topical decongestant such as oxymetazoline (Afrin™). Prior to decongestion, the clinician evaluates the appearance of the anterior nasal passageways. Typically, it is only after decongestion that the middle turbinates can be directly visualized on anterior rhinoscopy. However, examination of the nasal passages beyond this is very limited when using this method. Septal deviations, seen in up to 79% of the normal population, can obstruct a more complete examination when assessing with anterior rhinoscopy. If nasal endoscopy is to be performed following anterior rhinoscopy, then the nose is also sprayed with 2% lidocaine spray for anesthesia.

2. Nasal endoscopy

In contrast to anterior rhinoscopy, endoscopy introduces brilliant illumination into the dark cavities and permits magnified direct visualization of the mucosa,
turbinates, and, in post-surgical patients, the sinuses. Nasal endoscopy helps identify redness, swelling, polyps, crusting, mucous, pus deep in the nasal cavity and tumors.
There are two types of endoscopes available for evaluating the sinonasal passages—flexible fiberoptic endoscopes and rigid telescopes. They differ mainly in terms of patient tolerance and safety. With regard to patient comfort and direct access to sinus cavities, flexible endoscopy is generally superior to rigid endoscopy. However, image clarity, the facility to obtain cultures and sample tissues, the ability to control epistaxis, and the ability to perform surgical procedures is superior with rigid endoscopy.

Nasal Sprays used prior to your Nasal Examination
0.5% oxymetazoline & 4% lidocaine are used for decongestion and anesthesia prior to nasal endoscopy. When your nose is sprayed please do not sniff in. The spray atomizer will help the medicine be delivered adequately. Sniffing in can lead to more medication being delivered inside your throat than in your nose. Anesthetic spray in the throat can lead cause slight irritation initially followed by a temporary sensation of numbness, perception of difficulty swallowing or even a perception of difficulty breathing even though there is no airway swelling. These side effects can be attributed to the numbness present in your throat. Additionally, you should not drink or eat until you feel normal return of sensation of your throat (about 1 hour) following an examination with these sprays. This to avoid any inadvertent burn or choking on improperly swallowed food or drink.

Risks of Nasal Endoscopy
Although it is generally a very safe and very well-tolerated procedure, the most common adverse effects of endoscopy are patient discomfort/pain, nasal bleeding, and feeling faint or lightheaded from anxiety.

  • Indications for Nasal Endoscopy
  • Nasal/sinus-related complaint(s) recalcitrant to standard treatment.
  • Assess response of longstanding sinonasal disease to medical therapy.
  • Pathology at OMC/middle meatus suspected but not visualized on anterior rhinoscopy.
  • Pathology in sphenoethmoidal recess suspected but not visualized on anterior rhinoscopy.
  • Pathology in nasopharynx suspected but not visualized on routine exam.
  • Assess patency of surgically created sinus openings.
  • To visualize A nasal lesion not adequately seen on routine anterior rhinoscopy.
  • To visualize and/or to biopsy tumors or polyps.
  • To visualize and/or remove foreign body.
  • To culture by endoscopic guidance.

3. Radiologic Imaging

Computerized tomography (CT scan) of the sinuses gives fine detail about soft tissue swelling, the presence of fluid, anatomic abnormalities deep in the sinus cavities, osseous landmarks and bony dehiscences. It is the best radiological study for analysis of sinusitis. On the other hand, Magnetic Resonance Imaging (MRI) are the best imaging study for evaluation of tumors and brain herniation into the nose.

These techniques reveal important information necessary for proper diagnosis, treatment and monitoring. Often times, nasal endoscopic findings compliment findings seen on CT imaging, but they are not always the same. Interestingly, abnormalities detected on endoscopy or imaging can be present without symptoms.