diagnostic nasal endoscopy

ENT investigations

1. Diagnostic nasal endoscopy S.Barshni 23

2. Introduction Diagnosis of diseases of nose, PNS, and nasopharynx. Examine all clefts and crevices of nose and nasopharynx.

3. Indications Diagnose disease of nose and PNS. Diagnose source of bleeding in epistaxis. Assess response to medical or surgical treatment of nose and PNS. Take precise biopsy from nose and nasopharynx.

4. Anaesthesia Topical anaesthesia – 4% xylocaine. Vasoconstrictor – oxymetazoline first as nasal spray and then nasal packs

5. Position Sitting. Supine

6. Instruments 4mm 30°endoscope. When nasal passages are narrow, 2.7mm 30°endoscope, 2.7mm 70° endoscope. Freer’s elevator or elevator with a suction channel. Suction tips. Biopsy forceps. Antifog solution or savlon to prevent fogging of endoscopic lens.

7. Technique Nasal packs are removed. First pass Examination of nasopharynx and inferior meatus . Nasal cavity Septal deviation or spurs, discharge, colour of nasal mucous membrane. Pass endoscope along floor of nose into nasopharynx. Examine – opening of eustachian tube, walls of nasopharynx, Upper surface of soft palate and uvula, opening of eustachian tube of opposite side.

8. Examine margins of choana and posterior ends of turbinates. Examine inferior meatus for opening of nasolacrimal duct and hasner’s valve. Pressure over lacrimal sac may express drop of lacrimal fluid through nasolacrimal opening.

9. Second pass Examination of sphenoethmoidal recess, superior meatus and openings of sphenoid sinus and posterior ethmoidal cells. Endoscope is passed medial to middle turbinate. Examine posterior part of middle turbinate, sphenoethmoidal recess, superior turbinate and meatus, openings of posterior ethmoidal cells and opening of sphenoid sinus in posterior wall of sphenoethmoidal recess between nasal septum and superior turbinate.

10. Third pass examination of middle meatus Endoscope is passed from front into middle meatus. Examine uncinate process, bulla ethmoidalis, hiatus semilunaris, sinus of turbinate and frontal recess. Middle meatus is better entered from behind where space is wider than from front.

11. Complications Bleeding can occur due to suction or manipulation of instruments Controlled by vasoconstrictor nasal drops.

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