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Rhinoscopy

Rhinoscopy is used to examine the nasal cavity. Rhinoscopy includes two procedures: Anterior rhinoscopy and Posterior rhinoscopy. In anterior rhinoscopy, the rhinoscope is advanced through the nose to examine the nasal cavity. In posterior rhinoscopy, the rhinoscope is advanced through the mouth to examine the back of the nasal cavity above the soft palate. Rhinoscopy is often performed in conjunction with CT scan and dental examination to further evaluate patients with nasal, sinus or nasopharyngeal disease and to increase the probability that lesions are not missed. Rhinoscopy can be used to diagnose inflammation, foreign bodies, tumors, and fungal infections.

Uses of Rhinoscopy

In addition to allowing visual examination of nasal cavity, rhinoscopy can be used to:

  1. Identify the cause of clinical signs such as sneezing, nasal discharge, epistaxis (nosebleeds), stertor (snoring sounds) and stridor (inspiratory noise and wheezing).
  2. Obtain tissue samples (biopsy) for cytologic and histologic evaluation. Samples are evaluated for inflammation, infection, fibrosis and cancer. Biopsy can aid in characterization the extent of disease. This generally takes three to five days.
  3. Obtain samples for culture.
  4. Treat nasal, sinus or nasopharyngeal problems, such as removal of foreign body or nasal polyps, and introduction of medication into the nasal cavity or sinus to eradicate fungal infections.

Procedure

Rhinoscopy is performed under general anesthesia. The patient is generally fasted for 12 hours prior to rhinoscopy to decrease the risk of aspiration of stomach contents into the lungs during anesthesia. After being anesthetized, the patient is placed in sternal recumbency (on its chest) and anesthetic monitoring equipment is attached. The patientís heart rate and rhythm, respiratory rate, blood pressure, carbon dioxide level and oxygen saturation level are closely monitored while under anesthesia to prevent and minimize anesthesia-associated complications.

To prepare for rhinoscopy, the oral cavity is carefully examined for any abnormalities, such as deformed hard palate, mucosal hyperemia, foreign bodies, and dental disease. For anterior rhinoscopy, the tip of the rhinoscope is lubricated and gently advanced through the nose into the nasal cavity. For posterior rhinoscopy, the tip of the rhinoscope is advanced through the mouth into the back of the mouth and nasal cavity. As the endoscope is advanced, surfaces are closely examined for abnormalities including inflammation, ulcers, plaques, foreign bodies and masses. Nasal secretions and blood may be removed by flushing the nose with sterile saline to improve visualization. Photos and videos may be collected of normal and abnormal structures and motility for documentation and further study. A number of biopsy samples are generally collected, regardless of appearance, for histopathology. This is because tissues may be diseased even if they appear normal visually. If a foreign body is identified, it may be removed using grasping forceps, a snare or a basket retrieval device. Medication can also be injected directly into nasal cavity or sinus for treatment of fungal infections.

Rhinoscopy generally takes between 20 minutes and one hour depending on gross findings, number of biopsies taken or the number of foreign bodies found. At the end of the procedure, the rhinoscope is slowly removed. After the completion of rhinoscopy, a cold pack is generally applied to the nose to decrease bleeding and swelling from the procedure. At the completion of all the procedures, the patient is recovered from anesthesia. Most patients go home the day after the procedure.

Risks and Limitations

Rhinoscopy is generally considered a safe procedure. In addition to risks or limitations of endoscopy in general, the most common finding is that bleeding may persist for a short while after the procedure but it should stop on its own. In the rare event of severe bleeding, dilute epinephrine is instilled into the nose to stop the bleeding.

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