This document provides information about diagnostic nasal endoscopy including its indications, techniques, and complications. It is used to diagnose diseases of the nose, paranasal sinuses, and nasopharynx by examining all areas with an endoscope. Topical anesthesia is applied before inserting different sized endoscopes to visualize the nasal cavities, nasopharynx, sinuses and related structures. The endoscope is passed in multiple ways to thoroughly examine the nasal passages and related areas. Potential complications include bleeding that can be controlled with vasoconstrictor drops.

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.

8. 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.

9. ■ 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.

11. ■ 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.

13. ■ 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.

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

16. Thank u