Nasal endoscopy is a common, minimally invasive procedure performed by ear, nose, and throat (ENT) specialists to thoroughly examine the nasal passages and sinus openings. The technique uses a thin, lighted tube with a camera, called an endoscope, to gain a magnified view of the internal anatomy. This in-office examination is a rapid and effective way to diagnose various conditions affecting the upper respiratory tract.
Preparation and Patient Comfort
To ensure the patient’s comfort and provide the best view, the physician prepares the nasal cavity before inserting the scope. This preparation typically involves applying a combination of topical medications to the lining of the nose.
A topical decongestant, such as oxymetazoline or phenylephrine, is sprayed into the nasal passages to cause the blood vessels to constrict. This action shrinks the mucous membranes lining the nose, especially the turbinates, creating more space for the endoscope to pass through. Reducing swelling improves the physician’s ability to see the deeper structures of the nasal cavity.
Following the decongestant, a local anesthetic, commonly lidocaine, is applied as a spray or gel to numb the internal surfaces. This minimizes any discomfort or pain as the instrument moves through the narrow passages. The combination of decongestant and anesthetic makes the procedure generally well-tolerated, with most patients only reporting a feeling of pressure rather than sharp pain.
The Path of the Endoscope
The endoscope itself is a slender instrument, either rigid or flexible, usually measuring between 2.7 to 4 millimeters in diameter. The physician gently inserts this scope into the nostril and guides it along the natural curves of the nasal cavity.
The scope’s journey begins by navigating past the nasal turbinates, which are shelf-like structures of bone and tissue that warm and humidify the air we breathe. It is guided through the narrow air channels, known as the meatuses, which lie beneath the turbinates. The middle meatus is a particularly important area of focus, as it is the primary drainage pathway for several major sinuses, including the maxillary, frontal, and anterior ethmoid sinuses.
The instrument continues its path to the farthest extent of the nasal cavity, reaching the nasopharynx. This is the upper part of the throat located directly behind the nose. The average distance from the front of the nose to this posterior wall is approximately 9 to 11 centimeters in adults.
The goal is not typically to enter the sinuses themselves, but rather to examine the ostia, which are the small, natural openings connecting the sinuses to the nasal cavity. By visualizing these openings, the physician checks for signs of blockage, inflammation, or discharge. The scope provides a magnified view of the entire path, allowing for the detection of subtle abnormalities.
Common Reasons for the Procedure
Nasal endoscopy is primarily a diagnostic tool used to investigate a variety of persistent or concerning symptoms related to the nasal and sinus anatomy. One of the most frequent indications is the evaluation of chronic rhinosinusitis, a long-term inflammation of the nasal lining and sinuses. The procedure allows the doctor to directly visualize pus, swelling, and mucosal changes to confirm the diagnosis and assess the severity.
The examination is also routinely performed to look for nasal polyps, which are non-cancerous, teardrop-shaped growths that can block the nasal passages and sinus openings. If polyps are present, the endoscopy helps map their location and size, which is necessary for treatment planning. Similarly, unexplained nasal obstruction or congestion that does not respond to standard treatments often prompts an endoscopic look to identify structural issues like a deviated septum or enlarged turbinates.
Other reasons include investigating the cause of frequent or severe nosebleeds (epistaxis) by pinpointing the exact bleeding site. The procedure is also used to assess patients with a decreased sense of smell (hyposmia) or persistent facial pain that may originate from the sinuses. Furthermore, nasal endoscopy is an established part of post-operative care, allowing the ENT specialist to check the healing process and remove crusts or scar tissue following functional endoscopic sinus surgery.