Due to the intensive development of the medical technical base, endoscopic examination techniques have become one of the most informative examination methods that allow an accurate diagnosis. Appeared similar method and in otolaryngology. Nasal endoscopy is performed in cases when it is not enough to conduct an examination of the nasal cavity and nasopharynx using ordinary mirrors for a complete examination of the patient. The device used for inspection is a thin rigid or flexible tube with a diameter of 2-4 mm, inside which there is an optical system, a video camera and a lighting element. Thanks to such an endoscopic device, a doctor can examine in great detail all parts of the nasal cavity and nasopharynx at different magnifications and at different angles.

In this article, we will acquaint you with the essence of this diagnostic method, its indications, contraindications, methods of preparation for the study and the principles of the technique for performing nasal endoscopy. This information will help you understand the essence of this method of examination, and you will be able to ask questions that arise to your doctor.

Method essence

When performing nasal endoscopy, a special endoscope is inserted into the nasal cavity and nasopharynx, allowing you to examine the area under study. A rigid (non-bending) or flexible (changing direction) device can be used to perform the procedure. After inserting the endoscope, the otolaryngologist examines the nasal cavity, starting from the lower nasal passage. During the examination, the device gradually moves up to the nasopharynx, and the specialist can examine the condition of the inner surface and all anatomical formations of the studied cavities.

Endoscopy of the nose may reveal:

• inflammatory processes on the mucous membrane (redness, swelling, mucus, pus);
• disorders of the structure of the mucous membrane (hyper-, hypo- or atrophy);
• benign and malignant tumor formations (their localization and degree of growth);
• foreign objects trapped in the nasal cavity or nasopharynx.

Indications

Endoscopy of the nose can be performed for diagnostic purposes or as a therapeutic procedure.

Endoscopy of the nose can be prescribed for the following conditions and diseases:

• discharge from the nose;
• difficulty breathing;
• frequent;
• frequent;
• feeling of pressure in the face area;
• deterioration of smell;
• hearing loss or tinnitus;
• suspicion of inflammatory processes;
• snore;
• suspicion of the presence of tumors;
• delayed speech development (in children);
• suspicion of the presence of a foreign object;
• frontal;
• adenoids;
• ethmoiditis;
• facial trauma to the skull;
• curvature of the nasal septum;
• anomalies in the development of the paranasal sinuses;
• preoperative and postoperative period after rhinoplasty.

If necessary, during endoscopy of the nose, the doctor can perform the following diagnostic or therapeutic procedures:

• collection of purulent secretions for bacteriological analysis;
• biopsy of tissue of neoplasms;
• elimination of the causes of frequent nosebleeds;
• removal of neoplasms;
• surgical treatment of the nasal cavity after endoscopic operations (removal of crusts, mucus, treatment of wound surfaces).

Endoscopy of the nose can be performed not only to diagnose the disease, but also to control the effectiveness of the treatment or as a method of dynamic monitoring of pathology (excluding relapses, identifying threats of complications, monitoring the dynamics of neoplasm growth, etc.).

Contraindications

There are no absolute contraindications for performing nasal endoscopy, but in some cases such a procedure must be performed with caution or replaced by other diagnostic techniques. The risk group includes patients with the following conditions:

• allergic reactions to;
• disorders in the blood coagulation system;
• reception;
• frequent bleeding due to weakened blood vessels.

If there are allergic reactions to the local anesthetic used, the drug is replaced with another. And with an increased risk of bleeding, the study is carried out after preliminary special preparation of the patient for the procedure. To exclude trauma to the vessels in such cases, a thinner endoscope can be used.

Preparation for research

In the absence of contraindications, preparation for nasal endoscopy does not require any special measures. The doctor must explain to the patient the essence of the study and certify him that during the procedure he will not feel pain, and the discomfort will be minimal. In addition, the patient must be prepared to maintain complete immobility during the study. And if the examination is carried out for a child, then one of the parents must be present during the procedure.

If necessary, before the study, a test is carried out to identify a possible allergic reaction on a local anesthetic. If the patient is taking anticoagulants, the doctor may advise to temporarily stop using the drug or adjust the regimen.

If it is necessary to remove the neoplasm during endoscopy, the patient is recommended to remain after performing the surgical manipulation under the supervision of doctors for 24 hours. In such cases, he should take with him from home the things necessary for a comfortable stay in the hospital (comfortable clothes, slippers, etc.).

How the research is done

A nasal endoscopy procedure can be performed in an otolaryngologist's office. The patient sits in a special chair with a headrest, the position of which can change during the study.

If necessary, before the procedure, a vasoconstrictor drug (for example, Oxymetazoline spray) is injected into the nasal cavity to eliminate excessive swelling of the mucous membrane. After that, for anesthesia, the nasal mucosa is irrigated with a local anesthetic solution - for this, a spray can be used or the mucous membrane is lubricated with a swab soaked in the preparation.

After some time, after the onset of local anesthesia, which is expressed in the appearance of a slight tingling sensation in the nose, an endoscope is inserted into the nasal cavity. The doctor examines the condition of the mucous membrane on the image received on the computer monitor and slowly advances the device to the nasopharynx.

Examination during endoscopy of the nose includes the following steps:

• panoramic examination of the vestibule of the nose and the general nasal passage;
• the endoscope is moved along the bottom of the nasal cavity to the nasopharynx, the presence of adenoid vegetations, the state of the nasopharyngeal vault, orifices are specified auditory tubes and rear ends bottom shell nose;
• the device is moved from the vestibule to the middle turbinate and the condition of its mucous membrane and middle nasal passage is assessed;
• an endoscope is used to examine the upper nasal passage, the olfactory fissure (in some cases, the doctor may consider the state of the excretory openings of the ethmoid labyrinth cells and the superior turbinate)

During the examination, the specialist evaluates the following parameters:

• color of the mucous membrane;
• the presence of hypertrophy or inflammatory processes;
• the nature of the discharge (mucous, thick, purulent, liquid, transparent);
• the presence of anatomical disorders (narrowing of the passages, curvature of the nasal septum, etc.);
• the presence of polyps and other tumor formations.

The examination procedure usually takes no more than 5-15 minutes. If necessary, the diagnostic study is supplemented by surgical or medical procedures. After the completion of the procedure, the doctor prints the received photos and draws up a conclusion The results of the study are handed out to the patient or sent to the attending physician.

If there is no change in well-being after the endoscopy of the nose, the patient can go home. If the procedure was supplemented by performing surgical removal neoplasms, the patient is placed in the ward and remains under medical supervision for a day. After the endoscopy of the nose, the patient is recommended to refrain from intense blowing of his nose for several days, which can provoke the development of nosebleeds.

Endoscopy of the maxillary sinus

In some cases, the goal of diagnostic nasal endoscopy is to assess the condition of the maxillary sinus. Such a study is called sinusoscopy and is prescribed in the following cases:

• the need to clarify the diagnosis with an isolated lesion maxillary sinuses;
• presence foreign bodies in this region;
• the need to perform medical procedures.

Endoscopy of the maxillary sinus is performed as follows:

1. To relieve sinusoscopy, local anesthesia is performed to block the branches of the trigeminal nerve.
2. With the help of a special trocar with a sleeve, the doctor, using rotational movements, punctures the anterior wall of the maxillary sinus between the roots of the III and IV teeth.
3. The specialist inserts an endoscope with 30-70 ° optics through the sleeve into the cavity of the maxillary sinus and examines it. If necessary, a tissue biopsy is performed, performed with a curettage spoon with a flexible stem or angular forceps.
4. After completing the study, the doctor flushes the sinus several times antiseptic solution and with gentle rotational movements, removes the trocar sleeve.

Diagnostic sinusoscopy takes about 30 minutes. After performing the procedure, the patient may experience slight discomfort at the insertion site of the endoscope, which after a while is eliminated on its own.

Which doctor to contact

Diagnostic nasal endoscopy may be prescribed by an otolaryngologist. If necessary, this procedure can be supplemented with medical manipulations, tissue biopsy or collection of mucus samples for bacteriological analysis.

METHODS FOR STUDYING THE NOSE, SINTERS

Examination of the nose and paranasal sinuses is carried out after examining the history and begins with external examination and palpation. On examination, pay attention to the condition skin and soft tissues of the face and external nose, for the absence or presence of defects, for the symmetry of both halves of the face, as well as for the shape of the external nose. Palpation should be done carefully. By soft movements of the hand, the presence or absence of pain in the nasal region and the projection of the paranasal sinuses is established. If a fracture of the nasal bones is suspected, the pathological mobility of bone fragments and the presence of crepitus are determined.

Endoscopy of the nasal cavity

Inspection of the nasal cavity (rhinoscopy) is carried out using a light source, which should be located to the right of the subject, at the level of his ear at a distance of 15-20 cm, slightly behind so that direct light from him does not fall on the examined area. The focused light reflected from the frontal reflector is directed to the examined area.

Further research is carried out using a special expander (Fig. 1), held in the left hand, which is inserted into the vestibule of the nose. The doctor fixes the patient's head with his right hand, which allows changing its position during examination. In other cases, the doctor holds instruments for manipulation in the nasal cavity in his right hand.

Figure: one. Rhinoscopy instruments:

1 - mirror for anterior rhinoscopy; 2 - mirror for posterior rhinoscopy

Endoscopy of the nasal cavity is divided into front(direct) and back(indirectly). Anterior rhinoscopy is performed in two positions: with the head straight and with the head tilted back. In the first position, the vestibule of the nose, the antero-inferior half of the nasal septum, the anterior end of the inferior concha, the entrance to the inferior nasal passage and the lower and middle parts of the common nasal passage are visible (Fig. 2).

With anterior rhinoscopy, attention is paid to various signs reflecting both the normal state of endonasal structures and certain pathological conditions. The following signs are evaluated:

a) the color of the mucous membrane and its moisture;

b) the shape of the nasal septum and pay attention to the vasculature in its anterior sections, the caliber of the vessels;

c) the state of the turbinates (shape, color, volume, relation to the nasal septum), palpate them with a bell-shaped probe to determine elasticity and compliance;

d) the size and content of the nasal passages, especially the middle and in the area of \u200b\u200bthe olfactory gap. In the presence of polyps, papillomas or other pathological tissues, they are evaluated appearance and if necessary, take tissue for biopsy.

Posterior rhinoscopy allows you to examine the posterior parts of the nasal cavity, the vault of the nasopharynx, its lateral surfaces and the nasopharyngeal openings of the auditory tubes.

Posterior rhinoscopy is performed as follows (see Fig. 2, b): with a spatula, held in the left hand, press the front two-thirds of the tongue downwards and slightly forward. The nasopharyngeal speculum, pre-heated (to avoid fogging its surface), is inserted into the nasopharynx behind the soft palate, without touching the root of the tongue and the posterior pharyngeal wall. Disturbances are a pronounced gag reflex, a thick and "recalcitrant" tongue, a hypertrophied lingual tonsil, a narrow pharynx, a long uvula, protruding vertebral bodies in severe lordosis cervical spine, inflammatory diseases of the pharynx, tumors or scars of the soft palate. If, due to the presence of objective interference, conventional posterior rhinoscopy fails, appropriate application anesthesia is used to suppress the gag reflex, as well as pulling off the soft palate using one or two thin rubber catheters (see Fig. 2, r).

After application of anesthesia of the mucous membrane of the nose, pharynx and the root of the tongue, a catheter is inserted into each half of the nose and its end is withdrawn from the pharynx out of the pharynx using a forceps. Both ends of each catheter are tied together with slight tension, making sure that the soft palate and uvula do not curl towards the nasopharynx. Thus, immobilization of the soft palate is achieved and free access to the nasopharynx is opened.

In the nasopharyngeal mirror (diameter 8-15 mm), only separate areas of the examined area are visible. Therefore, to review all the formations of the nasopharynx, light turns of the mirror are made, sequentially examining the entire cavity and its formations, focusing on the posterior edge of the nasal septum and the vomer (see Fig. 2, in).

In some cases, it becomes necessary digital examination of the nasopharynx, especially in children, since they rarely manage to conduct an indirect posterior rhinoscopy. With a digital examination of the nasopharynx, its overall size and shape are assessed, the presence or absence of partial or complete obliteration, senechiae, adenoids, choanal obstruction, hypertrophied posterior ends of the inferior turbinates, choanal polyps, tumor tissue, etc. are determined.

A more detailed picture of the nasal cavity can be obtained using modern optical endoscopes (Fig. 3) and television endoscopy techniques.

Diaphanoscopy

In 1889, Th. Heryng was the first to demonstrate the method of light transmission of the maxillary sinus by inserting a luminous bulb into the oral cavity (Fig. 4, a, 2).

The diaphanoscopy procedure is carried out in a dark cabin with a weak dark green light, which increases the sensitivity of vision to red light. To scan the maxillary sinus, the diaphanoscope is inserted into the oral cavity and a beam of light is directed to solid sky, while the examined firmly fixes the diaphanoscope tube with his lips. Normally, a number of symmetrically located reddish light spots appear on the front surface of the face: two spots in the area of \u200b\u200bdog pits (between zygomatic bone, wing of the nose and upper lip), which indicate good airiness of the maxillary sinuses. Additional light spots appear in the region of the lower edge of the orbit in the form of a crescent with a concavity upward (evidence of the normal state of the upper wall of the maxillary sinus).

For transillumination frontal sinus a special optical attachment is provided that focuses light into a narrow beam, which is applied to the upper medial angle of the orbit so that the light is directed through its upper medial wall towards the center of the forehead. In the normal state of the frontal sinuses, dull, dark red spots appear in the region of the brow ridges.

Ultrasound procedure

Ultrasound examination is performed in relation to the maxillary and frontal sinuses; using this method, it is possible to establish the fact of the presence in the sinus of air (norm), fluid, thickening of the mucous membrane or dense formation (tumor, polyp, cyst, etc.). The device used for ultrasound examination of the paranasal sinuses was named "Sinusskan". The principle of operation is based on the irradiation of the sinus with ultrasound (300 kHz) and registration of the beam reflected from the formation in the sinus. The research result is displayed on a special display in the form of spatially spaced strips, the number of which corresponds to the number of echogenic layers. Their distance from the "zero" strip, corresponding to the surface of the skin, reflects the depth of each layer, which forms either the level of fluid in the sinus, or a mass formation.

X-ray examination

X-ray diagnostics is aimed at identifying the degree of airiness of the nasal cavity and paranasal sinuses, the presence of pathological formations in them, at determining the state of their bony walls and soft tissues of the facial region, the presence or absence of foreign bodies, identifying anomalies in the development of the facial skeleton, etc. For more effective detection of volumetric formations the maxillary sinus, radiopaque substances are used, for example, iodlipol, by introducing them into the sinus cavity. The anatomical and topographic features of the paranasal sinuses, in order to obtain sufficient information about their condition, require special styling in relation to the X-ray beam and the surface of the X-ray sensitive film, on which displays of certain structures of the studied area are visualized.

Examination of the anterior paranasal sinuses

Nose chin styling (Fig. 5) allows you to visualize the anterior paranasal sinuses, especially clearly - the maxillary:

L common sinuses (1) separated by a bony septum. Their image is limited to the bony border.

Orbits (2) darker than all other sinuses.

Lattice maze cells (3) are projected between the eye sockets.

Maxillary sinuses (4) located in the center of the front array. Sometimes there are bony septa inside the sinuses that divide them into two or more parts. Of great importance in the diagnosis of diseases of the maxillary sinus is X-ray imaging of its bays (see Fig. 6) - alveolar, lower palatine, molar and orbital-ethmoid, each of which can play a role in the occurrence of diseases of the paranasal sinuses.

Lower eye gapthrough which the zygomaticand infraorbital nerves, is projected below the lower edge of the orbit. It is important when performing local-regional anesthesia. When it narrows, "neuralgia of the corresponding nerve trunks occurs.

Round hole (6) is projected in the mid-medial part of the planar image of the maxillary sinus (on the roentgenogram, it is defined as a round black dot surrounded by dense bony walls).

It allows you to visualize those elements that are marked on the X-ray diagram. Lateral projection is important when it is necessary to assess the shape and size of the frontal sinus in the anteroposterior direction (for example, if it needs trepanopuncture), to determine its relation to the orbit, the shape and size of the sphenoid and maxillary sinuses, as well as many other anatomical formations of the facial skeleton and the anterior parts of the skull base ...

Examination of the posterior (craniobasilar) paranasal sinuses

The posterior paranasal sinuses include the sphenoid (main) sinuses; some authors classify the posterior cells of the ethmoid bone as these sinuses.

Axial projection (Fig. 8) reveals many formations of the base of the skull, it is used when necessary to visualize the main sinuses, the rocky part of the temporal bone, openings of the base of the skull and other elements. This projection is used in the diagnosis of skull base fractures.

Tomography

The principle of tomography was formulated in 1921 by the French physician A. Bocage and implemented in practice by the Italian radiologist A. Vallebona. This principle has become an integral part of orthopantomography and computed tomography. In fig. 9 shows an example of a tomogram of the anterior paranasal sinuses nose. In some cases, when there is a suspicion of an odontogenic disease of the maxillary sinus, an orthopantomographic examination is performed, which displays a detailed picture of the dentoalveolar region (Fig. 10).

CT scan (CT) (synonyms; axial computed tomography, computed x-ray tomography) is a method based on the circular transmission of the human body with a scanning x-ray emitter moving around the axial axis at a selected level and with a certain step.

In otorhinolaryngology, CT is used to diagnose inflammatory, oncological, and traumatic lesions of the ENT organs (Fig. 11).

Sounding of the paranasal sinuses

Probing of the paranasal sinuses (Fig. 12) is used to examine them using special endoscopes and to inject drugs into them. In the latter case, special catheters are used.

Study of the respiratory function of the nose

The simplest and fairly objective method, widely used in clinical practice, is the test with V.I.Voyachek's fluff. It allows you to judge the state of the respiratory function of each separate half of the nose, to which, during breathing, a cotton fluff is brought to each nostril through the nose. The movement of the fluff is used to judge the quality of nasal breathing. The "respiratory spots" method proposed by Zvaardemaker also belongs to simple methods for studying the respiratory function of the nose. When breathing on a polished metal plate brought to the nostrils of the nose with semicircular lines applied to its surface (R. Glyatzel's mirror), misted surfaces appear, according to the size of which the degree of air passage of the nasal passages is estimated.

Rhinomanometry. To date, a number of devices have been proposed for conducting objective rhinomanometry with the registration of various physical indicators of the air flow passing through the nasal passages. Thus, the method of computer rhinomanometry allows obtaining various numerical indicators of the state of nasal breathing. Modern rhinomanometers are sophisticated electronic devices in the design of which special microsensors are used, which convert the intranasal pressure and air flow velocity into digital information. The devices are equipped with special programs of mathematical analysis with the calculation of indices of nasal breathing, means of graphical reflection of the studied parameters in the form of monitors and printers (Fig. 13).

The presented graphs show that during normal nasal breathing, the same amount of air (ordinate axis) passes through the nasal passages in a shorter time with half, three times less pressure air jet (abscissa axis).

Acoustic rhinometry... This study uses the method of sound scanning of the nasal cavity in order to determine its volume and total surface area.

The installation consists of a measuring tube and a special nose adapter attached to its end. An electronic sound transducer at the end of the tube sends out a continuous broadband sound signal, or a series of intermittent sound signals, and records the sound reflected from the endonasal tissues back into the tube. The measuring tube is connected to an electronic computing system for processing the reflected signal. The graphical display of the parameters of sound rhinometry is carried out continuously. The display shows both single curves of each nasal cavity and a series of curves reflecting the dynamics of the changed parameters over time. The value of this method lies in the fact that with its help it is possible to accurately determine the quantitative spatial parameters of the nasal cavity, document them and study them in dynamics. In addition, the installation provides ample opportunities for carrying out functional tests, determining the effectiveness of the drugs used and their individual selection. A computer database, a color plotter, storage in memory of the received information with the passport data of the surveyed, as well as a number of other possibilities allow us to classify this method as very promising in both practical and research terms.

Endoscopy of the nose - This is a minimally invasive procedure involving a visual examination of the inner nasal surface, nasopharynx, paranasal sinuses. It is used to diagnose diseases of the ENT profile, it is included in the standard diagnostic complex for headaches of unknown origin. It is produced under local application anesthesia. To obtain the necessary information, the doctor inserts special mirrors or an endoscope equipped with a light source, high-quality optics and an eyepiece into the nose. The cost of the technique depends on the price of consumables, the working time of the specialists involved, such as medical organization.

Indications

Diagnostic endoscopy of the nose is indicated in preparation for otolaryngological interventions. It is necessary to get an accurate picture of the state of the area where the operation will be performed. In addition, nasal endoscopy is prescribed if the patient has the following complaints:

• mucous or purulent discharge that does not disappear within 2-4 weeks;
• recurring nosebleeds for no apparent reason;
• violation of nasal breathing;
• suspected curvature of the nasal septum;
• speech impairment caused by organic pathology;
• auditory hallucinations and hearing impairment;
• chronic inflammation.

Endoscopy can also be used for therapeutic purposes. During this procedure, bleeding is stopped, tissue is taken for cytological examination, and small polyps are removed. Trauma to healthy areas during manipulation is minimal.

Contraindications

Almost all contraindications to endoscopy of the nasal cavity and paranasal sinuses are relative, do not exclude the procedure, but require certain protective measures. List of conditions requiring compliance special measures precautions includes the following points:

• excessive sensitivity of the mucous membrane to irritating effects;
• weakness and fragility of the capillary network;
• anatomical defects and narrowing of the nasal passages, in which endoscopy can cause injury;
• neurological disorders associated with dysfunction of the vestibular apparatus;
• a history of allergic reactions to local anesthetics;
• psychomotor agitation, increased motor activity of the patient;
• exacerbation of mental illness.

Preparation for endoscopy of the nose

Manipulation does not require advance preparation, it can be carried out on the day of the first visit of the patient to a medical organization. Immediately before the start of endoscopy, the otolaryngologist performs the following preparatory procedures:

1. Taking anamnesis. Eliminate the presence of allergies to the drugs used. Find out the availability chronic diseases the respiratory system, find out if an endoscopy has been performed in the past.
2. Rehabilitation of the upper respiratory tract. Endoscopy cannot be performed if the nasal passages are filled with pathological secretions. Therefore, the patient is asked to blow his nose thoroughly. If the patient is unable to do this, an electric pump is used to remove mucus.
3. Anemization of the mucosa. Endoscopy is difficult with swelling of the mucous membranes and their increased blood supply. To restore sufficient patency of the anatomical holes, nasal vasoconstrictors in the form of drops are used.
4. Anesthesia. Anesthesia is carried out by application by introducing turunda soaked in lidocaine into the nasal openings. The nasal irrigation method is used less often, as it is less effective. If necessary (young children, psychiatric patients), general drug sedation may be prescribed.

Methodology

Nasal endoscopy can be performed with different penetration depths. There are the following types of survey.

1. Classical rhinoscopy.It is carried out using nasal speculum-dilators and nasopharyngeal speculum. It can be front, middle or back. The doctor inserts an instrument into the airways, expands them and examines them by directing a beam of light from the frontal reflector. With posterior rhinoscopy, examination is carried out through the mouth by introducing nasopharyngeal mirrors.
2. Endoscopy of the nose. The procedure begins with an examination of the lower nasal passage. The doctor slowly conducts the endoscope to the nasal conchas, assessing the condition of the mucous membranes, the nature of the existing secretion, the size and structure of the tumors (if any). Next, the middle nasal passage is examined, where special attention is paid to the state of the fountain, the lattice funnel, the opening of the sphenoid sinus. The upper passage is examined after a slight lateroposition of the middle shell.
3. Hymoroscopy. Performed only if pathology is suspected maxillary sinuses... Requires instrumental expansion of the natural anastomosis of the middle airway. The puncture is done with a trocar, through the sleeve of which endoscopic equipment is then introduced. This type of rhinoscopy has a higher cost.
4. Sinusoscopy.The study can be supplemented by examination of other sinuses located nearby: frontal, wedge-shaped. This type of nasal endoscopy requires additional surgical procedures to provide access, therefore, it is rarely performed for diagnostic purposes.

After endoscopy of the nose

After the end of the manipulation and removal of the equipment, the doctor conducts a visual external examination of the patient, inquires about his health. When a slight bloody discharge appears, the patient's head should be tilted slightly, gauze tampons should be inserted into the external nasal passages. Minor capillary bleeding is not considered a complication.

The performed maxillary or sinusoscopy requires inpatient monitoring of the patient for 12-24 hours. Control allows timely detection and correction early complications... Endoscopy of the nose without penetrating the sinuses can be performed on an outpatient basis.

Complications

Endoscopy of the nose rarely leads to complications. This happens mainly in cases where the manipulation involves puncture of the paranasal sinuses. Possible adverse reactions include:

1. Pain. On pain after the end of the anesthetic, about 1% of patients complain. To eliminate the unpleasant consequences, analgesics are prescribed. The duration of the course is 2-3 days.
2. Bleeding. Occurs during the examination or after a few hours. Caused by damage blood vessels... Minor hemorrhages do not require repeated interventions. With volumetric blood loss, the injured vein is cauterized or sutured.
3. Paresthesias. They occur after a sinus puncture. The patient complains of burning, creeping and tingling in the puncture area. Such phenomena disappear on their own after a few weeks.

The total number of complications does not exceed 2%. In the vast majority of cases, adverse effects are easily stopped and do not lead to permanent pathological changes.

Inspection of the nasal cavity (rhinoscopy) is performed using a light source. Most often, in rhinoscopy, as in other types of endoscopy, a frontal reflector is used to illuminate the object of study.

Inspection can also be carried out using one of the types of endoscopes with an autonomous light source or with fiber optics. Examination of the vestibule of the nose is carried out by simply lifting the tip of the nose with the thumb of the left hand, while the rest of the examiner's fingers rest on the patient's forehead (Fig. 2.3.1). This allows you to examine the inner surface of the vestibule of the nose, the movable part of the nasal septum and the condition of the skin lining them from the inside with hairs. This technique is often used when examining young children who do not allow for fear of inserting an instrument into their nose.

Further examination is performed using special dilators - nasal mirrors. The design of modern instruments originates from the nasal dilator developed by the Slovak physician Marcusovsky (1860).

The nasal speculum, held in the left hand, is carefully inserted into the vestibule of the subject's nose in a closed state. The mirror is displayed in open formso as not to pinch the hairs of the vestibule of the nose. Gradually pushing the branches apart, the nostril is widened and slightly raised upward. It is necessary to avoid pressing the mirror on the nasal septum, and also not to insert the mirror deeply, which can cause pain.

If the instrument is in the doctor's left hand, then with his right hand he fixes the patient's head, which allows you to change its position when examining the posterior parts of the nose. Examination of the nasal cavity through its anterior sections is called anterior rhinoscopy. It is performed in two positions (Fig. 2.3.2): 1) with the subject's head straight (first position) and 2) with the head tilted back (second position). In the first position are visible most of vestibules of the nose, the anterior-lower half of the nasal septum, the anterior end of the inferior concha and the common nasal passage. In the second position, it is possible to examine the upper and deeper parts of the nasal cavity. Manages to see upper part the septum of the nose, the middle nasal passage, the anterior third of the middle turbinate and the olfactory fissure. Turning the subject's head, one can examine in detail the listed structures of the nasal cavity.

To inspect the deeper parts of the nose, the so-called. medium, or deep, rhinoscopy. In this case, a nasal speculum with elongated lips is used (Killian's middle nasal speculum), after anesthesia of the mucous membrane with one of the types of surface anesthetic (Sol. Dicaini 2%). With swelling of the turbinates, they must be reduced by lubricating vasoconstrictor agents (for example, adding 3 drops of 0.1% solution of adrenaline in 1 ml of solution of dicain). Better yet, use a 3-5% cocaine solution, which has not only anesthetic, but also a vasoconstrictor effect.

Examination of the posterior parts of the nose and nasopharynx is called posterior rhinoscopy and is performed using a special small (nasopharyngeal) mirror with a diameter of 6 to 10 mm, attached to a metal rod at an angle of 115 °. Let us recall that the laryngeal speculum differs from the nasopharyngeal speculum not only in its larger size, but also in its larger angle of attachment to the rod (120 - 125 °).

For convenience, the mirror rod is fixed with a screw in a special handle. Historically, posterior rhinoscopy was developed earlier by the anterior Czech scientist Czermak in 1859, shortly after the introduction of laryngoscopy into clinical practice (Turk and Czermak, 1857).

Posterior rhinoscopy is performed as follows. With a spatula, taken in the left hand, the front 2/3 of the subject's tongue is pressed (deeper insertion of the spatula causes a gag reflex). The nasopharyngeal mirror, without touching the mucous membrane and the root of the tongue, is inserted into the oropharynx behind the soft palate (Fig. 2.3.3). To avoid fogging, the mirror is preheated over the flame of an alcohol lamp (the mirror side, but not the metal side!) Or in a vessel with hot water. Making light turns of the mirror, the entire nasopharynx is examined sequentially, focusing on the posterior edge of the nasal septum (vomer). At the same time, the choanas and the posterior ends of the turbinates, the side walls with the pharyngeal orifices of the auditory tubes, the nasopharyngeal vault, and the pharyngeal tonsil are examined. It should be emphasized that if with anterior rhinoscopy we can see only the inferior and middle turbinates, then with posterior rhinoscopy we can see all three. In fig. 4 (a) and (b) shows a diagram of the anterior and posterior rhinoscopic picture.

Posterior rhinoscopy is most difficult endoscopic method research. It is important that the subject does not strain and breathes through his nose. In this case, the soft palate hangs down, which allows a mirror to be inserted into the nasopharynx. If a pronounced pharyngeal reflex complicates examination, then in this case they resort to anesthesia of the mucous membrane of the root of the tongue and nasopharynx with one of the mucous anesthetics. In some cases, it is necessary to retract the soft palate with one or two rubber catheters passed through the nasal cavity into the oral cavity (Fig. 2.3.5). Examination of the nasopharynx can also be carried out using a special endoscope also after preliminary anesthesia of the mucous membrane. In this case, the endoscope (depending on its diameter and the state of the nasal cavity) can be inserted to inspect the nasopharynx both through the nose and through the pharynx (Fig. 2.3.6).

In early childhood as a rule, it is not possible to perform a posterior rhinoscopy. In such cases, they resort to digital examination of the nasopharynx.

When assessing the endoscopic picture, attention is consistently paid to the color, shine of the mucous membrane, the volume of the turbinates, the width of the nasal passages, defects of the nasal septum, its deformation and the contents of the nasal cavity.

Normally, the mucous membrane has a moderate pink color. With inflammation, it becomes more red in color (hyperemia). With vasomotor processes, it can have a bluish, marbled color (in cases of neurocirculatory form of vasomotor rhinitis) or pale and even white color with an allergic form of vasomotor rhinitis.

Normally, the mucous membrane has a moist sheen. With atrophic processes, it becomes dry and acquires the so-called. dry shine.

Enlarged turbinates are called hypertrophied. Hypertrophy can be false or true. With false hypertrophy, the turbinates are easily reduced under the action of vasoconstrictor drugs (observed in vasomotor and simple inflammatory rhinitis). True hypertrophy can be caused by an increase in the bone skeleton of the turbinate or the development of connective tissue elements in the submucosal layer (for example, in chronic hyperplastic rhinitis). In this case, there is no or almost no contraction of the mucous membrane and, consequently, the volume of the turbinates.

With atrophic processes ( atrophic rhinitis and especially with the fetid rhinitis of the ozena) atrophy of the turbinates occurs, and the nasal cavity becomes wide, while with anterior rhinoscopy, it is easy to examine the posterior pharyngeal wall and other details of the nasal cavity, which are usually not visible in the norm.

The pathological contents of the nasal cavity are primarily mucopurulent discharge. In acute and chronic rhinitis, the discharge is usually found in the common nasal passage. With inflammation of the paranasal sinuses, they are found in the middle nasal passage (with anterior rhinoscopy), as well as in the fornix of the nasopharynx and on its posterior wall, which can be established with posterior rhinoscopy. With atrophic processes in the nasal cavity, crusts accumulate, especially pronounced and possessing unpleasant odor by the lake.

In most cases, the following research methods are prescribed: rhinoscopy, radiography, ultrasound procedure sinuses. If these methods do not provide comprehensive information, nasal and nasopharyngeal endoscopy is prescribed. It has a budgetary cost and allows you to reduce the time and money for the diagnosis of pathology.

Method essence

This method is based on examining the inside of the nasal passages using a thin endoscope. Its diameter does not exceed 2-4 mm. There is a camera and a flashlight at one end, thereby transmitting the image. The outer end is equipped with an eyepiece. Thanks to this structure, the doctor can examine in detail the relief of the mucous membrane and nasal passages.

Does it hurt?

When asked "does it hurt when examining the nasal cavity?" - you can definitely answer - no. The procedure is absolutely painless and non-traumatic. Minor discomfort may be present in the presence of structural abnormalities, such as curvature of the nasal septum.

Indications and contraindications

Examination of the nose with an endoscope is indicated in the following cases:

• Diseases of the nasal cavity -,.
• Inflammatory diseases paranasal sinuses -, frontal sinusitis, ethmoiditis.
• Pathology of the upper respiratory tract - tonsillitis, pharyngitis.
• Allergic diseases - rhinitis, hay fever.
• Congenital or acquired developmental anomalies - curvature of the nasal septum.
• Frequent bleeding from the nose with no known cause.
• Breathing disorder,.
• Decreased or absent sense of smell, hearing, taste.
• Facial trauma.
• Before rhinoplasty and during the recovery period.
• Constant headache with an unclear reason.

The procedure is not recommended for people who are allergic to lidocaine. Relative contraindications include blood coagulation pathology (coagulopathy, thrombocytopathy). For examination in case of nosebleeds or slight vulnerability of the mucous membrane, a children's endoscope is used.

What can be seen with endoscopy?

Examination with an endoscope allows you to establish an accurate diagnosis, monitor treatment and some procedures. Endoscopy reveals the following pathology:

• Neoplasms (benign, malignant).
• Polyps.
• Thinning of the mucous membrane, ulcerative defects.
• Adenoids.

Endoscopic examination has advantages over other diagnostic procedures due to the following features:

• the integrity of the tissues is not violated;
• no special training required;
• can be performed at any age;
• allows you to assess the growth of adenoids over time;
• it is possible to carry out a differential diagnosis between the pathology of the nose and the upper throat;
• no recovery period.

How to prepare for the study?

Before the procedure, it is not advisable to inject drops, ointments, inhalation, or smoke into the nasal cavity. It is not recommended to take stimulants (containing caffeine). It is important to stay calm and not move during endoscopy. On the part of the doctor, it is necessary to explain to the patient all the stages and prevent any anxiety.

How is it done?

The procedure has several stages:

• The patient is seated in a chair, his head is thrown back a little.
• They cleanse the nasal passages of mucus and instill vasoconstrictor drops.
• At the end of the endoscope, the doctor will apply an anesthetic ointment or spray onto the area to be examined.
• The device is inserted into the nasal passage and examined.
• At the end, a conclusion is drawn up and treatment tactics are determined.

The picture from the endoscope camera is displayed on the monitor, where it can be enlarged. If necessary, take a photograph of the affected area. The research takes 20 to 30 minutes. If identified benign tumor or the polyp can be removed directly in the otolaryngologist's office.

Endoscopy in children

Endoscopy of the nose is performed at any age and has features when performed for a child. The examination must be carried out in the presence of parents. Children preschool age placed on the lap of one of the adults. With one hand, they fix the head in the forehead, with the other, they press their hands to chest. Frequent reasons for examining the nasal cavity for children are:

• foreign bodies;
• adenoids;
• polyps;

The child's anxiety during the procedure is more related to the experiences of the parents than to the procedure itself. Therefore, it is so important for adults to maintain their composure.

Examination with an endoscope allows you to painlessly examine the deep structures of the nose and accurately establish a diagnosis. It can be done easily in adults and children. For a successful endoscopy result, you need modern equipment and a qualified otolaryngologist.

Useful video on how an ENT endoscopic examination is performed