Rhinoscopy is an instrumental examination of the nasal cavity in otorhinolaryngology. The term has a Latin origin: “rhino” - “nose” and “scopia” - “watch”. This diagnostic study has several options, each of which involves the use of various auxiliary instruments - a nasal dilator, a nasopharyngeal mirror, and a rhinoscope.
Rhinoscopy as a research method is very common in ENT practice and is performed for each patient who comes to an otorhinolaryngologist with respiratory problems and pathologies of the upper respiratory tract and sinuses.
There are several types of rhinoscopy: anterior (direct, external), middle and posterior (indirect, retrograde, specular). Different types of rhinoscopy are performed using different tools and in different positions. Using the front rhinoscopy, the bottom of the nasal cavity, two-thirds of the septum of the nose and the front half of the middle and lower nasal concha are examined. Average rhinoscopy allows you to examine the middle nasal concha and the middle nasal passage with the olfactory gap. With posterior rhinoscopy, the back of the three nasal passages, nasal septum and nasopharynx are visible.
There are two more options for examining the nose - endoscopic (rhinoendoscopy) and surgical rhinoscopy, which have special indications for their conduct.
Anterior rhinoscopy is also called direct or external. Such an examination involves the use of a nasal dilator for examination. The patient sits opposite the doctor. The doctor fixes the patient’s head with his right hand, and with his left introduces a closed nasal dilator into the nostril. In this case, the depth of introduction of the viewing dilator depends on the mucosal site being examined and the patient's age. In young children, an ear funnel can be used instead. After administration, the dilator is carefully opened.
For direct rhinoscopy, the patient's head should be in one of two positions. The first option is an examination of the nasal cavity with the head upright. In this position, the lower part of the nasal cavity, the lower nasal passage and the lower third of the septum are accessible for examination. The second option involves throwing the patient's head back. In this position, the middle nasal passage and the anterior cells of the ethmoid labyrinth are accessible for inspection.
The middle nasal passage is examined most thoroughly, since the natural openings of the nose (maxillary, frontal) open in it.
A rhinoscopic examination assesses the condition of the mucous membrane (wet, dry, atrophic, swollen, pale, hyperemic, cyanotic, with spots, hemorrhages), describe the size of the nasal concha, septum, the nature and amount of discharge.
In some cases, with direct rhinoscopy, it is possible to examine both the posterior wall of the nasopharynx and the lymphoid tissue on it (adenoiditis can be diagnosed). In some cases, the patient during the examination is asked to utter some sounds (words) or to tilt his head to the right or left, thereby improving visual inspection.
Normally, with direct rhinoscopy, pain should not occur. If the patient is in pain, for example, after a nose injury, the mucous membrane is irrigated with a local anesthetic before examination.
The rhinoscopic picture should normally look like this:
- mucous pink;
- the partition is smooth;
- free nasal passages;
- shells are not enlarged.
In addition to examining the nasal cavity with a button probe, they feel the mucous membrane and evaluate its density, elasticity, as well as its shape, texture, localization, and mobility of pathological formations. In this way, foreign bodies can be detected and, in most cases, removed.
Anemization helps to improve the examination of the nasal passages and the differential diagnosis of hypertrophic and other forms of rhinitis. Anemization is the treatment of the nasal mucosa for several minutes with strong vasoconstrictors (ephedrine with adrenaline). After narrowing of the vessels, a much larger surface of the mucous membrane and nasal structures are accessible for examination. With hypertrophic rhinitis after anemization, the expansion of the nasal passages does not occur due to the pathologically thickened mucosa, which distinguishes it from other forms of rhinitis.
In many cases, anterior rhinoscopy can be performed without additional nasal dilators. For inspection, it is enough to raise the tip of the nose and illuminate the nasal cavity with a reflector or other light source.
Using average rhinoscopy, the middle nasal passage, two upper thirds of the nasal septum, nasal openings of the maxillary (maxillary) and frontal sinuses, lunate cleft and, in some cases, the posterior wall of the nasopharynx are examined. For examination, use a nasal dilator with long branches, which can be used to move the middle shell to the septum, exposing the middle nasal passage for inspection.
After the introduction of the nasal dilator with closed branches, they are carefully opened. On examination, evaluate:
- color and condition of the mucosa;
- patency of the nasal passages;
- curvature and defects of the septum;
- the presence and characteristics of pathological formations;
- quality and quantity of discharge.
Since the procedure is unpleasant and can cause pain, the nasal mucosa is pre-treated with local anesthetics, and with severe swelling of the mucosa - by vasoconstrictors.
This procedure is carried out using a nasopharyngeal mirror, which is inserted deep into the oropharynx, behind the palatine tongue. The tongue is pressed with a spatula so that it does not interfere with the examination. If possible, the patient should breathe through his nose.
The light from the reflector is directed to the mirror and the formations in the nasopharynx are examined. So that the patient does not have a vomiting reflex, the doctor should be careful when examining and avoid touching the spatula or mirror with the root of the tongue and back wall of the pharynx. With a pronounced gag reflex, the patient should treat the posterior pharyngeal wall with a local anesthetic spray before the procedure.
Rear (retrograde, indirect) rhinoscopy allows you to examine the choanas, pharyngeal openings of the auditory tubes, the back of the three nasal concha, nasal passages, the opener (the back of the nasal septum), the posterior wall of the nasopharynx and soft palate.
Knowing and considering which cavities and structures of the nose and nasopharynx allows rhinoscopy to be examined, indications for its implementation are:
- prolonged nasal congestion or dryness of an unspecified origin;
- purulent or copious watery discharge from the nose or their dripping into the throat;
- unpleasant odor in the nose;
- suspected adenoid growths, polyps, neoplasms, or foreign bodies;
- olfactory disturbances;
- pain in the paranasal sinuses;
- curvature of the septum of the nose;
- injuries to the nose and facial skull;
- abnormalities of the development of the facial skull.
Rhinoscopic examination is carried out for diagnosis, dynamic monitoring of the effectiveness of the treatment, before surgical interventions on ENT organs.
Anterior rhinoscopy has no contraindications. Secondary and posterior rhinoscopic examination is not performed for newborns, children under one year old and children of primary preschool age. With severe pain in older children and adults, anesthesia is performed before the procedure or it is replaced by endoscopic examination or other diagnostic methods.
Rhinoscopy is a minimally invasive diagnostic and diagnostic study with which you can examine the nasal cavity and perform minor manipulations on the intranasal structures that are difficult to access for conventional rhinoscopy.
This study is carried out using a rhinoendoscope (flexible or rigid), and an enlarged image of the investigated area is displayed on the monitor screen. Modern rhinoendoscopes allow photo and video fixation of the study, which is of particular value for assessing the dynamics of treatment.
Indications for rhinoendoscopy are:
- recurrent sinusitis (sinusitis, frontal sinusitis, ethmoiditis, sphenoiditis);
- polyps, cysts in the sinuses;
- curvature of the septum of the nose;
- impaired nasal breathing and smell;
- inflammatory diseases of the nose and nasopharynx;
- recurrent nosebleeds;
- injuries to the nose;
- pain in the nose and sinuses;
- diagnosis of tumors.
An endoscopic examination is carried out after local anesthesia by irrigation of the mucosa with local anesthetic sprays. It lasts no longer than half an hour, does not require preliminary preparation.
If in some areas of the nasal cavity there is no access even for the tube of the rhinoendoscope, surgical rhinoscopy is performed. Surgical rhinoscopy is a special case of an endoscopic procedure. An examination of the nasal cavity with an endoscope is preceded by excision of a hard-to-reach pathological site of the mucosa. After the introduction of the endoscope, small operations in the nasal cavity are possible. Surgical rhinoscopy is used for:
- removal of polyps;
- restoration of patency of the outlet openings of the paranasal sinuses;
- removal of fungal masses with fungal infection of the sinuses;
- restoration of the correct anatomical structure of the structures of the nose;
- removal of foreign bodies from the nasal passages and sinuses;
- treatment of cysts, bullas of the paranasal sinuses;
- scraping of hyperplastic nasal mucosa and sinuses.
In addition to medical, surgical rhinoendoscopy is used for diagnostic purposes - for the diagnosis of neoplasms by biopsy.
Unlike the diagnostic endoscopic procedure, surgical rhinoscopy is performed under general anesthesia, since the operation requires complete immobilization of the patient.
Features of the examination of the nasal cavity in children
Rhinoscopy in children up to a year and children of preschool age has its own characteristics. Children at this age categorically do not perceive such manipulations, so the procedure should be carried out as quickly and painlessly as possible. Most often, when examining the nasal cavity in young children, nasal dilators are not used, and if necessary, use ear funnels, since they have a small diameter. When using dilators, it is advisable to pre-treat the nasal mucosa with a local anesthetic spray.
If there is no need for a nasal dilator, the doctor raises the tip of the child’s nose with a finger and examines the accessible areas of the nasal cavity: the lower nasal passage, the lower conch. So that the child does not resist, parents or the doctor’s assistant sit him on their lap and fix their hands and head.
Back rhinoscopy in young children is recommended to be performed by palpation of the nasopharynx, however, if the child is not properly fixed, there is a risk of injury to the doctor himself (bite). In difficult cases, rhinoscopy is performed for children under general anesthesia, combining examination of the nasal cavity with taking biomaterial or surgical procedures.
Complications after a properly performed procedure are rare. In some cases, for example, with sensitive or inflamed nasal mucosa, nosebleeds of various intensities are possible due to trauma to the mirrors.
Do not forget that local anesthetic solutions can cause allergic reactions, and their use in the nasal cavity or nasopharynx is very dangerous risk of laryngospasm, swelling of the larynx and anaphylactic shock. To avoid this complication, before using a local anesthetic, the doctor must interview the patient (or the parents of the sick child) about his allergy or bronchial asthma.
Allergic reactions can also occur in people who previously did not have a history of allergic history. If an allergic reaction occurs immediately (Quincke's edema, laryngospasm), first aid should be provided in a timely manner. To do this, rhinoscopy using local anesthesia should be performed within the walls of a medical facility.
If bleeding or allergies occur in the subject, the rhinoscopic procedure must be stopped immediately, and the patient should be given emergency care.
Rhinoscopy is a simple and safe diagnostic method. A correctly performed procedure is painless for the patient, but it is very informative. However, in order for it to be painless and safe, the otorhinolaryngologist must strictly adhere to the methodology for its implementation.
Specialty: doctor pediatrician, infectious disease specialist, allergist-immunologist.
Total length of service: 7 years.
Education: 2010, Siberian State Medical University, pediatric, pediatrics.
Experience as an infectious disease specialist for more than 3 years.
He has a patent on the subject "A method for predicting a high risk of the formation of a chronic pathology of the adeno-tonsillar system in frequently ill children." As well as the author of publications in the journals of the Higher Attestation Commission.