Flexible Rhinoscopy
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Flexible rhinoscopy is a quick, office-based procedure used to examine the entire nasal cavity.
It is most commonly performed by otolaryngologists in the evaluation of nasal obstruction, sinusitis, epistaxis, anosmia, other symptoms of rhinitis, and head and neck cancer. It can also be performed by allergists in the evaluation of allergic rhinitis and radiation oncologists to assess the response of malignancy to radiation therapy. Internal medicine, family medicine, and emergency medicine doctors may also use flexible rhinoscopy to evaluate patients with epistaxis or nasal foreign bodies.
Flexible rhinoscopy is commonly performed in the office or at the bedside with no specific preprocedure restrictions. An average evaluation takes less than 2 minutes and is well-tolerated by the majority of patients.
Nasal obstruction is a sensation that one or both nasal passages are blocked. There are many causes of nasal obstruction, and the etiology is often multifactorial. Diagnosis requires a thorough history and physical examination, with imaging reserved for surgical planning and evaluating intracranial spread or invasion into adjacent structures. Flexible rhinoscopy is a useful adjunct to the physical examination that allows direct visualization of structures within the superior and posterior nasal cavities that may not be visible with anterior rhinoscopy alone.
The differential diagnoses of nasal obstruction are considerable (see below). A thorough history, including onset, duration, current medications, and aggravating/relieving factors, can help to narrow the differential diagnoses. Constant unilateral obstruction usually results from anatomic obstruction, whereas a seasonal congestion or one that responds to topical decongestants is typically due to an inflammatory pathology. Pediatric patients can present with life-threatening respiratory distress secondary to some congenital causes of nasal obstruction; therefore, prompt evaluation and treatment is essential in these patients.
Congenital causes of nasal obstruction include the following:
Choanal atresia
Pyriform aperture stenosis
Midnasal stenosis
Encephalocele
Nasal dermoid
Glioma
Teratoma
Nasolacrimal duct cyst
Turbinate hypertrophy
Septal deviation
Neonatal rhinitis
Vascular lesions
Craniofacial abnormalities
Anatomic causes of nasal obstruction include the following:
Septal deviation
Turbinate hypertrophy
Nasal valve collapse
Concha bullosa
Nasal/sinus tumor
Nasal polyposis
Septal perforation
Synechiae
Inflammatory causes of nasal obstruction include the following:
Allergic rhinitis
Nonallergic rhinitis
Rhinosinusitis [1]
Rhinitis medicamentosa
Systemic causes of nasal obstruction include the following:
Hypothyroidism
Medications (antihypertensives, antidepressants, antipsychotics, beta-blockers)
Rhinitis of pregnancy (rhinopathia gravidarum)
Wegener granulomatosis
Tuberculosis
Sarcoidosis
Rhinoscleroma
Rhinosporidiosis
Flexible rhinoscopy is indicated for the thorough evaluation of any patient with nasal obstruction or any nasal complaint not fully evaluated with anterior rhinoscopy. In addition, flexible rhinoscopy is commonly used for postoperative follow-up and as an adjunct to the evaluation of head and neck cancer.
Flexible rhinoscopy has no contraindications.
Discomfort and epistaxis are the most common complications. Allowing time for adequate anesthesia can help decrease the discomfort experienced by some patients. Knowledge of the intranasal anatomy and the rhinoscope’s maneuverability can decrease the length of the examination. Epistaxis can be avoided by minimizing contact with the nasal mucosa.
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Eelam Aalia Adil, MD, MBA Pediatric Otolaryngologist, Department of Pediatric Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Harvard Medical School
Eelam Aalia Adil, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Medical Association, Phi Beta Kappa, American Society of Pediatric Otolaryngology, Triological Society
Disclosure: Nothing to disclose.
Johnathan D McGinn, MD, FACS Associate Professor, Residency Program Director, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Johnathan D McGinn, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Rhinologic Society, Pennsylvania Medical Society, Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.
Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.
Flexible Rhinoscopy
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