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Nasal endoscopy is a diagnostic procedure that uses an instrument called an endoscope to view the inside of the nose and entrance to the sinuses. It is primarily used to detect abnormalities (e.g., structural defects, polyps, damage to the sinuses). The procedure can also be used to determine if certain surgeries are required or if medications are having their intended effect.

A nasal endoscope (or nasal telescope) is a thin, tube-like optical instrument (2.7 to 4.0 millimeters in diameter) designed to be inserted into the inner nose. It can be rigid and angled or flexible. The nasal endoscopy procedure involves the insertion of the endoscope through the nostrils and up the nasal passageway. Miniature lights in the device illuminate the patient’s nasal passages, nasal cavities and entrance to the sinuses. The endoscope is equipped with fiber-optic cameras that record and display detailed images of the interior of the nose.

Endoscopic cameras allow a physician to view any sinus-related abnormalities. Some endoscopes transmit images to a video screen, which can in some circumstances be viewed by the patient undergoing the procedure. The examination may also be recorded by a digital image archive (similar to a digital camera). Many endoscopes have attachments that allow physicians to remove tissue samples or fluid for further laboratory testing (biopsy).

The procedure is considered very safe and is almost always done without general anesthesia. However, nasal endoscopy is performed only under special circumstances because it is relatively expensive. It is most often used for diagnosing chronic (ongoing) and recurrent rhinosinusitis (sinus infection) or for highlighting the differences between allergies and unrelated sinus problems.

A nasal endoscopy is usually reserved for patients with persistent, chronic symptoms who have not responded to various therapies. Some of the main reasons a physician may order a nasal endoscopy include:

• To evaluate why a patient is failing to respond to a therapy or medication
  
  
• To determine whether surgery is necessary
  
  
• To examine the results of a sinus surgery
  
  
• To determine the effects of conditions such as severe allergies, immune deficiencies and mucociliary disorders (disorders that affect mucous membranes and cilia)
  
  
• To determine whether a nasal obstruction (e.g., polyps, tumor) is present in the nasal cavity
  
  
• To determine whether any foreign bodies (e.g., small object inserted by a child) are lodged in the nasal cavity
  
  
• To remove a nasal obstruction or foreign material from the nasal cavity  
  
  
• To determine whether an infection has moved beyond the sinuses
  
  
• To diagnose chronic or recurrent rhinosinusitis, particularly in children with asthma
  
  
• To diagnose the reason for anosmia (loss of the sense of smell)
  
  
• To evaluate any unusual discharges from the nasal cavity (e.g., blood, pus, cerebrospinal fluid)
  
  
• To collect fluids or tissue samples for evaluation (biopsy)
  
  
• To diagnose sinus barotraumas (caused by air pressure differences experienced while flying or scuba diving)
  
  
• To evaluate younger children for whom a medical history is considered unreliable
  
  
• To diagnose the reason for facial pain or headaches

The nasal endoscopy will ultimately yield a detailed diagnosis so a physician can determine whether the patient has a condition that requires specific therapy or medication.

In some cases, nasal endoscopy is used in combination with computed axial tomography. Also known as a CAT scan or CT scan, this is a painless test that uses multiple x-ray images, taken from different angles, to create three-dimensional images of body structures. CAT scans enable physicians to view the inside of the sinuses and other structures in the head. When used together, nasal endoscopy and CAT scans provide physicians with a more complete picture of what is occurring in the nose, sinuses and head. This ultimately aids diagnosis and leads to better treatment decisions.