Diagnostic search for diseases of the ENT organs, to which the nose belongs, includes various research methods. Among them, the most common are rhinoscopy and endoscopy. Examination of the nasal cavity can be performed on patients of any age group. This allows you to establish the presence or absence of pathological changes, to confirm or deny the preliminary diagnosis, formulated on the basis of the patient's complaints and anamnestic data obtained during the survey. Although the rhinoscopy method is considered simpler and faster, endoscopic examination provides a specialist with an expanded range of informational data, the ability to take a sample of material for further research.
Rhinoscopy
Rhinoscopy is included in the standard examination scheme at an otolaryngologist's appointment, who suspects pathology in the upper respiratory system. What it is? The named diagnostic method involves a visual examination of the nasal cavity (anterior and middle sections) and is classified as:
- Anterior rhinoscopy. Anterior rhinoscopy requires the use of a frontal reflector, which plays the role of an illuminator, as well as a special expander equipped with drop-down branches. Sequential advancement of the dilator allows one to examine the structures of the nasal cavity sections one by one.
- Middle rhinoscopy. Middle rhinoscopy is understood as an examination by the method of anterior rhinoscopy, combined with the introduction of a nasal speculum, which has elongated flaps. The goal of the doctor is to assess the state of the middle nasal passage.
- Posterior rhinoscopy. This type of examination consists in examining with a mirror when it is introduced into the throat cavity. The doctor uses a spatula to press down on the tongue and a small, mirrored device that should be positioned behind the soft palate.
If it is impossible to conduct a posterior rhinoscopy, it is replaced by palpation examination.
Palpation of the nasal part of the throat with the doctor's index finger is an alternative to posterior rhinoscopy, which is indicated when the patient is sensitive to irritation of the mucous membrane by touching the spatula (throat reflex). Posterior rhinoscopy is difficult to perform, usually in younger children.
When is a rhinoscopy performed, what does it reveal? During the survey, it is possible to inspect such structures as:
- the mucous membrane of the nasal cavity;
- nasal concha;
- nasal septum;
- nasal passages.
The doctor examines the surface of the mucous membrane, can detect the presence of pathological discharge, assess its nature, quantity and consistency. If rhinoscopy of the nose is combined with the use of a bulbous probe, the shape and mobility of pathological formations are determined, and differential diagnosis of polyps is carried out.
In order to increase the information content of diagnostics, it is shown
anemization of the mucous membrane.
Since rhinoscopy is a "reference" diagnostic method, it is necessary to eliminate factors interfering with examination, one of which is edema. After anemization, carried out by lubricating the mucous membrane with a solution of a special drug (Xylometazoline, Ephedrine, Adrenaline), it is possible to confirm or refute the assumption of hypertrophic rhinitis. If the lumen of the nasal passages remains narrowed, despite the application of the drug, this indicates the presence of the mentioned pathology in the patient.
Endoscopy
The need to obtain data on the state of the parts of the nose exists in various pathologies. These are not only obvious disorders of the respiratory system (neoplasms, rhinitis and sinusitis of various etiologies, recurrent nosebleeds), but also diseases of the pharynx, larynx (pharyngitis, laryngitis), ears (chronic otitis media). The indication may also be the impossibility of rhinoscopy. Of course, patients are interested in the question: nasal endoscopy - what is it? How is it carried out?
Endoscopic examination of the nose is based on an objective examination of the nasal cavity (rhinoendoscopy) and the nasopharynx (rhinopharyngoendoscopy) using an optical device. An endoscope (rhinoscope) is a tubular optical system. Flexible and rigid endoscopes are available. The study makes it possible to establish why the patient has respiratory and / or smell disorders, to identify cysts, neoplasms, congenital changes in the intranasal structures.
With the help of rhinoendoscopy, adenoid vegetations can be visualized.
The image obtained after insertion of the device into the nasal cavity is displayed on a special monitor on an enlarged scale. During the treatment period, the presence of records plays an important role, since it makes it possible to assess the patient's condition in dynamics.
During the procedure, you can not only examine the structure of the nose, but also take a biopsy of tissue in pathologically altered or "suspicious" areas for subsequent histological examination in order to establish a diagnosis. Endoscopic operations in the nasal cavity are also currently performed. The indications are:
- Recurrent sinusitis, accompanied by changes in the intranasal structures.
- Chronic purulent maxillary ethmoiditis.
- Polypoid sinusitis.
- Cysts of the paranasal sinuses, etc.
Bleeding from the nose makes it difficult to see with an endoscope.
During the procedure, irritation of the nasal mucosa should be avoided as this can lead to bleeding. When the mucous membrane bleeds, it becomes much more difficult to examine its surface, to see pathological changes in a narrow lumen.
Research features
In addition to describing the essence of rhinoscopy and endorinoscopy, patients are often interested in: how long will the procedure take? Are there any peculiarities of conducting - for example, in childhood? Does the doctor's actions cause painful sensations? Applicable to these questions, one should talk about such points as:
- duration of manipulations;
- anesthesia, or pain relief;
- contraindications and complications.
How long the examination of the nasal cavity lasts during rhinoscopy or rhinoendoscopy cannot be said unequivocally. Much depends on the variant of the pathology. In some cases, the doctor needs no more than a few minutes to detect pathological changes, in others, nasal endoscopy can last up to half an hour or even longer. Rhinoscopy usually takes less time than endoscopy.
Pain is one of the main obstacles in the implementation of diagnostic measures, especially if the child needs anterior and posterior rhinoscopy. Local anesthesia can be applied during the procedure for high-quality manipulation and patient comfort. Anesthesia with local anesthetics (Lidocaine, Mepivacaine) is also required for patients who are prescribed endoscopic rhinoscopy. To avoid complications, it is necessary to inform the doctor in advance about the allergy to medications.
Examination of children in difficult cases is carried out under anesthesia.
There are not many contraindications to rhinoscopy by introducing a dilator or an endoscope. One of the relative is nosebleeds - this interferes with the endoscopy procedure, significantly reduces the information content of the results obtained.Also, it is impossible to carry out the procedure to a patient in a state of motor and mental agitation, since there is a risk of injury.
Can there be complications after examining the nasal cavity? Experts say that if the manipulations are performed correctly, there should be no violations associated with the procedure performed. Among the alleged pathologies, damage to the mucous membrane of the nasal cavity can be called.
