DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20160066

Diagnosis of chronic rhinosinusitis: can nasal endoscopy be the new gold standard in developing countries?

Sushant Tyagi, Mohit Srivastava, Vandana Singh

Abstract


Background: Objective of the study was to study the role of diagnostic value of nasal endoscopy in diseases involving nasal cavity and paranasal sinuses particularly chronic rhinosinusitis in developing countries.

Methods: A total of 200 Patients with clinical evidence of sinonasal diseases were evaluated. All patients were subjected to thorough ENT examination with special emphasis on anterior and posterior rhinoscopy. Nasal Endoscopy was done using Hopkins rod endoscopes ( 0º, 30º, 45º, 70º and 90º) - diameter 2.7 mm/ 4 mm, length 18 cm after administering a spray puff of Xylocaine with adrenaline (10 drops of adrenaline to 2 ml of Xylocaine). Computed tomography of paranasal sinuses was done in 100 patients whose symptoms, examination and clinical picture were sufficient to warrant the procedure.  

Results: The most common anatomical variations detected on nasal endoscopy were deviated nasal septum (83.5%) followed by paradoxical middle turbinate (42.5), and concha bullosa (26.5%). Accessory middle turbinate was seen in 7 out of 200 cases (3.5%). The most common pathological abnormality detected on nasal endoscopy was mucopus in middle meatus (69%) and next were hypertrophied (45 and 35% inferior and middle turbinate respectively) and congested turbinates (44.5%), followed by polypoidal changes (28%) and oedematous/congested uncinate process (27.5%).

Conclusion: Diagnostic nasal endoscopy can prove to be a better diagnostic modality compared to CT scan when conditions like middle meatal secretions, condition of mucosa, polyps are looked for. It can detect early polypoidal and other pathological changes missed on CT which can aid in early diagnosis and medical management of sinonasal diseases thereby preventing patient from unnecessary surgical exposure. Also being easily available and cost effective, patients can be spared from unnecessary cost and radiation exposure by performing diagnostic nasal endoscopy prior to CT.

Keywords


Chronic rhinosinusitis, Nasal endoscopy, CT-PNS

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References


Orlandi RR, Marple BF. Developing, Regulating, and Ethically Evaluating New Technologies in Otolaryngology-Head and Neck Surgery. Otolaryngol Clin N Am. 2009;42:747-52.

Draf W. Endoscopy of the paranasal sinuses, New York:Springer-Verlag Inc, 1983 (quoted by-Schlosser RJ, Kennedy DW. Nasal Endoscopy. In: Gleeson M, editor. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. Edward Arnold Publishers ltd. 2008;2:1344-54.

Maltz M. New instrument: the sinuscope. Laryngoscope.1925; -35: 805-11 (quoted by-Schlosser RJ, Kennedy DW. Nasal Endoscopy. In: Gleeson M, editor. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. Edward Arnold Publishers ltd. 2008;2:1344-54.

Messerklinger W. Endoscopy of the nose. Baltimore: Urban Et Schwarzenberg. (quoted by-Schlosser RJ, Kennedy DW. Nasal Endoscopy. In: Gleeson M, editor. Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery. Edward Arnold Publishers ltd. 2008;2:1344-54.

Soudry E, Nayak JV. Nasal Endoscopy. American Rhinologic Society: revised. 2011;9.

Durr DG, Wright ED, Gall RM. Sinonasal Endoscopy Reporting Format: Emphasis on Chronic Rhinosinusitis. The Journal of Otolaryngology, 2005;34(3):183-8.

Huerter JV. Functional Endoscopic Sinus Surgery and Allergy. Oto laryngol Clin North Am. 1992;25(1):231-7.

Huerter JV. Functional Endoscopic Sinus Surgery and Allergy. Oto laryngol Clin North Am. 1992;25(1):231-7.

Hughes RGM, Jones NS. The role of nasal endoscopy in outpatient management, Clin. Otolaryngol. 1998;23:224-6.

De Cleyn M, Kersschot EA, De Clerek ES. Paranasal sinus pathology and non allergic respiratory tract diseases. Allergy. 1986;41:313-8.

White PS, Maclennan AC, Connolly AA. Analysis of CT scanning referrals for chronic rhinosinusitis. J Laryngol Otol. 1996;110(7):641-3.

Kasapoglu F, Onart S, Basut O. Preoperative evaluation of Chronic Rhinosinusitis patients by conventional radiographies, computed tomography and nasal endoscopy. Kulak BurunBogazIhtisDerg. 2009;19(4):184-91.

Zojaji R. Mirzadeh M, Naghibi S. Comparative Evaluation of Preoperative CT Scan and Intraoperative Endoscopic Sinus Surgery Findings in Patients with Chronic Rhinosinusitis. Iran J Radiol. 2008;5(2):77-82.