Rhinoscopy represents an instrumental examination procedure for the evaluation of the nasal cavity. In general, rhinoscopic visual examinations are among the routine procedures in otolaryngology and are associated with correspondingly low risks and complications.
What is rhinoscopy?
Rhinoscopy is the term used to describe the visual inspection or mirroring (-copy) of the nose (rhino-). Rhinoscopy is the visual inspection or mirroring (-copy) of the nose (rhino-), in the context of the anatomy and condition of the interior of the nose, especially the nasal cavity, can be checked and evaluated. In general, a distinction is made between anterior (rhinoscopia anterior), middle (rhinoscopia media) and posterior rhinoscopy (rhinoscopia posterior) depending on the section of the nose to be inspected. In addition to otoscopy (ear examination), rhinoscopy is one of the standard and routine examination procedures in otolaryngology and allows the diagnosis of various causes of disease and symptoms such as foreign bodies, tumors, sources of bleeding, malformations, tissue neoplasms, and inflammatory changes.
Function, effect, and goals
Rhinoscopy provides an assessment of the anatomic-structural nature of the interior of the nose, particularly the nasal mucosa, nasal septum, and nasal secretions. In addition, blood and pus accumulations, conchal as well as mucosal swellings, mucosal ulcers, anatomical malformations, polyps, tumors and/or foreign bodies can be detected. Especially in the case of a suspected maxillary sinusitis (sinustitis maxillaris), rhinoscopy is the basic examination for diagnosis. In general, a distinction is made between anterior, middle and posterior rhinoscopy, depending on the area of the nose to be examined. In anterior rhinoscopy, a so-called nasal speculum, a forceps-like instrument with a small funnel and a light source at the end for widening the nasal passages and taking tissue samples (biopsy), is inserted into the nasal opening. Rhinoscopia anterior is used to evaluate the nasal vestibule (nasal vestibule), locus Kiesselbachi (anterior third of the nasal septum or septum), ductus nasolacrimalis (nasolacrimal duct), inferior turbinate, and inferior septal segments. Blood, crusts or mucus obstructing the view can be carefully wiped away or suctioned off. If inflammatory changes are present, a smear can be taken and the material taken subsequently analyzed in the laboratory. In contrast, middle rhinoscopy uses an elongated nasal speculum or nasal endoscope consisting of a flexible plastic tube or a rigid metal tube as well as a light source and camera. Middle rhinoscopy is used especially to evaluate the main nasal cavity (cavum nasi), the infundibulum nasi, and the posterior nasal passages. In addition, pathological changes in the area of the paranasal sinuses (sinus paranasales) can be detected by middle rhinoscopy. During posterior rhinoscopy, the choanas (posterior nasal cavity openings), the posterior turbinate and septal segments, and the nasopharynx are inspected. For this purpose, a mirror angled at about 120 degrees is inserted through the oral cavity while the tongue is pressed down by spatula pressure, allowing breathing through the nose during the examination, which creates a large space between the slackened soft palate (velum palatinum) and the posterior pharyngeal wall. Posterior rhinoscopy is used to determine whether purulent nasal secretions are leaking from the maxillary sinus (sinus maxillaris), ethmoid sinus (sinus ethmoidalis), or sphenoid sinus (sinus sphenoidalis). In addition, tumors (including adenoid growths), septal deviations (deviations of the nasal septum), enlarged pharyngeal tonsils (tonsilla pharyngealis), polyps, and thickening of the posterior conchal ends can be diagnosed during posterior rhinoscopy.
Risks, side effects, and hazards
Rhinoscopic examination procedures are generally painless as well as free of side effects and associated with minor complications. Different instruments to be selected depending on the size of the nostrils ensure a low risk of injury.In addition, care should be taken during a rhinoscopy to ensure that pressure is exerted on the comparatively insensitive nostrils when spreading the speculum in order to avoid injury to the sensitive nasal septum. If there is inflammation and/or swelling in the area of the nasal mucosa that makes examination difficult, a decongestant or anesthetic nasal spray can also be used. If there is insufficient visibility of the nasopharyngeal space as a result of a pronounced gag reflex with simultaneous elevation of the soft palate (palatum molle), a so-called velotraktio may be indicated during posterior rhinoscopy. In this procedure, following surface anesthesia, a thin rubber catheter is inserted nasally to pull the soft palate forward. The expanded space allows a larger mirror to be used. Furthermore, if the insertion of a rigid nasal endoscope is considered uncomfortable, the nasal mucosa can be anesthetized in advance of rhinoscopy.
