Nasal Endoscopy
1231 116th Avenue NE, Suite 915
Phone: (425) 454 - 3938
What is a nasal endoscopy (CPT 31231)?
A nasal endoscopy is a diagnostic endoscopic procedure, used to evaluate the nasal passages, the paranasal sinuses, and the nasopharynx.
A rigid nasal endoscope
What are the indications (reasons) for a nasal endoscopy?
Like any type of endoscopic evaluations (such as a colonoscopy, bronchoscopy, esophagoscopy, etc.), a nasal endoscopy is used to examined parts of the body that cannot be easily visualized and on a routine external examination. Specifically, a nasal endoscopy is used to evaluate for any sinonasal problem that is not readily seen with anterior rhinoscopy (light and speculum).
Most common nasal and sinus complaints do not warrant more advanced evaluation beyond the routine primary care exam. However, if the symptoms are chronic without a clear reason or if it is unresponsive to treatment, then a nasal endoscopy by an ENT specialist can be performed to further evaluate the underlying problem, guide treatment, and rule out any concerning pathology. Common indications for a nasal endoscopy include, but are not limited to:
- Evaluation of chronic sinus and nasal symptoms/complaints;
- Surveillance of response to medical and/or surgical therapy;
- Monitoring of chronic sinusitis or nasal polyps;
- Evaluation and treatment of bloody nose (epistaxis);
- Evaluation and diagnosis of nasal and sinus tumors;
- Guidance for culture of the sinuses;
- Evaluation of cerebrospinal fluid leak (CSF leak) with chronic clear runny nose;
- Evaluation of smell disorders;
- Evaluation of potential nasal/sinus origin of facial pain and/or numbness.
Source: ARS
Various pathology found during a nasal endoscopy in my clinic
Chronic sinusitis
46-year-old woman with recurrent sinus infections with pressure, fatigue, congestion, and cough despite multiple courses of antibiotics. Nasal endoscopy showed pus + mucus draining from sinus into the throat.
Deviated septum
28-year-old man with chronic trouble breathing, worse at night and when exercising. Nasal spray was not helpful. Nasal endoscopy showed a deviated septum further back after nasal decongestant was applied.
Nasal polyp
53-year-old man with chronic nasal congestion, loss of smell, and asthma for more than two years. Antibiotics and steroid helpful intermittently. Nasal endoscopy showed polyps on both sides.
Nasal tumor
36-year-old woman with intermittent bloody nose and nasal congestion on the right. Nasal spray and allergy medication was not helpful. Nasal endoscopy showed a tumor arising from the septum.
How is a nasal endoscopy performed?
Although most types of endoscopy require general sedation or anesthesia, a nasal endoscopy can typically be performed with topical anesthesia (topical spray) in the office. As a result, it is typically performed on the same day as your ENT visit. The patient is awake and generally sits upright. The nose is usually sprayed with a topical local anesthetic and a decongestant (e.g. lidocaine & oxymetazoline). After the nose is adequately numbed, a ridged or flexible small fiberoptic scope (usually 3.0 mm in diameter or about the size of a spaghetti noodle) is inserted into each nostril and advanced towards the back of the nose. The doctor may look directly through the eyepiece or on a monitor to evaluate the anatomy. Typically, three passes are made on each side to examine the inferior meatus, middle meatus, nasopharynx, sphenoethmoid recess, and olfactory cleft. The findings are discussed with the patient immediately during the same visit.
Nasal endoscopy in patient with a chronic post-nasal drip and headache. Active sinusitis was found. The patient was subsequently treated with sinus surgery after failing antibiotics.
What are the risks of a nasal endoscopy?
A nasal endoscopy is a safe and low-risk procedure. Allergic reaction to topical anesthetics such as lidocaine or decongestants such as Afrin is rare. In rare cases, epistaxis (a bloody nose) can occur, although this is usually mild and self-limiting. No significant adverse risks are expected with a nasal endoscopy.
What should I expect during and after a nasal endoscopy?
After a topical anesthetic is sprayed, you may notice numbness in your nose and throat. This typically lasts for one hour. As the scope is inserted, you may experience some pressure in the nose and sinus. Some patient may experience reflexive tearing of the eyes during the procedure. The discomfort is generally minimal and subsides as soon as the scope is removed.
The topical spray can occasional drain down the throat, leading to throat numbness for about one hour. If numbness is present, the patient should refrain from eating or drinking for about one hour to avoid aspiration. There are no other restrictions after a nasal endoscopy. The patient may drive home or return to work.
What else can be done with nasal endoscopy in the office?
Most contemporary treatments of nasal and sinus problems can be safely managed endoscopically. Common in-office endoscopic procedures can include control of epistaxis (nose-bleeds), biopsy of nasal masses/tumors, sinus debridement after sinus surgery, drainage of nasal abscesses and infections, and guidance for sinus culture. In appropriately selected patients, limited sinus surgery, nasal polyp removal, and balloon sinuplasty can be performed in the clinic with nasal endoscopy.