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Introduction ⬇

Nasal endoscopy, also known as rhinoscopy, is a procedure that visualizes the anterior ethmoid, middle turbinate region, and middle meatus sinus areas. A rhinolaryngoscopy procedure includes examining the larynx and oropharynx. Although the purposes of nasal endoscopy are primarily to relieve infection and other symptoms of inflammation and to alter structural abnormalities in these areas, it can also be a valuable diagnostic tool. Retained secretions may contribute to chronic recurrent sinus infections, which may lead to systemic infections, cyst formation, or mucoceles that can erode sinus walls into areas of the eyeball, eye orbit, or brain.

Patients having recurrent episodes of acute or chronic sinusitis that are not responsive to antibiotic or allergy therapy are candidates for nasal endoscopy as both a diagnostic and therapeutic modality.

Procedure ⬆ ⬇

Nasal endoscopy may be performed as an outpatient or office procedure. More extensive examination and operative procedures may require admission to a healthcare facility or special diagnostic center.

  1. Remove facial prostheses, dentures, hairpieces, and jewelry before the procedure.

  2. Insert an IV line for the administration of medications.

  3. Have the patient assume a supine position in the surgical suite. Prep the face and throat according to established protocols and properly drape the area. Tape eye pads in place to protect the eyes from injury. Perform other positioning and pressure point padding as necessary.

  4. Administer IV sedation as needed. Spray the nose with a topical anesthetic, and inject a small amount of 1% lidocaine with 1:200,000 aqueous epinephrine into the appropriate areas (unless contraindicated because of allergy or for other reasons) to provide anesthesia and control of bleeding. Refer to Chapter 1 for IV conscious sedation precautions.

  5. Introduce the endoscope to permit visualization of the nasal interior; the sinus cavities are not opened.

  6. Sinus computed axial tomography scans and magnetic resonance imaging may be necessary adjuncts to this procedure to permit visualization of areas not accessible through endoscopy.

  7. Perform treatment for underlying disease or malformations using local or general anesthesia and medications to achieve a state of conscious sedation. Diagnostic and surgical techniques vary according to preoperative findings.

  8. Fill a 10-mL syringe with antibiotic ointment at the end of the procedure. Use a small catheter attached to the syringe tip to direct ointment to the appropriate areas. Insert nasal packing into the nares. Tape a small (2 × 2 inches) “mustache dressing” to the end of the nose to collect secretions and blood. Usually, this dressing can be changed as needed.

  9. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormalities that may be revealed include the following conditions:

  1. Chronic sinusitis (edematous or polypoid mucosa)

  2. Cysts

  3. Mucocele

  4. Sinus erosion

  5. Anatomic deformities or obstructions

  6. Pathologic sinus discharge (infectious process)

  7. Enlarged middle turbinates

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the test purpose, benefits, risks, and procedure.

  2. Confirm that a properly signed and witnessed consent form in in the patient’s medical record (see Chapter 1) as well as appropriate laboratory and diagnostic test results, history and physical examination, current drug therapies, and allergies before the procedure.

  3. Ensure that the patient fasted from midnight the day before the procedure. Preprocedure preparation that was ordered is completed, such as: stopping anticoagulants as ordered and removing any nasal jewelry (nasal piercings).

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Encourage oral fluids after nausea or vomiting has resolved; the patient may experience nausea or vomiting if blood is swallowed because blood is irritating to the GI system.

  2. Postprocedural instructions may include the following:

    1. Take prescribed medications as ordered (usually a broad-spectrum antibiotic and pain medication). Soothing gargles may be ordered.

    2. Report excessive bleeding or sinus discharge, unusual pain, fever, nausea or vomiting, or visual problems immediately.

    3. Do not allow the patient to drive or sign legal documents for 24 hours because of the effects of anesthetics and sedation.

  3. Follow the usual precautions involved in the care of any person having received sedation and analgesia. The patient who has received drugs to achieve conscious sedation may require closer monitoring, positioning on the side to prevent aspiration, and a longer recovery time than those who receive local anesthesia.

  4. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient appropriately about possible treatment (medications [e.g., steroids, antibiotics]). Numbness of the face may continue for several weeks.

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care. Provide written discharge instructions.

Clinical Alert

  1. Sinuses are poorly visualized through routine sinus x-ray films.

  2. If sinus problems appear to be related to dental problems, the patient should see a dentist or oral surgeon before sinus endoscopy is performed.

  3. Severe nasal septal deviation must be corrected before endoscopy.

  4. Potential complications include periorbital bleeding, cerebrospinal fluid leak, cellulitis, visual disturbances, and subcutaneous orbital emphysema.

  5. Direct trauma to the nasofrontal duct is associated with increased risk for postoperative stenosis.

Reference Values ⬆

Normal