The importance of preoperative nasal endoscopy in patients with sinonasal disease

Abstract

Functional endoscopic sinus surgery (FESS) has popularized the use of telescopes in sinus surgery and has emphasized the importance of nasal endoscopy and computed tomography (CT) in the evaluation of patients with diseases of the nose and paranasal sinuses. Variations in intranasal and sinus anatomy have been implicated in the etiology of chronic and recurrent sinusitis, and CT imaging has become an important diagnostic tool. Despite this, some patients present with symptoms and telescopic examination suggestive of sinonasal disease, yet demonstrate little abnormality on CT scan. The authors reviewed videoendoscopic and CT examinations of 100 consecutive patients with symptoms of sinus disease and found 9% of patients with abnormal telescopic examination in the context of negative CT findings. In those patients whose CT examinations were positive, telescopic nasal endoscopy was especially useful in delineating the type of soft tissue which obscured the area of the middle meatus. In those patients whose CT examinations were negative, telescopic examination demonstrated septal deflections, mucosal edema involving the middle meatus, as well as turbinate and adenoid hypertrophy. These findings demonstrate that telescopic nasal examination is an important diagnostic modality which often yields important information when evaluating patients with sinonasal disease.

Endoscopia nasossinusal associada à tomografia computadorizada dos seios paranasais no diagnóstico de obstrução nasal crônica

“…Two cases of nasal polyposis were evidenced by nasofibroscopy and not by CT scan, in addition to two other cases in which we did not observe CT affections, which were detected by nasofibroscopy, that us, normal CT scan with nasofibroscopy affections (septum deviation and turbinate hypertrophy). Similar findings were reported by Vining, 1993, in which patients who had negative CT scan showed endoscopic exam with septal deviation, mucosa edema involving the middle meatus, as well as adenoid and turbinate hypertrophy. Pizzichetta, 1994, in a similar study, did not consider the CT findings in most of the studied cases to explain the symptoms of nasal obstruction, considering the endoscopic exam enough to that purpose.…”

“A Comparative Study of Chronic Sino-Nasal Diseases Between Diagnostic Nasal Endoscopy (DNE) And CT Scan”

“…Variations in intranasal and sinus anatomy have been implicated in the etiology of chronic and recurrent sinusitis, and CT imaging has become an important diagnostic tool. Despite this, some patients present with symptoms and telescopic examination suggestive of sinonasal disease, yet demonstrate little abnormality on CT scan 2 …”

Diagnosis of Adult Chronic Rhinosinusitis: Can Nasal Endoscopy Predict Intrasinus Disease?

“…[8][9][10][11][12][13] Nasal endoscopy plays a key role in identifying anatomical structural variations and mucosal changes of middle meatus and osteomeatal complex causing drainage block leading to CRS both in patients with normal CT and in patients with abnormal scans. 10,[14][15][16] It was also noted earlier that there was close association between endoscopy and CT scan in the diagnostic work up of CRS. 14,17 However, both nasal endoscopy and CT scan are performed to establish diagnosis in routine practice since the relative values of each has not been well established.…”