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Nasal endoscopy provides the rhinologist with unparalleled visualization with brilliant illumination of the nasal cavity, which permits more accurate diagnosis of nasal conditions. The authors present their rationale for using diagnostic endoscopy in the office practice of rhinology. The equipment requirements and technical considerations are fully explained. Endoscopy also serves as an excellent teaching tool and source of photodocumentation.

Visual assessment of velopharyngeal portal is the most effective way of determining portal function during phonation. Direct methods involve viewing the movements of the palate and pharyngeal walls either via nasal endoscopy or oral panendoscopy. Indirect methods utilize radiographic and ultrasonic techniques, though the latter are less precise than the former since they show only pharyngeal wall motion but not the region of contact or gap between velum and pharyngeal walls.

OBJECTIVE: To evaluate efficacy of nasal endoscopy in diagnosing nasal pathologies.DURATION OF STUDY: 01 November 2013 to 30 Jun 2014STUDY DESIGN: ProspectivePLACE OF STUDY: ENT A Unit Hayatabad Medical Complex, Peshawar, ENT unit Saidu group ofteaching hospitals, swat.MATERIAL & METHODS: Eighty (80) patients were included in the present study, with fifty sixmale and 24 female. They presented with nasal obstruction 54 (67.5%), persistent rhinorrheal6 (20%),Nasal bleed 50 (62.5%), headaches, 18(22.5%) foul breath 6 (7.5%) and olfactory disturbances 7(8.75%). Anatomic variations were found on nasal endoscopy, Concha bullosa 9 (11.25%) was thecommonest anatomic variation followed by enlarged bulla.RESULTS:Enlarged adenoids were found in 3(3.75%) patients, Hypertrophy of posterior end of inferiorturbinate 5 (6.25%)Discharge in middle meatus 12 (15%),Polyps in 9 (11.25%), Nasopharyngeal mass 4(5%), Mass in nasal cavity 7 (8.75%), Posterior spur 11 (13.75%), Angifibroma 3 (3.75%), Nasalsynaechia 4(5%), Antrochonal polyp 3 (3.75%), Inverted papiloma 3 (3.75%), Rhinolith 2 (2.25%),Atrophic rhinitis 3 (3.75%) and Allergic rhinitis 13 (16.25%).CONCLUSION: Nasal endoscopy can find nasal and sinus pathology that might easily be missed withroutine speculum and nasopharyngeal examination. For patients with unexplained nasal sinus symptoms,the general otolaryngologist might consider rigid nasal endoscopic office examination as part of theroutine office examination.KEY WORDS: Nasal Endoscopy, Nasal Pathologies.

In order to determine the best method of imaging the velopharyngeal portal so as to appreciate the interrelationships of palatal and pharyngeal wall movements during speech, one must consider the purposes of the examination: First is the desire to image the velopharyngeal (VP) portal; second, the desire to image the portal in motion; third, the desire to image it while simultaneously recording the patient’s speech. If the method of imaging the VP portal does not satisfy all three of these requirements, the study will give less than adequate diagnostic information and inappropriate therapeutic decisions may result.

This paper reviews the visual methods available for the examination of the velopharyngeal portal in function. The various forms of nasal endoscope are differentiated together with the advantages and limitations of display and recording systems. Basic endoscopic technique is described.

Adenoid hypertrophy is the most common cause of nasal obstruction in paediatric patients. Over the years, various methods to assess the adenoid size were proposed such as the posterior rhinoscopy and the radiological examination of the nasopharynx. Nasal endoscopy was introduced for children in the 80's, and nowadays this is a known and diffuse method in routine practice. The purpose of this article is to describe the personal experience in the assessment of the adenoid size in children, with a particular regard to the flexible nasal endoscopy, and to analyse the literature reports. The personal technique is described in performing nasal endoscopy in paediatric patients, reporting advantages and possible disadvantages of the procedure. A retrospective analysis was conducted on 6036 children since 1999 to 2010. In most cases children fully collaborated to complete the exam. No major or minor complications (such as nose bleedings or other traumatic injuries) were observed. No topical intranasal decongestant, local or general anaesthesia were used in our series. In our opinion, nasal endoscopy in children is a reliable, safe, accurate, easily tolerated and dynamic diagnostic method to assess the adenoid size.

Nasolacrimal duct obstruction is normally treated with extranasal dacryocystorhinostomy, but nasal endoscopic dacryocystorhinostomy has recently become more common due to the development of nasal endoscopy. The subjects of the study were 23 patients who underwent nasal endoscopic dacryocystorhinostomy between December 2001 and July 2005 at Kohka Public Hospital, and who were followed for 6 months or longer. The presence or absence of lacrimal canaliculus obstruction was examined in a lacrimal probe test before surgery, and lacrimal contrast XP and CT were performed. During surgery, a Nunchakutype silicon tube was indwelled usually. The silicon tube was removed 3 months after surgery, and the success of the surgery was evaluated based on the improvement of subjective symptoms. The success rate was 88%, but obstruction recurred in 3 patients. Nasal endoscopic dacryocystorhinostomy was repeated in all recurrent cases, and obstruction recurred again in 1 patient. Pus was retained in the lacrimal sac in the recurrent cases, suggesting the involvement of infection.

The prognostic significance of the size of mastoid air cell system in the results of myringoplasty has been a matter of debate. Fifty ears with dry central perforation following C.S.O.M. were investigated. The size of mastoid air cell system was determined with planimetry of the X-ray picture and eustachian tube function was assessed using flourescein dye and nasal endoscopy. Myringoplasty was performed in all the 50 ears and postoperative results in terms of graft take up and hearing gain were assessed. The correlation between the size of mastoid air cell system, results of myringoplasty and tubal function has been discussed. The results show no correlation between the size of mastoid air cell system, postoperative results of myringoplasty and eustachian tube function.

Nasal obstruction is a common problem in patients with obstructive sleep apnea (OSA). Systematic evaluation of nasal obstruction remains challenging due to the high number of variables and factors that contribute to nasal obstruction. Nasal examination by means of anterior rhinoscopy is limited to the evaluation of anterior septal deviation, internal nasal valve angle, and inferior turbinate size, but obstruction due to posterior septal deviation and nasal polyposis may go undiagnosed. The primary objective of this study was to determine the incidence of posterior nasal obstruction in OSA patients. Specifically, we were interested in other causes of posterior nasal obstruction that were difficult to assess by anterior rhinoscopy examination alone, and that required nasal endoscopy for identification. This is a retrospective case series study. Flexible fiberoptic examination of the nasal cavity was performed on 274 consecutive OSA patients evaluated at the Stanford Sleep Surgery Clinic. Examination video files were recorded and later reviewed and scored by a single investigator blinded to the patients’ subjective nasal complaints. Anatomic features that contribute to posterior nasal obstruction were noted. Posterior septal deviation was the most common incidental finding in OSA patients with posterior nasal obstruction. Other causes included nasal polyposis, nasal mucosal inflammation, and purulent mucosal discharge. In total, there were 73/274 (26.6%) patients for whom nasal endoscopy provided findings that directed management. Nasal endoscopy provides additional diagnostic information in a significant number of OSA patients who complain of nasal obstruction. Our findings suggest the use of nasal endoscopy for OSA patients who complain of nasal obstruction or CPAP intolerance, despite unremarkable anterior rhinoscopy examination.

In Reply .—Dr Lapidot appears to have several misconceptions about functional endoscopic sinus surgery. Dr Greenfield does deserve our recognition for his early and persistent advocacy of more accurate diagnosis in sinus disease, utilizing nasal endoscopy, sinuscopy, and multiplanar tomography, and for drawing our attention to the inaccuracies of routine sinus roentgenograms. However, the interpretation of significant findings, rationale for therapy, and surgical approach used by Dr Greenfield differ substantially from the approach described. The technique that I have termed functional endoscopic sinus surgery was originally developed by Messerklinger based on a lifetime experience in nasal endoscopy and research in the field of mucociliary clearance, and initially utilized over a decade ago. The key to this technique is the accurate diagnosis of areas of ventilatory and mucociliary obstruction, usually in the ostiomeatal complex. No attempt is made to exenterate all disease from the secondarily involved sinuses, which usually improve spontaneously

Background The concept of control of chronic rhinosinusitis (CRS) has only recently been introduced by the EPOS expert panel following the concept of control in allergic rhinitis and asthma. The aim of this study was to examine the degree of control of CRS at a mean period of 3-5 years after endoscopic sinus surgery (ESS) and to correlate the new criteria of control of CRS to VAS (visual analogue scores) for sinonasal symptoms and the SNOT-22 questionnaire. Another aim was to find out if patients changed from controlled to partly controlled or uncontrolled following nasal endoscopy. Methods