The Nasal Telescope

The nasal telescope is an optical instrument for examining the nose. This examination is known as diagnostic nasal endoscopy. Because the telescope is so slender (only 2.7-4.0 mm in diameter), it may be passed easily through the nostril to examine the nasal passages and the sinuses. In some nasal telescopes, the view is straight ahead from the tip of the instrument; in other telescopes, the view is at an angle from the tip of the telescope. These 'angled' telescopes can be used to see around corners--much like a child's toy periscope. The standard nasal examination is quite limited; however, nasal endoscopy provides a detailed examination of both the nasal cavity and sinuses. Also, nasal telescopes are also used during surgical procedures in the office and operating room.
 

Nasal Endoscopy Room

Nasal endoscopy is commonly performed in the office of otorhinolaryngologists (ENT doctors). The ENT doctor can look directly through the telescope. Alternatively, a medical video camera can be attached to the telescope, and then the images are viewed on a special video monitor as shown here. The examination may be recorded on a VCR, or a digital image archive (like a digital camera) may be used. If a patient wishes, he or she may view the images from his or her own examination.

Nasal Endoscopy

Patients tolerate nasal endoscopy very well. Many ENT doctors will apply a topical nasal decongestant and numbing medicine to the lining of the nose by a nasal spray prior to endoscopy. Often, the examination can be completed without any special medicines at all.

 

Frontal Sinus Instruments

These instruments are also designed to be used during nasal endoscopy both in the operating room and in the office. Note that the instruments are curved. Because the instruments are bent, it is possible to reach around corners. These instruments are used with the 'angled' telescopes.

 

More Frontal Sinus Instruments

These instruments are for procedures aimed at the frontal sinus (located in the forehead). Because the frontal sinus is located above the nose, the instruments are curved, so that they can reach the entrance to the sinus while the instruments are passed through the nose. Endoscopic frontal sinus surgery is very complicated, since the anatomy of this region is so complex.

 

Nasal Endoscopy in the Operating Room

Since the early 1980's, endoscopic sinus surgery has become a common method for the treatment of surgical treatment of sinus infections that do not improve with antibiotic treatment. Some surgeons prefer to look directly through the telescope, while other surgeons (shown here) will use a medical video camera that sends a TV picture to a video monitor. The reference frame is used for computer-aided surgery (described below). It is important to remember that endoscopic sinus surgery is a challenging and demanding surgical procedure.

 

Computer-Aided Sinus Surgery

Recently, computer-aided surgery (CAS) systems have been introduced into sinus surgery. This technology allows a surgeon to directly localize specific points seen during endoscopy with the CT scans that have been obtained prior to surgery. CAS provides important anatomic information--as a result, CAS probably decreases the risks of surgery and may improve the results of surgery.

 

Endoscopic View of The Middle Turbinate

This is a normal middle turbinate in the patient's right nasal cavity. Note that the right side is marked on the image. The middle turbinate is a normal structure of the sidewall of the nose. During the routine nasal examination, a physician cannot really see the middle turbinate reliably, but an ENT doctor can use nasal endoscopy for an inspection of this structure. This is important, since a small amount of swelling in this area can cause sinus infections.

 

Endoscopic View of Acute Sinusitis

Nasal endoscopy can be used to make the diagnosis of acute sinusitis. In this example, pus is seen draining under the middle turbinate. This infected nasal mucus will fall posteriorly and produce symptoms of 'postnasal drip.' Endoscopy can tell which sinuses are involved, and it can confirm the diagnosis of sinusitis. Also, endoscopy can be used to guide cultures of the infected mucus. These cultures provide important information so that the ENT doctor can choose an appropriate antibiotic.

 

Endoscopic View of Maxillary Sinus Mucus Recirculation

This patient reported persistent sinus infections despite previous surgery. In this picture, pus is seen draining from the natural ostium (drainage opening) of the maxillary sinus. This mucus is then falling back into the maxillary sinus through an antrostomy (surgical opening) that had been made during surgery. This occurrence is known as maxillary sinus mucus recirculation. It happens since the maxillary sinus tries to push mucus to the natural opening, even if a surgeon has created an opening in another location. Revision endoscopic sinus surgery can be performed to fix this problem.

 

Endoscopic View of Nasal Polyps

This picture shows nasal polyps. Note the orientation of the picture. Polyps are seen filling the middle meatus. The uncinate process is an important landmark. This uncinate process looks unusual, since as they grew, the polyps have pushed it forward.