Diagnostic nasal endoscopy I pass


Dr. T. Balasubramanian M.S. D.L.O.

Synonyms: Diagnostic nasal endoscopy, DNE, I pass

Introduction:  Examination of nose has been revolutionised by the advent of nasal endoscopes.  These endoscopes are nothing but miniature telescope.  It comes in the following sizes 2.7mm, and 4mm.  It comes in various angulations namely 0 degrees, 30 degrees, 45 degrees, and 70 degrees.  The 2.7 mm endoscope is used for diagnostic nasal endoscopy and in children.  For diagnostic nasal endoscopy it is better to use a 2.7 mm 30 degree nasal endoscope if available.  A 4mm 30 degree nasal endoscope can also be used for diagnostic nasal endoscopy in adults.

Procedure:  Topical anesthetic 4% xylocaine is used to anesthetise the nasal cavity before the procedure.  About 7 ml of 4% xylocaine is mixed with 10 drops of xylometazoline.  Cotton pledgets are dipped in the solution, squeezed dry and used to pack the nasal cavity.  Pledgets are packed in the inferior, middle and superior meati.  Packs are left in place for full 5 minutes.  Diagnostic endoscopy is performed using a 30 degree nasal endoscope.  If 2.7 mm scope is available it is preferred because it can reach the smallest crevices of the nose.  4mm endoscope is sufficient to examine adult nasal cavities.

First pass:  In this the endoscope is introduced along the floor of the nasal cavity.  Middle turbinate is the first structure to come into view.  Its superior attachment is studied.  Inferior surface of the middle turbinate is studied.  As the endoscope is slid posteriorly the adenoid tissue comes into view.  On the lateral surface of the nasopharynx the pharyngeal end of eustachean tube can be identified.  Its function can be assessed by asking the patient to swallow.  The endoscope is now turned 90 degrees in the opposite direction, the uvula and soft palate comes into view.  The endoscope is again rotated by 90 degrees in the same direction, the opposite side pharyngeal end of eustachean tube is visualised.  In this field both eustachean tubes become visible. 


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