Nasal endoscopy: What have we been missing?

McCoul ED, Ganeshan V, Nguyen T. Int Forum Allergy Rhinol. 2024; 1-5. https://doi.org/10.1002/alr.23394

Summary

Endoscopic view of middle turbinates in three different patients.
(A) Normal, with mucosa that resembles the adjacent septal mucosa.
(B) Vascular injection and deepened reddish hues suggestive of acute inflammation.
(C) Pale appearance with loss of vascular markings suggestive of atopic disease or early polypoid change.

Despite the widespread adoption of nasal endoscopy (NE) in the evaluation of sinonasal disease, its diagnostic potential may still be underutilized. Developments in endoscopic technology have led to significant improvements in video quality and maneuverability.

Endoscopic view of the nasopharynx showing a rivulet of nonpurulent mucus.
Note that the lack of mucus coloration potentially has a camouflaging effect
relative to the surrounding normal mucosa.

However, there is concern that NE continues to be used primarily for the identification of gross pathology, with relative neglect of more subtle findings such as surface features of inflammation and mucus. With fewer technical limitations to perceive these abnormalities, there is potential to greatly improve the diagnostic value of NE. The reader is herein asked to consider several important visual nuances encountered during NE, with the hope that this engenders an appreciation of the versatility of NE as a diagnostic tool.

PDF