FAQ

NASAL ENDOSCOPY IS CONSIDERED A THIN LENS OF A DIAMETER LESS THAN HALF A CENTIMETER AND ITS LENGTH IS 20 CM AND IT IS USED THROUGH THE NOSTRILS WITHOUT THE USE OF ANY ANESTHESIA OR NASAL DECONGESTANTS AND IT IS USED TO DIAGNOSE NEARLY ALL NASAL CONDITIONS IN AN EARLY STAGE. THE VIEW TAKEN BY THE ENDOSCOPE IS TRANSFERRED TO A SCREEN AS WELL AS IT CAN BE RECORDED OVER THE COMPUTER AND PRINTED IN THE MEDICAL REPORTS.

THE ROLE OF ENDOSCOPY IN DIAGNOSIS IS VERY IMPORTANT AS IT IS USED TO DIAGNOSE ALL THE DISEASE THAT AFFECTS THE NOSE AS CHRONIC SINUSITIS, NASAL POLYPS, AND FUNGAL INFECTION.

NASAL ENDOSCOPY IS USED IN TREATMENT OF NEARLY ALL NASAL CONDITIONS THROUGH THE NOSTRIL WITHOUT THE NEED TO MAKE INCISIONS IN THE FACE OR SUBLABIAL. IT IS WORTH MENTIONING THAT THE ENDOSCOPIC SURGERY IS A ONE DAY SURGERY, AND IT CAN BE DONE UNDER LOCAL OR GENERAL ANESTHESIA AND CAN BE DONE TO ALL PATIENTS INCLUDING CARDIAC, DIABETIC, ASTHMATIC PATIENTS AND THEY LEAVE THE HOSPITAL IN THE SAME DAY.

THE ERA OF ENDOSCOPY IS MUCH BETTER THAN THAT WHAT WAS USED BEFORE AS IT WAS DONE THROUGH FACIAL INCISIONS AND THE PATIENT HAVE TO STAY IN THE HOSPITAL FOR MORE DAYS.

IN CASES OF NASAL POLYPS ENDOSCOPY HELPS THE COMPLETE REMOVAL OF THE POLYPS USING THE SHAVER TO ENSURE THAT THE POLYPS WON’T RECUR.

AND IN CASES OF CHRONIC SINUSITIS THE ENDOSCOPY HELPS TO REACH THE OPENING OF THE AFFECTED SINUSES AND EXCISION OF THE POLYPS AND SUCTION OF THE RETAINED SECRETIONS AND WIDENING OF THE SINUS OPENING TO ENSURE THAT THE CONDITION WON’T RECUR.

AND IN CASES OF FUNGAL INFECTION THE ENDOSCOPY HELPS IN COMPLETE EXCISION OF THE FUNGAL POLYP AND THE THICK MUCUS.

AND IN CASES OF BENIGN AND EARLY MALIGNANT TUMORS THE ENDOSCOPY HELPS THE COMPLETE REMOVAL OF THE TUMOR FROM THE ROOT.

AND IN CASES OF LATE MALIGNANT TUMORS THAT EXTEND TO THE EYE THE ENDOSCOPE HELPS IN PARTIAL REMOVAL OF THE PARTS IN THE NASAL CAVITY AND THE NASAL SINUSES.

AND IN CASES OF CONGENITAL OBSTRUCTION OF THE POSTERIOR NASAL OPENING IN CHILDREN THE ENDOSCOPY HELPS IN REOPENING OF THE OSTIUM WITHOUT THE NEED OF DOING INCISIONS IN THE SOFT PALATE, AS WAS DONE IN THE PAST, AS THAT ENSURE THE NORMAL SUCKLING OF THE CHILD AFTERWARDS.

AND IN CASES OF CEREBROSPINAL FLUID LEAK AND SKULL BASE DEFECTS THE ENDOSCOPY HELPS IN THE DETECTION OF THE SITE OF THE LEAK AND CLOSURE OF THE DEFECT WITHOUT THE NEED OF DOING EXTERNAL APPROACHES FROM THE BRAIN AS WAS DONE BEFORE.

AND IN CASES OF INFLAMMATION OF THE LACRIMAL SAC THE ENDOSCOPE HELPS IN DRAINAGE OF THE PUS THROUGH THE NOSTRIL WITHOUT THE NEED OF DOING ANY INCISIONS BESIDE THE EYE AS WAS DONE BEFORE.

IT IS WORTH MENTIONING THAT PITUITARY TUMORS ARE REMOVED EFFICIENTLY THROUGH THE NOSE BY THE ENDOSCOPE TOGETHER WITH THE NEUROSURGERY TEAM WITHOUT THE NEED OF MAKING INCISIONS IN THE SCALP OR THE BRAIN AS WAS DONE BEFORE.

IT IS WORTH MENTIONING THAT THAT ENDOSCOPIC SURGERY IS A FINE SPECIALIZED SURGERY AND NEEDS EXPERIENCE AND ESPECIAL EQUIPMENTS AND THIS SURGERY SHOULD BE DONE AT EXPERIENCED PHYSICIANS TO PREVENT COMPLICATION ESPECIALLY BLEEDING OR INJURY TO THE EYE OR THE BRAIN.

Epistaxis is a common symptom and it is more in children than that in adults, and it has no dissemination between males and females.

In adults it is usually caused by hypertension while in children is due to capillary rupture.

In adults bleeding is usually profuse and from the posterior part of the nose and it is difficult to be managed by simple methods and hospitalization is often mandatory.

As for children it is relatively less than adults but it usually worries both the child and his parents, and usually it is managed in the outpatient clinic without the need of hospitalization.

Other causes of epistaxis are traumatic injury of the nose, malignant neoplasms, blood disorders and patients on antiplatelet as aspirin.

Conventional management of epistaxis is by putting a piece of cotton impregnated by nasal drops in the nostril or even cauterization of the bleeding site and this is usually enough in mild or anterior nasal bleeding.

In more critical cases especially in elders the need of nasal packing to compress the bleeding site and hospitalization to control the blood pressure.

Recent advances are now available as using the nasal endoscope to detect the site of bleeding and cauterization to stop bleeding without the need to be admitted in a hospital or even nasal packing.

Nasal sinuses are air compartments that are found in the skull and they are distributed around the eye.

Frontal sinus is above the eye, ethmoidal sinuses are adjacent to the eye and maxillary sinus is below the eye while sphenoid sinus is behind the eye.

Nasal sinuses continuously secretes mucous and is drained from through their natural openings to the nasal cavity then back to the throat all the way to the stomach to ensure cleanness of the nasal cavity.

The functions of the nasal sinuses are still unclear but assumptions that they are present to secrete mucous to clean the nose or for protect the eye or they act as a sound box for the resonance of one’s voice.

Chronic sinusitis is more common in adults than that in children and there is no discrimination between males and females.

Chronic sinusitis id due to prolonged obstruction of the sinus opening which results in entrapment of mucous inside which leads to chronic inflammation and even formation of polyps though failure of medication like antibiotics and nasal drops to drain this trapped mucous.

As a complication of chronic sinusitis is extension of the infection to the eye or the brain which leads to proptosis, decreases the visual acuity as well as severe headache and lack of concentration.

Other symptoms of chronic sinusitis are nasal obstruction, anterior nasal discharge, chocking due to posterior nasal discharge together with chronic headache and in severe cases snoring, loss of smell and muffled voice.

Diagnosis of chronic sinusitis is by using the nasal endoscopy to detect the site of pus and polyps as well as computed tomography that detect the affected sinuses and whether there is extension to the eye or the brain.

In the old days, surgery was done through facial incisions either above the eye brow or beside the eye or sub labial to access the affected sinus and this leads to facial disfigurement and prolonged convalescence period.

Recent advances promoted the use of nasal endoscopy for the removal of nasal polyps using the shaver, suction of the pus from inside the sinus and widening of the sinus ostium which guarantee not recurring the disease once more.

It is worth mentioning that endoscopic sinus surgery became a one day surgery and it can be done under local or general anesthesia through that nasal opening sparing and incisions in the face using the endoscope to be our eye and the shaver to be our hand.

Nasal polyps are a common disease and it affects men and women, adults and children.

The patient complaint of nasal obstruction, anterior and posterior nasal discharge, headache, with progression of these polyps snoring, muffled sound, anosmia and mouth breathing.

Many types of nasal polyps are known, the most common is that accompanied by chronic sinusitis, fungal sinusitis and allergic polyps.

The condition is diagnose using the nasal endoscopy to detect the sinuses involved and the type of the polyps , in addition to the computed tomography to detect the extension to the eye and/or the brain.

Sometimes biopsy is taken for pathology if the diagnosis of tumor is suspicious.

Nasal polyps are treated using nasal endoscopy and the shaver to ensure the complete removal of the polyps and that the polyps won’t recur.it is worth mentioning that the nasal polyps surgery is a one day surgery and it is done through the nostril without any incisions in the face or sublabial as it was used to be done like that in the past days.

It is worth mentioning that the excised polyps have to be send for pathology assessment to exclude malignancies and to detect the protocol of treatment to prvent recurrence.

In case of polyps on top of chronic sinusitis proper antibiotics , and in cases of allergic polyps nasal sprays must be taken and in case of fungal polyps corticosteroids must be takenand then local sprays.

Nasal tumors are uncommon and it affects men more than women, elderly more than children.

Nasal tumors are much more in smokers.

Nasal tumors may be benign or malignant, benign are more common.

Patient complains from nasal obstruction on the side of the tumor, headache, thick mucus and proptosis of the eye in case of orbital involvement. And in cases of vascular tumors there is also epistaxis and this type is more common in males in the second decade. And in cases of malignant tumors in addition of the above; offensive nasal discharge is present.

Nasal tumors are diagnosed using the nasal endoscopy to detect the site and type of the tumor, in addition to the computed tomography to detect any extension to the orbit and the brain. In many cases nasal biopsy is taken to detect the type especially in malignant and fibrous tumors. The most common benign nasal tumors are the fibrous, bony and vascular types.

Benign nasal tumors are treated using the nasal endoscopy and the shaver and the drill, and all of this is done from the nostril without any facial or sublaial incisions.

And in cases of malignant tumors complete excision in early stages from the nostril as long as it is limited to the nasal cavity and the nasal sinuses and in case of spread under the skin or to the mouth open surgery is done through an incision in the face to remove the tumor totally and in many cases the need of radiotherapy and chemotherapy after the operation to ensure complete destruction of the tumor and that it won’t recur.

Fungal sinusitis is not a common disease of the nose but the number of cases is increasing nowadays. In adults more than children, no discrimination between males and females.

Fungal sinusitis could be invasive or noninvasive:

What is the most important initially is the correct diagnosis of the type of the fungal infection as both types are totally different regarding their diagnosis, treatment, prognosis and complications.

1. Noninvasive fungal sinusitis is more common and is usually accompanied by allergic rhinitis towards fungus.

Unilateral nasal obstruction with thick mucus of offensive odor and sometimes proptotic eye due to the pressure applied from the nasal polyps.

Diagnosis is achieved by using the nasal endoscopy to detect the affected side, thick mucus , Computed tomography is mandatory to detect any other affected sinuses and the extension of the polyps invading the eye and/or brain.

Treatment is by using the endoscope and the shaver to excise the polyps totally from its roots and suction of the mucus from the affected sinuses and widening of the sinus ostium to guarantee that the disease won’t recur.

Calculated dose from corticosteroids is essential after the surgery to regress the mucosal hypertrophy and for normal aeration of the affected sinus to prevent reaccumilation of fungal debris. Immunotherapy is recommended as this will decrease the incidence of recurrence.

It is worth mentioning that these cases are a one day surgery and is done through the nostrils without any incisions in the face or sublabial.

Follow up is mandatory in these cases every three months to detect any early recurrence

2. Invasive fungal sinusitis symptomatize by severe headache from the beginning and it usually affects immunocomprimised patients as in case of diabetes, renal failure ,malignant tumors, corticosteroids and chemotherapy.

The patients with invasive fungal sinusitis usually complaing of severe headache, fever, severe pain around the eye and then thick offensive secretions as the disease progresses together with deterioration of vision, proptosis of the eye and more serious is extension to the brain and disturbance of conscious.

Diagnosis is made by nasal endoscopy to detect the affected and gangrenous part as well as the computed tomography and magnetic resonance imaging to detect affected sinuses and extension of the disease to the eye and/or the brain.

Treatment is done by nasal endoscopy to remove the dead tissues from the nose and the sinuses as well as managing the preexisting condition (diabetes etc.) together with antifungal medication and of course this is done under physician’s supervision to prevent the complication of these drugs on the liver and the kidney.