EN3.2 | Diagnostic Nasal Endoscopy — Summary & Reflection

KEY TAKEAWAYS

Diagnostic nasal endoscopy uses a rigid Hopkins rod lens endoscope (4 mm, 0°/30°/70°) with a cold fibre-optic light source to inspect the entire nasal cavity and nasopharynx under topical anaesthesia. Preparation: xylometazoline decongestion (10 min) then 4% lignocaine anaesthesia (5 min). Three-pass survey: Pass 1 (0° scope) — nasal floor, inferior meatus, nasolacrimal duct opening, posterior choana, nasopharynx, adenoid, Eustachian tube orifices; Pass 2 (0° or 30°) — middle turbinate, middle meatus, ostiomeatal complex (hiatus semilunaris, uncinate, bulla ethmoidalis, maxillary ostium); Pass 3 (0°) — sphenoethmoid recess, sphenoid ostium, posterior ethmoid. Key interpretive rules: bilateral grey grape-like polyps from middle meatus = ethmoidal nasal polyps (allergic/CRS); unilateral single polyp extending to choana = antrochoanal polyp from maxillary antrum (children/young adults). Laterality of polyps is non-negotiable: bilateral ≠ unilateral. JNA = pulsatile vascular nasopharyngeal mass in adolescent male with epistaxis — DO NOT BIOPSY — contrast CT/MRI and urgent tertiary referral. OMC disease on Pass 2 = chronic rhinosinusitis mechanism — guides FESS planning.

REFLECT

Diagnostic nasal endoscopy relies on a systematic approach that resists the temptation to focus only on the most obvious finding. Reflect on the clinical reasoning challenge this poses: if Pass 1 immediately reveals a large mass in the nasopharynx, how would you ensure you still complete Pass 2 and Pass 3 before deciding on management? In your clinical posting, observe whether the surgeon always completes all three passes, or whether a dominant finding causes the examination to be curtailed. Note the implications for diagnostic completeness. Write two sentences in your reflective journal about the tension between efficiency and systematic completeness in a procedural examination.