This article is a review by Tichenor et al of the history of nasal and sinus endoscopy in evaluating and treating chronic rhinosinusitis (CRS); the equipment and techniques used by allergists to perform endoscopy; and common endoscopic findings in patients with CRS, including those who have undergone sinus surgery. The authors noted that nasal and sinus endoscopy is employed for a variety of CRS-related disorders because it allows visualization of or access to the septum, middle meatus, uncinate process and hiatus semilunaris, accessory ostia, and sphenoethmoidal recess and choana. In patients who have undergone sinus surgery, endoscopy can be used to detect or treat several conditions, including perforated septum, retained secretions, non-patency of the surgical ostium, recirculation of mucus, hyperplastic nasal disease, synechiae, empty nose syndrome, frontal sinus disease, dental and related disease, and atrophic rhinitis.
Tichenor et al commented that sinus examinations are easier to perform with flexible endoscopes than with rigid endoscopes, although rigid endoscopy provides better optics and visualization and can be done without an assistant. According to the authors, concerns about adverse events (other than vasovagal reactions) during nasal endoscopic evaluations of allergic disease are minimal; in particular, there is little risk of bleeding.
The reviewers noted that EndoSheath® Technology with a channel external to the endoscope but within the sheath (Vision Sciences/Medtronic Xomed, Jacksonville, FL) represent a valuable addition to otolaryngologic endoscopy for two primary reasons: they substantially shorten the time between endoscopic procedures because the necessity of sterilizing endoscopes after use is avoided, and the channel allows brushings or procedures such as removal of foreign bodies or fungus balls to be performed with an endoscope not originally designed for surgical procedures. Tichenor et al concluded that nasal endoscopy is a critical component of the management of CRS.