Rhinoscopy can be a life-saving diagnostic tool...

This toolkit provides allergists with critical information and guidance concerning the flexible rhinolaryngoscope and how to best make use of it in practice.

Anterior rhinoscopy using otoscopes with nasal speculum attachments provide only a keyhole perspective of the anterior nose. Flexible endoscopy however allows examination of the entire nasal cavity and more distal anatomy. It is most commonly performed by otolaryngologists in the evaluation of nasal obstruction, sinusitis, epistaxis, anosmia, other symptoms of rhinitis, and head and neck cancer. It can also be performed by allergists in the evaluation of the upper airway. Flexible rhinoscopy is commonly performed with no specific pre-procedure restrictions or contraindications. With practice and experience, the office-based procedure takes only a few minutes and is well tolerated by the majority of patients.

Important Upper Airway Structures
The major passages and structures of the upper respiratory tract include the nose or nostrils, nasal cavity, mouth, throat (pharynx), and voice box (larynx).
 
 
Technique of Examination
The physician interested in extending his knowledge of the nose, the pharynx, and the larynx can use fiberoptic rhinoscopy for examination of virtually all patients with upper airway complaints. There are, of course, certain limitations when it comes to examination of children, but with a reassuring bedside manner, proper and safe restraint techniques, and judicious use of analgesics, amnesics and sedatives, examination of even very small children can be accomplished.
 
 
Upper Airway Pathology
The differential diagnoses of nasal obstruction include both anatomic, inflammatory, and infectious causes. Anatomic causes identifiable through nasal endoscopy include nasal polyps, nasal valve collapse, septal deviation/perforation, synechiae, and turbinate hypertrophy. Nasal or sinus tumor may occur as well, of course, but fear of missing this diagnosis should not preclude the attempt. Sources of inflammation and infection can also be predicted. Thorough history, including chronic illnesses, past surgeries, current medications, onset, duration, and aggravating/relieving factors, can help to narrow the differential diagnoses.
 
 
Resources
This set of resources comes from the Introductory Course in Rhinolaryngoscopy by Jerald W. Koepke, MD.
 
 


Attendees practice using a rhinolaryngoscope during the ACAAI annual meeting

Ask an Expert: Your Rhinolaryngoscopy Questions Answered

Q: I have not performed rhinoscopies for a number of years. My current Welch Allen rhinoscope is no longer manufactured.  Can you provide me with detailed instructions on how to clean a flexible non-channel rhinolarynoscope? 

Dr. Dana V. Wallace, Associate Professor, Nova Southeastern Allopathic Medical School, Davie Florida
A: Most rhinolarynoscope manufacturers will have their own set of cleaning AKA "reprocessing" instructions and it would be best to review their recommended method, when this is available. While non-channel rhinolarynoscopes are easier to reprocess than those with a channel, similar cleaning/disinfecting procedures are recommended for both. New products continue to be developed, e.g., Aldahol 1.8 high-level disinfectant and FlexClean 895 detergent, as featured on the Olympus website. 
http://medical.olympusamerica.com/customer-resources/cleaning-disinfection-sterilization/reprocessing-products

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Thanks to the contributors, editors, and reviewers for their critical assistance on this toolkit: Dana Wallace, MD; John B. Hagan, MD; Thomas R. Murphy, MD; Jeffrey L. Shaw, MD; Jerald W. Koepke, MD; and Mervat Nassef, MD