Rhinoscopy

Rhinoscopy (from the Ancient Greek ῥίς — “nose” and σκοπέω — “to look, to examine”) is an instrumental visual examination of the nasal cavity. This procedure is a fundamental and essential component of a comprehensive otorhinolaryngological evaluation. It helps assess the nasal mucosa and anatomical structures and identify pathological processes.

Depending on the region of the nasal cavity being examined and the tools used, rhinoscopy may be classified as anterior, middle, or posterior. In modern clinical practice, endoscopic examination is gaining increasing importance.

Types of Rhinoscopy

• Anterior rhinoscopy: The most common and routine method used to examine the anterior sections of the nasal cavity. It is performed using a nasal speculum (dilator) and a light source (such as a head mirror or headlamp). A healthcare professional inserts the speculum into the nasal vestibule and inspects the anterior portion of the nasal septum, the inferior and partially the middle nasal conchae, as well as the common nasal meatus.
• Middle rhinoscopy: An extended version of anterior rhinoscopy aimed at visualizing the middle nasal meatus. It is conducted using elongated blades of the nasal speculum, typically after decongestion of the mucosa with vasoconstrictive drops to enhance visualization. This method allows for the evaluation of the drainage pathways of the frontal and maxillary sinuses, as well as the anterior ethmoidal cells.
• Posterior rhinoscopy (epipharyngoscopy): A procedure used to examine the posterior sections of the nasal cavity (choanae) and the nasopharynx. The classical technique utilizes a specialized nasopharyngeal mirror inserted through the oral cavity. This method is technically challenging and uncomfortable for the patient. Today, it has been almost entirely replaced by endoscopic techniques.
• Endoscopic rhinoscopy: The gold standard of modern nasal examination. It is performed using a thin rigid or flexible endoscope equipped with a video camera. This method enables a detailed, magnified view of all regions of the nasal cavity and nasopharynx, including those that are otherwise difficult to access.

Diagnostic Significance

Rhinoscopy enables healthcare professionals to assess numerous parameters and detect signs of various diseases.

During the examination, the following is evaluated:

• Nasal septum: Deviations, spurs, crests, perforations, hematomas, or abscesses.
• Nasal conchae: Size (normal, hypertrophied, atrophied), and mucosal color (normally pink; pale bluish in allergy; bright red in inflammation).
• Nasal meatuses: Width, patency, and pathological secretions (mucus, pus, blood). Pus in the middle nasal meatus is a classic sign of sinusitis.
• Mucosa: Color, moisture, and degree of edema.
• Pathological lesions: Polyps, foreign bodies, tumors, or sources of bleeding.

Clinical Applications

Rhinoscopy is a mandatory procedure in cases involving nasal obstruction, nasal discharge, epistaxis, reduced sense of smell, or headaches and facial pain. It facilitates the diagnosis of acute and chronic rhinitis, sinusitis, allergic rhinitis, nasal polyposis, deviated nasal septum, and may indicate the presence of neoplasms. Endoscopic rhinoscopy is indispensable for accurate diagnosis, surgical planning, and postoperative monitoring of the nasal cavity and paranasal sinuses.