What Is a Rhinoscopy?

Rhinoscopy is an instrument used to inspect the nasal cavity, commonly known as an anterior rhinoscopy, which is composed of a left piece, a right piece, a card spring and a connecting shaft. Anterior rhinoscopy is an indispensable instrument for examining the nasal cavity. Straight and curved rhinoscopes and small rhinoscopes suitable for children are commonly used.

Chinese name: Rhinoscopy
Foreign name: Rhinoscope

Management category: Class I medical devices
Category Name: Other instruments for ENT

Rhinoscopy and Rhinoscopy

Anterior rhinoscopy is a method of observing the nasal cavity through the anterior foramen of the nose. The light reflected by the frontoscope is used to look at the color of the mucosa on the walls of the nasal cavity, the size of the middle and lower turbinates, the shape of the nasal septum, the secretions in the nasal cavity, and whether there are any tumors or foreign bodies To achieve the purpose of diagnosing diseases. Normal nasal mucosa is light red, and the surface is smooth, moist and shiny. During acute inflammation, the mucosa is bright red with viscous secretions. During chronic inflammation, the mucous membrane is dark red, the front end of the lower turbinate is sometimes mulberry-shaped, and the secretions are mucopurulent. The mucosa of allergic rhinitis is pale edema or pale purple, and the secretions are thin. Atrophic rhinitis mucosa atrophy, dryness, loss of normal luster, covered pustules, lower inferior turbinate, occasional hypertrophy or polyp-like changes in the middle turbinate. Doctors often ask for a front rhinoscopy. ^[1]

How to use nose mirror

1. Nasal vestibular examination. The examinee was instructed to tilt his head back later, the examiner fixed the examinee's forehead with his left hand, raised the tip of his nose backwards with his right thumb, then pushed it left and right, and inspected the entire view of the nasal vestibule with the help of frontal mirror reflection light. Observe the nasal vestibular skin for swelling, erosion, ulcers, crusts, and whether the nose hair is falling off. Then check the nasal cavity.

2. Nasal examination. The examiner holds the nosepiece with his left or right hand, holding the nosepiece opening and closing joint with his thumb and index finger, holding one leg of the nosepiece to the palm of the hand, and holding each other's fingers with a handle to control the opening and closing of the nosepiece. examiner. The reflected light from the frontal mirror shines on the tip of the nose. First, place the closed nose mirror (parallel mirror parallel to the bottom of the nose) into the nasal vestibule. The depth of the nose mirror should not exceed the nasal threshold to avoid pain or damage to the nasal septum mucosa and bleeding. . Then, slowly open the front nose and check each part of the nasal cavity in turn.

First position: When the subject's head and face are in a vertical position or the head is slightly lower, the bottom of the nasal cavity, lower turbinate, lower nasal passage, nasal septum, and lower total nasal passage can be clearly seen. You can gently move the nosepiece to the left or right, or use the right hand to support the subject's pillow to tilt the head slightly forward, and at the same time lift the nosepiece up slightly with your left hand, so that you can clearly see the bottom of the nasal cavity. Inferior turbinate atrophy, movement of the nasopharynx and soft palate can be seen.

Second position: The examinee tilts his head 30 ° backwards, and can see the middle nasal passage and the middle of the nasal septum, the middle turbinate, middle nasal passage, and part of the olfactory fissure.

Third position: Based on the second position and tilted back 30 °, you can see the nasal mounds, the front of the middle turbinate, the middle nasal passage and the lower part of the anterior olfactory, and the upper part of the nasal septum. But the upper nasal passage and upper turbinate cannot be seen. The normal nasal mucosa is light red, and the mucosal surface is smooth and moist.

After the examination is completed, do not pull the two leaves together when withdrawing the nose to avoid pinching the nose hair and causing pain. When examining a child, ask a family member or nurse to hold the child and sit in front of the child. The family member or nurse clamps the child's lower limbs with his thighs, holding his chest and upper limbs around his chest with one hand, and his head with the other. Then use a small front nose or large otoscope to check. If there is too much nasal secretion, you can scoop it out or suck it out with an aspirator before checking.

During the inspection of the nasal cavity, the position of the patient's head can be appropriately changed in order to observe the nasal cavity in detail according to the needs of the situation. For example, when the nasal mucosa swells and affects the observation, 1% to 2% ephedrine saline cotton pieces can be placed in the nasal cavity for 3 to 5 minutes and removed, or 1% ephedrine saline can be sprayed 1 or 2 times until the mucosa contracts. Re-examine the nasal cavity; if suspicious lesions are found in the nasal cavity, use a blunt probe or cotton wool to probe deeply and softly to see if it is easy to bleed. For purulent secretions, distinguish pus The source of the liquid is of certain value in the diagnosis of sinusitis; the smear examination of the scraped surface of the suspected lesion is also of certain reference value in the diagnosis of inflammatory properties and benign and malignant tumors. ^[2]

Clinical Significance of Rhinoscopy

1. Nasal vestibule. Inspect the skin of the vestibule of the nose for swelling, erosion, cleft palate, crusting, and nasal hair loss. Nasal vestibitis is a diffuse inflammation of the skin of the nasal vestibule. If the nasal vestibular skin is cleft, crusted, and the nose hair is scarce, and the skin lesion spreads to the upper lip skin, attention should be paid to identifying it with eczema. The epistaxis is a localized purulent inflammation of the nasal vestibular hair follicles, sebaceous glands, or sweat glands, which are mostly unilateral. The nasal vestibular skin has pimples-like bulges and significant tenderness. Sometimes epistaxis can also occur at the tip of the nose and wings. May be accompanied by symptoms of systemic poisoning. The anterior lower edge of the nasal septum is dislocated, sometimes protruding into one side of the nasal vestibule, and pushing the tip of the nose to the opposite side, you can see the anterior edge of the dislocation, or you can pinch it with your fingertips.

2. Nasal mucosa. Care should be taken to observe the color, shape and presence of mucous membranes. In the early stage of acute rhinitis, the mucosal congestion was bright red, often accompanied by mucus secretions; the chronic inflammation mucosa was dark red, and its shape varied according to the disease; allergic rhinitis, pale edema of the mucosa, purple gray or blue gray, Accompanied by clear water-like secretions.

3 Turbinates and nasal passages. With a nasal examination, the distance between the front of the inferior turbinate and its corresponding nasal septum is 2 to 3 mm under normal conditions; the lower nasal passage and the bottom of the nasal cavity can be seen. If the turbinate is enlarged and in direct contact with the nasal septum, the lower nasal passage is not easy to see. When the patient suffers from atrophic rhinitis, the lower turbinate is small and the bottom of the nose can be seen at a glance. When swallowing, the movement of the soft palate can sometimes be seen. There is pus on the nasal floor, and sometimes the pus is covered with moss on the surface of the lower turbinate, which is like a waterfall. It usually indicates that there is sinusitis in the anterior group. The surface of the back of the nasal floor and the turbinate is full of pus.

Normally, the leading edge of the middle turbinate is straight and free, and the color of the mucosa is slightly lighter than that of the lower turbinate, and it does not contact the nasal septum. Such as the turbinate swelling, hypertrophy, or polypoid changes, mostly due to sinusitis; sometimes the inferior turbinate atrophy, the middle turbinate can also have modern compensatory hypertrophy. Normally, the middle nasal passage is fissured under the middle turbinate, and sometimes there are semicircular raised ethmoids above the middle nasal passage and the anterior lower hook process. The inflammation of the sinuses in the anterior group can be expressed by pus in the middle nasal passage. If the amount is large and is found in the middle of the middle nasal passage, most of it comes from the maxillary sinus. If it appears in the front of the middle nasal passage, it mostly comes from the frontal sinus. Sometimes pus can be seen. The fluid cascades from the middle nasal passage to the surface of the lower turbinate. In posterior sinusitis, pus often accumulates in the upper nasal passages and olfactory fissures and flows backward to the nostrils. Pay attention to distinguish them from foreign bodies in the nasal cavity, tumors and malignant granulomas. If the boundary mark is not clear during the examination, the pus should be sucked up and sprayed with ephedrine solution to make the nasal mucosa contract. Chronic inflammation is often accompanied by degeneration of the middle nasal polyps. If the middle nasal passage often has bloody secretions, it is necessary to consider whether there is a tumor in the sinus; if the yellowish liquid flows out, the possibility of a cyst in the sinus should be considered. The nasal mound is located at the bulge above the middle nasal passage. Normally, the color of the mucosa is the same as that of the middle turbinate, and it is pale red. If there is congestion, it is bright red, which is mostly signs of anterior ethmoidal infection.

4 Nasal septum shape and mucosa. The nasal septum is rarely perpendicular to the base of the nose, and the cartilage is often on one side. Condyles or rectangular processes may appear at the junction of the cartilage and the vulva. The upper mucosa of the nasal septum is sometimes hypertrophic and nodular and soft to the touch. During the examination, attention should be paid to changes in erosion, bleeding, and perforation in the lower Li area before the nasal septum. If the nasal septum is deflected, you should pay attention to whether there is ventilation and drainage obstacles; those with high nasal septum deflection can often see compensatory hyperplasia and hypertrophy of the mucosa on the concave surface, but those with sinusitis in the back group due to chronic inflammation and secretions Nodular hypertrophy can occur on one side of the nasal septum, or on both sides of the mucosa. Septum bilateral swelling and tenderness, nasal septum hematoma should be considered, infection can become abscess.

5 Smell. The olfactory fissure is a narrow gap between the middle turbinate and the nasal septum. If there is empyema, it is more suggestive of inflammatory lesions in the sinuses of the posterior group. When the middle turbinate is swollen, it can contact the nasal septum, so that the olfactory cleft is blocked and it is not easy to see its depth.

Notes on rhinoscopy

Inspection requirements: The nose should not go too deep, so as not to cause pain or damage the nasal septum mucosa and cause bleeding. When removing the nosepiece, do not close the two leaves completely to avoid pain caused by pinching the nose hair. For uncooperative children, parents can hug them, holding their heads in one hand, holding their arms in one hand, holding the children's legs with both knees, and examining them with a small nose.

Nasal nasal mirror cleaning method

Rinse the used nose under running water, and use the operator to brush the sides of the nose lens with a toothbrush and dry with dry gauze. The end of the nose lens should be tightened with rubber bands to open the nose lens. Ultrasonic cleaning machine with 1: 200 Bijiemei multi-enzyme cleaning solution was ultrasonically cleaned for 5 minutes, and then rinsed under running water to remove moisture and dry. Lubricate the shaft joint and put it into a special paper-plastic packaging bag according to the length of the nosepiece. Inside, put the chemical instruction card, and seal it with a heat-sealing machine. The outside of the bag is marked with the department, item name, sterilization date, expiration date, and operator name. Into the plasma low temperature sterilizer, the disinfection time is about 60min. ^[1]