Rhinoscopy

RHINOSCOPY (from Greek rhis-nose and skopeo-I look), a method for examining the nasal cavity, by means of which it can be inspected through the nasal opening or through the mouth and nasopharynx and choanae, - the anterior and posterior R. Rhinoscopy is performed in a darkened room under artificial lighting and presents a number of difficulties, since it requires the skill to handle a nasal mirror and a frontal reflector; in addition, a habit of interpreting the visible picture is necessary. When examining the nasal cavity from the front, the narrow nostril opening is widened and simultaneously lifted by the blades of the nasal mirror; the rays of light from the reflector illuminate the cavity. The examination is carried out according to a definite plan; first of all, the parts located near the entrance are examined, where cracks, ulcers, abrasions, furuncles, scars, etc., may be noted. In the deeper parts, the first identifying point is the nasal septum, which in the norm lies in the plane of the middle line of the skull, but is very often curved to one side or the other, has bumps or projections; attention is paid to the color of the mucous membrane, which is usually red; sometimes on the front part of the septum, dilated vessels, crusts, cracks, scars, and small ulcers are visible. The second identifying point is the inferior turbinate, which in front usually appears in the form of a rounded convex body, departing from the lateral wall of the nasal cavity. In many cases, in addition to the anterior end, its middle part and even the posterior end can be inspected. In a normal nose, a fairly wide slit always remains between the inferior turbinate and the septum. The color of the mucous membrane of the turbinate is for the most part the same as that of the septum, but can vary widely in its shades depending on the state of congestion of the cavernous tissue and connective tissue degeneration; in cases of stasis the turbinate has a bluish or gray color; often it is covered with thick mucus, which further increases the variations in color. Then the inferior nasal passage is examined, and on the floor of the nasal cavity a large accumulation of mucus is often found. With a wide nasal passage, the posterior wall of the pharynx can be seen with the characteristic moving light reflex during the act of swallowing. The third identifying point is the middle turbinate. In order to see it, the patient's head must be slightly tilted back. If the inferior turbinate, which lies in the way of the inspection, does not interfere, the anterior end of the middle turbinate and its lower part are visible deep in the nose, however, its view is often hindered by the incorrect position or projection of the septum. Together with the inspection of the middle turbinate, it is necessary to orient oneself regarding the state of the middle nasal passage - a space very important in diagnostic terms; the presence of a strip of pus in it indicates inflammatory diseases of the accessory cavities of the nose. The color of the mucous membrane of the middle turbinate is paler than that of the lower parts of the nasal cavity; mucus and crusts are often noted in it, or it seems shiny. In its form, the middle turbinate undergoes various variations, being either a swollen rounded body or a thin plate; in the latter case, one can look under the middle turbinate and into the narrow slit between it and the upper part of the septum. Sometimes the turbinate is so enlarged that it occupies the entire middle passage with its mass and even descends into the lower one. The superior nasal passage, or olfactory slit, rarely yields to inspection due to its narrowness, just as the superior turbinate does. Indispensable auxiliary means in anterior rhinoscopy are lubrication of the nasal mucosa with a cocaine solution (3-10%) and probing. Cocaine, acting on the smooth muscle of the cavernous tissue, causes contraction of the swollen mucous membrane of the nasal turbinates, as a result of which the internal parts of the nasal cavity become more accessible to inspection. At the same time as the cocaine lubrication, probing is also carried out. In most cases, without the use of cocaine and adrenaline, it is impossible to speak about the condition of the nasal mucosa in both acute and chronic rhinitis. Through the nostrils, middle R. can also be performed, for which a special Killyan dilator with long blades is used, which are introduced into the middle nasal passage: by spreading the branches of the mirror, one tries to push the middle turbinate toward the septum, in which case the area of the middle passage with the openings of the accessory cavities becomes accessible to inspection. In small children, instead of a nasal dilator, a wide ear funnel can be used. Posterior rhinoscopy is used for examining the posterior parts of the nasal cavity through the nasopharynx (see Pharynx, examination of the pharynx).