Question: When a doctor examines the sinuses with nasal endoscopy, how much of the sinus cavities can the doctor actually see? Could a sinus infection persist in a deep area where a doctor cannot see?
Answer:
Thanks for the question. Much has changed with the easy use and availability of endoscopes- small lighted telescopes- in medicine. As a sinus doctor, we use an endoscope frequently as part of our examination. It allows us to painlessly see areas of the nose and sinus drainage passages that we could only guess at without them.
In looking through the telescope, we look at both nasal passages. We examine the septum, to see if it is straight or twisted (deviated) and whether this is blocking a patient’s breathing or blocking sinus drainage. We look at the turbinates, which are thin bones covered with membranes. They add surface area to the nose and improves it’s role as nature’s filter and humidifier of the air we breath.
We then look at the area where the sinuses drain. The most important area for this is called the “middle meatus”. Through this space the maxillary (cheek), ethmoid (between the eyes) and the frontal (forehead) sinuses all drain. The sphenoid sinuses (behind the eyes) drain further back. We can see whether this area is draining pus and/or is obstructed by swelling, a deviated septum or growths, such as polyps. When we see pus in this area, we can readily make a diagnosis of sinusitis. We typically would culture the drainage to see which bacteria may be causing the infection and which antibiotic would be most effective in treatment, if any.
However, the sinus openings are too small to enter with our current nasal endocscopes in most cases, unless one has had previous surgery. Therefore, there ARE areas that are not well seen by nasal endoscopy- most typically the frontal sinuses. An infection, as you suggest, could easily persist in an area we cannot see. If, as sinus specialists, we continue to be concerned about a patient’s symptoms, we would suggest imaging (by CT scan without contrast) to view any such areas. The combination of nasal endoscopy and CT imaging would get the answer for us.
I hope this helps-
Robert Pincus MD
Associate Professor Otolaryngology
NY Sinus Center
Frequently Asked Questions
Nasal endoscopy allows doctors to see the nasal passages, septum, turbinates, and the middle meatus where the maxillary, ethmoid, and frontal sinuses drain. However, the openings to the sinuses themselves are too small to enter with the endoscope in most cases, limiting direct visualization of the sinus cavities.
Yes, sinus infections can persist in deep areas of the sinuses that are not visible through nasal endoscopy, such as the frontal sinuses, because the sinus openings are too small to be accessed by the endoscope.
Nasal endoscopy helps visualize if there is pus or obstruction at the sinus drainage pathways, particularly at the middle meatus. Seeing pus enables the doctor to diagnose sinusitis and potentially obtain a culture to identify the bacteria causing the infection.
Since nasal endoscopy cannot visualize certain sinus areas, especially the frontal sinuses, imaging such as a CT scan without contrast is recommended if symptoms persist. This provides a complete view of all sinus cavities to detect infections or blockages not visible endoscopically.
During nasal endoscopy, doctors examine the septum to check for deviation, evaluate the turbinates for swelling or other issues, and assess the middle meatus where several sinuses drain. These areas are important for breathing and drainage functions of the nose.
Yes, when pus is seen draining from the nasal passages via endoscopy, doctors can take a culture of the drainage. This helps identify the bacteria causing the infection and informs which antibiotics might be most effective for treatment.
