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Mohamed A. Taha, MD1,2, Christian A. Hall, MD1,3, and Henry P. Barham, MD1,3

Nasal endoscopy is considered the standard of care for appropriate and cost-effective diagnosis and management of sinonasal diseases as it allows for direct visualization of inflammatory, infectious, neoplastic and other complex pathologies.

Kuhn reviewed the importance of endoscopy, stating that it aids in direct evaluation of mucosa.1 Endoscopy allows for tissue sampling and staging of severity of sinonasal disease. It allows for direct evaluation of structural changes such as scarring, resected turbinates, partially resected uncinate processes, residual ethmoid cells, posterior fontanel antrostomies, not connected to the maxillary sinus ostium, and sphenoid sinus stenosis. Other applications mentioned by Kuhn include culturing the sinuses for fungus or bacteria, inserting a cannula for the delivery of drugs into sinuses. For postoperative maneuvers, including lysing scar tissue, removing bone chips that remain after surgery, and managing polyps that occur in the immediate postoperative period.

Kennedy et al stated that the advent of endoscopic instrumentation has revolutionized the way in which otolaryngologists manage sinus diseases.2 Endoscopy permits accurate diagnosis of the nasal manifestations of sinus disease by revealing findings easily missed with anterior rhinoscopy. It allows for meticulous follow-up, as the marsupialized sinus cavities are readily accessible to direct inspection, thus allowing an objective measure of surgical and medical treatments, so detecting potential for subsequent development of ongoing, chronic or recurrent sinusitis, video or photographic recording of persistent changes, & evaluation of such changes over time. Use of nasal endoscopy to subjective survey of patient symptoms is recommended as it provides direct, easily available, and predictive measure following surgery.

Stammberger stated that the combination of diagnostic endoscopy with the computed scan has proven to be the ideal method for examination.3 Through this combination, lesions that otherwise might have gone undiagnosed can be identified and treated. They based their endoscopic surgical concept upon these diagnostic approaches, to remove the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. According to their diagnostic endoscopic concept using the Messerklinger technique, they were able to demonstrate that disease processes typically spread from the ethmoid to the frontal and maxillary sinuses.

Nasal endoscopy may be supplemented with radiology and acoustic rhinometry,4 but endoscopy alone has proven to be the cornerstone of rhinologic care. While nasal endoscopy has been categorized as an aerosol-generating procedure, our implemented protocol resulted in zero transmissions to our providers (P < 0.05), despite significant amounts of exposure to COVID-19 positive cases.5 Unnecessarily avoiding nasal endoscopy will likely lead to misdiagnosis, delayed diagnosis, inappropriate and/or delayed treatment. In addition, replacement of endoscopy with radiology, laboratory evaluation and acoustic rhinology stands to increase cost of care. As we have proven safety, nasal endoscopy should remain the standard for appropriate care, patient safety, and healthcare cost.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Henry P. Barham https://orcid.org/0000-0002-4969-4977

1Rhinology and Skull Base Research Group, Baton Rouge General Medical Center, Baton Rouge, Louisiana
2Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
3Department of Rhinology/Skull Base Surgery, Sinus and Nasal Specialists of Louisiana, Baton Rouge, Louisiana

References

1. Kuhn FA. Role of endoscopy in the management of chronic rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 2004;193:15–18.
2. Kennedy DW, Wright ED, Goldberg AN. Objective and subjective outcomes in surgery for chronic sinusitis. Laryngoscope. 2000;110(3 Pt 3):29–31.
3. Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Concept, indications and results of the
   Messerklinger technique. Eur Arch Otorhinolaryngol. 1990;247:63–76. doi:10.1007/BF00183169
4. Cankurtaran M, Celik H, Cos ̧ kun M, et al. Acoustic rhin- ometry in healthy humans: accuracy of area estimates and ability to quantify certain anatomic structures in the nasal cavity. Ann Otol Rhinol Laryngol. 2007;116(12):906–916.
5. Taha MA, Hall CA, Rathbone RF, et al. Rhinologic pro- cedures in the era of COVID19: health-care provider pro- tection protocol [published online ahead of print]. Am J Rhinol Allergy. 2020. doi:10.1177/1945892420927178

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