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?
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