ENDOSCOPIC EXAMINATION OF THE NOSE
During the last 15 years, developments in endoscopic instrumentation have revolutionised out-patient nasal examination. The first of these was the development of the flexible, fibre-optic laryngoscope (Figure 41), which is essentially a fine fibre-optic cable with a powerful light source and lens. Modern fibre-optic laryngoscopes are less than 4mm in diameter and can readily be introduced into the nasal cavity with the application of some surface local anaesthetic. They enable the examiner in most cases to make a detailed assessment of all parts of the nasal cavity and of the nasopharynx. More recently the use of rigid metal endoscopes, using the Hopkins rod-lens system, has allowed even more diagnostic accuracy, although these instruments can be painful to use on out-patients and many surgeons prefer the flexible ones. The advantage of the rigid endoscopes is that they are obtainable with a variety of lens angles, which can improve the view of the lateral nasal wall in the assessment of sinus disease, but I find the fibre-optic laryngoscope quite satisfactory for this purpose. Fibre-optic endoscopy of the nose takes only a few moments, and my current view is that a nasal case has not been examined properly unless this technique has been used.