From Speculum to Scope: Advancing Sinonasal Disease

Background: Sinonasal diseases are common in otorhinolaryngology, ranging from inflammation to complex infections and neoplasms. Anterior rhinoscopy is often used for initial evaluation but is limited to the anterior nasal structures thus missing deeper pathologies. Nasal endoscopy offers a more comprehensive view allowing detailed visualization of both the anterior and posterior nasal cavities. Despite its superior diagnostic capabilities, nasal endoscopy is still underused due to factors like cost and expertise. Objective: To compare merits and demerits of nasal endoscopy vs. anterior rhinoscopy in diagnosis of sinonasal disease. Methods: A prospective observational study was conducted on 110 patients presenting in the Department of ENT, PMCH, Udaipur from April 2024 to March 2025 with symptoms of sinonasal disease. Each patient underwent both anterior rhinoscopy and diagnostic nasal endoscopy. Results: Nasal endoscopy proved significantly better than anterior rhinoscopy for detecting sinonasal abnormalities, identifying conditions like concha bullosa (40.90% vs. 2.72%), ethmoidal polyps (19.09% vs. 9.09%) etc. It also provided a more detailed assessment of regions such as the sphenoethmoidal recess and superior turbinates and nasopharynx, which were not accessible with anterior rhinoscopy. Conclusion: The study highlights the critical role of nasal endoscopy in accurately diagnosing sinonasal disease, particularly in chronic or refractory cases where subtle or posterior pathology may be present. Despite being more resource-intensive, nasal endoscopy should be integrated into routine clinical practice for comprehensive evaluation, as it enables precise diagnosis, better treatment planning, and improved patient outcomes