Kumar M V Vinay, Prasad K U Raghavendra, Gowda P R Belure, S R Manohar, P K Chennaveerappa
Assitant Professor, Department of ENT, Hassan Institute of Medical Sciences , Hassan, Karnataka, India .
J Clin Diagn Res. 2013 May;7(5):831-3. doi: 10.7860/JCDR/2013/4421.2995. Epub 2013 May 1.
Epistaxis is one of the common symptoms encountered in the Otorhinolaryngology department. Many times the cause for epistaxis is not found on anterior and posterior rhinoscopy. The present study was undertaken to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding.
Fifty patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy.
The use of the nasal endoscope allowed diagnosis of bleeding points and treating them directly. Epistaxis was more in male patients especially in the 3rd and after the 5th decade. On endoscopic examination,the bleeding points were identified as coming from the crevices of the lateral nasal wall, posterior spur on the septum, posterior deviation of the septum with ulcer, congested polyps, enlarged and congested adenoids, scabs or crusts in the crevices of the lateral nasal wall and angiofibroma. Endoscope also helps in the treatment of epistaxis, which includes endoscopic selective nasal packing using gelfoam, endoscopic cautery or diathermy and endoscopic polypectomy. Other patients with adenoids, scabs and crusts and angiofibroma were managed on their merits.
Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.
鼻出血是耳鼻咽喉科常见症状之一。很多时候，鼻前镜和鼻后镜检查无法找到鼻出血的原因。本研究旨在评估硬性鼻内窥镜在鼻出血诊断和治疗中的作用，这些鼻出血在常规鼻前镜和鼻后镜检查中未发现任何特定病变。
对50例鼻出血患者在局部麻醉下使用硬性鼻内窥镜进行研究。纳入研究的患者年龄在15岁以上，有鼻出血且愿意接受硬性鼻内窥镜检查。15岁以下患者未纳入研究，因为在局部麻醉下对他们进行鼻内窥镜检查困难。仅选择那些鼻前镜和鼻后镜检查无法明确鼻出血原因的患者进行研究，这样做是为了消除鼻内窥镜检查的偏差。
使用鼻内窥镜能够诊断出血点并直接进行治疗。男性患者鼻出血更为常见，尤其是在第三个十年及之后。在内窥镜检查中，出血点被确定为来自鼻侧壁缝隙、鼻中隔后嵴、伴有溃疡的鼻中隔后偏、充血息肉、肿大和充血的腺样体、鼻侧壁缝隙中的痂皮或硬痂以及血管纤维瘤。内窥镜还有助于鼻出血的治疗，包括使用明胶海绵进行内窥镜选择性鼻腔填塞、内窥镜烧灼或透热疗法以及内窥镜息肉切除术。其他患有腺样体、痂皮和硬痂以及血管纤维瘤的患者则根据具体情况进行处理。
鼻内窥镜不仅有助于确定出血点的位置，还能治疗位于鼻腔后部和外侧的出血区域。
