Role of endoscopy in the management of chronic rhinosinusitis

Endoscopy has multiple uses in both the medical and surgical management of chronic rhinosinusitis (CRS). This article reviews applications of endoscopy in preoperative evaluation and postoperative management of CRS. Before operation, nasal endoscopy is the standard for tissue sampling, evaluation of the mucosa, identifying structural alterations, and staging of allergic fungal sinusitis. As part of the surgical procedure, endoscopy may be used to minimize the time needed for postoperative debridement. Applications of endoscopy in in-office medical management of CRS include culturing the sinuses for fungus or bacteria, inserting a cannula for the delivery of drug therapy, and various minor manipulations following a surgical procedure. Perhaps the most important role for endoscopy in patients with CRS is in medical management, particularly in cases involving eosinophilic inflammation. Angled telescopes are important for visualizing areas often overlooked in sinuses that may otherwise appear to be normal, ie, the depths of the maxillary, frontal, or sphenoid sinus. Further use and research are likely to elicit more uses for this important technology.