Rhinoscopy: Travel Through The Nose

Travis Stork: Here to help us is Dr. Warner Carr. He is an Allergy and Immunology specialist. He is going to perform a state-of-the-art procedure, it's called rhinoscopy, on Laura right now. We are going to get a close-up look inside your nose and throat. So -- Dr. Warner Carr: Shall we begin? Travis Stork: Walk us through what you are doing as you do it and everyone at home, she's already had some numby medicine placed in her nose as well as evasive constrictor. So let's get started. Dr. Warner Carr: Right. So this scope is a little bit different than the one you saw earlier. This one is only 2.4 millimeters so you can do this in little kids, almost infants. Are you ready, Laura? Laura: Yeah. Dr. Warner Carr: Alright. So just relax. What we are going to see, and I am going to look out of this monitor over my shoulder here. Alright, as we go in, you see her inferior turbinate which is a fancy way of talking about an area of the nose, and I think we have a cartoon of this in a second, that increases the surface area of the nose. You also see her septum right there. Travis Stork: And the septum is the middle part of your nose that separates your left from your right side. Dr. Warner Carr: Correct, correct. As we proceed that's her middle turbinate, we are going to proceed all the way back to the back of her throat real quick. How are you doing, Laura? Laura: I am fine. Dr. Warner Carr: Doing alright, I am going to sneak down here just a little bit and see if we can sneak underneath. So this is the floor of her nasal cavity and as we come back to the back of the nose, look right here, and you will see, that is her adenoid tissue right there; part of the tonsils, part of the adenoids and we are going to sneak down to the back of her throat. You see her Eustachian tube there right on my left. Alright, in view, we are starting to see her uvula. We just passed her uvula and that right there is her epiglottis, you see that? Travis Stork: Absolutely. Dr. Warner Carr: And here in just a moment, we are going to see her vocal cords. So there are her vocal cords. Say E. Laura: E. Dr. Warner Carr: Say hello. Laura: Hello! Dr. Warner Carr: Okay. How are you doing with that? Laura: Fine. Dr. Warner Carr: Are you tolerating okay? I am going to slowly back out, slowly back out. So we looked quickly through one side of her nasal passage. Now I am going to come up slow, and look at some of the structures that we see. Travis Stork: And what you are looking for right now are things like polyps which are soft gross, they can affect your breathing, they can affect your sense of taste and smell, right? Dr. Warner Carr: Absolutely. So polyp comes out of the nasal and sinus cavity. And right there, I am going to stop for just a moment. Right directly in front of us, that's the adenoid, and if you look right there at about 9 o'clock on that monitor, you see a little hole. That is the Eustachian tube. So you see why people that have nasal congestion can have ear popping because of the Eustachian tube to the middle ear. Travis Stork: Closing off? Dr. Warner Carr: Right, it gets closed off. And as I pull slowly back out of her nasal cavity, you are going to see a little bump come into view on the right. That is her septum. You see that her septum is deviated a little bit and she actually has a little spur that I saw going in coming out. Okay, I am going to come all the way out of her nose and quickly go in the other side and see what we see. So coming out slowly and there we go. Turn you head this way just a little bit right there. Travis Stork: And while you are doing this Dr. Carr, walk us through symptoms that people should worry about beyond the common cold. Dr. Warner Carr: Right, so you know, Travis, there is a lot of reasons to do this procedure and symptoms to really worry about changes in sense of smell, changes in sense of taste. This is also for cancer screening so somebody who has been a long-term smoker, has a change in their voice. That could be a cancer of the throat; you can see polyps and nodules on the voice box as well. So you see we were able to directly visualize that. What we are seeing here -- you are doing, okay? Let's come back. Alright, so she's got her deviated septum, we are sneaking between the different structures of her nose and as we get closer up here, what I am going to try to do in Laura is sneak up here and see if we see any polyps. Now, you see a structure, you see a structure right there at about 3 o'clock, that my friend is a small nasal polyp coming out of her ethmoid sinuses most likely. So that's why she's had a change in her sense of smell. And then we could go back down, there is her Eustachian tube. I am going to slowly back out here at this point. Travis Stork: And Laura that was pretty painless, right? Every now and then when you bump against the turbinate, it hurts a little bit, but pretty quick. Dr. Warren Carr: Pretty quick. Travis Stork: Painless procedure. Laura: Yup. Dr. Warren Carr: Painless procedure, you can do this in the office very quickly. You saw I did the whole exam in less than five minutes. So with you, you have got a little bit of deviated septum, the center part of your nose is kind of shifted to one side and you have that polyp that Travis was talking about, that's plugging your nose on that side so you can't smell and it will affect your sense of taste. Travis Stork: And there are treatments that people can get out there for these polyps if they go see their doctor that sometimes can help produce some of that information, right? Dr. Warren Carr: Absolutely. There is a whole litany of different things that we can do. Travis Stork: Okay. Well, thank you so much, Laura. Laura: Thank you! Travis Stork: Thank you, Dr. Carr. Dr. Warren Carr: Alright.