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THE ROLE OF ENDOSCOPIC EXAMINATION IN EARLY DIAGNOSIS OF NASAL
POLYPS
Rustamova Etibor Ibragimovna
Department of Otorhinolaryngology, Samarkand State Medical University
https://doi.org/10.5281/zenodo.17310945
Introduction.
Nasal polyps represent a chronic inflammatory condition of the nasal and
paranasal mucosa characterized by the formation of benign edematous protrusions that lead to
nasal obstruction, anosmia, postnasal drip, and recurrent infections. Their etiology is
multifactorial, involving complex interactions between chronic inflammation, allergy, infection,
and genetic predisposition. Early diagnosis plays a crucial role in improving treatment outcomes
and preventing irreversible mucosal changes. However, traditional diagnostic methods such as
anterior rhinoscopy and imaging often fail to detect early or small lesions, resulting in delayed
management. Endoscopic nasal examination has emerged as a highly sensitive diagnostic tool,
providing detailed visualization of the nasal cavity and paranasal sinus ostia, enabling early
detection and characterization of mucosal pathology. This study aims to assess the clinical value
of nasal endoscopy in the early diagnosis of nasal polyps and to compare its diagnostic accuracy
with conventional examination methods.
Objective
The primary objective of this study was to determine the diagnostic significance
of nasal endoscopy in the early detection of nasal polyps and to evaluate its role in identifying
subclinical or small lesions that are often missed during anterior rhinoscopy or radiographic
imaging. Additionally, the study aimed to establish the correlation between endoscopic findings
and histopathological results, highlighting the importance of routine endoscopic evaluation in
patients with chronic rhinosinusitis symptoms.
Materials and Methods
This prospective clinical study was conducted at the
Otorhinolaryngology Department of Samarkand State Medical University from January 2022 to
March 2024. A total of 120 patients aged 18–70 years with symptoms suggestive of chronic
rhinosinusitis, such as nasal congestion, facial pressure, and decreased sense of smell, were
included. All participants underwent a complete otorhinolaryngologic evaluation including
anterior rhinoscopy, nasal endoscopy using a 0° and 30° rigid endoscope, and computed
tomography (CT) of the paranasal sinuses. Endoscopic findings were classified according to the
Lund-Kennedy endoscopic scoring system. Biopsy samples were taken from suspicious lesions for
histopathological confirmation. The diagnostic yield of endoscopy was compared with that of
anterior rhinoscopy and CT imaging. Statistical analysis was performed using SPSS software; p-
values less than 0.05 were considered statistically significant.
Results
Nasal endoscopy identified polyps in 82 out of 120 patients (68.3%), whereas
anterior rhinoscopy detected only 54 cases (45%), demonstrating a significantly higher sensitivity
for endoscopic examination (p<0.001). Among the endoscopically detected cases, 24 (29.3%)
represented early-stage polyps confined to the middle meatus or ethmoidal recess, which were not
visible on anterior rhinoscopy. CT imaging confirmed the presence of sinonasal mucosal
thickening or polyposis in 74 cases (61.6%), consistent with endoscopic findings in 68 patients
(91.9%). Histopathological examination verified the presence of inflammatory nasal polyps in 79
cases (96.3% of endoscopic detections). The mean endoscopic Lund-Kennedy score was 4.6 ± 1.2
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in early-stage disease and 8.1 ± 1.5 in advanced disease, showing a direct correlation between
endoscopic grading and disease severity (r=0.74, p<0.001). The study also revealed that early
endoscopic detection allowed medical management to be initiated in 22 patients, preventing
progression to extensive polyposis requiring surgery.
Discussion
The results of this study confirm that nasal endoscopy significantly enhances
the diagnostic accuracy of nasal polyps compared to traditional examination methods. It allows for
direct visualization of the nasal cavity, enabling detection of small or hidden lesions in areas that
are inaccessible to anterior rhinoscopy. Moreover, endoscopic examination provides valuable
information about the extent of mucosal inflammation, anatomical variations, and patency of sinus
ostia, all of which are crucial for planning appropriate therapeutic interventions. Early
identification of polyps facilitates timely initiation of medical therapy such as corticosteroid nasal
sprays or systemic anti-inflammatory agents, potentially reducing the need for surgical
intervention. The high correlation between endoscopic and histopathological findings underscores
the reliability of endoscopy as both a diagnostic and follow-up tool. While CT imaging remains
essential for surgical planning, it cannot replace the detailed mucosal assessment provided by
endoscopy. Therefore, nasal endoscopy should be considered an indispensable part of the
diagnostic algorithm for patients presenting with chronic nasal symptoms.
Conclusion
Endoscopic examination plays a pivotal role in the early diagnosis and
management of nasal polyps. It offers superior sensitivity and specificity compared to
conventional diagnostic methods, enabling clinicians to identify early-stage lesions that are often
missed by anterior rhinoscopy. The study demonstrates that incorporating nasal endoscopy into
routine clinical evaluation of patients with chronic rhinosinusitis symptoms results in earlier
detection, improved therapeutic outcomes, and reduced progression to advanced disease. Regular
use of nasal endoscopy, in combination with imaging and histopathology, forms the cornerstone of
modern rhinologic diagnostics and should be emphasized in both clinical practice and
postgraduate medical training to enhance patient care outcomes.
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