What You Need to Know Before Getting a Nasal Endoscopy

Join Dr. Greg Smith and Dr. Nishant Reddy in this eye-opening episode of the We Nose Noses podcast, as they pull back the curtain on nasal endoscopy. This minimally invasive procedure is a powerful tool in ENT practice, offering a closer look at nasal and sinus structures that traditional exams can’t reveal. Discover the many reasons an ENT might recommend this procedure, from unexplained ear pain to chronic sinus issues. Plus, get the inside scoop on the patient experience, how long it takes, whether anesthesia is needed, and what to expect when the bill arrives. If you’ve ever wondered why a nasal endoscopy is crucial for diagnosing sinus conditions, this episode is for you.

What you’ll learn:

• Why nasal endoscopy is a essential for diagnosing conditions beyond just nasal congestion
• Common conditions that require a nasal endoscopy, from sinus issues to ear and throat problems
• How insurance companies view nasal endoscopy, why there might be extra costs, and how to prepare for them

If you’re dealing with sinus or nasal issues, this episode will help you understand whether a nasal endoscopy might be the right step in your diagnosis. 

Dr. Smith

Hello, welcome back to our We Nose Noses podcast. This is Greg Smith, Dr. Greg Smith, along with Dr. Nishant Reddy here today. And we’re going to be talking today about nasal endoscopy.

It’s an important part of ENT examination. It is a procedure. well I’m going to leave it up to Dr. Ready to start off with kind of what nasal endoscopy it is, what you might expect to have with a nasal endoscopy, kind of give a patient experience.

D. Reddy

Sure. So a nasal endoscopy a it’s a not exactly part of your physical examination. It’s considered technically a separate procedure, but it’s done in the office and it’s done typically as soon as we do the physical examination after we get your history.

And what it is, is it’s a small little tube. um It’s either flexible or rigid. And this tube is inserted into your nose and it’s gently navigated through your nose so that we can visualize structures in the front of your nose and the back of your nose by your sinuses to get an idea of what your anatomy looks like and in a way that you cannot get with a regular physical examination Right.

Dr. Smith

So like a regular physical examination, we often will look with either like a little speculum, like a little cylindrical speculum. Sometimes we’ll look with a little kind of like a duckbill speculum that opens and closes the nasal speculum.

And those give us some ideas as to what might be going on within the front of the nasal mucosa, the lining in the nose or a septum in the turbinates. But doesn’t really give you the full picture of what might be going on in the nose or sinus.

So there are lots of reasons why someone might want to do a nasal endoscopy. It’s not that you just show up to an ENT and they’re going to do a nasal endoscopy on you because you’re in the office.

There’s usually a lot of different reasons why it might be beneficial. You want to talk about some indications or some reasons why you might need to get a nasal endoscopy during a patient visit?

Dr. Reddy

So, you know, typically when a patient comes in, they have some type of a chief complaint and that chief complaint can be something like a sore throat or it could be a runny nose or it could be ear pain. And all sorts of different other but potential possibilities. And when most patients are going to their primary care doctor, they’ll get evaluated in kind of the traditional way.

But when you come to see an ear, nose and throat doctor, you know, we’re considered specialists. And one of the thing that differentiates us from a lot of other specialties is we’re able to do a nasal endoscopy and get a much closer look at these types of complaints.

Almost every single ear, nose and throat chief complaint you can potentially lead to a nasal endoscopy. There’s very few that may not lead to a nasal endoscopy.

You know, for example, if you come in with earwax, obviously you don’t need a nasal endoscopy, but you know, let’s say you have something that’s, that may be not as traditional as what you would think that you would need a nasal endoscopy for, for example, you have some hearing loss and then we might look into your ear and we might see some fluid behind your eardrum on one side. And that might be causing your hearing loss. Now the question is, should we do a nasal endoscopy afterwards? And most people would think, why would you look in someone’s nose if I’m coming in with the hearing loss?

And and the the reason is, is that we’re looking in the back of the nose to see if there’s any potential growth there or even cancer that might be causing that fluid and you know behind your eardrum.

So, but the more common reasons why we’re doing nasal endoscopies are things are mostly nasal complaints. Things like runny nose, stuffy nose, trouble breathing through your nose, sinus issues, things like that.

Dr. Smith

But even other things, as you alluded to, like the earwax conundrum, a patient may come in with fullness in their ears and may… think that it’s just earwax. And then you look in there, maybe there is some earwax, but it’s not enough to really trigger fullness or there’s zero wax at all. And all you might see is a little bit of vascular inflammation on that eardrum. And I can’t tell you how many times that I see that and end up finding on nasal exam a sinus infection. So we’re looking to make sure that we’re not missing something bad because this isn’t a normal thing and you may not have had a ah viral infection that pre pre predestined this. So you might not realize why you have this.

And so we’re looking for other causes. And so dizziness is something that sometimes patients come in and sometimes they have a sinus infection or ear pressure and fullness. Sometimes even cough, like patients may have a cough and think that it might be reflux or bronchitis or other things that we know to trigger cough.

And sometimes you’ll do a nasal endoscopy and find pus draining out of their nose. and it’s a sinus infection and patients don’t really always have a lot of symptoms. So the nasal endoscopy really is a is a helpful part of our examination because it really gives us a full picture of what might be contributing to a lot of those ear, nose and throat problems, which we see on a regular basis. So as far as the nasal endoscopy goes, you know as Dr. Reddy said, it’s a small little tube, sometimes flexible, sometimes rigid.

It can be done with or without at the topical anesthesia, with or without topical decongestants. You know, Dr. Reddy and myself both typically don’t do any topical anesthesia or decongestant. That doesn’t mean that it’s any worse or any better. It’s mostly preference as to what’s kind of used most commonly. It’s not wrong to use either one of those. It’s also not wrong to, to not use those either.

Dr. Reddy

Well, we’ll well give you a rationale for not using top of anesthesia. It’s not because we want to torture people. Right. Right. um So first of all, when we do a nasal endoscopy and I’ve gotten many done myself and you’ve gotten many done yourself, it’s pretty quick procedure.

And you know, if it’s done by someone that’s skilled, it’s usually painless for the most part. When you’re numbing someone up for a procedure like this, which is really, really short, right? You’re talking usually within a minute or so.

You’re now dealing with the lasting effects of the anesthesia for maybe a half an hour, right? I mean, this, this anesthesia first you know numbs up your nose, but it also numbs up your throat because it drips into your throat and then you can’t swallow liquids well and things like that.

It’s just annoying. So, and the other thing is I just find that the topic and and topical anesthesia doesn’t do too much.

Dr. Smith

Right. Right.

Dr. Reddy

It just doesn’t like help the procedure that much. It doesn’t make it that much more comfortable in my opinion. And then the final reason is that when you’re spraying the topical anesthesia, it actually changes. your physical exam a little bit. Now you have liquid in your nose that you don’t normally have, right? And the liquid itself in your nose can elicit a runny nose and it can elicit a reaction in your nose to try to, you know, kind of get rid of the foreign body essentially.

And so you’re looking, you’re examining someone and their unnatural state in ah in a way.

D. Smith

Agreed. Agreed. Yeah. And having had it done as Dr. Reddy said myself to to my, I’ve let students and people train on me. I would much rather prefer personally not to have the local anesthetic because the feeling when it drips into your throat is sometimes more disconcerting and uncomfortable than the procedure itself.

So nasal endoscopies are a beneficial component of an ENT examination. They’re typically quick and fast. Do you want to talk about ah one thing that patients often ask? Like they they all, most people understand that they’re kind of necessary, but the always what comes up is typically the the component of it’s a procedure.

And so there might be a charge, you know, there is a charge with any procedure that’s done.

Dr. Reddy

So this is, you know, one source of frustration with patients is that um you might come to see an ENT doctor like us, and you might be used to just going to your primary care doctor or urgent care, where essentially the types of things that are built through insurance is the office visit, but not necessarily procedural.

Dr. Smith

And that office visit encompasses a ah typical history and full physical examination.

Dr. Reddy

Correct. Right. And um you know you might be used to going and getting a lab test done or an imaging test done, which is going to be a separate bill. So the nasal endoscopy is similar to that, where the lab test you get at the doctor’s office is going to be billed separately.

And the nasal endoscopy is also billed separately. The source of frustration really comes when patients aren’t necessarily completely aware of that. And they might come into the ENT doctor like us.

They might complain of ear pain or something, and we don’t see anything in the ear. So we’re looking for a nasal source of the ear pain or so a throat source of the ear pain. And we do a scope and they go home, they get their bill and they see that now they have two separate charges.

And you know, part of it’s just a time issue where we don’t have the ability to explain the rationale for, you know, every single thing that we’re doing to the full degree, maybe as much as we should, we have a lot of this stuff on paperwork and things that all of our patients sign and are fully aware of, but going through the entire process of like exactly every single thing that we’re looking for is not always feasible.

Dr. Smith
Right. And the cost of it may be variable depending on your insurance company as well. The one one nice thing is that it is covered under insurance. So it is medically necessary.

It is rare that an insurance company denies it. Just the coverage and how it gets portrayed onto the, or given to the patient sometimes is a little bit different. And that has to, a lot of the times do with, deductibles with health insurances, which we unfortunately have to deal with now very frequently, even ourselves. And sometimes some insurances consider it a surgical procedure because it has a code that is consistent with a surgical code.

Others cover it with a regular routine medical care. Others have a different ah deductible when it comes to surgery procedures. So a lot of the the frustration of the of the patient and the physician and the offices that use endoscopies and whether it be a nasal endoscopies or other type of other additional procedures that are done during a routine visit, is the is the so insurance component of it. And so that is always something that if there is a question or is a concern, you should always ask um your insurance company. You can always ask the the physician’s office that you’re in.There’s always the ability to get kind of a predestined or pre figure as far as the cost of a procedure to be done. And so as a patient, you always have a right to ask like, okay, is this procedure necessary? Do you know the cost of it? What is my cost going to be? And sometimes it’s not always so easy just to say, oh this is going to be one hundred dollars and this is what the procedure costs, because there are a lot of variable factors with insurances nowadays.

So my recommendation as well for that any patient is to know what your insurance costs are. Don’t assume that just because it’s covered, it means there’s zero cost onto you, especially with high deductibles. And so be really familiar with your insurance plans. Correct.

Dr. Reddy

Yep. Anything else to add about that? No. Actually, let me go over why is it considered a separate procedure and why you know why is there that separate cost to it?

The reason is is because the equipment, first of all, is very, very expensive. right So the equipment you know is easily in the thousands of dollars range for every individual scope. And then when you add in like the video monitors and video components of all this stuff, it can easily get into the six-figure range.

Dr. Smith

And the sterilizing and processing and cleansing of the of the scopes.

Dr. Reddy

Yeah. And yeah, and every scope needs to, there’s a sterilization protocol and then there’s a maintenance protocol for all of these scopes. There’s a storage protocol. It’s not as simple as a stethoscope that doesn’t need all that stuff. So that’s kind of the rationale for it.

D. Smith

Anything else to add?

Dr. Reddy

No, that’s all I have.

D. Smith

Very good. So thank you again for joining us for another episode of the We Nose Noses Podcast. Make sure to like and subscribe. Take care, guys.