Nasendoscopy: What Is a Nasal Endoscopy and What Can It Diagnose?
- Aug 28
- 9 min read
Last reviewed: 25 August 2026, Mr Tim Biggs
Mr Tim Biggs is a Consultant ENT Surgeon, Rhinologist and Facial Plastic Surgeon (MB BCh, PhD, FRCS ORL-HNS)
If you are being assessed for a blocked nose, sinus problems, nasal polyps, recurrent nosebleeds, post-nasal drip or another nasal condition, one of the most useful parts of an ENT consultation is often nasendoscopy, also known as nasal endoscopy.
A standard examination looking into the front of the nostrils can provide useful information, but much of the nasal cavity cannot be seen adequately this way. Nasendoscopy allows me to examine much further inside the nose and, depending on the type of endoscope used, the back of the nose and throat as well.
It is a quick outpatient examination, usually taking only a few minutes. Most patients tolerate it extremely well and, in my practice, the majority choose to have the examination without local anaesthetic.
Importantly, I have access to nasal endoscopy across my private practice. Flexible nasendoscopy is available at Nuffield Health Wessex Hospital in Chandler's Ford and Medicana Winchester, while at Adnova Clinic in Fareham I use rigid nasal endoscopy.
This means that wherever you attend for a nasal or sinus consultation, I have the facility to undertake a more detailed examination when clinically appropriate.
What Is Nasendoscopy?
Nasendoscopy is an examination of the inside of the nose using a thin endoscope.
An endoscope is essentially a narrow viewing instrument containing a sophisticated optical system. It allows an ENT specialist to inspect structures much deeper within the nasal cavity than can be seen during a routine examination.
You may hear several different terms used for the procedure, including nasendoscopy, nasal endoscopy, flexible nasendoscopy, flexible nasal endoscopy, rigid nasal endoscopy and diagnostic nasal endoscopy.
Although there are differences between rigid and flexible endoscopes, their fundamental purpose is the same: to provide a detailed view of areas of the nose that cannot be adequately assessed from the outside.
For a rhinologist, an ENT surgeon specialising in disorders of the nose and sinuses, nasal endoscopy is one of the most important diagnostic tools available.
You can read more about the range of nasal conditions and treatments I manage.
Why Might I Need a Nasendoscopy?
Many nasal conditions produce very similar symptoms.
For example, a patient complaining of a persistently blocked nose could potentially have a deviated nasal septum, enlarged inferior turbinates, nasal polyps, chronic rhinitis, chronic rhinosinusitis, nasal valve narrowing, scar tissue following previous surgery or a combination of several problems.
Symptoms alone therefore do not always tell us exactly what is happening.
Nasendoscopy allows me to look directly at the internal anatomy and nasal lining and correlate those findings with the symptoms you have described.
This can substantially improve the accuracy of diagnosis and help determine whether you need medical treatment, further investigation or surgery.
What Is the Difference Between Rigid and Flexible Nasendoscopy?
There are two main types of nasal endoscope: rigid and flexible. Both are extremely useful, but they have slightly different characteristics.
Flexible Nasendoscopy
A flexible nasendoscope is a very thin, flexible instrument that can be gently passed through the nasal cavity. Because the end of the instrument can be manoeuvred, it can be used to examine the nasal passages, the back of the nose and, when required, further down towards the throat and voice box.
Flexible nasendoscopy can therefore be particularly useful when symptoms involve more than the nasal cavity itself. I have access to flexible nasendoscopy at Nuffield Health Wessex Hospital in Chandler's Ford, Eastleigh, and Medicana Winchester.
Patients considering an appointment can read more about my nasal and sinus surgery service at Nuffield Health Wessex Hospital and my nasal and sinus service at Medicana Winchester.
Rigid Nasal Endoscopy
A rigid nasal endoscope is a narrow, straight telescope.
Although it does not bend like a flexible endoscope, it provides an excellent, detailed view of the nasal cavity and is particularly useful in specialist rhinology and sinus practice. I use rigid nasal endoscopy at Adnova Clinic in Fareham.
Rigid endoscopy can provide excellent visualisation of the internal nasal anatomy, including areas relevant to sinus drainage, the septum and turbinates. For patients attending specifically with nasal or sinus disease, it can be an extremely valuable examination.
Does Nasendoscopy Hurt?
For most people, nasendoscopy is very tolerable.
You may notice a strange sensation inside the nose, mild pressure, a slight tickling sensation, watery eyes or an urge to sneeze. However, the endoscopes are narrow and the examination is performed gently. Most patients are pleasantly surprised by how straightforward it is.
Do I Need Local Anaesthetic for Nasendoscopy?
Usually, no.
In my practice, most patients have nasendoscopy without local anaesthetic because the examination is quick and generally very well tolerated. Local anaesthetic can be used if you would prefer it or if there is a particular reason that it may make the examination easier.
The disadvantage is that anaesthetic spray can run towards the back of the nose and throat and cause temporary numbness. It also tends to have an unpleasant or bitter taste.
If your throat becomes numb, you should avoid hot drinks for approximately 30 minutes afterwards, because reduced sensation could increase the risk of accidentally burning yourself.
For a procedure that often takes only a few minutes and is usually very tolerable, many patients therefore prefer simply to have the examination without anaesthetic.
What Can Nasendoscopy Find?
Deviated Nasal Septum
A deviated septum is one of the most common structural causes of nasal obstruction.
Endoscopy can help establish where the deviation occurs, how severe it is, whether it extends further backwards and whether another condition is contributing to the blockage.
This is important because not every septal deviation needs surgery. A particularly important distinction is whether symptoms are coming from the septum or the nasal valves. I've explained this in more detail in my guide to nasal valve collapse versus a deviated septum.
Enlarged Inferior Turbinates
The inferior turbinates are normal structures that help warm, filter and humidify inhaled air.
However, they can become enlarged because of rhinitis and other conditions. Endoscopy helps assess whether turbinate enlargement is contributing significantly to nasal obstruction and whether medical treatment or turbinate surgery might be appropriate.
Nasal Polyps
Nasal polyps are inflammatory swellings arising from the lining of the nose and sinuses.
They can cause nasal obstruction, reduced sense of smell, nasal discharge, post-nasal drip and recurrent sinus symptoms. Some polyps are visible during a simple nasal examination, but others are situated deeper within the nasal cavity.
Endoscopy provides a much better assessment of their presence and extent.
I have written a detailed guide to nasal polyps and sinus surgery explaining why polyps develop and when surgery may be considered.
Chronic Rhinosinusitis
Patients with chronic rhinosinusitis typically experience symptoms for at least 12 weeks.
These can include nasal obstruction, discharge, reduced smell and facial pressure.
Nasendoscopy may identify inflammation, polyps, mucus or discharge and swelling around the sinus drainage pathways. When appropriate, these findings can be combined with a CT scan of the sinuses to build a more complete picture. You can also read more about my sinus surgery and chronic rhinosinusitis practice in Hampshire, including endoscopic sinus surgery and management of complex frontal sinus disease.
Infection and Nasal Discharge
Endoscopy can help identify where abnormal discharge is coming from.
This can be useful when assessing recurrent or persistent sinus infections. Rather than simply seeing mucus at the front of the nose, it may be possible to identify discharge coming from particular areas deeper within the nasal cavity.
Post-Nasal Drip
"Post-nasal drip" is a common symptom but not a diagnosis in itself.
Endoscopic examination can help determine whether there is excess mucus, rhinitis, sinus disease, polyps, inflammation or another abnormality at the back of the nose.
This helps avoid treating every case of post-nasal drip in exactly the same way.
Recurrent Nosebleeds
Nasendoscopy can sometimes identify prominent blood vessels, crusting, inflamed tissue, a specific bleeding point or other abnormalities requiring investigation.
This is particularly useful when nosebleeds are recurrent or predominantly affect one side.
Septal Perforation
A septal perforation is a hole through the nasal septum. It can cause crusting, bleeding, whistling, dryness and nasal obstruction.
Endoscopy helps assess the size, location and condition of the surrounding tissue, all of which are important when deciding how the perforation should be managed.
I have a separate detailed guide explaining the different types of septal perforation closure and when surgical closure may or may not be advisable.
Can Nasendoscopy Diagnose Nasal Valve Collapse?
Nasal valve collapse requires a broader assessment because the nasal valve is a dynamic structure.
Diagnosis therefore involves examining the nose externally as well as internally and observing what happens during inspiration.
Nasendoscopy can form part of this assessment, but it should not be considered in isolation.
This is particularly important for patients who have had a previous septoplasty but remain blocked despite being told their septum is now straight.
One characteristic clue is that breathing improves when the cheek is gently pulled sideways. I explain why this happens in my article “I Can Breathe Better Pulling My Cheek — What Does That Mean?”.
For a more comprehensive explanation, see my guide to nasal valve collapse.
Nasendoscopy vs CT Scan: What's the Difference?
These tests provide different information and often complement one another.
Nasendoscopy provides a direct, real-time view of the nasal cavity.
A CT scan provides detailed imaging of structures that cannot be seen directly, particularly the sinuses themselves.
For example, a patient with suspected chronic rhinosinusitis might initially undergo consultation and nasal endoscopy. If the symptoms and findings suggest significant sinus disease, a CT scan may then be appropriate. Conversely, if endoscopy demonstrates that symptoms are more likely related to rhinitis or a structural nasal problem, imaging may not be necessary. This is one reason specialist assessment before automatically arranging a scan can be valuable.
Nasendoscopy Before Rhinoplasty and Septorhinoplasty
Internal nasal assessment is also important when considering rhinoplasty.
A nose should not be assessed purely from photographs or external appearance.
Before functional or cosmetic nasal surgery, it is important to understand septal anatomy, the nasal airway, turbinate size, evidence of previous surgery, the condition of the nasal lining and other potential causes of obstruction.
This is particularly relevant when a patient wants cosmetic rhinoplasty but also reports difficulty breathing. Sometimes a seemingly cosmetic consultation identifies an underlying functional problem that should be incorporated into surgical planning.
My broader rhinoplasty and sinus surgery service for Southampton and Hampshire patients explains how functional nasal assessment and cosmetic rhinoplasty planning fit together.
Rigid Nasal Endoscopy at Adnova Clinic, Fareham
At Adnova Clinic in Fareham, I use rigid nasal endoscopy as part of my specialist nasal and rhinoplasty practice when clinically appropriate.
Adnova is also where I perform my private rhinoplasty and septorhinoplasty surgery.
Having rigid nasal endoscopy available means patients attending with cosmetic or functional nasal concerns can have the internal nasal anatomy assessed alongside the external appearance of the nose.
This is particularly valuable for rhinoplasty assessment, functional septorhinoplasty, nasal valve problems, previous unsuccessful nasal surgery, revision rhinoplasty, septal perforation and complex structural nasal problems.
Flexible Nasendoscopy at Nuffield Health Wessex Hospital
Flexible nasendoscopy is available during my private ENT clinics at Nuffield Health Wessex Hospital in Chandler's Ford, Eastleigh.
You can read more about my Nuffield Wessex nasal and sinus clinic.
This is particularly convenient for patients from Southampton, Eastleigh, Winchester, Romsey and the surrounding Hampshire area.
Flexible Nasendoscopy at Medicana Winchester
I also have access to flexible nasendoscopy at Medicana Winchester.
My dedicated Medicana Winchester nasal and sinus surgery page explains the conditions assessed and treatments available there.
Patients can attend for specialist assessment of persistent nasal blockage, sinusitis, nasal polyps, rhinitis, post-nasal drip, recurrent nosebleeds, reduced sense of smell and other nasal and general ENT symptoms.
Is nasendoscopy painful?
Most patients find nasendoscopy very tolerable. You may experience mild pressure, tickling, watery eyes or an urge to sneeze, but the examination is usually completed within a few minutes.
Do I need anaesthetic for a nasal endoscopy?
Usually not. Most patients choose to have nasendoscopy without local anaesthetic because it is quick and generally well tolerated. Anaesthetic spray can be used if required or preferred.
Why might I choose not to have local anaesthetic?
Local anaesthetic spray can have an unpleasant taste and may temporarily numb the back of the throat. If your throat becomes numb, you should avoid hot drinks for approximately 30 minutes. Because nasendoscopy is usually very quick, most patients prefer to have it without anaesthetic.
What is the difference between rigid and flexible nasendoscopy?
A rigid nasal endoscope is a narrow, straight telescope that provides excellent detailed views of the nasal cavity. A flexible nasendoscope can bend and can be used to examine the nose, back of the nose and, where necessary, the throat and voice box.
Where does Mr Tim Biggs perform flexible nasendoscopy?
Flexible nasendoscopy is available with Mr Tim Biggs at Nuffield Health Wessex Hospital in Chandler's Ford, Eastleigh, and at Medicana Winchester.
Where is rigid nasal endoscopy available?
Mr Tim Biggs uses rigid nasal endoscopy at Adnova Clinic in Fareham as part of his specialist nasal, sinus, rhinoplasty and septorhinoplasty practice.
How long does nasendoscopy take?
The endoscopic part of the examination usually takes only a few minutes. It is performed during an outpatient consultation and normally requires no special recovery period.
Can nasendoscopy diagnose sinusitis?
Nasendoscopy can identify features associated with sinus disease, including inflammation, polyps and abnormal discharge. In some cases, a CT scan of the sinuses is also required to assess the sinuses and drainage pathways fully.
Can a nasal endoscopy detect nasal polyps?
Yes. Nasal endoscopy is particularly useful for identifying polyps situated deeper within the nasal cavity that may not be visible during a simple examination of the front of the nose.
Can nasendoscopy show a deviated septum?
Yes. It can help assess the location and extent of a septal deviation and determine whether other abnormalities, such as turbinate enlargement, are also contributing to nasal obstruction.
Can nasendoscopy diagnose nasal valve collapse?
Nasendoscopy can contribute to the assessment, but nasal valve collapse is a dynamic structural problem and requires external and internal examination while assessing the nose during breathing.
Can I have a nasendoscopy at my first appointment?
Where clinically appropriate, nasal endoscopy can often be performed as part of the initial specialist consultation because endoscopic facilities are available across Mr Tim Biggs' private nasal and sinus practice.
