Diagnostic Procedure
Rhinoscopy: Seeing What a Standard Exam Cannot
A flexible fiberoptic look at the nose, throat and larynx that finds the causes of chronic cough, sinusitis, postnasal drip and recurrent ear infections.
What rhinoscopy is
Rhinoscopy is a test in which our physicians use a flexible fiberoptic scope attached to a bright light to look into the nasal passages, back of the throat and larynx (voice box). This minimally invasive examination allows for a more thorough look at the nose, throat and larynx in order to diagnose problems that are otherwise difficult to visualize.
A penlight and a good history will take a doctor a long way. They will not show you the back of a nasal cavity, the drainage pathways of a sinus, or the tissue at the top of the throat where a cough is often being generated. Rhinoscopy does — in a few minutes, in the office, without surgery.
What it is used to evaluate
This procedure, along with physical examination, is very helpful in evaluating:
- Persistent or chronic cough
- Acid reflux
- Sinusitis
- Recurrent ear infections
- Chronic headaches
- Chronic postnasal drip
Fixed upper-airway blockage
The physician can determine whether there are any fixed blockages in the upper airway, such as a deviated septum or nasal polyps — structural findings that change the treatment plan and are invisible from the outside.
The cough that outlasted everything
Chronic cough is a serious medical condition with debilitating and disruptive consequences: throat tickle, throat clearing, hoarseness, urinary incontinence, anxiety and depression, affecting professional performance, personal relationships and social life. Seeing the upper airway directly is often what finally narrows the list.
Vocal cord dysfunction
Rhinoscopy allows us to directly examine the larynx and vocal cords in patients with persistent hoarseness, voice changes, chronic cough, or unexplained shortness of breath. It can identify vocal cord problems, inflammation, or more significant abnormalities such as a growth or mass. It can also help diagnose vocal cord dysfunction, which can cause breathing difficulties that may mimic asthma or other lung disease.
What the appointment is actually like
The scope is flexible and thin, and the examination is minimally invasive. It is done sitting up, in the office, and takes only a few minutes. There is no incision and no operating room. Most people are surprised by how quickly it is over and how much information it produces.
Because we strive to complete testing and interpretation on the same day as your evaluation visit when possible, rhinoscopy is frequently performed during the same appointment as your history, physical exam and allergy testing. You will leave the initial evaluation visit with a diagnosis and treatment steps.
Why an Allergist is doing this examination
Dr. Sher is one of the nation’s leading Allergists specially trained in Rhinoscopy. That matters because the questions an Allergist/Immunologist brings to the scope are different ones.
An allergist is looking at the same tissue while already holding your skin test results, your FeNO reading, your spirometry and your history of sinus infections and antibiotic courses. Structure and inflammation get interpreted together, in one visit, by one physician — instead of arriving as separate reports from separate offices months apart.
Where rhinoscopy fits in a chronic cough work-up
Chronic sinusitis is associated with allergic rhinitis and asthma, and sinusitis can cause persistent postnasal drip and chronic cough. A cough that has lasted months is rarely one thing — it is usually two or three overlapping contributors, each of which was partially treated at some point.
Dr. Mandel Sher is a world-renowned cough expert. He and his cough colleagues recently recognized neurogenic cough, caused by inflamed nerve endings in the back of the throat and respiratory tract. Sher Allergy patients can be seen in the specialized Center for Cough clinic, where chronic cough is the entire focus.
- Gastroesophageal acid and non-acid reflux
- Hoarseness
- Hypersensitive cough syndrome
- Laryngeal reflux
- Neurogenic cough
- Throat clearing
Chronic upper-airway symptoms on the Gulf coast
Pinellas County gives an irritated upper airway very little rest. Oak and other tree pollen dominate late winter and spring, and the humid subtropical climate supports mold and dust mites all twelve months. Add offshore red tide blooms, which are a documented respiratory irritant for beach communities on certain wind days, and a postnasal drip or cough can look seasonal for years without ever being seasonal at all.
That is precisely the situation where a direct look at the nose and throat is worth more than another month of watchful waiting. Patients travel to our Largo office from Seminole, Belleair, Clearwater, Pinellas Park and St. Petersburg — a short drive from most of mid-Pinellas via Seminole Boulevard, Ulmerton Road or East Bay Drive.
Common questions about rhinoscopy
Does rhinoscopy hurt?
It is described as a minimally invasive examination. The scope is flexible and thin, the exam is brief, and it is performed sitting up in the office rather than in an operating room. Most patients tolerate it well. Tell your physician if you are anxious about it — they will walk you through what they are doing as they go.
How is rhinoscopy different from a CT scan of my sinuses?
A scan shows structure captured at one moment; rhinoscopy shows the living tissue and how it looks and behaves right now, including inflammation, drainage and secretions. The two answer different questions. Rhinoscopy is also done in the office during your visit, with your physician looking and explaining in real time.
I have already had sinus surgery and I am still congested. Would this help?
It may. Rhinoscopy shows whether fixed blockages such as a deviated septum or nasal polyps are present, and it lets the physician see what the tissue looks like after surgery. When symptoms persist after structural treatment, the question shifts to what is driving the inflammation — allergy, an eosinophilic process, or chronic infection — which is squarely allergy and immunology territory.
Can rhinoscopy explain a cough that no one has been able to diagnose?
It is one of the tools most likely to move that case forward. Rhinoscopy, along with physical examination, is very helpful in evaluating persistent or chronic cough, acid reflux, sinusitis, recurrent ear infections, chronic headaches and chronic postnasal drip — several of which commonly overlap in a long-standing cough.
Is rhinoscopy performed on children?
Sher Allergy Specialists is a pediatric and adult practice, and rhinoscopy is listed among the tests and treatments offered for pediatric allergy, asthma and immune system conditions. Whether it is appropriate for a particular child depends on their age, their symptoms and what the examination is expected to answer. Call our office team and they will help you understand what to expect.
Do I need a referral, and is it covered?
Many patients come directly and many are referred by their physician or ENT; either is welcome. Sher Allergy Specialists participates in most insurance plans, and our office team reviews your eligibility, benefits and anticipated financial responsibility before your visit. Call 727-397-8557 and they will check your specific plan.
Stop guessing about your nose, sinuses and throat
If a cough, drip, headache pattern or run of sinus and ear infections has never been fully explained, call our friendly Sher Allergy team to schedule an evaluation.
Largo Professional Center
11200 Seminole Blvd #310
Largo, FL 33778
Monday 8:00-5:00
Tuesday 9:00-6:00
Wednesday 8:00-5:00
Thursday 8:00-5:00
Friday 8:00-12:00