Overview of Flexible Nasopharyngoscopy
A flexible nasopharyngoscopy is an important process that ear, nose, and throat (ENT) doctors often use. Sometimes, it’s also called fiberoptic nasendoscopy, flexible nasolaryngoscopy, or flexible fiberoptic nasopharyngolaryngoscopy. This procedure helps doctors take a closer look at your nose, throat, and airway using a special tool with a light and camera, known as a fiberoptic scope.
This method of examination came into wider use in the 1950s thanks to the work of two innovators named Hopkins and Stortz. The first fiberoptic scope that could be used in medicine was made in 1963 by a person named Hirschowitz.
Anatomy and Physiology of Flexible Nasopharyngoscopy
Nasopharyngoscopy is a procedure that allows doctors to look at parts of your throat and nose that are difficult to see otherwise. It can be performed on adults, children who can cooperate, and babies if their parents give permission. Usually, this test is done to check up on areas that have been treated before (like after surgery, radiation therapy, or chemotherapy) or to investigate any areas that are causing concern.
There are numerous abnormalities and diseases that doctors can find with this procedure. Here are some of the main things they look for:
In the nasal cavity, doctors use a method that lets them examine all areas of it. They check for things like a crooked septum, bone outgrowths, swelling of the nasal passages, blockage, discharge, swollen tissue, bleeding, holes in the septum, growths, adhesions, and crusting.
In the back part of the nasal space, they inspect areas such as the Eustachian tube openings (which connect your ear to your throat), the fossa of Rossenmuller (a small area in the upper part of the throat), and the adenoidal pad (a patch of tissue located high on the back wall of the throat). Adenoids usually get smaller as you reach adulthood, so if they are large, further investigation is required. They also look for any abnormal masses that may need additional scrutiny.
The base of your tongue and the small pockets on either side of it (valleculae) are checked for masses, cysts, or abnormalities. The lingual tonsils, which is a group of lymphoid tissues, are located here and can often lead to irregular findings. If any abnormal mass is spotted, it needs to be checked out further, as this is a common place for a type of cancer known as oropharyngeal squamous cell carcinoma to develop.
Doctors also look at the epiglottis, which is a small piece of cartilage that covers your windpipe when you swallow. In children, problems with the epiglottis and surrounding tissue might show a condition called laryngomalacia. However, if there is inflammation in the epiglottis, known as epiglottitis, this procedure should only be done by highly experienced professionals and in a safe environment, as it can cause a sudden closure of the windpipe and worsen the patient’s breathing.
In the piriform fossae, which are two small pockets located on either side of your larynx, any accumulation of saliva, fullness, or masses need additional investigation.
Finally, the larynx, or voice box, is examined for any abnormalities like swelling, lumps, changes in the mucous membrane or issues with the vocal cord movement. If the patient experiences difficulty breathing (stridor), the procedure needs to be done in a safe environment by experienced professionals and under anesthesia.
Why do People Need Flexible Nasopharyngoscopy
Doctors commonly use a type of telescope called an endoscope to examine the inside of your body, especially in a hospital environment. These examinations are often carried out in emergency situations to check your airways, voice-related issues (such as ongoing hoarseness), a feeling like something is stuck in your throat (known as globus sensation), recurring nosebleeds, and to screen for or monitor tumors or cancer.
The endoscope can also be used in a number of other situations, such as:
1. Take out a foreign object that is easily reachable.
2. Examine conditions like obstructive sleep apnea, which is a sleep disorder where breathing repeatedly stops and starts. However, this doesn’t make it easy to identify which patients would benefit from surgery.
3. Check for velopharyngeal insufficiency, a condition where the soft palate fails to close properly, resulting in difficulties with speech.
4. Evaluate the status of the airway during an emergency and decide whether a patient needs to be admitted to an Intensive Care Unit (ICU) or needs support in breathing.
In addition to this, a fiber endoscopic evaluation of swallowing (or FEES) can be performed together with speech and language specialists to help patients with problems swallowing. It’s also possible to inject medicine directly into the vocal cords in the doctor’s office to treat conditions where the nerves controlling the voice box are damaged (known as vocal cord paralysis). Lastly, doctors can use an endoscope to check the inside of your windpipe (a procedure known as tracheoscopy).
When a Person Should Avoid Flexible Nasopharyngoscopy
There are a few cases when a procedure called flexible nasopharyngoscopy, used to examine the nose and throat, might not be recommended. The key situations are when a patient is suffering from conditions known as acute epiglottitis and croup. Acute epiglottitis is a severe and potentially life-threatening inflammation of the epiglottis, a flap at the base of the tongue that keeps food from going into the windpipe. Croup, on the other hand, is a common respiratory problem in young children that causes a barking cough. If these conditions are present, doing this procedure could cause a laryngospasm, where the vocal cords suddenly seize up or close when taking in breath, posing a great risk. It is preferred to leave this procedure in such scenarios to an experienced ear, nose, and throat surgeon.
Other situations where caution is advised include in patients with coagulopathies – which are conditions that might cause excessive bleeding – and in those who have had trauma to their skull and face, where there’s risk that the equipment might accidentally reach the brain.
Equipment used for Flexible Nasopharyngoscopy
Let’s talk about a medical tool called the flexible nasopharyngoscope. It’s basically a miniature camera that your doctor uses to look inside your nose and throat. There are different versions of this tool, some use fibre-optic technology and others use digital chips. The size of the camera varies, from as small as 1.9 mm for kids, up to 6 mm for adults.
If you’re wondering how they get the picture out, a viewing camera can be attached to the scope (unless it’s a digital version, which doesn’t need one). The light needed to see inside your nose or throat can come from a small, portable light source. This light travels through a light lead if needed.
The image from the camera appears in real-time on a monitor. This monitor can even take pictures and print them out! Don’t worry, the tool is kept clean and safe with a decontamination system. This might include a disposable sheath that covers the scope, chlorine dioxide wipes, or an endoscope washer-disinfector unit.
Your doctor might also use a spray that acts as a decongestant and numbs your nose or throat a bit. There’s also a lubrication gel to help the scope slide in easily. Everything is kept clean with alcohol wipes and tissues are used as needed.
Who is needed to perform Flexible Nasopharyngoscopy?
An ENT surgeon is a doctor who specializes in ear, nose, and throat problems. They are trained to do surgeries in these areas to help patients get better. Similarly, a maxillofacial surgeon is also a doctor, but they focus on the face, mouth, and jaw. They deal with conditions such as broken jaw or facial bones, removed teeth, or other problems linked with these areas of the body.
There are also speech and language therapists. They aren’t surgeons, but they have a crucial role in the patient’s recovery. They work on strengthening the patient’s speech and language skills and help them swallow more easily again. They use a special tool called a fiber optic camera that goes into the throat to get a closer look at how the patient swallows. This is known as a fiberoptic evaluation of swallowing.
How is Flexible Nasopharyngoscopy performed
Step 1: Before we begin
* We will make sure that the scope (a long, thin device that allows the doctor to see inside your body) is clean and functioning properly. This is to ensure your safety. There are different methods to clean the scope, which may vary depending on your hospital’s guidelines. Your hospital has a strict set of guidelines for ensuring the cleanliness of equipment and preventing infections, which we follow strictly. On request, these guidelines can be accessed.
* Our doctors always check that the procedure is appropriate for the patient’s needs, especially if the patient has a history of certain illnesses or conditions. It’s also helpful if previous images or results have been taken of the patient, which the doctor will review.
It’s completely normal to feel nervous about the procedure, but don’t worry, it’s minimally invasive and is done quickly. Even though it might be a little uncomfortable, it usually isn’t painful. It’s an important procedure because it gives us very useful information about your condition. To make you as comfortable as possible, we’ll use a nasal spray that helps to numb your nose. This helps to make the process easier and less painful for you, but it does take a few minutes to start working. You should know that the spray might cause an unusual taste and a numb feeling in your throat for about an hour. During this time, avoid eating or drinking.
Step 2: Getting ready for the procedure
* We usually only need verbal permission before beginning this procedure.
* To make sure we can see inside your body clearly, we’ll test the image clarity and focus of the scope first.
* We’ll explain the procedure and what to expect throughout it.
* We’ll ask if one of your nostrils is more open than the other. Depending on the answer, we may use the nasal spray.
* A useful tip is to sit upright with your head supported, as if you’re sniffing the fresh morning air.
* We’ll lubricate the scope, then briefly wipe the tip either with an alcohol wipe or on your tongue to stop it from getting foggy.
* The doctor will either look straight down the scope or watch on a monitor.
Step 3: The examination
* We’ll gently insert the scope into your nostrils, then we’ll check your nose, the back of your nasal cavity, base of your tongue, throat, and voice box. This helps us see if everything looks normal.
* If any foreign items are found lodged in your nostrils, our doctors will gently remove them while using the scope to see what they’re doing.
* We’ll ask you to do certain actions to help us see specific areas more clearly:
* Inhale deeply: makes it easier for us to move the scope to the back of your nasal cavity
* Stick your tongue out: helps us to see the base of your tongue more easily.
* Puff out your cheeks or turn your head to each shoulder: these actions can help us see hidden areas where infections might hide.
* Say “Eeee” or count to ten out loud: this makes your vocal cords move apart, which might help our doctors see certain issues.
* Swallow: this can clear away any blood or mucus from the scope if they’re making it hard for us to see properly.
Step 4: After the examination
* You might feel dizzy after the procedure, but don’t worry, this feeling will pass. Just take a moment to rest before standing up.
* After the procedure, try to avoid eating and drinking anything for an hour.
* If you experience a nosebleed or cough shortly after the examination, don’t worry – these are short-lived effects and will typically pass after a couple of minutes.
Step 5: After you leave
* We will fill out all necessary paperwork once the examination is complete. This includes tracing where the scope has been, ensuring the right costs are calculated, and collating your results.
* We’ll make sure all relevant documents and images from your procedure are kept safe and properly labeled in your patient file.
Possible Complications of Flexible Nasopharyngoscopy
There are a few unexpected issues that can happen with medical procedures, though these are rare. The most common are sneezing, and accidental tearing and bleeding from the mucus-lined tissues within the nose. To avoid these issues, your doctor will try to reduce swelling in your nose and use as little force as possible.
There’s also a very rare but serious risk called laryngospasm. This is a condition where the muscles that keep food and drink from going into your windpipe suddenly tighten up. It’s reported in less than 1% of procedures.
Some people might experience gagging or have a negative reaction to the medicine used to reduce swelling in the nose. These are also potential risks.
Lastly, damage to the body’s structures is more likely if a rigid scope is used. This is an instrument that allows doctors to look inside your body. However, such damage is rarely seen when flexible scopes are used, which are more easily manoeuvred.
What Else Should I Know About Flexible Nasopharyngoscopy?
Flexible nasopharyngoscopy involves placing a thin, flexible tube with a light and camera attached to its end into the nose to examine the nasal cavity and throat. The use of this high-tech tool, along with the modern fiber-optic imaging technology, has greatly improved the way ear, nose, and throat (ENT) doctors operate in their clinics. The introduction of “chip-on-the-tip” digital flexible scopes is the next leap in this technology, offering clear, high-resolution images. This tool is a significant improvement over earlier methods where ENT doctors had to use hand-held mirrors to examine a patient’s throat.
In clinics where they treat patients with head and neck cancers, almost everyone gets examined via flexible nasopharyngoscopy. The tool allows doctors to monitor the progress of treatments, check for any recurrence of the disease, or observe the effects of cancer treatments. It is also a crucial device in emergency situations like breathing difficulties or neck abscesses. In fact, the flexible nasopharyngoscope has become as essential to an ENT surgeon as an otoscope, a tool used by doctors to look inside the ears, and is used quite routinely.
