Fiberoptic Nasopharyngoscopy - An Overview

Introduction

Fiberoptic or flexible nasopharyngoscopy is an essential skill of an ENT (ear, nose, and throat) specialist used to diagnose nose, throat, and airway infections. It is a common diagnostic procedure used in adults, children, and babies. An endoscope (a flexible tube with an attached camera and light) is inserted through the nose to examine the nose, back of the tongue, throat, and voice box to assess any abnormalities. This technique cannot diagnose any condition below the vocal cords (vocal folds).

What Are the Abnormalities That Fiberoptic Nasopharyngoscopy Can Examine?

Numerous abnormalities or defects can be examined by fiberoptic nasopharyngoscopy. They are as follows:

• Nasal Cavity Abnormalities: Nasal cavity examination with fiberoptic nasopharyngoscopy helps to detect:

  • Turbinates hypertrophy (nasal turbinate bone enlargement).

  • Deviated nasal septum.

  • Nasal cysts, polyps, and nodules (overgrowth of nasal tissue).

  • Sinus infections.

  • Nasal septum perforation.

  • Oro-nasal communication.

  • Nasal obstruction.

• Posterior Nasal Space defects: Posterior nasal space examination helps to detect:

  • Eustachian tube orifice defects (tube connecting the nasopharynx to the middle ear).

  • Adenoids (enlarged lymphatic tissues between the back of the nose and throat).

• Abnormalities in the Base of the Tongue: Fiberoptic nasopharyngoscopy helps to examine any defects, irregularities, cysts, and abnormal mass related to the base of the tongue.

• Defects in the Epiglottis: Any swelling of the epiglottic flap (flap tissue that covers the windpipe while swallowing food) can be detected.

• Voice Box (Larynx) Abnormalities: Examination of the voice box or larynx helps to detect:

• Vocal cord defects like vocal cord polyps and nodules (abnormal tissue growth on the vocal cords).

• Vocal fold (bands of tissue that vibrate to produce sound or speech) movements.

• Vocal fold cyst (pus or fluid-filled pouch between the infected vocal folds).

• Vocal cord ligaments are like abnormalities in arytenoid ligaments.

Pyriform Fossa: Any swelling or pooling of saliva in the pyriform fossa or sinus (pear-shaped space between the two laryngeal openings) can be detected by fiberoptic nasopharyngoscopy.

What Are the Indications of Fiberoptic Nasopharyngoscopy?

Fiberoptic nasopharyngoscopy is indicated in the following:

• Removal of the visible foreign body from the throat.

• Assessment of OSA (obstructive sleep apnea syndrome).

• Evaluation of swallowing pattern in patients with swallowing difficulties.

• For performing vocal cord injection procedures in case of vocal fold paralysis.

• For evaluation of VPI (velopharyngeal insufficiency- failure of the soft palate to close against the back of the throat resulting in the escape of air leading to nasal tone in speech).

• Examination of airway obstruction.

What Are the Contraindications of Fiberoptic Nasopharyngoscopy?

Fiberoptic nasopharyngoscopy is avoided in the following cases:

• Acute Epiglottitis: It is a condition in which tissue or flap covering the windpipe while swallowing is inflamed (swollen). Fiberoptic nasopharyngoscopy is not indicated in these patients as there is a risk of laryngospasm (an uncontrolled or abnormal movement of the vocal folds).

• Croup: It is an upper airway infection characterized by obstructive breathing and a barking cough. It is most commonly seen in children. Fiberoptic nasopharyngoscopy is avoided in these patients as there are chances of complete airway obstruction or blockage.

What Is the Equipment Used for the Fiberoptic Nasopharyngoscopy Procedure?

Types of equipment used for fiberoptic nasopharyngoscopy procedures are

• Flexible endoscopic tube diameter of 1.9 millimeters for children and 6 millimeters for adults.

• A portable light source.

• A monitoring device.

• Light lead.

• Topical anesthetic spray.

• Lubrication gel.

• Image printer.

• Alcohol wipes.

What Are the Advantages and Disadvantages of the Fiberoptic Nasopharyngoscopy Procedure?

Advantages:

• No radiation exposure is present in this technique.

• It helps evaluate the areas behind the tongue and the palate.

• Tests can be performed with the patient's asleep or awake position.

• Tests can be completed in both sleep or awake positions.

• Tests are readily available and are less expensive.

Disadvantages:

• It might create some discomfort in a few patients while inserting a nasopharyngoscope in the nose.

• It is a technique-sensitive test that demands high skills and expertise.

What Is the Technique of the Fiberoptic Nasopharyngoscopy Procedure?

The technique of the fiberoptic nasopharyngoscopy is done by the following steps:

• Clean the scope before starting the procedure.

• Reassure and explain the procedure to the patient.

• A topical nasal spray like Xylometazoline is used to clear the nasal discharge and anesthetize the nasal tissues for easier endoscopic tube placement.

• Cautiously insert the scope into the nostril.

• Any foreign body present can be removed using forceps for clear visibility.

• Patients are asked to perform various movements like sniffing in, taking their tongue out, cheeks blowing, or swallowing to help properly visualize the nasopharynx, base of the tongue, piriform fossa, and vocal cords, respectively.

• Carefully examine the nose, throat, base of the tongue, and vocal cords for abnormalities.

• The patient is advised not to drink or eat for one hour after the procedure.

What Are the Complications Associated With the Fiberoptic Nasopharyngoscopy Procedure?

• Gagging is seen in some patients.

• Adverse reactions from the nasal decongestant spray.

• Laryngospasm is seen in one percent of cases (an uncontrolled and abnormal movement of the vocal folds).

• Damage to the nasal structures due to trauma from a rigid endoscope.

• Nosebleeds (epistaxis) or coughing may occur soon after the procedure, but it is temporary and last for about two to three minutes.

• Some patients may feel light-headed, so they are advised to stay seated for some time after the procedure is complete until they feel well to stand.

Conclusion

Flexible or fiberoptic nasopharyngoscopy is a very crucial diagnostic tool used by an ENT (ear, nose, and throat) specialist for evaluating the presence of deformities in the nose, throat, base of the tongue, and upper airway. It is an essential tool in evaluating the cancerous lesion, checking the response from the treatment, and for any recurrence present. It is a painless procedure; however, it can cause discomfort to the patient while inserting the endoscope into the nostril. Fiberoptic nasopharyngoscopy has served as a boon for healthcare workers in the field of clinical diagnostics as it shows the complete view of the internal structures of the nose, throat, and voice box that helps to diagnose and manage the associated abnormalities easily.