Lecture Notes: Flexible Nasal Endoscopy

Introduction

• Procedure Purpose: Extension of examination in ENT clinic or acute setting to assess larynx.
• Objective: Teach tips for easier procedure for both practitioner and patient.
• Equipment: Stack available to observe different structures.

Pre-Procedure Considerations

• Self-Introduction: Always introduce yourself to the patient.
• Local Protocol: Adhere to local safety protocols, especially during pandemics as it’s an aerosol-generating procedure.
• Patient Consent: Explain the procedure to the patient and obtain consent.

Equipment and Tools

• Camera: Fiber optic camera with a light source for visualization.

Anesthesia

• Local Anesthetic: Offer the option of local anesthetic (phenylephrine and lidocaine).
  • Purpose: Easier and more tolerable for patient, acts as decongestant.

Conducting the Procedure

1. Patient Preparation

   • Confirm absence of allergies.
   • Check nasal passage for blockage.
   • Patient posture: Neck still, head down slightly, look straight ahead.

2. Endoscopy Process

   • Spray Anesthetic: Spray solution in patient’s nose.
   • Navigating the Scope:
     • Insert scope moving through nasal structures avoiding contact with tissue.
     • Visualize structures such as inferior turbinate, septum, lateral nose aspect.
     • Rotate camera to view Rosenmüller Fosse and Eustachian tube opening.

3. Observations in the Throat

   • Larynx Structures:
     • Visualize tongue base, follicular, epiglottis, vocal cords.
     • Assess vocal cords movement and identify anterior commissure.
     • Identify arytenoids and aryepiglottic folds.
   • Function Tests:
     • Adduction test: "Say ee" and observe.
     • Cough and phonation tests.

4. Anatomy Checks

   • Check for retention cysts, tonsils, piriform fossae.
   • Avoid triggering cough reflex to assess both sides for potential issues.

Post-Procedure

• Assessment Focus: Function (movement) and anatomy (abnormal features).
• Withdrawal: Carefully remove the scope, ensuring no damage.
• Discussion: Review findings with the patient.

Conclusion

• Highlight usefulness and tips for clinical practice.

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These notes capture the key steps and considerations in performing a flexible nasal endoscopy as demonstrated in the lecture.