Medical professionals love to use really big terms and this
is especially true of ENT doctors. So
whenever a patient comes in and needs a special exam using a fiberoptic scope,
we proudly announce that, “Yessiree, you’re gonna need a nasopharyngoscopy!” Sound fun? Aw, come on! That’s a 17-letter
word!
Actually, this procedure is not as hideous as it seems, as
demonstrated by the person in the picture who is having the time of her life…well,
that’s a stretch, but she’s sporting a delightful smile and not screaming and
kicking about. By the way, that’s my
wife and she’s not a patient, so I’m not violating any privacy issues here. And she didn’t slug me at the end.
For patients presenting with throat or voice problems, the
ENT doc first dons a headlight, grabs your tongue with a piece of gauze and
places a round dental mirror way in the back of your throat to visualize further
down, all for the purpose of viewing the larynx or voice box, as well as the
part of the throat around the larynx, including the back of the tongue and the hypopharynx, which is the entryway into
your esophagus. The mirror can also be
flipped upwards to view the back of the nose called the nasopharynx. Yet in many
instances a good view of these structures is inadequate by such means and more
specialized tools are needed. Your ENT
doc will then resort to this gnarly looking piece of equipment with a long,
flexible tube that lights up at one end, and has a lever with an eyepiece at
the other.
This is a fiberoptic scope or more specifically a nasopharyngoscope. The procedure has a variety of names such as
fiberoptic laryngoscopy or nasopharyngoscopy or flexible fiberoptic endoscopic
exam, etc, but the gist of this is a tube is placed through your nose and down
into your throat. The device has a long
fiberoptic cable within the shaft of the tube as a means of delivering the
light from its source at the other end. Another
fiberoptic brings the image to the eye piece where it is magnified. The scope also has a device that allows the
doc to move its tip, allowing for easier passage as well as for maneuvering to see
adjacent areas outside the scope’s field of view.
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| Flexible Fiberoptic Nasopharyngoscope |
Whenever we must do this procedure, I often tell patients it
sounds and looks more hideous than it actually feels, and most people tolerate
this quite well. It usually takes just
about a minute to do a good exam. We
also do this in young children with vocal or throat problems.
This procedure is done through the nose and not the mouth,
contrary to conventional wisdom. The
nasal approach is actually much more comfortable, as it bypasses the gag reflex
which is generally strong on the back of the tongue, the soft palate and over
the tonsils.
First a nasal decongestant is sprayed into the nose on each
side, namely neosynephrine or oxymetazalone, which are over the counter
medications one can purchase at most any grocery store. The purpose of this medication is to decongest
the soft tissue inside the nose, or shrink those tissues down which improves
the ability to pass the scope through the nose with less effort. Next, an anesthetizing solution is sprayed
into the nose. This is often topical
lidocaine. You will also notice the
spray dripping down your throat and typically doesn’t taste all that great and
your throat might become temporarily numb, but this is expected so don’t worry. Some
practitioner’s use cocaine…yes the same cocaine that people snort, but his is a
very dilute solution and unfortunately won’t make you high. Cocaine has medicinal properties, as it
decongests tissue and anesthetizes it, and many of us use it during nasal and
sinus surgery…legally.
After about a minute or two the doc will then place the
scope in one nostril inspect it and often will inspect the other one as
well. This gives a view of the
structures inside the nose. Having
determined which side appears more patent and easier to pass the scope (and
yes, each side of the nose is not an exact mirror image of the other and, as
with most things, we humans have a wonderful asymmetry throughout). The scope is then gradually passed further
into the nose, nearly parallel to the floor and not up into the head as some
patients intuitively think it will go.
The doc then flexes the scope tip so it can be guided downward behind
your soft palate and uvula, and then a good view of the stuff that needs to be
seen is seen. Since the scope is flexible, the doc can avoid bumping into structures and also look into more obscure and narrower areas.
Your doc may then have you see something like “eeee” or “aaaa”
which actual serves a purpose and not merely to humor your physician. When you use your voice in this manner, the
vocal cords of your larynx come together (or adduct in medical jargon) which allows the examiner to assess
movement of the cords and better visualize for subtler lesions. The tissue around the larynx area also is
examined. In addition, either on the way
down or on the way out, your doc can also visualize the nasopharynx, eustachian
tubes and the rest of the nasal cavity.
After it’s over, patients often ask whether I need to look at
the other side. I explain that once the
scope is farther back into the nasopharynx, the nasal septum (the partition or
wall that divides the nose into left and right sides) ends and does not travel
all the way to the back of the nasopharynx, and so the larynx and throat are actually
viewed in a midline position of the scope, and a good view of the left and
right sides of the nasopharynx is easily achieved merely by flexing or bending
the tip of the scope to view those areas.
A cautionary
note for some patients: Afterwards your
throat may feel strange and numb for up to an hour. I advise not drinking any hot food or
beverages or spicy foods for about an hour due to the numbness. Since throat sensation is diminished, you
won’t experience the same sensations you typically have with normal swallowing,
and as such a few people have felt they either can’t swallow or they become a
bit concerned by the odd sensation. This
will pass. I typically warn
patients who seem to have a tendency for anxiety that sometimes they may feel a
bit panicky when the throat gets numb, at times causing a globus sensation (a foreign body or “lump” sensation in the throat)
or they feel as if their throat is closing off, but it actually isn’t. This sensation will
eventually pass as the patient is reassured and starts to relax. Since this is an office procedure using no
sedation, you can drive and go about your normal activities with the dietary
exceptions above.
So, if you have an appointment with your ENT doc in the
near future and you’re anxious about the possibility of having a
nasopharyngoscopy done, rest assured this is pretty mild compared to a lot of
things that can occur in doctors’ offices, such as shots, blood draws, or a
rectal exam.
©Randall S. Fong, M.D.
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