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Nasal laryngoscopy
Aka: Nasal laryngoscopy, Laryngeal Exam, Nasopharyngoscopy, Rhinolaryngoscopy, Nasolaryngoscopy, Nasolaryngoscope, Laryngeal Lesion, Vocal Fold Lesion- Indications
- Hoarseness evaluation
- Persistent Hoarseness beyond 2 weeks
- Higher risk for Laryngeal Neoplasm
- Associated symptoms
- Chronic Problems
- Chronic Sinusitis
- Chronic Serous Otitis Media
- Recurrent Otalgia
- Chronic Cough
- Chronic Rhinorrhea
- Chronic nasal obstruction
- Acute Problems
- Hoarseness evaluation
- Complications
- Preparation
- Patient gently blows nose
- Mix Topical Decongestant with Lidocaine
- Phenylephrine or Afrin (0.25% to 2%)
- Lidocaine 2 to 4% (4% preferred)
- Atomize solution into nares
- Atomizer example: Wolff Tory Mucosal Atomization Device (MAD)
- Spray or apply intranasally in least obstructed naris (typically into both)
- Wait 5-10 minutes
- Technique
- Patient sits upright with head slightly forward
- "Sniffing" position
- Consider applying K-Y jelly to shaft of scope
- To defog scope
- Defogging solution OR
- Mucus from nose also defogs lens (gently touch sidewall)
- Swallowing will clear lens of mucus (may cause gag)
- Patient should breath through nose to keep nares open
- Patient repeatedly says "K" to elevate Soft Palate
- Also opens eustachian tube
- Patient protrudes Tongue to visualize vallecula
- Cord Movement
- Patient repeatedly says "E" to view cord movement
- Patient takes deep breath to see full abduction
- Patient sits upright with head slightly forward
- Anatomy: Landmarks
- Nose
- Inferior Meatus
- Nasolacrimal ostia
- Middle Meatus (Osteomeatal complex)
- Frontal Sinus ostia
- Anterior Ethmoid Sinus ostia
- Maxillary Sinus ostia
- Superior Meatus
- Posterior Ethmoid Sinus ostia
- Above superior meatus
- Sphenoid Sinus ostia
- Inferior Meatus
- Nasopharynx
- Torus tubarius
- Eustachian tube ostia (encased in torus tubarius)
- Rosenmuller's fossa
- Cleft posterior to torus tubarius
- Common site for nasopharyngeal cancer
- Adenoids
- Posterior to torus tubarius
- Torus tubarius
- Oropharynx
- Hypopharynx and Larynx
- Central Larynx
- False Vocal Cords
- True Vocal Cords
- Ventricle (between true and false cords)
- Posterior Larynx
- Piriform sinus
- Corniculate and Cuneiform cartilage
- Contiguous "lumps" on aryepiglottic folds
- Aryepiglottic fold
- Central Larynx
- Nose
- Findings
- Nose
- Nasal Foreign Body
- Acute Sinusitis
- Septal perforation
- Septal abscess or Septal Hematoma
- Nasal Polyp
- Oropharynx
- Obstructive airways (Sleep Apnea)
- Large adenoids
- Large lingual Tonsils
- Obstructive airways (Sleep Apnea)
- Larynx
- Laryngeal contact ulcer (mucosa or arytenoid cartilage)
- Direct Trauma (e.g. intubation)
- Inhaled Corticosteroid
- Vocal Abuse
- Reflux Laryngitis
- Laryngeal inflammation
- Allergy
- Post-intubation
- Inhaled Corticosteroids
- Tobacco Abuse
- Reflux Laryngitis
- Leukoplakia (white, thickened epithelium)
- Carcinoma or dysplasia (esp. male smokers over age 60 years)
- Benign Leukoplakia
- Vocal fold Hemorrhage (subepithelial, typically unilateral)
- Vocal Abuse
- Direct Trauma
- Anticoagulants
- Laryngeal Neoplasm (Exophytic or ulcerated lesions)
- Laryngeal papillomatosis
- Human Papillomavirus Infection (HPV)
- Laryngeal granuloma
- Trauma (e.g. post-intubation)
- Vocal Abuse
- Inhaled Corticosteroid
- Reflux Laryngitis
- Laryngeal cysts, pseudocysts or Nodules (or bilateral mid-vocal fold fibrous masses)
- Vocal cord abuse
- Laryngeal Polyps (sessile or pedunculated)
- Reinke Edema (Polypoid chorditis, Superficial lamina propria swelling)
- Reflux Laryngitis
- Tobacco Abuse
- Vocal cord abuse
- Displaced vocal cord (paramedian or lateral)
- Recurrent laryngeal nerve injury
- Vagus Nerve injury
- Laryngeal contact ulcer (mucosa or arytenoid cartilage)
- Nose
- Protocol: Equipment care
- Avoid bending scope into tight angles
- Clean lens with lens cleaner and paper
- Scope Sterilization
- Soak in glutaraldehyde for 20 minutes
- Rinse scope of cleaning solution
- Hang up to dry
- Disposable scope sheeth
- Alternative to sterilization of scope itself in glutaraldehyde
- Allows for more rapid, safe reuse of Nasolaryngoscope
- Charges: CPT Codes
- 31575 Nasolaryngoscopy
- 92511 Diagnostic Nasopharyngscopy with endoscope
- 99070 Supplies and disinfection charge
- Reference
- Hocutt (1990) Am Fam Physician 42(5): 1257 [PubMed]
- Patton (1992) Primary Care and Cancer 12(5): 13
- Feierabend (2009) Am Fam Physician 80(4): 363-70 [PubMed]
- House (2017) Am Fam Physician 96(11): 720-8 [PubMed]