Definition & Overview
Nasopharynx endoscopy, also known as nasopharyngoscopy, is a medical procedure that involves the examination of the internal surfaces of the nose and throat – collectively known as the nasopharynx. This is performed by an ENT specialist or otolaryngologist by inserting a thin, flexible, usually fiber optic instrument called nasopharyngoscope into the nose through the nostrils.
The endoscope used for this procedure is a thin tube fitted with an eyepiece, a camera lens, and a light source to ensure a clear field of vision as the instrument is passed through the nostrils into the deeper regions of the nasopharynx. Some nasopharyngoscopes are also equipped with suctions and forceps (and other “grasping” instruments) that can be used to clear the sinus cavities and perform a biopsy (to collect tissue samples) when and as needed.
The procedure takes a few minutes and is usually performed as an outpatient procedure. A local anesthetic is occasionally used to minimise discomfort, while paediatric patients are given a sedative prior to the procedure.
Nasopharynx endoscopy is a medical diagnostic procedure and is performed to detect and diagnose abnormalities in the nasopharyngeal area.
Who Should Undergo and Expected Results
Nasopharyngoscopy allows ENT specialists or otolaryngologists to evaluate the nasal mucosa, sinonasal anatomy, and nasal pathology. This is often recommended as the initial method for the evaluation of patients who show symptoms of the following conditions:
- Nasal stuffiness
- Chronic sinusitis
- Nasal polyps or abnormal growth in the nose
- Nasal tumors or suspected cancer of the nose, throat (oropharyngeal or nasopharyngeal) or voice box (larynx)
- Nasal obstruction or foreign body in the nose or throat
- Epistaxis (abnormal or recurrent nose bleeds)
- Problems with speaking (dysphonia)
- Obstructive sleep apnoea (breathing problems during sleep)
- Problems with swallowing (dysphagia)
Endoscopy is also often used to observe patient’s progress following a nasopharynx surgery and track the effectiveness of antibiotic therapy. For cancer patients, it can be performed as a routinary test to check the effectiveness of chemotherapy in removing tumors in the nasopharynx. Many surgeons also utilise endoscopy before performing procedures such as cleft palate reconstruction to assess potential risks.
How is the Procedure Performed?
Prior to the procedure, the nasal passage may be applied with a local anesthetic spray or the patient may be asked to take a lozenge to prevent discomfort and gag reflex. If the endoscopy will be followed by a biopsy, the nose is usually packed with cotton that is saturated with anesthetic.
As soon as the anesthesia takes effect, the doctor will start the procedure by guiding the tip of the nasopharyngoscope through the nostril. As the tip is further advanced along the nasal cavity, the doctor starts to note abnormalities and make observations. The nasopharyngoscope is equipped with a lighting system as well as a camera that allows doctors to observe the nasal airways through a monitor.
The scope is then guided into the throat to as far as the larynx. To examine the vocal cords, the doctor usually asks the patient to speak. As the scope is slowly withdrawn, the ENT continues to examine the nasopharynx. Should abnormalities be detected, photographs will be taken so further analysis can be carried out later on.
Among the physical features doctors watch out for are: sites of nasal bleeding, swelling of the mucus membranes, enlargement of the nasal turbinates, crooked nasal septum, the presence of polyps or tumors, as well as the presence of pus draining from sinus cavities. If there are nasal polyps, tumors or any mass formation in the nasopharyx, a biopsy can be performed and the obtained tissue samples will be further analysed by a pathologist for possible malignancy.
Possible Risks and Complications
Endoscopy of the nasopharynx allows ENT doctors to visualise the structures in the respiratory tract. Although the procedure is quick and minimally invasive, it comes with a few risks. Some complications include laceration and bleeding, vomiting, and respiratory collapse. These complications are easily avoided if the procedure is performed by a highly experienced doctor.
There are also no contraindications for nasal endoscopy. However, extra care during the procedure is given to those who have a history of bleeding disorders and who are currently taking anticoagulants, to ensure that bleeding does not happen. Moreover, patients with cardiovascular disease are usually advised to consult with the ENT doctor before the procedure for necessary precautionary measures.
Bentsianov BL, Parhiscar A, Azer M, Har-El G. The role of fiberoptic nasopharyngoscopy in the management of the acute airway in angioneurotic edema. Laryngoscope. 2000 Dec. 110(12):2016-9.
Choy AT, Gluckman PG, Tong MC, et al. Flexible nasopharyngoscopy for fish bone removal from the pharynx. J Laryngol Otol. 1992 Aug. 106(8):709-11.