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Mastering Endoscopy Procedures: An In-depth Guide to Instrumentation and Interpretation

Explore the world of endoscopy procedures like endoscopy, FNP, and FEES in this comprehensive guide. Learn about equipment familiarity, anatomical landmarks, risks, and contraindications. Discover the nuances of direct and indirect laryngoscopy, rigid oral endoscopy, and flexible nasopharyngoscopy. Understand the adverse reactions, topical anesthesia, prevention methods, and adverse reactions. Enhance your knowledge about performing and interpreting endoscopic results, especially focusing on the larynx. This guide is a must-have for healthcare professionals looking to excel in endoscopy practices.

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Mastering Endoscopy Procedures: An In-depth Guide to Instrumentation and Interpretation

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  1. Goal For The Day An introduction to performing and interpreting the results of Endoscopy, FNP, FEES procedures. We can add a bit about FEES, too, so that voice and swallowing overlap. Remember, you’re still looking at the larynx.

  2. General Goal #1 Familiarity with equipment • endoscope(s), • camera • cabling • light source • video capabilities

  3. General Goal #2 Recognition of anatomical landmarks • Examination of nasal passage and velopharyngeal port • Positioning the scope for nasal endoscopic exam • contrasting rigid and flexible endoscopy

  4. General Goal #3 Gain knowledge of the risks and the contraindications of FNP • Topical anesthesia vs. decongestants: • Vasovagal response • Specific risks and contraindications • Liability

  5. Endoscopy • Direct Vs. indirect laryngoscopy • Rigid oral endoscopy • Flexible nasopharyngoscopy • Endo: as in “endolymph”--scopy as in scope---endoscope

  6. Direct Laryngoscopy • Requires general anesthesia • Requires hospital admission for an out-patient surgical procedure done by a physician • Often employed when a biopsy is needed or in microlaryngoscopy • Used with a variety of surgical procedures

  7. Rigid Oral Endoscopy • Hopkins Rod; 70 and 90 degree • increased fiberoptic cabling = better visual resolution • placed in the oral cavity; effectively eliminates examination of the dynamic aspects of speech movements • straight light or stroboscopic light source

  8. View with Rigid Endoscope • Note the brightness of the image • Note the size of the image • Resolution • Nodule on R cord

  9. Indirect Laryngoscopy • Mirror laryngoscopy: head mirror, light source, warmed dental mirror; no magnification or video-recording • Flexible nasopharyngoscopy: provides a controlled view of the vocal tract

  10. Flexible Nasopharyngoscopy (FNP) Basic instrumentation: • light source is mandatory • camera* • VCR* • monitor* • time/date/character generator* (* means it’s not mandatory)

  11. Adverse Reactions • Discomfort • Nose bleed • Allergic reaction/hypersensitivity to topical anesthesia or nasal spray • Laryngospasm • Vasovagal response

  12. Topical Anesthesia • Lidocaine HC1 2%---amide family, not related to Novocain, Cetacaine)---use 1-2 ml (PDR=10 ml/100# body weight) ->allergic reaction is rare; limited to nasal mucosa, reaction mile including swelling and erythema (Lancet, 1971)

  13. Decongestant(s) • Oxymetazoline HC1 0.05% as is usually found in Allerest, Dristan, Neosynepherine, Sinarest

  14. Laryngospasm Strong, aversive, mechanical stimulation of laryngeal structures, or food, liquid, GER entering laryngeal vestibule--->VC adductor spasm Prevention: don’t touch the FVC, TVC or the arytenoids

  15. Vasovagal Response • Mechanical stimulation of the upper airway (especially the nasal passage) • Sympathetic NS reaction to emotional stimuli (fear, anxiety) increases heart rate, BP--”fight of flight mechanism: • If no action, bradycardia-->syncope • other causes of syncope:cardiac conditions, BP meds

  16. Preventing Vasovagal Response • Reassure the patient • If acute cardiac condition, either don’t do FNP/FEES or monitor BP and cardiac rhythm • Ask about history of fainting • Anesthetize the nasal passage

  17. Adverse Reactions • Perforation of the mucosa; bleeding most common effect • Stimulation of the Vagus causing laryngospasm • Allergic reaction to topicals • Infection, sinusitis (if endoscope is not properly cleaned

  18. Adverse Reactions, cont. • Laceration of pharyngeal mucosa, esophageal or pharyngeal perforation, mediastinitis • Aspiration pneumonia, from aspirating food, liquid, or oropharyngeal secretions • Laryngitis from abrasion/irritation of the mucosa within the laryngeal vestibule

  19. Summary • FNP can be done by SLPs to examine a biologic function: laryngeal valving, swallowing and its disorders • FNP/FEES requires knowledgeable, intuitive and competent examiners • Change in Liability • Managed care vs. NHS Models

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