Chapter Seventeen Flashcards
Chapter 17Nasopharyngoscopy
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Endoscopy—
Nasopharyngoscopy (also called nasendoscopy or videonasendoscopy)—
a procedure that allows the visualization of the interior of a canal or hollow organ by means of a special instrument called an endoscope
a minimally invasive endoscopic procedure that allows visual observation and analysis of the velopharyngeal mechanism during speech
Equipment: Basics
Flexible fiberoptic endoscope
Range in size from 2.2 mm to almost 5 mm diameter
Equipment: Complete System
Eyepiece with a lever for moving the tip of the scope
Specially designed camera that attaches to the eyepiece
External microphone
High-intensity light source for illumination, typically halogen or xenon
High-resolution monitor
High-quality digital video recorder
Clinical Uses for Nasopharyngoscopy
Nasopharyngoscopy is widely used for….
It can determine
evaluation of velopharyngeal function
the size, location, and probable cause of VPI, which is important for surgical planning
Clinical Uses for Nasopharyngoscopy
Nasal surface of velum may reveal evidence of ______
Absent or dysplastic _______
Concavity or notch in velum, especially the _______
__________corresponding to defect in velum
Nasal surface of the hard palate may show ….
submucous cleft:
musculus uvulae
posterior border
VP gap in midline
actual size and extent of an oronasal fistula.
Clinical Uses for Nasopharyngoscopy
Posterior pharyngeal wall may show:
1.Evidence of Passavant’s ridge
- Adenoid pad
a) Can evaluate size and potential for airway obstruction
b) Can evaluate for protrusions or fissures the can affect firmness of velo-adenoidal closure
3.Displaced internal carotids, based on pulsations on the posterior pharyngeal wall
Clinical Uses for Nasopharyngoscopy
Larynx and vocal folds may show:
Vocal fold nodules
Laryngeal anomalies associated with craniofacial anomalies
Clinical Uses for Nasopharyngoscopy
Treatment planning for VPI:
1.
2.
Can determine the best surgical procedure for the patient
Can help the prosthodontist design and modify an effective appliance, if surgery is not an option
Can evaluate the results of surgery for VPI:
If there is residual hypernasality or nasal emission or if there is postop airway obstruction, can help surgeon to determine the appropriate surgical revision procedure.
Clinical Uses of Nasopharyngoscopy
Can be used to…
Can be used to provide…
evaluate swallowing
biofeedback when the problem is due to abnormal function
Nasopharyngoscopy Preparation
Child must be able to…
Child must be able to _______
produce connected speech and repeat words and short sentences.
cooperate sufficiently.
Nasopharyngoscopy Preparation
Provide info on…
Do a..
Explain
_____and ______(if passing the scope).
what to expect before the day of the appointment.
perceptual evaluation and practice speech sample.
the procedure.
Wash hands and wear gloves
Nasopharyngoscopy Preparation
Use a _______(i.e., Afrin) and a _______(i.e., tetracaine), and administer through a nose spray; this must be ordered by a physician and mixed by a pharmacist.
Coat the sides of the scope with _________(2%) gel.
decongestant and topical anesthetic
viscous lidocaine
Positioning the Patient
Patient _______
For very young kids: 1. 2. 3. 4.
seated upright
Put child on parent’s lap.
Have parent “hug” around the arms and hold the child’s hands.
Parent puts a leg over child’s legs if necessary.
Have nurse or someone else hold the head still.
Learning to Perform the Procedure
Nasopharyngoscopy can be done by a ______ (e.g., an ENT or plastic surgeon) or by a ________
To learn to perform the procedure:
Review _____documents.
Attend focused _____.
Mentor with an _______
Review videotapes of _____.
Obtain supervised ______.
physician or speech-language pathologist
ASHA
courses
experienced professional.
exams
experience
Passing the Scope
Endoscope inserted..
For unilateral clefts,
through largest nostril.
try the unaffected side first.
Passing the Scope
Scope is guided…
Inferior meatus is not good because scope will _____ and move with velum during speech.
Superior meatus is _____.
up and over the inferior turbinate, through the middle meatus, through the choanal orifice, to the VP port.
rest on velum
too narrow
Once the scope is in nasopharynx, it needs to be…
The scope can be rotated slightly from one side to the other to
turned down with the lever so that it is perpendicular to the opening.
see both sides of the port.
Passing the Scope
VP function is observed on _____
The left side of the screen will show ….
a monitor.
the patient’s right side and vice versa
Speech Samples
Depends on the results of the \_\_\_\_\_\_\_ 1. 2. 3. 4.
speech evaluation
Repetition of syllables with pressure-sensitive phonemes
Repetition of sentences loaded with pressure-sensitive phonemes
Counting from 60 to 70
Repetition of nasal syllables and sentences and prolonged /m/ to evaluate nasal obstruction
Interpretation
Submucous cleft
IMAGE
Interpretation
Oronasal fistula
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Interpretation
Irregular adenoids
IMAGE
Interpretation
Passavant’s Ridge
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Interpretation
Tonsillar hypertrophy with tonsil in the pharynx
IMAGE
Interpretation
Small gap
IMAGE
Interpretation
Large gap
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Interpretation
Vocal nodules
IMAGE
Interpretation
Pharyngeal flap
IMAGE
Interpretation
Sphincter pharyngoplasty
IMAGE
Advantages of Nasopharyngoscopy
1. 2. 3. 4. 5. 6. 7.
It provides excellent resolution and visualization of all the structures.
The location, size, and shape of the opening can be determined.
Even very small openings can be seen.
The results of surgeries for VPI can be seen.
It can be done without radiation.
It is well tolerated, even by young patients.
It can provide biofeedback.
Limitations of Nasopharyngoscopy
1.
2.
3.
It requires a degree of cooperation.
It causes slight discomfort and can be scary for kids.
The equipment is expensive to purchase and maintain.
Summary
Nasopharyngoscopy is an important procedure for evaluation of ____.
It is effective in determining the ____________ of a velopharyngeal gap, and is used for surgical planning.
It can also be used to evaluate the ________of surgery for VPI.
It can determine the source of _______when it occurs.
It can be used to evaluate ______and vocal fold function.
VPI
size, shape, location, and cause
effectiveness
upper airway obstruction
swallowing
