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Subject: Flexible Fiber-Optic Nasolaryngoscopy
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Numerous flexible fiber-optic laryngoscopes are available; however, they all have basic common features, including a monocular eye piece for viewing; hand piece with controls to flex the tip of the scope; and the fiber-optic bundle, which is inserted during examination. The diameter of most fiber-optic bundles range from 3 to 4 mm, with the working length typically being up to 300 mm. A light source is also required.
Chronic nasal airway obstruction
Unilateral serous otitis media in an adult
Impeding airway collapse
Suspected epiglottitis/supraglottitis in a child
PITFALL: The lidocaine solution has a bitter taste. Warn the patient about this unpleasant effect. The examiner should pause for a few seconds after administering the first two sprays to allow the anesthetic to take effect and to permit the patient to respond to the taste.
PITFALL: A patient’s glasses can interfere with anchoring the hand to the patient’s face or be hit during the procedure. Consider asking the patient to remove glasses before the procedure.
PITFALL: During insertion of the endoscope, mucus can adhere and obscure the view through the scope. Gently tap the tip of the scope against the wall of the nasopharynx to clean the view on the scope. If the view becomes obscured while examining the larynx, have the patient swallow to clear the tip of the scope. It is almost never necessary to completely withdraw the scope to clear the lens.
Olympus USA, 2 Corporate Center Drive, Melville, NY 11747 (www.olympusamerica.com)
WelchAllyn, 4341 State Street Road, Skaneateles Falls, NY 13153 (phone: 800-535-6663; www.welchallyn.com/medical)
Endosheath Technology, Vision Sciences, 9 Strathmore Road, Natick, MA 01760 (phone: 800-874-9975; http://www.visionsciences.com/)
Pentax, 30 Ramtand Road, Orangeburg, NY 10962 (phone: 800-431-5880; www.pentax-endoscopy.com)
Lidocaine hydrochloride (4% solution or 2% jelly) is available from Astra Pharmaceuticals, Westborough, MA (phone: 508-366-1100) or through a local pharmacy.