Endoscopic examination of ENT organs. Indications and contraindications for nasopharyngeal endoscopy

Almost every procedure for examining patients for pathologies of the ENT organs necessarily includes, in addition to examination and anamnesis, also instrumental diagnostic methods aimed at visualizing the internal state of the organs. Similar instruments are various options for micro- and endoscopies.

Microscopy of ENT organs

Microscopy is an examination of mucous membranes ENT organs under a microscope.

Microscopy is the only accurate tool for making an accurate diagnosis. It is carried out using specialized ENT microscopes (link to our models), which make it possible to diagnose both atypical and sluggish inflammatory processes of the middle ear, tympanic membrane and the walls of the ear canal itself. The most important way in which these microscopes differ from conventional microscopes is the ability to carry out medical procedures, as well as microsurgery, simultaneously with examination.

Figure 1. Specialized otolaryngology microscope Haag-Streit Surgical ALLEGRA 50

A similar procedure is performed without any anesthesia or surgery. During the procedure, the doctor sits in front of the patient and places a microscope with a light source in the required position so that the eardrum can be effectively examined.

Using this diagnostic you can determine:

• injuries caused by a sudden change in pressure (membrane ruptures);
• perforation of the eardrum;
• inflammation of the tympanic membrane and middle ear.

Endoscopy of ENT organs

Endoscopy of ENT organs- This is an examination of the mucous membranes of the ENT organs using endoscopes. This procedure is carried out both for the respiratory tract (nasopharynx, larynx, trachea) and for the auditory organs.

According to the method of image transmission, all endoscopes are divided into:

Fiberscopes- a cheaper type of endoscope in which the image is transmitted through an optical system to the viewing eye on the endoscope. As a result, the image is not processed and can only be seen by the doctor.

Video endoscopes- a device with a camera installed at the end of the endoscope, the image from which is displayed on a specialized medical monitor through an image processing system.

Depending on the area (ear, throat, nose) it is applied:

• pharyngoscopy - examination of the oral cavity and pharynx ;
• laryngoscopy - examination of the larynx;
• stroboscopy - examination of the vocal cords;
• rhinoscopy - examination of the nasopharynx;
• otoscopy - examination of the middle ear and auditory canal;
• nasopharyngoscopy - an examination carried out to exclude malformations of the tonsils and adenoids;
• sleep endoscopy - examination of the upper respiratory tract with a flexible endoscope during medicated sleep. This is an innovative solution in the diagnosis of snoring and apnea.

An interesting feature: not all such devices can be classified as endoscopes. For example, the Heine Mini 3000 viewing otoscope is not one of them because it cannot be connected to a cold light source or image capture system.

The use of endoscopy in otolaryngology opens up wide opportunities for access to previously closed parts of the nasal cavity, maxillary and frontal sinuses, as well as the larynx, where the doctor cannot physically look. This technique makes the detection of polyps of the mucous membrane and deformations of the nasal septum simpler, allowing an accurate diagnosis of the patient's condition. In addition, the endoscopic technique used for the ear makes it possible to describe the inflammatory processes of the middle ear and assess the condition of the tympanic membrane.

For example, the pharynx is quite successfully examined using fibrolaryngoscopic techniques. It allows you to visually evaluate all the features of its structure, as well as take pictures/videos. There is another known method of examining the larynx, it is called microlaryngoscopy. The technique involves analyzing the vocal cords and the larynx as a whole under optical magnification using a rigid video endoscope (strobe scope), often inserted into the trachea using an intubation laryngoscope (through a laryngoscope, the endotracheal tube passes through the oral cavity and larynx, entering the trachea between the vocal cords).

Today, stroboscopes are the only imaging tool that allows complex studies of the trachea and voice-forming apparatus. The use of such a technique allows you to accurately determine the source of the problem and target targeted areas of the larynx. It is very important that to insert a stroboscope into the larynx, additional incisions in the neck are not required; everything happens through the natural respiratory tract.

As for the nasopharynx, a method called fibrorhinopharyngoscopy is actively used today. This technique only allows for visualization of the nasopharynx while simultaneously performing a biopsy, which is very convenient for verifying suspected tumors.

Auxiliary equipment

To carry out endoscopic diagnosis and therapy, in addition to the ENT unit itself with endoscopy support, as well as related ENT equipment, the following devices are needed:

For video endoscopy

• a specialized video endoscope (the Atmos company also uses video image capture from fiberscopes, i.e. the endoscope can be used simultaneously as both a video and a fiberscope);
• cold light source with light guide;
• medical monitor.

For fiberoscopy

• Specialized fiberscope;
• Cold light source with light guide.

With the help of endoscopic diagnostics it is possible to identify and determine:

• level and degree of respiratory tract obstruction;
• pathology of narrowing of the oropharynx;
• physical condition of the epiglottis;
• shape, size of the root of the tongue, distant palate and uvula.

Indications for endoscopic examination:

• problems breathing through the nose;
• copious nasal discharge;
• problems with smell;
• snore;
• stopping breathing in a horizontal position (during sleep);
• problems with the function of the auditory tube;
• recurrent nasal bleeding;
• tumors of the nasal cavity;
• chronic tonsillitis;
• acute and chronic laryngotracheitis;
• dysphonia (violation of voice functions).

Conclusion

The use of the latest microscopy and endoscopy technologies in the treatment of ENT diseases makes it possible to simplify several times not only the identification of the diseases themselves, but also to provide a reasonable explanation to the patient regarding the pathology, showing it on a video image.

Many different types of examinations are used to diagnose nasopharyngeal pathologies. But endoscopy of the nasopharynx is considered the most accurate, modern and painless. This method of examination helps the doctor recognize the disease at the earliest stage and prescribe appropriate treatment. The procedure is performed using a special device – an endoscope. It looks like a thin tube with a miniature camera and a bright flashlight attached to the end. This device allows for a complete examination of nasopharyngeal pathologies.

What is nasopharyngeal endoscopy?

Nasal endoscopy is a modern research method that allows you to clarify an earlier diagnosis. This procedure can be performed from different angles and greatly enlarges the image, which makes it easier to make a diagnosis.

Endoscopy of the ENT organs is considered a low-traumatic diagnostic method; it is often used during various operations on the nasopharynx. To conduct such a study, no lengthy preparation of the patient is required, no incisions are required, and there is no rehabilitation period as such.

Endoscopic examination of the nose is a completely painless procedure that does not cause much discomfort to the patient. The duration of this procedure is only a few minutes, after which the person can immediately go home.

Endoscopy of the nasopharynx can be indicated not only for adults, but also for children of different ages.

Indications

Nasal endoscopy in an adult or child is indicated for:

• difficulty breathing;
• deterioration of sense of smell and constant nasal discharge;
• regular nosebleeds;
• frequent migraines, as well as a feeling of squeezing in the bones of the face;
• various inflammatory pathologies of the nasopharynx;
• hearing loss or a feeling of constant tinnitus;
• delayed speech development in children;
• constant snoring.

Most often, endoscopy is performed for sinusitis, hay fever, sore throat, pharyngitis, rhinitis, inflammation of the ethmoid labyrinth and frontal sinuses. The procedure is often prescribed for adenoiditis to determine the degree of proliferation of lymphoid tissue. According to the doctor’s indications, the procedure can be prescribed for a number of other diseases in order to clearly indicate the clinical picture.

Indications include facial injuries of varying severity, deviated nasal septum, as well as preoperative and postoperative diagnostics.

Endoscopy helps to quickly confirm the diagnosis of sinusitis. Early diagnosis prevents various complications.

What does endoscopy show?

Endoscopy should be done when there is doubt about the correctness of the diagnosis or the extent of damage to the nasopharynx needs to be determined.

Using an endoscope, a doctor can detect the slightest pathological changes in the mucous membranes of the nasopharynx. The device allows you to see changes of the following nature:

• Tumors of various origins.
• Proliferation of adenoid tissue.
• Pathologies of the maxillary sinuses.
• Polyp growths of different sizes.
• Disturbed structure of the walls of the nasopharynx.

Endoscopy of the nasopharynx is especially indicated for children to confirm the diagnosis.. This procedure is painless, therefore it is perceived normally by children of different ages.

Endoscopy allows you to magnify the structure of the nasal cavity 30 times. Due to this, surgical operations can be performed more efficiently.

How to carry out the procedure

Endoscopy of the nasal cavity is performed with the patient sitting. The patient sits on a special chair, which resembles a dental one, and leans his head back on a comfortable headrest.

The nasal cavity is locally anesthetized. Lidocaine gel or anesthetic spray can be used for this. The tip of the endoscope is lubricated with gel, and the spray is sprayed into the nasopharynx.

After local anesthesia, a burning and tingling sensation is felt in the nose. This may cause temporary discomfort to the patient.

After the nasopharynx is numbed, the endoscope is carefully inserted. A picture showing the condition of the nasopharynx is displayed on a large screen. The sinuses and noses are examined one by one. The whole procedure lasts no more than 20 minutes. This time includes anesthesia, the examination itself, printing of photographs and writing a report by a specialist.

If indicated, surgical endoscopy may also be performed.. During this procedure, tumors are removed, and the mucous membrane is not greatly injured. There is no risk of severe bleeding with this type of surgery. There are no scars or unattractive scars left on the face. The patient remains under the doctor’s supervision for only a day and is then discharged for outpatient treatment.

After the endoscopy is done, the specialist writes a conclusion on a special form.

How to prepare for an endoscopy

Endoscopic examination of the nasopharynx in adults and children does not require any special preparation. This manipulation is easily tolerated even by young children.. Before the examination, the doctor tells the patient in detail about the principles of endoscopy and answers all questions that arise.

Young children need to be mentally prepared for the examination; for this, the doctor demonstrates the principle of operation of the device and tells the child that the procedure is painless. During the examination, the patient should sit quietly and not move. Breathing should be smooth. If pain or discomfort occurs, you can always tell the doctor who is performing the procedure.

There are endoscopes for adults and children, both types have the finest optical fiber. The patient, if desired, can also watch on the big screen what is happening in the nasopharynx.

Contraindications

There are only two contraindications to performing endoscopy. Carry out the procedure with caution or do not resort to it in the following cases:

• If you are allergic to lidocaine or other drugs used for local anesthesia.
• If you are prone to nosebleeds.

If the patient frequently has nosebleeds, he should notify the doctor who will conduct the endoscopic examination. In this case, endoscopy of the nasal cavity is performed with a very thin device, which is usually used to examine children. The procedure is also performed with caution if the mucous membrane is overly sensitive.

They try not to resort to endoscopic examination of the nasopharynx even in case of some neurological disorders.

Endoscopy of the nasopharynx is a fairly new diagnostic method that allows you to identify pathologies of ENT organs at different stages. If necessary, an operation can be performed using an endoscope to remove tumors, polyps and adenoids. In this case, there is no severe bleeding, no scars remain on the face, and the patient recovers in a short time.

The throat plays an important role in the human organ system. In a healthy state, the laryngeal mucosa looks clean and pink, without inflammation or enlarged tonsils. For various diseases of a cold, nervous, tumor, traumatic nature, tissues react with certain changes. Various examinations are used to diagnose them. The most informative of them is endoscopy of the larynx, which allows you to clarify and record any deviations from the norm, as well as take a tissue sample if a biopsy is needed.

What is endoscopy used for?

The endoscopy method refers to the field of diagnostic research using flexible tubes equipped with light-fiber optics devices. The larynx area is part of the ENT system, the problems of which are dealt with by the branch of medicine - otolaryngology. In addition to a visual examination, an ENT doctor has an endoscopic diagnostic method in his arsenal, which is prescribed for problems with the voice, swallowing, and injuries. There are several types of examination, depending on the area being examined:

• pharyngoscopy is used to visualize the oral cavity and the condition of the pharynx;
• during laryngoscopy, the laryngeal cavity is examined;
• rhinoscopy is used to view the nasal passages;
• Otoscopy is necessary to view the auditory canal along with the outer ear.

Interesting fact: doctors have been examining the internal surfaces of the ear, larynx and nose for more than a hundred years. However, at the dawn of the era of endoscopic diagnosis, routine instruments were used - special mirrors. Modern diagnostics are performed with sophisticated devices equipped with high-precision optics with the ability to record results.

Advantages of endoscopic diagnosis

If you have problems with your voice, ear and throat pain, hemoptysis, or injuries to the larynx, it becomes necessary to examine the larynx and vocal cords using laryngoscopy. A diagnostic examination of the larynx is performed with a rigidly fixed or flexible endoscope, which allows you to see the internal area of ​​the organ in different projections on the monitor screen. Thanks to the capabilities of the video system, the doctor can examine problem areas in detail, recording the results of the endoscopic examination on a disk.

This type of diagnosis, popular in otolaryngology, has a number of advantages:

• harmlessness of manipulation due to the absence of electromagnetic influence;
• absence of pronounced signs of discomfort and pain;
• endoscopy provides a reliable result and the ability to collect a tissue sample.

Diagnostic examinations are performed in modern medical centers using various instruments. Depending on the type of laryngoscopy, a vibrating fiber endoscope or laryngoscope is used for direct diagnosis. Visual inspection is performed with a system of mirrors that reflect the light of a lamp to illuminate the larynx during indirect endoscopy. Microlaryngoscopy is carried out with a special operating microscope to identify tumor lesions of the larynx.

Endoscopic examination techniques

The examination is carried out by a doctor who treats diseases of the ears, nose and throat. The possibility of instrumental research allows you to accurately determine the diagnosis in order to prescribe the correct treatment regimen for people of different ages. What types of larynx diagnostics are prescribed?

Indirect view of laryngeal endoscopy

For the study, which is carried out in a darkened room, the patient should sit with his mouth wide open and his tongue protruding as much as possible. The doctor examines the oropharynx using a laryngeal mirror inserted into the patient’s mouth, which reflects the light of the lamp refracted by the frontal reflector. It is attached to the doctor's head.

To prevent the viewing mirror in the throat cavity from fogging up, it must be heated. To avoid gagging, the examined surfaces of the larynx are treated with an anesthetic. However, the five-minute procedure has long been outdated and is rarely performed due to the low information content of the semi-reverse image of the larynx.

An important condition: before prescribing a modern method for diagnosing the condition of the larynx, the patient should be convinced of the need for endoscopy and familiarized with the features of preparation for it. It is also necessary to find out information about the health problems of the person being examined, it is useful to reassure the person that he will not be hurt, there is no danger of lack of air. It is advisable to explain how the manipulation is carried out.

Direct method of research

This type of laryngoscopy is flexible when a movable fiber laryngoscope is used. In the case of using a rigidly fixed device, the technique is called rigid, and is used mainly for surgical intervention. The introduction of modern equipment makes it easier to make a diagnosis and allows you to achieve the following goals:

• identify the causes of changes or loss of voice, pain in the throat, difficulty breathing;
• determine the degree of damage to the larynx, the causes of hemoptysis, as well as problems with the respiratory tract;
• remove a benign tumor, rid a person of a foreign body trapped in the larynx.

If the information content of indirect diagnostics is insufficient, examination by the direct method is relevant. Endoscopy is performed on an empty stomach, but under local anesthesia after taking medications to suppress mucus secretion, as well as sedatives. Before starting the procedure, the patient must warn the doctor about heart problems, blood clotting characteristics, a tendency to allergies, and possible pregnancy.

Features of direct endoscopy of the larynx

• Direct flexible endoscopy method

Diagnosis is carried out under the supervision of a group of health workers. During the manipulation, the doctor uses a fiber-optic fiber endoscope equipped with a movable distal end. The optical system with adjustable focusing and illumination provides a wide range of viewing of the laryngeal cavity. To avoid gagging, the throat is treated with an anesthetic spray. To prevent injury to the nasal mucosa, the nose is instilled with vasoconstrictor drops, since the endoscopic procedure is carried out by inserting a laryngoscope through the nasal passage.

• Complexity of rigid endoscopy

The study allows, together with examining the condition of the larynx, as well as the vocal cords, to remove polyps and take material for a biopsy. The diagnostic procedure, which lasts approximately 30 minutes, is considered particularly complex. Therefore, they are conducting research in the operating room of a hospital. When the patient lies on the operating table and falls asleep under anesthesia, the beak of a rigid laryngoscope equipped with a lighting device is inserted into his larynx through the mouth.

An important point: during the procedure, swelling of the larynx is possible, so after the examination the patient’s throat is covered with ice. If the vocal cords have been interfered with, the person will have to remain silent for a long time. Eating and liquids are allowed no earlier than two hours after the endoscopy was performed.

Possibility of complications

The use of modern medical technology in endoscopic diagnostics helps the doctor detect pathology and determine the degree of its development, which is especially important for drawing up a treatment program. In addition, this is an excellent opportunity for the patient and his relatives to visually familiarize themselves with the problem and understand the need for treatment.

If cancer is suspected, the results of autofluorescence endoscopy become the most reliable diagnosis of the problem. However, it is worth considering that any type of endoscopic diagnosis is associated with a possible risk for the patient’s condition.

1. The consequence of treatment with an anesthetic may be difficulty swallowing, a feeling of swelling of the root of the tongue, as well as the posterior pharyngeal wall. A certain risk of swelling of the larynx cannot be excluded, which results in impaired respiratory function.
2. For a short time after endoscopy of the larynx, symptoms of nausea, signs of hoarseness and pain in the throat, and muscle soreness may be felt. To alleviate the condition, regularly rinse the throat walls with a soda solution (warm).
3. If a biopsy sample was taken, a cough with bloody clots in the sputum may begin after it. The condition is not considered pathological; unpleasant symptoms will go away in a few days without additional treatment. However, the risk of bleeding, infection, and respiratory tract injury exists.

The risk of developing complications after endoscopy increases due to blockage of the airways by polyps, possible tumors, and inflammation of the cartilage of the larynx (epiglottis). If a diagnostic examination provokes the development of airway obstruction due to spasms in the throat, emergency assistance is required - a tracheotomy. To perform it, a longitudinal dissection of the tracheal area is required to ensure free breathing through a tube inserted into the incision.

When research is prohibited

In modern otolaryngology, laryngoscopy is considered one of the most productive ways to study the disease-prone larynx. Although the direct diagnostic method provides the ENT doctor with comprehensive information about the condition of the organ, the procedure is not prescribed in the following situations:

• with a confirmed diagnosis of epilepsy;
• injury to the cervical vertebrae;
• for heart disease, myocardial infarction in the acute phase;
• in case of severe stenotic breathing;
• during pregnancy, as well as allergies to medications to prepare for endoscopy.

Interesting: microlaryngoscopy is used for a detailed overview of the vocal cords, as well as the general condition of the larynx. A delicate examination is performed using a rigid endoscope equipped with a camera. The instrument is inserted through the mouth without an additional incision in the cervical area. The manipulation usually accompanies laryngeal microsurgery and is performed under general anesthesia.

Fluorescent microlaryngoscopy will require the administration of an additional drug. Sodium fluorescein allows you to assess the condition of the laryngeal tissues based on the varying degrees of absorption of the fluorescent substance. Thanks to innovative technologies, a new endoscopy method has emerged - fibrolaryngoscotch. The procedure is carried out with a fiberscope with a movable flexible end, providing an overview of all parts of the larynx.

I was at an appointment with ringing in my ear. Reception, examination, recommendations - everything is at a decent level. Polite attitude towards clients. Excellent qualification. Thank you for the examination and prescribing medications :-)

Thank you so much for your professionalism, attentiveness, and friendliness! Wonderful doctor.

Shulyak A.A.

Many thanks to Dr. R.D. Aliskandiev for the attentive and qualified treatment of patient Maria Allkins. We also thank Dr. Kinel A.V. With gratitude and respect.

Skobelev family

Thank you very much to a wonderful specialist and attentive person, Laura Azatyan A.S. Such a professional approach, individual in the choice of medications, in making a diagnosis. All her recommendations helped my son Ya. Skobelev a lot. We express our deep gratitude to her and wish her further professional achievements.

Maria Romanikhina

Good afternoon I would like to express my deep gratitude to the ENT doctor at the clinic in Maryino, Maya Maratovna! How afraid I was to do the procedure!.. The doctor calmed me down and did everything absolutely NOT painful, quickly and easily! Without a single hitch or unnecessary movement. Golden hands! Now I will only turn to her with my nose.

I would like to express my deep gratitude to Aliskandiev Rashid Dibirovich not only for his professionalism and knowledge of his business, but also for his sensitive attitude towards his little patients. Thanks a lot! with best wishes in your work and in all your endeavors!

Lysenko Anna

In the spring of this year, I began to experience severe dizziness, the neurologist whom I consulted diagnosed: “benign positional paroxysmal vertigo.” This disease is associated with the ear and does not require drug treatment, you just need to perform a set of exercises that will eventually lead to a complete cure. But doing these exercises turned out to be a big challenge, because... were accompanied by severe attacks of nausea and after stopping the exercises the condition remained terrible for a long time. I couldn’t do them and the dizziness continued. My friend advised me to contact a young specialist otolaryngologist Anatoly Vitalievich Kinel at the IMMA Kurkino clinic. The doctor was very sympathetic to my problem, and... the disease is quite rare, he asked me to make an appointment next time and promised to cure me in one appointment. At the next appointment, the doctor already knew exactly what manipulations needed to be done with my head, and within 10-15 minutes he relieved me of the unpleasant symptoms that had been tormenting me for a very long time. I would like to express my gratitude for your concern, professionalism and individual approach to solving the problem! Sincerely, Lysenko Anna.

Pyatkova Yu.V.

I express my deep gratitude and appreciation to ENT doctor Aliskandiev R.D. Thank you for your attentiveness and your professionalism!

I would like to express special gratitude to ENT doctor Anatoly Vitalievich Kinel for his professional approach to the patient, professional skills, and medical tactics in managing the patient! He is a real specialist! I would like to wish him health, many interesting clinical cases and creative success!!!

This is the first time in my life that I am writing a review... I would like to express my deep gratitude to Evgeniy Evgenievich for his attentiveness and high-quality work. Doctors, of course, are primarily specialists to whom we turn for help, but it is always nice if the doctor is not only a first-class specialist, but also a pleasant person to talk to. My appointment with Evgeniy Evgenievich was easy, despite the fact that I was very afraid. Thank you very much again!

Pinenkova Olga

Good doctor Anatoly Vitalievich Kinel, at least he helped us a lot. I would like to express my gratitude for your attention, understanding, professionalism and responsible attitude towards your business. Calm, polite, attentive, patient. From the first appointment, the doctor established friendly contact with the child and all procedures are carried out with a bang. The prescribed treatment always helps us. We will definitely come again if necessary.

Rykhlinsky N.Ya.

Good afternoon It is extremely rare that I find time to provide feedback on the work of certain specialists in various areas of service provision. Having received assistance in the field of otolaryngologists in your clinic - this is certainly the case when I had to send this letter! My profession requires me to constantly monitor my health, especially with regard to ENT diseases. Unfortunately, over the past 6 months I have had to contact you several times, and each time the reason for returning was the specialists Kinel A.V. and Aliskandiev R.D. THANKS A LOT!!! Correctly, without unnecessary emotions, consistently, and most importantly professionally, the treatment was provided!!! I can say WITHOUT A DOUBT - PROFESSIONALLY!!! After a re-diagnosis of bilateral purulent sinusitis, I underwent inpatient treatment in the 1st city hospital of the UDP of the Russian Federation in the ENT surgery department, where I was observed by HIGH-level specialists, definitely the treatment of the above-mentioned Doctors in your clinic is in no way inferior, and in some places much more correct in my opinion sight!!! Once again, a HUGE THANK YOU to Anatoly Vitalievich and Rashid Debirovich, and of course to you for organizing the process.

25 Mar 2017

Demyanenko Anastasia

I express my gratitude to Anatoly Vitalievich Kinel. He is a very experienced and good doctor. He helped us a lot. We only go to him and recommend him to everyone! Thank you very much.

Today we had a reception. We really enjoyed the consultation. Everything is clear and without unnecessary digressions. I didn’t recommend anything unnecessary for me, a mother on breastfeeding, even for a 6-month-old child. Same. We really enjoyed.