Intranasal Scope Negotiation Trajectories for Flexible Nasopharyngolaryngoscopy

Abstract

Background and objectives: Flexible nasopharyngolaryngoscopy (F-NPLS) is a routine procedure performed in office settings. We compared two different intranasal scope navigation techniques used during F-NPLS, evaluating patient comfort and practitioner satisfaction.

Methods: This is a prospective, randomized, parallel-group controlled study. Patients undergoing F-NPLS to evaluate the upper airway were enrolled and randomized into two study groups. Patients in group A underwent intranasal scope negotiation following a trajectory below the middle turbinate; for group B, a trajectory along the inferior turbinate was used. The primary outcome evaluated was the successful, unhindered negotiation of the scope on the first attempt. Secondary outcomes included patient-perceived pain, incidents of mucosal trauma and bleeding, and the frequency and necessity of repeat scopy.

Results: In total, 111 patients were randomized into group A (n=53) and group B (n=58). Baseline characteristics, such as age and sex, were similar in both groups. There was no statistically significant difference between the groups with respect to the primary outcome (group A: 52.8% vs. group B: 55.2%, p=0.8). The frequency of F-NPLS without episodes of mucosal trauma was significantly higher in group B (group A: 56.9% vs. group B: 35.9%, p=0.004). Mucosal ecchymosis was a common finding in group A (group A: 41.5% vs. group B: 13.8%, p=0.03), while nasal bleeding was more frequently observed in group B, although the difference was not statistically significant (group A: 29.3% vs. group B: 22.6%, p=0.42).

Conclusion: The present study demonstrated that the success rate of unhindered F-NPLS was comparable between the two trajectories. However, patients experienced moderate to severe pain during repeat scopy compared to the initial F-NPLS attempt.

Keywords: Endoscopic surgical; Laryngoscopy; Nose; Pain.

Fig. 1.

Diagrammatic representation of the lateral nasal wall, showing the intranasal trajectories of F-NPLS. The black track indicates the “below middle turbinate” trajectory, while the red track shows the “along the inferior turbinate” trajectory.

Fig. 2.

Endoscopic still images of group A captured during F-NPLS via the “below middle turbinate” trajectory at three landmarks: at the nasal vestibule (A), below the anterior end of the MT (B), and below the posterior end of the MT, showing the NP (C). S, septum; MT, middle turbinate; NP, nasopharynx.

Fig. 3.

Endoscopic still images of group B during F-NPLS via the “along the inferior turbinate” trajectory at three landmarks: at the nasal vestibule (A), below the anterior end of the MT (B), and below the posterior end of the MT, showing the NP (C). S, septum; MT, middle turbinate; NP, nasopharynx.

Fig. 4.

Comparison of unhindered flexible nasopharyngolaryngoscopy (F-NPLS) during the first attempt between both trajectories.

Fig. 5.

Distribution of pain score by mucosal injury type (A) and by number of attempts of flexible nasopharyngolaryngoscopy (F-NPLS) (B). VAS, visual analog scale.