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Goal For The Day

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. General Goal #1. Familiarity with equipment endoscope(s),

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Goal For The Day

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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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