Clinical Skills

Flexible Nasendoscopy

In this station you may be asked to perform a flexible nasoendoscopy examination on a mannequin, which may have pathology. You may also be asked to draw a larynx and answer questions around the clinical skill. 

Equipment

  • Flexible nasoendoscope

  • Light source

  • Alcohol wipe for tip

  • Lubricating jelly

  • Tissue for patient


Procedure

  • Introduce self, check patient’s identification, obtain verbal consent, apply hand gel, ask about pain

  • Obtain verbal consent: Explain to the patient that the examination is not painful but may be uncomfortable and may cause them to sneeze, gag, bleed and eyes water.

  • Focus scope

  • Lubricate end

  • Apply alcohol swab to tip

  • Perform anterior rhinoscopy –  ask which nostril is better

  • Offer local anaesthetic spray, check allergies if so

  • Advance scope

  • Structures looking at

    • Base of tongue / Vallecula / Posterior pharyngeal wall and lateral pharyngeal wall / Epiglottis – both sides /Arytenoids / Aryepiglottic folds / Piriform fossae /False cords / True cords – anterior commissure, symmetrical, mobile /Subglottic space

  • Looking for

    • Symmetry

    • Motion surface architecture evidence of masses or inflammation

    • Cords – mobile, symmetrical

    • Pooling of saliva

  • Explain positive and negative findings to patient

  • Advise further management

  • If used local anaesthetic, advise the patient not to eat or drink for next 30-45 minutes

  • Clean scope and record findings

 

Knowledge

Indications

  • To examine the nasal cavity e.g. evaluate sinonasal symptoms, epiphora, unilateral nasal disease

  • To examine the larynx/pharynx and assess vocal cord movement

No absolute contraindications

  • Caution in patients with bleeding tendencies

  • Risk of vasovagal in anxious patient or those with cardiovascular disease

Documentation for nose exam

  • Mucosal surface – moist, dry, telangiectasia, crusting/perforation

  • Mucosal colour – pink, hyperaemic, pale

  • Pus – presence of abscess, location

  • Secretions – viscous, thin, bloodstained

  • Turbinates – swollen, absent, adhesions

  • Anatomical variations – septal deviations, spurs, concha bullosa, accessory ostia, evidence of prev surgery

Documentation of a larynx

  • You may be asked to draw a diagram of a larynx. There are many different ways to draw this so ensure that you label the diagram including which part is anterior, posterior, left and right.


What is in the local anaesthetic spray?

Co-phenylcaine – Lidocaine Hydrochloride 5% w/v and Phenylephrine Hydrochloride 0.5%