Laryngeal Exam Direct Laryngoscopy
Rhinolaryngoscopy
Nasopharyngoscopy

Indications
Hoarseness evaluation
Persistent Hoarseness beyond 2 weeks
Higher risk for Laryngeal Neoplasm
Tobacco abuse
Alcohol Abuse
Associated symptoms
Dyspnea
Laryngeal pain
Aspiration
Dysphagia
Chronic Problems
Chronic Sinusitis
Chronic Serous Otitis Media
Recurrent Otalgia
Chronic Cough
Chronic Rhinorrhea
Chronic nasal obstruction
Acute Problems
Hemoptysis
Acute Sinusitis
Suspected Nasal Foreign Body


Complications
Laryngospasm (if scope were to touch larynx)
Epistaxis


Preparation
Patient gently blows nose
Mix Topical Decongestant with Lidocaine
Phenylephrine (0.25% to 2%)
Lidocaine 2 to 4% (4% preferred)
Spray or apply intranasally in least obstructed naris
Wait 5-10 minutes


Technique
Patient sits upright with head slightly forward
"Sniffing" position
Consider applying K-Y jelly to shaft of scope
To defog scope
Defogging solution OR
Mucus from nose also defogs lens
Swallowing will clear lens of mucus (may cause gag)
Patient should breath through nose to keep nares open
Patient repeatedly says "K" to elevate Soft Palate
Also opens eustachian tube
Patient protrudes Tongue to visualize vallecula
Cord Movement
Patient repeatedly says "E" to view cord movement
Patient takes deep breath to see full abduction


Landmarks
Nose
Inferior Meatus
Nasolacrimal ostia
Middle Meatus (Osteomeatal complex)
Frontal sinus ostia
Anterior ethmoid sinus ostia
Maxillary sinus ostia
Superior Meatus
Posterior ethmoid sinus ostia
Above superior meatus
Sphenoid sinus ostia
Nasopharynx
Torus tubarius
Eustachian tube ostia (encased in torus tubarius)
Rosenmuller's fossa
Cleft posterior to torus tubarius
Common site for nasopharyngeal cancer
Adenoids
Posterior to torus tubarius
Oropharynx
Epiglottis
Vallecula
Tongue base (lingual tonsil)
Hypopharynx and Larynx
Central Larynx
False vocal cords
True vocal cords
Ventricle (between true and false cords)
Posterior Larynx
Piriform sinus
Corniculate and Cuneiform cartilage
Contiguous "lumps" on aryepiglottic folds
Aryepiglottic fold


Findings
Nose
Nasal Foreign Body
Acute Sinusitis
Septal perforation
Septal abscess or Septal Hematoma
Nasal polyp
Oropharynx
Obstructive airways (Sleep Apnea)
Large adenoids
Large lingual tonsils
Larynx
Smoker's Laryngitis
Laryngeal Nodule
Laryngeal Polyp
Laryngeal contact ulcer
Laryngeal Neoplasm
Laryngeal granuloma
Reflux Laryngitis


Equipment care
Avoid bending scope into tight angles
Clean lens with lens cleaner and paper
Soak in glutaraldehyde for 20 minutes
Rinse scope of cleaning solution
Hang up to dry


CPT Codes
31575 Nasolaryngoscopy
92511 Diagnostic Nasopharyngscopy with endoscope
99070 Supplies and disinfection charge