Otorhinolaryngology

Otorhinolaryngology is the branch of medicine that deals with the prevention, diagnosis and both medical and surgical treatment of disorders affecting the head and neck region, i.e., the ears (hearing and balance), nose (breathing and sleep apnoea) and throat (voice and swallowing), including, for example, the surgical treatment of the thyroid and parathyroid glands, as well as the medical and surgical treatment of the tonsils, base of the skull, mouth, tongue, salivary glands, tumours of the neck and facial region, etc. Although these various areas may seem unrelated, it is common for them to be jointly affected by the same pathological process, be it infectious, tumour, traumatic or other, which is why they are treated by a specialist known as an ENT surgeon.

Nasal fibroscopy (also known as “rhinoendoscopy” or “nasopharyngoscopy”) is a method used during a common outpatient ENT examination, which allows for the medical assessment of the inner tissue of the nose, nasopharynx and soft palate, in suspected cases or the monitoring of many of the conditions that can affect the first tract of the upper airways (in particular, the nasopharyngeal district) in adults and children.

Since the development of the first rigid endoscope for enlarged viewing of the nasal cavities by Harold H. Hopkins of the Imperial College London (UK) in 1960, nasal endoscopy has allowed for a radical change to the surgical approach required, for example, for the treatment of chronic sinusitis or nasal polyposis, making it possible to switch from procedures that are destructive and extremely taxing for the patient, to minimally invasive interventions such as Functional Endoscopic Sinus Surgery (FESS).

Nasal endoscopy can be performed with a rigid endoscope or a flexible nasopharyngoscope. Both of these devices consist of a small-diameter tube, connected to a camera, that is inserted into the nasal cavities through the nostrils and moved in different directions and angles in order to obtain as complete and accurate a view of the inner tissues of the nose as possible, first reaching the nasopharynx (the region between the nose and the throat) and then the pharynx and larynx.

The examination requires no anaesthesia and is painless; the procedure takes about 10 minutes.

Fibrolaryngoscopy can be performed without any specific preparation.

The patient can drink and eat without restriction both before and after the procedure.

These methods, using either a flexible nasopharyngoscope or a rigid endoscope, have become essential means of assessment for the study of the principal pathologies of the nose (turbinates, polyps, sinusitis), of the nasopharynx (adenoids etc.), of the hypopharynx (conditions affecting the base of the tongue and the epiglottis) and of the larynx (nodules, polyps, dysphonia, etc.).

The procedure not only provides an accurate view of the nasal passages, nasopharynx and larynx so as to highlight all the main pathologies affecting these parts of the anatomy, but is also particularly suited to the study of all types of dysphonia (voice disorders) as it allows the movement of the vocal cords to be observed while the patient uses their voice naturally, without the specialist having to pull the tongue, as is the case with indirect laryngoscopy (i.e. a classic form of examination with a mirror).

The careful study of chordal motility and morphology is often decisive in assessing the chances of successful corrective logopaedic treatment in forms of both “functional” and “organic” dysphonia.

Fibrolaryngoscopy plays an equally fundamental role in the study of all pathologies that may cause habitual snoring and the much more serious sleep apnoea syndrome (OSAS).

Nasal endoscopy with rigid endoscopes is particularly indicated in postoperative check-ups and/or during pharmacological treatment.