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Pharyngoscopy
Last reviewed: 25.02.2021
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The standard procedure for examining the pharynx - pharyngoscopy - is performed by an otolaryngologist to determine its condition and diagnose diseases.
Types of pharyngoscopy
Depending on the localization of the examination of the parts of the pharynx - upper (nasal), middle (oral) or lower (laryngeal) - there are types of pharyngoscopy.
Oropharyngoscopy, upper pharyngoscopy or mesopharyngoscopy involves examining the oral part - the oropharynx.
Examination of the nasal part (nasopharynx) and its distal parts is called epipharyngoscopy or posterior rhinoscopy, which can be indirect and straight.
With hypopharyngoscopy (called indirect laryngoscopy), the lower part of the pharynx - the hypopharynx, that is, the laryngopharynx - is examined.
Today, pharyngoscopy is also performed using a pharyngoscope, which is an electronic fiber-optic device equipped with a camera that transmits an image to a monitor. Modern endoscopic pharyngoscopy makes it possible to examine all parts of the pharynx and the upper part of the respiratory tract. For example, its application allows you to find out the anatomical causes of snoring and obstructive sleep apnea and decide how to get rid of this problem.
Indications for the procedure
Pharyngoscopy is an integral part of the study of the pharynx , and the indications for its conduct may be complaints: perspiration and sore throat (aggravated by swallowing); feeling of a lump (foreign body) in the throat and difficulty swallowing; hoarseness or nasalness; dryness and burning in the nasopharynx; difficulty breathing through the nose.
In the same cases, as well as in acute respiratory diseases and acute respiratory viral infections, pharyngoscopy is performed on the child.
The presence of the listed symptoms is characteristic of many acute and chronic diseases of the pharynx , and it is impossible to establish the true cause of the patient's complaints without visual examination.
If an otolaryngological disease is suspected, pharyngoscopy reveals acute and chronic inflammatory processes in the mucous membrane of the pharynx, as well as pathologies of the tonsils, problems with the vocal cords, stenosis and neoplasms of the laryngopharynx. [1]
Technique of the pharyngoscopy
The most common type of pharyngoscopy performed by otolaryngologists, therapists and pediatricians is oropharyngoscopy, and the technique for conducting this examination is simple.
The doctor needs a pharyngoscopy spatula and good lighting. ENT doctors use artificial lighting and a head reflector - a round mirror that reflects light with a hole in the center.
The patient should open his mouth wide (and breathe through his nose), after which the doctor presses the back of the tongue down with a spatula and examines the walls of the oropharynx, palatine arches and tonsils. By pressing on the arch of the palatine tonsil (tonsil), the presence of the contents of its crypts is checked. And in order to raise the lateral lingual-supraglottic folds for better visualization of the pharynx (entrance to the pharynx), as well as to determine the degree of mobility of the soft palate, the patient is asked to say "ah-ah". [2]
If the patient has an increased gag reflex, the posterior pharyngeal wall is sprayed with an anesthetic spray containing lidocaine.
When examining the nasopharynx through the mouth - indirect epipharyngoscopy (posterior rhinoscopy) - use nasopharyngeal mirrors of various diameters, having a long handle, and a spatula. Also, examination of the nasopharynx can be carried out through the nose - by direct epipharyngoscopy using a flexible endoscope, before the introduction of which the nasal mucosa is treated with an anesthetic solution. In this way, pharyngoscopy of the adenoids is carried out - the pharyngeal (adenoid) tonsil located in the posterior wall of the nasopharynx .
The algorithm for conducting pharyngoscopy of the lower part of the pharynx (hypopharyngoscopy) is somewhat different from the types of examination already mentioned. With indirect (mirror) hypopharyngoscopy, a laryngeal mirror is used, and the examination is performed with the tongue sticking out of the mouth, which is held and slightly pulled forward (using a gauze napkin, this can be done by a doctor or an adult patient). The doctor focuses the light with the frontal reflectors and introduces the laryngeal mirror. For direct hypopharyngoscopy, a directoscope mirror is used. [3]
Pharyngoscopic signs of some diseases
Pharyngoscopy for angina (acute tonsillitis) visualizes the mucous membrane of the walls of the middle part of the pharynx (which is often called the throat), uvula (uvula) and palatine tonsils.
Pharyngoscopic signs of catarrhal sore throat include: pronounced redness and enlargement of the palatine tonsils, swelling of the arches, the presence of focal infiltrates or fibrinous film on the tonsils.
The most characteristic pharyngoscopic signs of follicular tonsillitis: hyperemia and swelling of the tonsils and arches, tonsillar fossa and soft palate; the presence on the tonsils of a large number of rounded yellowish-white (the size of a match head) suppurating lymphoid follicles.
Explicit pharyngoscopic signs of lacunar tonsillitis are manifested in the form of the same hyperemia and edema of the tonsils, as well as the presence of a yellowish-white plaque on them and accumulation of pus in their lacunae (crypts).
Pharyngoscopic signs of acute pharyngitis / exacerbation of chronic pharyngitis are intense hyperemia and swelling of the pharyngeal mucosa (often tonsils, arches and uvula) and serous plaque on the tonsils.
Pharyngoscopic signs of a pharyngeal abscess - accumulation of pus in the pharyngeal space at the level of the upper and middle parts of the pharynx - can be visualized as focal redness of the mucous membrane of the posterior pharyngeal wall and its protrusion. When a retropharyngeal abscess is localized at the level of the hypopharynx, diagnosis is carried out by X-ray or CT of the neck.
Complications after the procedure
Usually, there are no consequences and complications after examining the larynx. But an allergy to local anesthesia is not excluded, as well as a reaction in the form of a gagging pharyngeal reflex - if the spatula was inserted too deeply and affected the root of the tongue innervated by the glossopharyngeal nerve.
Reviews
Reviews of doctors and patients regarding pharyngoscopy, as the main objective method of clinical research in otolaryngology, confirms its important role in the diagnosis of various diseases.