Nasal endoscopy (for cleft palate patients with velopharyngeal dysfunction)

鼻內窺鏡檢查是甚麼？
Nasal endoscopy is suitable for cleft palate patients with velopharyngeal dysfunction, allowing a doctor to examine the nose, pharynx, larynx and other areas.

What is a nasal endoscopy?
A nasal endoscope is a thin, flexible fibre optic tube fitted with a light source and lens that allows a doctor to clearly see the inside of a patient's nose, pharynx and larynx.

Who needs to have a nasendoscopy assessment of their speech ability?
For patients with impaired speech due to a cleft palate or velopharyngeal insufficiency, such as hypernasality, nasendoscopy allows for a detailed, real-time assessment of the condition.
Additionally, if a doctor suspects damage to the pharynx or tonsils (e.g., nasal polyps, persistent nosebleeds, or foreign objects lodged in the nasal cavity or throat), a nasal endoscope can be used for examination.

Other examination methods for jaw pharyngeal closure insufficiency

1. Subjective assessment of speech: This examination provides no information on the structure of velopharyngeal closure and is therefore of no use for subsequent surgical planning.
2. Videofluoroscopic swallowing study: An imaging examination using X-rays to provide images of dysphagia from another angle.
3. Dynamic MRI: This examination does not use radiological contrast techniques and can dynamically reflect the velopharyngeal closure in real-time, but the availability of this service is limited.

Inspection procedure
The doctor will administer a local anaesthetic to the patient's nostril. The patient will be seated upright, and the endoscopy technician will insert the nasendoscope into one of the nostrils; the entire procedure will take approximately 10 to 15 minutes.
If a nasal endoscopy is clinically indicated to assess velopharyngeal insufficiency, a speech and language therapist is usually present. The patient may be asked to make specific sounds and say certain words or sounds during the assessment.

Risk
Common complications

1. Slight mucosal bleeding (usually stops on its own)
2. Slight soreness in the nasal passages and throat.
3. Sneezing (usually stops after the nasal endoscope is removed)

Severe rare complications
Damage to the respiratory and digestive tracts

Contraindications
There are no absolute contraindications for nasal endoscopy.

1. Patients taking blood thinners or who have structural abnormalities of the body should consult their doctor before undergoing the procedure.
2. As this procedure must be performed with the patient awake (without sedation), it may not be suitable for young children (under five years of age).

Preparation for inspection
Before commencing the procedure, informed consent must be obtained from the patient/parent of a minor. The doctor will administer local anaesthesia by inserting cotton swabs soaked in lignocaine (or a similar local anaesthetic) into the patient's nostrils for several minutes.

Aftercare
Patients must not drink or eat hot beverages or food for the first 30 minutes after the procedure, before the local anaesthetic wears off. Some patients may experience slight mucosal bleeding after the procedure, and they should avoid blowing their nose forcefully.

Follow-up appointment
Doctors and speech therapists will jointly watch the nasal endoscopy video footage and make appropriate follow-up arrangements (e.g. speech therapy, surgical treatment, etc.).

Notes
This leaflet is for reference only and does not include all possible complications. Other unforeseen complications may occur. Actual risks may vary for certain patient populations. Please contact your doctor for more information.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/paedsurg_nasoendoscopyforvelopharyngealdysfunctionincleft_0330_chi.pdf