Clinical objective research methods in the field of otolaryngology play a significant role in diagnosing various diseases. These ways of visualizing the pathology are valued for the lack of invasive intervention. One such method of examining ENT organs is pharyngoscopy.
What determines the pharyngoscopy
This research method helps the specialist to discover the following pathology data:
- development stage;
- localization of pathology;
- variety.
So, in the presence of a patient with tonsillitis, through pharyngoscopy, the doctor fixes the swelling of the pharyngeal mucosa, palatine tonsils, their enlargement. On the back wall of the pharynx, the specialist visualizes the formed small grains, a yellowish-white coloration( this is characteristic of the follicular stage of the disease).
If the patient has lacunar angina, plaque can be detected, the presence of purulent exudate. If you remove the spatula with a spatula, the bleeding will not begin.
If the patient develops pharyngitis, the doctor will see on the palatine tonsils ulcers, serous raid. It is possible to bleed when removing such a plaque with a spatula.
In the presence of a pharyngeal abscess, the patient shows a protrusion of the mucosa in the region of the posterior pharyngeal wall( closer to the right side).
Structure of the pharynx
Indications
Indications for which the doctor can prescribe pharyngoscopy may be the assumption of the presence, progression in the patient of various diseases of the ENT organs, tumor processes, various anomalies, foreign matter. For each type of examination there are special indications.
Rear rhinoscopy is prescribed with:
- to an external object inside the nasopharynx;
- inflammation of the mucosa of various organs of the nasopharynx( arch, khohan, walls, auditory tubes);
- pathologies of nasal tonsils;
- abnormalities in the development of the nasopharynx, the holes of the auditory tubes, nasal khohans.
For oropharyngoscopy, the specialist usually directs if:
- has an external object inside the oropharynx;
- sore throats;
- of various types of abscess( tonsillar / paratonsillar);
- anomalies, manifested in different structures of the oral cavity, pharynx.
- inflammation of the investigated area( gingivitis, glossitis, pulpitis, pharyngitis, uvulitis, tonsillitis, stomatitis);
- hypertrophy of palatine tonsils;
- tumors of the investigated area.
This imaging technique can be assigned to assess the crypt content of the tonsils.
With regard to indirect laryngoscopy, it is prescribed by a specialist with the assumption that the patient has
- laryngeal narrowing;
- abnormalities of various organs;
- tumors in the field of examination;
- inflammation of the lingual tonsil;
- pathology of the vocal cords;
- of the retropharyngeal abscess;
- is a foreign object inside the larynx, larynx, pear-shaped twists;
- inflammatory diseases of the larynx, mucous lateral walls of the pharynx, epiglottis.
Types of
In practice, ENTs can use several different types of pharyngoscopy. The choice of the appropriate method is performed taking into account the pharyngeal region in which there is a violation. The pharynx is divided into 3 parts:
- nasopharynx;
- oropharynx;
- the laryngopharynx.
For the examination of each of these departments, respectively, such research methods are used:
- posterior rhinoscopy;
- mesopharyngoscopy;
- hypopharyngoscopy.
Upper
To perform visualization of the nasopharynx the doctor needs a medical instrument - a mirror( nasopharyngeal), spatula. To prevent the occurrence of unpleasant sensations in the patient during the examination, the doctor warms up the medical instrument with warm water before the procedure.
Average
Oropharyngoscopy is considered the most popular method of pharyngoscopy. It is carried out by means of a reflector. Usually, when performing this method of examination, the doctor needs a spatula, good lighting, which can be artificial, natural.
Lower
The examination is carried out by a specialist using a medical instrument - a guttural mirror. To ensure that the subject does not experience any discomfort, this tool must be preheated.
This diagnostic method enables the otolaryngologist to assess the state of such areas: lingual tonsil, tongue root, vocal cicle, pear-shaped twists, the initial part of the trachea, vocal cords, mucous laryngopharynx, epiglottis.
How the endoscopy of the pharynx is performed, see in our video:
Types of
There are three types of examination that we consider( back rhinoscopy, mesopharyngoscopy, hypopharyngoscopy).Each of them is used to examine a specific area of the oral cavity. Let's consider each of them in more detail.
Rear Rhinoscopy
This survey method promotes visualization of the vault, apertures of the auditory tubes, nasal khohans, side walls of the nasopharynx, tonsil nose.
This type of examination is usually prescribed for detection:
- of an alien body;
- anatomical features, malformations of formation of eustachian tubes, nasopharynx, hoan nose;
- pathology of the nasopharyngeal tonsil;
- inflammation on the mucous membranes of the nose, eustachian tubes, nasopharynx.
The examination does not last long( 1 - 2 minutes).To insert a special mirror inside the throat, the specialist must press down the root of the tongue downwards with a spatula. Mirror placed inside should be very carefully, so as not to touch randomly different structures of the pharynx, because this will provoke vomiting. Breathing during the procedure, the patient should perform only with his nose.
Mesopharyngoscopy
This method of examination is considered the most frequently prescribed in ENT practice. It is used not only by otolaryngologists, but also by other specialists( therapists, pediatricians).
This procedure is performed if:
- pathology of palatine tonsils;
- inflammation of the oral mucosa, throat;
- of tonsillar, paratonlesillar abscess;
- of a foreign object inside the nasopharynx;
- defect of the oropharynx, oral cavity;
- tonsillitis;
- in the oropharynx.
The examination is carried out by means of a spatula, the ENT pushes the root of the tongue downwards. Performing an examination, the specialist draws attention to the condition, color of the mucosa of all areas of the mouth, tongue, palatine tonsils, gums, palate( hard / soft), throat walls.
To examine the contents of the crypts of the palatine tonsils, the specialist gently presses on the anterior arch of the amygdala. This squeezes the contents of the crypt. To correctly assess such an indicator as mobility of the soft palate, the doctor asks the examinee to pronounce the letter "A".
Hypopharyngoscopy or indirect laryngoscopy
Indirect laryngoscopy is performed to examine the larynx. For the survey, you need a guttural mirror, a source of lighting. Reasons for the appointment of visualization are:
- stenosis of the larynx;
- presence of foreign body;
- pathology of the tonsils;
- abnormalities of the vocal cords;
- congenital malformations;
- inflammation in the laryngeal mucosa;
- pharyngeal abscess.
On examination, the ENT holds the patient's tongue with fingers( while using a napkin).The doctor pulls the subject slightly forward, and down.
The patient's breathing during the performance of this examination should be calm, free. It must be done by the nose. Sometimes a specialist asks for the following sounds: "E", "Y".
When the patient has a marked gag reflex, he is irrigation mucous by an agent-anesthetic.
Complications after procedure
Usually, after examination of the larynx, oral cavity, no complications are noted. Occasionally, allergies to local anesthetic agents used in clinics may occur.
How is the visual examination of ENT organs performed in our video:
Contraindications
There are no contraindications for such an inspection.