Nasopharyngeal laryngoscopy examination

Hello everyone, namaste
Today I would like to share some information regarding the diagnostic nasal endoscopy. The procedure is well know and flexible nasopharyngeal laryngoscopy ( NPL) , most common procedure I do to my patients in my outpatient clinic settings.
NPL simply uses a flexible endoscope that passes through the patient's nasal cavity, then to the nasopharynx and upto the hypopharynx to visualize the upper airway.

Procedure
The patient is first positioned sitting on the chair and topical local anaesthetic solution in instilled. Then the scope is passed via the nostril. It involves three passes:
First pass
In first pass, the scope is introduced along the floor of the nasal cavity to visualize the structures like nasal septum, inferior meatus and turbinates, nasopharynx, fossa of rosenmuller and the eustachian tube orifices.

Second pass
I'm second pass, the scope is introduced along tha nasal floor and on reaching the choana, it is angulated upwards to visualize the nasal roof l, superior turbinates, superior meatus, opening of the sphenoid sinus and the sphenoethmoidal recess.
Third pass
In third pass, the scope is passed beneath the middle turbinate to visualize the middle meatus and the osteomeatal complex. Any secretions, polypoidal mucosa and masses are looked.

As we introduce the scope along the nasal floor, the nasal septum and the inferior turbinates are seen first.

Image after the scope has reached the nasopharynx. Here we can see the congested nasopharyngeal mucosa. It is free of any masses. We can seen the eustachian tube orifice, fossa of rosenmuller, posterior end of inferior turbinate and the nasopharynx

Here we can see the lateral pharyngeal wall, the right pharyngoepiglottic fold and the base of tongue which looks healthy devoid of any masses, secretions and tumors.

Here we can see the glottic opening. Bilateral arytenoids, true and false vocal cords and the laryngeal ventricles are visible.

In addition to the above structures, the bilateral pyriform fossa are also visible which looks healthy.

A more close and magnified view of the glottis

So, this NPL procedure is a simple office based procedure that an ENT surgeon uses most commonly in the out patient setting. If you have any curiosity regarding this procedure we can discuss in the comment section. Feel free to ask

All images are mine clicked with consent from the patient and patient party. Thank you all.

References:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC6857406/
2. https://medlineplus.gov/ency/article/007507.htm
3. https://onestophospital.co.uk/treatments/nasal-endoscopy-and-laryngoscopy/