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Flexible Nasopharyngoscopy:-



Description and structures being viewed

The flexible nasopharyngoscope is in the right nostril of this patient. The middle partition (septum) of the nose is seen on the right and the inferior turbinate is seen on the left. This structure has the ability to swell and block the nose.



We are at the back end of the nose and can just make out the soft palate on the bottom.



We are now behind the nose in the “nasopharynx”. The telescope is looking down into the area behind the tongue and straight down into the voice box and the wind pipe ( Trachea).



Further down, nearing the voice box, we can see the rough surface of the back end of the tongue (4-7 O’clock position). The leaf like structure roughly in the middle is the “epiglottis”. Under cover of this lies the voice box (larynx).



Going further down towards the voice box, we see the epiglottis ( at the bottom of the picture, at the 4-7 o’clock position).The larger flat area at the top of the picture is the “posterior pharyngeal wall” or the back wall of the food pipe. This is the wall we normally see on saying a wide ‘Ahhh” in front of the mirror. In the middle the “V” shaped structure is the opening of the voice box. The dark line running across horizontally from the 3 O’clock to the 8 o’clock position is the opening of the food pipe (oesophagus) which normally remains closed as it is here.



The patient is asked to say “eee” and the vocal cords are seen to come close to each other. The vocal cords are the two whitish cords seen in the middle.



The patient is asked to take a deep breath and the vocal cords move furthest away from each other. The space opened up leads straight down into the wind pipe.



The upper end of the wind pipe is clearly seen. The thick pinkish band at the top of the picture running across horizontally from the 2 o’clock position to the 9 o’clock position is composed of the two small pieces of cartilage which drive the vocal cords. One is located at each end back end of the vocal cord. The intervening part which walls off the back part of the voice box opening is called the “interarytenoid area”. In case of acid reflux from the stomach, this area and the arytenoids on either ends of the vocal cords get swollen or congested.



The examination ends with a gentle withdrawal of the telescope.




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