Fiberoptic Endoscopy Research Articles

The Use of Fibrolaryngoscopy in Muscle Tension Dysphonia in Telemarketers

IntroductionMuscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. MethodsWe reported on an observational, analytic, and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. ResultsThe posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior–posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. ConclusionsThe heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.

Stentless endoscopic transnasal repair of bilateral choanal atresia starting with resection of vomer

ObjectivesTo assess the results of a transnasal endoscopic repair of congenital choanal atresia beginning by resection of the posterior portion of the vomer and ending by no stent. MethodsSeven patients with bilateral congenital choanal atresia aged ranging from 3 to 15days were operated upon between June 2009 and September 2011. This transnasal endoscopic approach allowed resection of the posterior portion of the vomer first then the atretic plates and part of the medial pterygoid plate if needed leaving no stent. Postoperative control included office fiberoptic nasal endoscopy. ResultsAdequate functional nasal breathing was maintained in all patients during follow up of 11 to 23months. Apart from one case that complicated by palatal defect, no any other complications were detected. ConclusionThe described technique was proved to be very effective, allowing fast recovery, and one step surgery with early discharge from hospital using neither stents nor nasal packing. Good patency with no reduction in functional quality was also observed.

Prevalence of Gastroesophageal Reflux Disease in Premature Calves

Gastroesophageal reflux (GER) is the presence of gastric contents proximal to the stomach. Pathologic consequences secondary to GER are termed gastroesophageal reflux disease (GERD). The purpose of this study was to determine the prevalence of GER and GERD in premature calves by endoscopic examination. Ten healthy and 51 premature calves were included in the study. All premature calves also had respiratory distress syndrome. Esophagoscopy of premature calves was conducted by fiber optic endoscopy. Abnormalities such as increased saliva, hyperemia, hemorrhage, petechiae, presence of abomasal content in the esophagus, and relaxation of the lower esophageal sphincter (LES) were evaluated by endoscopy. The prevalence of GERD and GER in the premature calves was 55 and 67%, respectively. Hyperemia and hyperemia with hemorrhage or petechiation of the esophageal mucosa were determined by endoscopic examination. Hyperemia was commonly observed in the distal esophageal mucosa, although a few hyperemic areas also were observed in other portions of the esophagus. In addition to these abnormalities, LES relaxation, abomasal fluid in the distal esophagus, abomasal content in the esophagus, and increased saliva also were observed in premature calves with GER. The prevalence of both GER (67%) and GERD (55%) in premature calves was high in the study. Endoscopy provides a practical, rapid, noninvasive, and reasonably accurate method for determining the presence of GER and GERD in premature calves.

Craniofacial morphology and sleep apnea in children with obstructed upper airways: Differences between genders

To correlate sleep apnea with craniofacial characteristics and facial patterns according to gender. In this prospective survey we studied 77 male and female children (3-12 years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch (MA), and vertical growth coefficient (VERT) index. The prevalence of sleep apnea was 46.75% with no statistical difference between genders. Among children with obstructive sleep apnea (Apneia Hypopnea Index - AHI ≥ 1) boys had higher AHI values than girls. A predominance of the dolichofacial pattern (81.9%) was observed. The following skeletal craniofacial measurements correlated with AHI in boys: FD (r(s)=-0.336/p=0.020), MP (r(s)=0.486/p=0.00), and VERT index (r(s)=-0.337/p=0.019). No correlations between craniofacial measurements and AHI were identified in girls. Craniofacial morphology may influence the severity of sleep apnea in boys but not in girls.

Utilidad de la fibrolaringoscopía en la disfonía por tensión muscular en teleoperadores

IntroductionMuscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. MethodsWe reported on an observational, analytic and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. ResultsThe posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior-posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. ConclusionsThe heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.

Reliability of subjective, linear, ratio and area cephalometric measurements in assessing adenoid hypertrophy among different age groups.

To test the validity of four different types of lateral cephalometric radiograph (LCR) measurements as a diagnostic test of adenoid hypertrophy in different age groups of mouth-breathing children. Eighty-six mouth-breathing children (male 54.65%, mean age 7.0 ± 2.2 years) were randomly selected from a hospital population. Adenoid obstruction of the nasopharynx was evaluated by subjective, linear, ratio, and area LCR measurements. Each measurement was compared with flexible fiberoptic endoscopy diagnosis. Kendall correlation coefficients for agreement between tests were ≥ 0.67 and kappa scores were substantial (≥ 0.64). Higher correlation coefficients and agreement values were found in older age groups. When the sample was stratified by age, the 3- to 5-year-old age group showed lower correlation coefficients and agreement strength for subjective, linear, and ratio measurements. The sensitivity of LCR varied from 71% (ratio) to 84% (linear). The specificity varied from 83% (linear) to 97% (ratio). The positive predictive value varied from 88% (linear) to 97% (ratio). The negative predictive value varied from 70% (ratio) to 78% (linear). The validity of each measure was different among the age groups. LCR is a valid method for measuring adenoid hypertrophy in children from 6 to 12 years old. The diagnosis of adenoid hypertrophy, based on LCR measurements, in children with primary dentition (3-5 years old) should be made with caution. The combination of linear and ratio LCR measurements is a reliable screening tool to determine the need for an ear, nose, and throat evaluation.

Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE Classification system

Drug-induced sleep endoscopy (DISE) offers an unique evaluation of the upper airway. After pharmacologic induction of unconscious sedation, it is possible to evaluate endoscopically the structures contributing to upper airway obstruction in sleep disordered breathing. The authors describe DISE techniques and the VOTE classification system for reporting of DISE findings. The VOTE classification focuses on the primary structures that contribute to upper airway obstruction and represents a common language to describe the patterns of obstruction during DISE. The latter can facilitate the scientific evaluation of DISE, including its role in directing treatment.

Drug-induced sleep endoscopy (DISE) for non-CPAP treatment selection in patients with sleep-disordered breathing

Drug-induced sleep endoscopy (DISE) for non-CPAP treatment selection in patients with sleep-disordered breathing

The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients

The main pathological event of obstructive sleep apnea hypopnea syndrome (OSAHS) is the apneic collapse of the upper airways (UA). Frequently, UA collapse occurs at the same time at different section levels. Identifying the site and the dynamic pattern of obstruction is mandatory in therapeutical decision-making, and in particular if a surgical therapy option is taken into account. Nowadays, awake fiberoptic nasopharyngeal endoscopy represents the first level diagnostic technique to be performed in such patients, but recently, the drug-induced sleep endoscopy (DISE) has been introduced to overcome the limits of the awake nasopharyngeal endoscopy. Whatever diagnostic tool we decide to use, one of the main problems encountered is the standardization of the description of the sites and dynamic patterns of UA collapses. In this paper, the authors describe the NOHL classification, which could be applied during awake and sleep endoscopy, and allows a simple, quick, and effective evaluation of grade and patterns of UA collapse, suggesting its application, especially in therapeutical decision-making and in the analysis of surgical outcomes.

Rigid Endoscopic Examination of Neonatal Larynx in OPD as a Screening Procedure

ABSTRACT Objectives/hypothesis To describe a novel method of examination of neonatal larynx, using a 70° rigid 4 mm fiber optic endoscope in OPD as a screening procedure for evaluation of neonatal stridor/hoarse cry. Study design Examination technique and safety profile of a novel method of examination of neonatal larynx in OPD using widely available 70° rigid 4 mm endoscope. Results Ten neonates, underwent laryngoscopy as described below, whose age and weight in kilograms were recorded. The pulse rate, O2 saturation levels and mean arterial pressure were recorded during the procedure to know the effect of the procedure on hemodynamics and respiration of the neonates. Time taken for the procedure for satisfactory view of larynx is also recorded and tabulated. Conclusion The novel method of examination of neonatal larynx using 70° 4 mm rigid endoscope in OPD/ward is a safe procedure and gives excellent view/recording of neonatal larynx in its native anatomical and functional status. How to cite this article Pingili HCR, Kumar SR. Rigid Endoscopic Examination of Neonatal Larynx in OPD as a Screening Procedure. Int J Phonosurg Laryngol 2012;2(2): 74-76.

Upper gi endoscopy in relation with carcinoma stomach

Objectives: To find out Incidence of carcinoma stomach in patients who underwent upper GI endoscopy To identify different pathological conditions in patients who underwent upper GI endoscopy Materials & Methods: A Prospective study was done in seven hundred sixty patients in a period of one and half years in Fishtail Hospital, Gairapatan, and Pokhara, Nepal from April 2008 to September 2010. Findings were analyzed in different forms considering their age, sex, site, and their specific pathology with Microsoft Excel 2007. Most of endoscopies were done as out-patient basis (98%). Local anesthetic (4 % xylocaine gargle) was used before the procedure. Results: This study shows 58% females (M: F-1:1.38) and of 25-45 age groups are mostly affected from Upper G. I. problems. Commonest finding was gastroduodenitis (28.9%) and in 1.57% carcinoma stomach was detected. Conclusion: Fiber-optic endoscopy is a safe and commonly used investigation. It is important that all personnel under taking this procedure are adequately trained and that resuscitation facilities are always available.

Etiopathogenesis, diagnosis, staging and preoperative preparation of patients with gastric cancer

The gastric cancer is, after colon cancer, the most common cancer of the gastrointestinal tract. Diagnosis of gastric cancer is usually based on the use of contrasting radiography, fiber-optic endoscopy with biopsy and histologic specimen examination. Proper diagnosis is very important for accurate preoperative tumor grading and selection of surgical intervention. The proper determination of the degree of advanced malignancy is of great importance for the proper treatment of patients with gastric cancer. Western surgeons use TNM system of classification tumors is given by the American Committee on Cancer (AJ CC), while the eastern surgeons and Japanese use the Japanese classification system which was inaugurated in 1981. Operational resolution of gastric cancer is certainly the main therapeutic procedure in the treatment of this disease. Prior to any operational work, for the successful resolution of operational cancerous lesions require adequate preoperative preparation of patients. In this way we reduce the number of postoperative complications.

Learning curves of novice anesthesiology residents performing simulated fibreoptic upper airway endoscopy

Learning curves of novice anesthesiology residents performing simulated fibreoptic upper airway endoscopy

Supraglottoplasty for Occult Laryngomalacia to Improve Obstructive Sleep Apnea Syndrome

To evaluate the polysomnographic outcomes after supraglottoplasty (SGP) performed for obstructive sleep apnea syndrome (OSAS) associated with occult laryngomalacia. Retrospective case series with medical chart review. Tertiary pediatric medical center. Twenty-two patients aged 2 to 17 years met the inclusion criteria of polysomnography-proven OSAS and occult laryngomalacia seen on flexible fiber-optic sleep endoscopy. Infants with congenital laryngomalacia were excluded. Carbon dioxide laser SGP was performed either alone or in conjunction with other operations for OSAS. Preoperative and postoperative nocturnal polysomnographic data were paired and analyzed statistically. Supraglottoplasty for occult laryngomalacia resulted in statistically significant reduction in the apnea-hypopnea index (AHI) (from 15.4 to 5.4) (P <.001). Subgroup analysis of children who underwent either SGP alone or in combination with other interventions showed comparable reductions in AHI. Medical comorbidities were associated with worsened postoperative outcomes, although still significantly improved compared with baseline. Overall, 91% of children had an improvement in AHI, and 64% had only mild or no residual OSAS after SGP. Supraglottoplasty is an effective technique for the treatment of OSAS associated with occult laryngomalacia.

Current status of device-assisted enteroscopy: Technical matters, indication, limits and complications

Enteroscopy, defined as direct visualization of the small bowel with the use of a fiberoptic or capsule endoscopy, has progressed considerably over the past several years. The need for endoscopic access to improve diagnosis and treatment of small bowel disease has led to the development of novel technologies one of which is non-invasive, the video capsule, and a type of invasive technique, the device-assisted enteroscopy. In particular, the device-assisted enteroscopy consists then of three different types of instruments all able to allow, in skilled hands, to display partially or throughout its extension (if necessary) the small intestine. Newer devices, double balloon, single balloon and spiral endoscopy, are just entering clinical use. The aim of this article is to review recent advances in small bowel enteroscopy, focusing on indications, modifications to improve imaging and techniques, pitfalls, and clinical applications of the new instruments. With new technologies, the trials and tribulations of learning new endoscopic skills and determining their role in the diagnosis and treatment of small bowel disease come. Identification of small bowel lesions has dramatically improved. Studies are underway to determine the best strategy to apply new enteroscopy technologies for the diagnosis and management of small bowel disease, particularly obscure bleeding. Vascular malformations such as angiectasis and small bowel neoplasms as adenocarcinoma or gastrointestinal stromal tumors. Complete enteroscopy of the small bowel is now possible. However, because of the length of the small bowel, endoscopic examination and therapeutic maneuvers require significant skill, radiological assistance, the use of deep sedation with the assistance of the anesthetist. Prospective randomized studies are needed to guide diagnostic testing and therapy with these new endoscopic techniques.

Diagnostic endoscopic ultrasonography in the gastrointestinal tract

Endoscopic ultrasonography is a relatively new technology that combines the use of flexible fiberoptic endoscopes with high-resolution ultrasound technology. It proved to be highly accurate and useful in the staging of gastrointestinal malignancies, as well as in characterizing the nature of subepithelial lesions and disorders of the pancreaticobiliary system. In this overview the variety of current evidence based diagnostic options of endoscopic ultrasonography are discussed.

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

IntroductionNasal respiratory obstruction is a very common otolaryngologic problem, often caused by adenoid hypertrophy (AH). Nasal fiberoptic endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. ObjectiveThe aim of our study was to analyze the diagnostic value of rhinomanometry after nasal decongestant (ND) test for the evaluation of adenoid hypertrophy in children. Materials and methodsSeventy-one of 97 collaborative children, aged 6–12 years, affected by upper airways obstructive symptoms and diagnosed as ‘chronic oral breathers’ by a standardized questionnaire were included in the study. The first evaluation included a complete physical examination, anterior rhinoscopy and anterior active rhinomanometry. Patients with a positive rhinomanometry underwent a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using nasal fiberoptic endoscopy (NFE). ResultsAt rhinomanometry a normal nasal airflow was found in 19 (26.8%) of children while nasal obstruction was underlined in 52 (73.2%). These patients were tested also with rhinomanometry after ND which confirmed the presence of nasal obstruction in 29 (55.7%) of patients. All patients included in the study underwent a NFE: 34 (47.8%) of them presented severe AH with an occlusion >75% of the choanal opening (grade≥3) and 37 (52.2%) presented no or a mild form of AH (grade<3). When compared to NFE, rhinomanometry test after ND had 82.7% sensitivity and 82.6% specificity. Positive predictive value and negative predictive value were 85.7% and 79.2%, respectively. Two receiver operating characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to rhinomanometry after ND vs NFE. ConclusionsRhinomanometry after ND, compared to rhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children, and it may be helpful to avoid unnecessary surgical procedures in children with temporary nasal obstruction.

Application of Autofluorescence Endoscopy for Colorectal Cancer Screening: Rationale and an Update

As the result of basic researches, several intravital fluorophores have been determined so far in human colorectal tissue. Autofluorescence endoscopy (AFE) can detect slight alterations in their distribution and concentration during the colorectal carcinogenesis process and, thus facilitate noninvasive screening colonoscopies without the need for fluorescent substances or staining reagents to be administered. While detecting faint autofluorescence intensity by conventional fiberoptic endoscopy remains challenging, the latest AFE system with high-resolution videoendoscope capabilities enables such detection by using a false-color display algorithm. To this end, the diagnostic benefits of AFE have been reported in several multicenter randomized controlled studies of colorectal cancer (CRC) screening and differential diagnosis. CRC screening using the latest AFE technology could, therefore, lead to future reductions in CRC mortality.

Importance of ENT assessment in stratifying candidates for sinus floor elevation: a prospective clinical study

The aim of this article was to describe our experience in the field of preoperative ear, nose and throat (ENT) assessment in each candidate for (maxillary) sinus floor elevation (SFE) after the introduction of a systematic protocol. The protocol evaluates the sinus compliance by means of ENT preliminary examination with nasal fiberoptic endoscopy to identify all of the situations that may predispose to post-lifting complications, i.e. potentially irreversible (PIECs) and presumably reversible (PRECs) ENT contraindications to SFE, and to evaluate its impact on SFE success. Patient candidates for SFE were carefully assessed by means of case-history collection, complete ENT evaluation with nasal fiberoptic endoscopy and imaging to detect PIECs, PRECs, or no ENT contraindications for SFE. In case of PRECs, SFE was postponed until complete clinical recovery. Impact of preoperative ENT assessment on SFE outcome was assessed by means of post-lifting telephonic interview and ENT evaluation. PRECs were detected and resolved before SFE was performed in 38.2% of our 34 patients; no intra- or post-lifting complications occurred in the patients with no ENT contraindications or PRECs. The results of the study suggest that a careful multi-tasking preoperative management, including an ENT assessment with fiberoptic endoscopy and a radiological evaluation extended to the ostio-meatal complex, is very useful in candidates for SFE.

Laryngoscopy: time to shed fresh light?

Laryngoscopy: time to shed fresh light?