Flexible Fiberoptic Endoscopy Research Articles

Flexible fiberoptic endoscopy and laser surgery in obliterated cochleas: human temporal bone studies.

The use of conventional drilling procedures in cochlear implant surgery of ossified cochleae poses special risks to the facial nerve and the carotid artery. This study evaluated the alternate use of flexible fiberoptic endoscopy and mid-infrared laser surgery for recanalization of partially and artificially obliterated cochleae in freshly dissected human cadavers. A pulsed Holmium:YAG-laser (lambda = 2120 nm) was used in the free-running mode (1180 mJ, 250 microseconds pulse, 5 Hz). A 660 microns optic quartz fiber was positioned in the center of the round window niche and slowly--endoscopically guided--advanced in contact shooting over 1.5 cm, creating by vaporization and photoablation a passage through the artificial bony occlusion in the basal segment of the cochlea. In all experiments, laser application (110-130 pulses) resulted in complete recanalization of the bony occlusions without damaging surrounding structures. The microendoscopy proved capable of guiding the laser fiber through the curved segment of the basal turn allowing identification of normal bone, bone cement, and laser-treated bone cement. If partial ossification of the basal turn is present, this technique could give access to place analog as well as digital implants deep within the cochlea.

Evaluation of Airway Complications in High-Risk Preterm Infants: Application of Flexible Fiberoptic Airway Endoscopy

We sought to determine factors that would predict the development of subglottic stenosis (SGS) and tracheomalacia (TM) in preterm infants. The utility of a semiquantitative measurement of airway dimensions was assessed in relation to signs of airway complications. We also sought to determine from a high-risk population of infants those likely to have abnormal findings identified by bronchoscopic examination. Prospective airway endoscopy was performed for preterm infants who were intubated for 7 days or more or who demonstrated chronic oxygen needs beyond 28 days after birth and 36 weeks postconceptional age. Subjects were 117 preterm (less than 36 weeks' gestation) infants from two level III intensive care nurseries. Endoscopy was used to classify the type and degree of airway injury. Subglottic stenosis was defined subjectively and compared with an objective measurement using subglottic spatial relations described as a trans-subglottic/vocal cord ratio (TSG/VC). Clinical signs and symptoms and other risk factors were evaluated as significant predictors of SGS and TM, identified by bronchoscopy. Moderate or severe airway abnormalities were identified in 32 patients (27.3%); 13 with SGS, 17 with TM, and 2 with both. All but one infant with TSG/VC less than 0.83 had signs and symptoms of airway dysfunction. Variables more commonly found in patients with SGS included greater number of intubations, use of inappropriately large endotracheal tubes, and longer duration of intubation. Higher averaged mean airway pressure during the first week after birth and lower gestational age were clinical features associated with TM. Flexible bronchoscopic evaluation of a high-risk population demonstrated a higher incidence of moderate or severe SGS or TM than previously suspected. Subglottic stenosis and TM appear to have different etiologies based on different factors associated with their development. The TSG/VC ratio correlated well with obstructive symptoms and may represent a means to quantitate clinically subglottic narrowing. Infants with chronic lung disease who have persistently elevated partial pressure of carbon dioxide, apnea, or phonation abnormalities are most likely to have airway abnormalities identifiable by bronchoscopy.

ＯＳＡＳに対するＫＴＰレーザーの使用経験 舌根正中部切除術

A 31-year-old male with obstructive sleep apnea syndrome was treated with KTP/532 laser midline glossectomy. He had complained of severe snoring and hypersomnolence for 2 years and sleep apnea for 1 year. His apnea index (Al) was 65.0 events/h and the lowest arterial O2 saturation (SaO2) was 44%. Cephalometric analysis and flexible fiberoptic pharyngeal endoscopy during Muller's maneuver indicated that the space-occupying sites responsible for sleep apnea were at two different levels (oropharynx-soft palate and hypopharynx-base of the tongue). The application of KTP/532 laser to midline glossectomy with uvulopalatopharyngoplasty caused slight bleeding but no obvious complications. Postoperative respiratory parameters were greatly improved: Al 5.5 and lowest SaO2 85%. Cephalometric and fiberoptic findings showed an enlarged pharyngeal space at the level of the base of the tongue. Sleep-related complaints disappeared completely.

Endoscopic anatomy and map of the equine bronchial tree.

To develop a bronchoscopic map of the equine respiratory tree, the major airways of the lungs of 6 healthy Thoroughbred horses were systematically explored with a flexible fibreoptic endoscope through a tracheostomy while the horses were sedated in stocks. With the carina as the reference point, measurements were made of distances to the branches of the major airways using markers on the shaft of the endoscope. All branches were explored until the narrowing of their diameters prevented further advancement of the endoscope. Positions of origins of branches from the parent bronchus were recorded in relation to a 12 h clock. Branching patterns of the right and left lungs were similar. Seventeen branches of the principal and caudal lobar bronchi of the left lung, and 18 branches of the principal and caudal lobar bronchi of the right lung were identified. Mean explorable distances from the carina to the ends of the right and left caudal lobar bronchi were 34.0 +/- 3.5 (sd) and 34.5 +/- 3.0 cm, respectively. Generally, smaller horses had shorter explorable bronchial lengths. Branching patterns of the parent bronchi were fairly consistent among horses, particularly the branches closest to the carina. After endoscopy and euthanasia, the lungs were removed, and dried with pressurised air flowing through them for 7-10 days. Attempts to explore the airways of the dried lungs endoscopically were relatively unsuccessful, because airways were much smaller in the dried lungs, and many of the branches were distorted when compared with their antemortem appearances. However, having a dried lung specimen as a reference during the bronchoscopic procedure was useful for maintaining orientation in the lungs. Radiographs were used to estimate the location of the origin and destination of each airway branch in relation to the nearest intercostal space. This makes the airway map useful when lesions identified radiographically are to be lavaged.

An observation of the third ventricle under flexible fiberoptic ventriculoscope: Normal structure

The third ventricle, which is deeply seated in the center of the brain, is one of the most inaccessible regions from which to obtain information before surgery. A new flexible fiberoptic endoscope for examination of the ventricles is presented herein. The main advantages of this new device over existing fiberoptic instruments are the extended flexibility of the tip and its small diameter. Using this endoscope, one can observe the third ventricle in situ in patients with hydrocephalus associated with various lesions. The neural and vascular structures in the inner wall of the third ventricle are also illustrated.

Infection in Endoscopy: Protection of Staff

Increasing use of flexible fiberoptic endoscopy in both diagnosis and therapy of gastrointestinal disease, and recent worldwide concern regarding the transmission of HIV infection of health care workers together with reports of cross-infection of patients of possible epidemic proportions, has led to an increased awareness and reexamination of techniques used for instrument cleaning and disinfection. At the same time, the dangers of exposure of staff to the chemicals used in the these techniques with a measurable morbidity recently has been highlighted.

Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals

Concern is increasing regarding the risk of transmission of blood-borne pathogens by means of improperly reprocessed medical devices. On-site surveys of policies and practices were performed in 18 reprocessing areas in eight randomly selected hospitals in Massachusetts to assess current practices for reprocessing of flexible fiberoptic endoscopes. Manufacturers' and internal written protocols, were reviewed, employees were interviewed, and procedures were observed. Reprocessing included high-level disinfection in 17 of 18 areas, with 16 areas using 2% glutaraldehyde; ethylene oxide gas sterilization was used in one area. Considerable interhospital and intrahospital variability was found in high-level disinfection procedures, including equipment, contact time (range 10 to 45 minutes), disinfectant testing, and rinsing. Disinfection of internal channels was inadequate in three areas, recommended sterilization of biopsy forceps was not performed in five, and written protocols were unavailable in three. Ad hoc deviation from established written or verbal protocols occurred in eight areas during reprocessing of flexible fiberoptic endoscopes from patients known to have AIDS; ethylene oxide sterilization was used in seven areas and a separate device was used in one. Interviews with personnel revealed that lack of knowledge of high-level disinfection contributed to the discrepancies between policy and practice. We conclude that reprocessing of flexible fiberoptic endoscopes is inconsistent and potentially ineffective. Knowledge that a flexible fiberoptic endoscope was used for a patient with AIDS influences practice.

Navigation of the nose with flexible fiberoptic endoscopy.

The introduction of flexible fiberoptics into medicine revolutionized the evaluation and treatment of velopharyngeal dysfunction. In this paper, rigid endoscopy and flexible fiberoptic scopes are discussed, including their respective advantages and disadvantages. Anesthetic and anatomic considerations relative to the endoscopic procedure are presented. Transnasal endoscopy permits documentation of static and dynamic anatomy, information that may be fundamental for the understanding and treatment of patients with velopharyngeal dysfunction.

Navigation of the Nose with Flexible Fiberoptic Endoscopy

Navigation of the Nose with Flexible Fiberoptic Endoscopy

Oto-Rhino-Laryngological Research Society (ORS) The following are the abstracts of the meeting held in Newcastle in April 1992

Clinical Otolaryngology & Allied SciencesVolume 17, Issue 5 p. 461-467 Oto-Rhino-Laryngological Research Society (ORS) The following are the abstracts of the meeting held in Newcastle in April 1992 First published: October 1992 https://doi.org/10.1111/j.1365-2273.1992.tb01694.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract The relevance of needle electrode positioning in electrocochleography The mini-grommet and tympanosclerosis formation: 2 years on Altered dental sensation following nasal septal surgery An evaluation of the role of bone-anchored hearing aids in the management of hearing impairment Defects in the assessment of TM perforations Preliminary characterization of purified mucin from effusions in cleft palate patients Hyperlipidaemia and hearing loss: a true association? Changes in middle ear pressure following nasal septal surgery A better treatment for rhinitis Ear disease and the timing of cleft palate surgery Long-term co-trimoxazole single agent therapy in Wegener's granulomatosis Multiple primary malignancies in patients with head and neck cancer; the implications for follow-up The detection of nasal vasomotor oscillations in the human nose Incus transposition: the effect of the first stage procedure Otorrhoea following ventilation tube insertion: identifying risk factors Presbycusis and changes in the cochlea and ventral cochlear nucleus The early diagnosis of synchronous oesophageal carcinoma in patients with head and neck malignancy using flexible fibreoptic endoscopy and Lugol's iodine Diathermy and ligature haemostasis after tonsillectomy: a prospective study Volume17, Issue5October 1992Pages 461-467 RelatedInformation

Comparison between Multiview Videofluoroscopy and Nasendoscopy of Velopharyngeal Movements

The videofluoroscopic and nasopharyngoscopic observations of velopharyngeal movements during speech were compared in 80 subjects with hypernasal speech. An endviewing flexible fiberoptic endoscope was used for nasopharyngoscopic examination. This failed to demonstrate movements of the lateral pharyngeal walls that were videofluoroscopically documented in one third of the patients. In the cases of disagreement, the angle of view was impaired because of the presence of adenoid tissue. The misinterpretation at nasopharyngoscopy was explained by an unfavorable observation position of the flexible scope and failure to pass it further into the pharynx. Conclusions are satisfactory that videofluoroscopy is an indispensable procedure for assessing velopharyngeal function.

Creation of tracheo-esophageal fistula for voice restoration using the flexible fiberoptic endoscope

Creation of tracheo-esophageal fistula for voice restoration using the flexible fiberoptic endoscope

Transendoscopic Nd: YAG Laser Ablation of Vaginal Septa in a Bitch

A vaginal septum was diagnosed in an English bulldog bitch during routine estrous cycle staging. The septum extended 16 cm from the vestibulo-vaginal junction to just caudal to the cervix. The septum was removed by two applications of an Nd:YAG laser via a flexible fiberoptic endoscope. Complete healing occurred over a 5-week period and was uneventful. The bitch was bred and subsequently delivered four puppies vaginally. Transendoscopic laser ablation provided a noninvasive approach to surgically remove a vaginal septum in the dog.

Radiographic Demonstration of Esophageal and Tracheal Fistulas at Autopsy Using a Contrasting Medium That Vulcanizes at Room Temperature

Esophageal and tracheal fistulas, which occur in 0.05% of medicolegal autopsies, were demonstrated in three cases by a postmortem radiographic technique using silicone rubber/lead oxide as a contrasting medium that vulcanizes at room temperature. In one 83-year-old male, a tracheoesophageal fistula was detected, which had developed after surgical repair of an esophageal rupture caused by a flexible fiberoptic endoscope. In a second case, carcinoma of the esophagus in a 78-year-old male had eroded the trachea and arcus of the aorta creating a fatal tracheoesophagoaortic fistula. In a third case, 55-year-old female developed a tracheobrachicephalic artery fistula as a result of an infiltrating cystic adenocarcinoma of the trachea, resulting in a fatal hemorrhage into the trachea. The results of this study indicate that diagnostic radiologic methods using a vulcanized contrasting medium are useful in supplementing normal dissection in autopsy cases with suspected fistulas of the esophagus or trachea.

Accuracy of flexible fiberoptic endoscopy in identifying abnormal endotracheal tube positions: Kietrich KA, Conrad SA, Romero MD, et al Pediatr Emerg Care 6: 257–259 Dec 1990

Accuracy of flexible fiberoptic endoscopy in identifying abnormal endotracheal tube positions: Kietrich KA, Conrad SA, Romero MD, et al Pediatr Emerg Care 6: 257–259 Dec 1990

The mechanics of endoscope disinfection

The decontamination of flexible fibreoptic endoscopes has considerably improved in recent years. This is mainly due to the introduction of instruments with more accessible channels, the use of automated washer disinfectors and a greater awareness of the problems associated with disinfection. Unfortunately the most widely used and effective disinfectant is 2% glutaraldehyde and this is toxic, irritant and sensitizing. With the implementation of Control of Substances Hazardous to Health legislation, strict environmental controls are required to reduce skin contact and vapour inhalation. Alcohol is probably the most suitable alternative disinfectant at present but it is flammable and cannot be used in automated systems. Other agents are either insufficiently effective or corrosive. Autoclavable or heat tolerant rigid endoscopes are now available but flexible endoscopes will not tolerate heat disinfection temperatures.

Balloon technology and its applications in gastrointestinal endoscopy

Forceful dilatation of narrow segments of human tubular organs is not a new concept. In several ancient civilizations there are references to such techniques, particularly dilatation of the urethra, though most historical instruments would be classified as bougies. The first balloon to be described was probably used in the first half of the last century to dilate the urethra (Guthrie, 1834). Gastroenterology did not come into the field until the latter half of the nineteenth century, when an expanding bag was suggested as a method of treating oesophageal motility disorders (Russel, 1898). Most balloon dilators used in gastroenterology until the 1970s were made of rubber, sometimes combined with other materials, and tended to be used under X-ray for oesophageal dilatation, mainly to treat achalasia. The last 25 years have seen two major technical advances which enhanced the popularity of the balloon. Flexible fibreoptic endoscopy has allowed visualization of strictures in parts of the gastrointestinal tract which were not accessible to older instruments. The ease of use and relative safety of such instruments has led to their universal adoption. Improvements have been made in balloon technology by introducing new materials and improving the quality of the balloons. These can now be used either in conjunction with flexible endoscopes (through the scope; TTS), allowing direct observation of the dilating process, or under radiological control.

Accuracy of flexible fiberoptic endoscopy in identifying abnormal endotracheal tube positions

This study was carried out to investigate the accuracy of a simple, nonmaneuverable, flexible fiberoptic catheter in identifying both normal and abnormal endotracheal tube (ETT) positions. In addition, the utility of flexible fiberoptic endoscopy (FFE) for ETT position determination in inexperienced hands was examined. One adult dog was sedated and instrumented in the esophagus and trachea with identical ETTs. Four possible ETT positions (trachea, carina, bronchus, esophagus) were randomly assigned. One investigator positioned the ETT into the assigned position by fluoroscopy. Four other blinded investigators were asked to determine the ETT position using the fiberoptic catheter. Each blinded investigator was given 15 seconds to complete the examination and record the ETT position. Randomization resulted in 25 ETT positions examined by each of the four blinded investigators for a total of 100 FFE determinations. FFE ETT determination was correct in 97% of the examinations. All esophageal intubations were correctly identified. Two tracheal locations were misdiagnosed as carina and bronchial, while one carinal location was incorrectly judged as tracheal. The sensitivity of FFE ETT localization was 91.7%, and the specificity was 98.6%. There was no difference in performance by investigator training level or endoscopy experience. We conclude that FFE is a rapid and accurate method for determining both normal and abnormal ETT locations. ETT position determination can be confidently performed by health professionals with minimal training.

Endoscopy of the Cochlea during Cochlear Implantation

We have previously demonstrated that multichannel cochlear implants may be effective in partially obstructed cochleas. In practice, however, it may be difficult to determine whether electrode insertion is feasible prior to attempting it. Initial trials with a flexible fiberoptic otologic endoscope on 10 cadaver temporal bones were previously reported. On the basis of these trials, endoscopy of the inferior segment of the cochlea during cochlear implantation seemed feasible. In the present study, the same endoscope was used on eight subjects undergoing cochlear implantation, six of whom had partially obstructed cochleas. Endoscopy was found to be helpful in visualizing obstructed segments, determining patency after the obstruction was removed, and identifying normal structures of the cochlea. Documentation with videotape and 35-mm photography constitutes the majority of this paper.

Colonoscopic Decompression of Pseudo-obstruction and Volvulus

Flexible fiberoptic endoscopy has an integral role in the management of colonic pseudo-obstruction and volvulus. Colonoscopic decompression is the primary method for diagnosis and treatment of colonic pseudo-obstruction. Some patients require repeat endoscopic decompression, but few require tube cecostomy. In the case of sigmoid volvulus, endoscopic examination is useful as a temporizing measure to allow preparation of the colon and patient for elective definitive operative treatment.