ViscousLidoNosesm
A fiberoptic nasopharyngoscope is a handy tool to check patients for suspected foreign bodies (e.g. fishbone stuck in throat) or laryngeal edema. Depending on the diameter of your fiberoptic cable, it may be fairly uncomfortable for the patient despite generous viscous lidocaine instillation through the nares and nebulized lidocaine. Alternatively or additionally, you can make your own lidocaine-oxymetazoline nasal atomizer which works well.

What if the patient is STILL not tolerating the procedure well?

Trick of the Trade

Use a nasal trumpet guide to help with nasopharyngoscopy

Often the most painful part of the NP scope procedure is the right-angle turn inferiorly that the camera takes just passed the conchae. A soft, more malleable nasal trumpet serves as added padding so that the fiberoptic cable doesn’t contact the sensitive mucosal structures of the nasal passage. Additionally it helps to guide the scope straight to your target area of the posterior pharynx and larynx. Note that you may need to pull the nasal trumpet out slightly if it obscures your view as shown the last image.

 

NasalTrumpet

 

NPscope_patientTrumpetBlur

Thanks to Dr. Gabriel Cade (Wilderness Medicine fellow, Baystate Medical Center) and Dr. Lucienne Lutfy-Clayton (Baystate Medical Center) for contributing this trick of the trade!

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD