Flexible nasendoscopy (camera down the nose)

What is flexible nasendoscopy?

Flexible nasendoscopy, also called nasoendoscopy or nasopharyngolaryngoscopy, is an examination in which we pass a very thin, flexible tube with a light and a lens on the tip through your nose. It lets us see inside your nose, the upper part of your throat and your vocal cords. It is done in the clinic and you do not need to stay in hospital.

We usually look directly through the endoscope, without connecting it to a screen. At the end we explain what we have seen.

What is it for?

Some areas of the nose and throat cannot be seen with a normal examination using a light. Nasendoscopy lets us look at them when you have, for example:

• Hoarseness or a change in your voice lasting more than 4 weeks. This is the most common reason we do the test.
• A feeling of a lump or something in your throat, constant throat clearing or a cough with no clear cause.
• Difficulty or pain when swallowing that does not improve.
• A persistently blocked nose, snoring or suspected large adenoids in children.
• Suspected reflux reaching the throat: Laryngopharyngeal reflux.
• Follow-up of a known problem, such as a vocal cord nodule or polyp, or a vocal cord that does not move well.

It lets us see inflammation, nodules, polyps, lesions or problems with how the vocal cords move.

How should I prepare?

You hardly need to prepare:

• You do not need to fast.
• Tell us if you take blood thinners, are allergic to any anaesthetic or often have nosebleeds.
• If you gag easily, tell us before we start. We can adapt the technique.
• If the test is for a child, explain that it is a small camera, not an injection, and that a trusted adult will be with them.

What happens during the test?

1. You sit in the chair with your back supported and your head upright.
2. We spray a local anaesthetic (lidocaine) into your nose to make it more comfortable. It tastes bitter and your nose and throat feel slightly numb.
3. We pass the endoscope through one nostril and move it forward gently, without forcing it.
4. We look at your throat and vocal cords. We will ask you to breathe, say sounds such as “eee” or “aaa” and swallow, so we can see how everything moves.
5. We remove it. The whole test usually takes about 5 minutes.

If you gag a lot, we can also put a little anaesthetic in your throat. For children we use a paediatric endoscope, sized for them. For patients who need follow-up we connect a camera and often record the examination on video so we can compare pictures between visits.

Does it hurt? Are there any risks?

It does not usually hurt, but it can be uncomfortable for a few seconds. It is normal to feel pressure or tickling in your nose, an urge to sneeze, watering eyes or a bit of gagging. This passes as soon as the endoscope is out.

• Most common: mild, short-lived discomfort.
• Uncommon: a small nosebleed that stops by itself.
• Very rare: dizziness or fainting, an allergic reaction to the anaesthetic or a brief spasm in the throat.

It is a safe, widely used test in ENT. Serious complications are very rare.

Results

We see the images at the time of the test, so we usually explain what we find at the end. If you need anything else (another test, a biopsy or treatment), we will talk it through and plan the next steps with you.

After the test

• You can go back to normal life, including work and driving.
• If we sprayed anaesthetic in your throat, do not drink water or eat for 30 minutes, until the numb feeling has passed.
• It is normal for your nose to run a little or for mucus to have a trace of blood for a few hours.

When to seek advice

Call 112 (in Spain) or your local emergency number if you have difficulty breathing or feel you are choking.

Contact us soon if, after the test:

• Your nosebleed does not stop after pinching the soft part of your nose for at least 5 minutes.
• You have a fever or a severe sore throat that is getting worse.
• Your lips or face swell, or you get severe itching or hives.

Frequently asked questions

Does flexible nasendoscopy hurt? It does not usually hurt. It can be uncomfortable for a few seconds, mainly from pressure in the nose and some gagging, but the anaesthetic spray helps make it more comfortable.

How long does it take? About 5 minutes in total. The camera is in your throat for only a few moments.

Can children have it? Yes. We use a thinner paediatric endoscope. With a good explanation and a trusted adult beside them, most children cope well.

Can I eat or drink afterwards? Yes, unless we have put anaesthetic in your throat. In that case, wait 30 minutes before drinking water or eating.

Can I drive or go to work afterwards? Yes. We do not use sedation, so you can return to your normal activities.

Will I get a copy of the images? It depends. For patients who need follow-up we often record a video to compare with later examinations. Ask us if you would like a copy.

References

1. Stachler RJ, Francis DO, Schwartz SR, et al. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg. 2018;158(1_suppl):S1-S42.
2. Cain AJ, Murray DP, McClymont LG. The use of topical nasal anaesthesia before flexible nasendoscopy: a double-blind, randomized controlled trial comparing cophenylcaine with placebo. Clin Otolaryngol Allied Sci. 2002;27(6):485-8.
3. Jonas NE, Visser MF, Oomen A, et al. Is topical local anaesthesia necessary when performing paediatric flexible nasendoscopy? A double-blind randomized controlled trial. Int J Pediatr Otorhinolaryngol. 2007;71(11):1687-92.
4. Chadha NK, Lam GOA, Ludemann JP, Kozak FK. Intranasal topical local anesthetic and decongestant for flexible nasendoscopy in children: a randomized, double-blind, placebo-controlled trial. JAMA Otolaryngol Head Neck Surg. 2013;139(12):1301-5.

For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.

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