Skip to main content

Advertisement

SpringerLink
Log in

Is Direct Laryngoscopy Obsolete? “Trans Nasal Oesophagoscopy” the Complete Endoscopic Solution in Head Neck Practice

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Direct laryngoscopy (DL) is the standard of care for the evaluation of suspicious lesions in the larynx and hypo pharynx but requires general anaesthesia and a dedicated operation theatre. While DL offers us the ability to map the lesion adequately and take a biopsy, it requires workup for anaesthesia well as rigid oesophagoscopy for assessing the oesophagus with its associated complications. Sixty-nine patients underwent TNE under topical anaesthesia. The lesions were mapped and biopsies taken. Those patients who had an inadequate evaluation on TNE or negative biopsy underwent direct laryngoscopy. Completeness of evaluation, adequacy of biopsy, presence of synchronous oesophageal lesions and the modified Gloucester Comfort Score for patient comfort was documented. Amongst 69 cases enrolled for TNE evaluation, 97% of cases had an adequate mapping of disease extent, and 100% adequacy of biopsy material. General anaesthesia could be avoided in 92.75% of patients. TNE took a median time of 8 min. Synchronous oesophageal tumours were seen in 5.8% of patients. There were no complications and 74% patients did not experience any discomfort. TNE appears to be simple, safe, efficient office based diagnostic procedure. TNE has the potential to be the new standard of care making DL obsolete.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

DL:

Direct laryngoscopy

FOL:

Fibre optic laryngoscopy

GA:

General anaesthesia

TNE:

Trans nasal oesophagoscopy

References

  1. Lee Y-C, Wang C-P, Chen C-C et al (2009) Transnasal endoscopy with narrow-band imaging and Lugol staining to screen patients with head and neck cancer whose condition limits oral intubation with standard endoscope (with video). Gastrointest Endosc 69(3):408–417

    Article  Google Scholar 

  2. Mourão J, Moreira J, Barbosa J, Carvalho J, Tavares J (2015) Soft tissue injuries afterdirect laryngoscopy. J Clin Anesth 27(8):668–671

    Article  Google Scholar 

  3. Morimoto M, Nishiyama K, Nakamura S et al (2010) Significance of endoscopic screening and endoscopic resection for esophageal cancer in patients with hypopharyngeal cancer. Jpn J Clin Oncol 40(10):938–943

    Article  Google Scholar 

  4. Postma GN, Cohen JT, Belafsky PC et al (2005) Transnasal esophagoscopy: revisited (over 700 consecutive cases). Laryngoscope 115(2):321–323

    Article  Google Scholar 

  5. Ball AJ, Rees CJ, Corfe BM, Riley SA (2015) Sedation practice and comfort during colonoscopy: lessons learnt from a national screening programme. Eur J Gastroenterol Hepatol 27(6):741–746

    Article  Google Scholar 

  6. Teppo H, Alho O-P (2009) Comorbidity and diagnostic delay in cancer of the larynx, tongue and pharynx. Oral Oncol 45(8):692–695

    Article  Google Scholar 

  7. Allison P, Franco E, Feine J (1998) Predictors of professional diagnostic delays for upper aerodigestive tract carcinoma. Oral Oncol 34(2):127–132

    Article  CAS  Google Scholar 

  8. Murata A, Akahoshi K, Sumida Y, Yamamoto H, Nakamura K, Nawata H (2007) Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients. J GastroenterolHepatol. 22(4):482–485

    Google Scholar 

  9. Yagi J, Adachi K, Arima N et al (2005) A prospective randomized comparative study on the safety and tolerability of transnasal esophagogastroduodenoscopy. Endoscopy. 37(12):1226–1231

    Article  CAS  Google Scholar 

  10. Wang C-P, Lee Y-C, Yang T-L, Lou P-J, Ko J-Y (2009) Application of unsedatedtransnasal esophagogastroduodenoscopy in the diagnosis of hypopharyngeal cancer. Head Neck 31(2):153–157

    Article  CAS  Google Scholar 

  11. Kawai T, Yamamoto K, Fukuzawa M, Sakai Y, Moriyasu F (2010) Ultrathin transnasal esophagogastroduodenoscopy. Nihon Rinsho 68(7):1264–1267

    PubMed  Google Scholar 

  12. Cohen JT, Benyamini L (2014) Transnasal flexible fiberoptic in-office laryngeal biopsies—our experience with 117 patients with suspicious lesions. Rambam Maimonides Med J 5(2):e0011

    Article  Google Scholar 

  13. Kelley DJ, Wolf R, Shaha AR et al (1995) Impact of clinicopathologic parameters on patient survival in carcinoma of the cervical esophagus. Am J Surg 170(5):427–431

    Article  CAS  Google Scholar 

  14. Guardiola E, Chaigneau L, Villanueva C, Pivot X (2006) Is there still a role for triple endoscopy as part of staging for head and neck cancer? Curr Opin Otolaryngol Head Neck Surg 14(2):85–88

    PubMed  Google Scholar 

  15. Schwartz LH, Ozsahin M, Zhang GN et al (1994) Synchronous and metachronous head and neck carcinomas. Cancer 74(7):1933–1938

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery (Surgical Oncology), Sri Ramachandra Medical College and Research Institute, No. 1, Ramachandra Nagar, Porur, Chennai, 600116, India

    P. Lakshminarasimman

  2. Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012, India

    Prathamesh S. Pai

  3. Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012, India

    Shaesta Mehta & Prachi Patil

Authors
  1. P. Lakshminarasimman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prathamesh S. Pai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shaesta Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prachi Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prathamesh S. Pai.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lakshminarasimman, P., Pai, P.S., Mehta, S. et al. Is Direct Laryngoscopy Obsolete? “Trans Nasal Oesophagoscopy” the Complete Endoscopic Solution in Head Neck Practice. Indian J Otolaryngol Head Neck Surg 73, 310–314 (2021). https://doi.org/10.1007/s12070-021-02368-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-021-02368-4

Keywords

Search

Navigation