ear, nose, and throat disorders
How To Do Flexible Laryngoscopy
Step by Step Description of Flexible Laryngoscopy
Preparation Check that the laryngoscope, including the light source and suction, are working properly. Adjust eyepiece focus (use letters such as on drug or equipment packaging). Check both nares and use the one that appears more widely patent. Hold the nares open with a nasal speculum. Insert the speculum with the handle parallel to the floor and open the speculum vertically; stabilize your hand by placing one or two fingers against the patient's nose. Apply the topical vasoconstrictor/anesthetic. Procedure Do the following about 5 to 15 minutes after the application of the vasoconstrictor/anesthetic: Lubricate the laryngoscope tip. Insert the laryngoscope tip into the nose and advance it slowly adjacent to the inferior turbinate (either above or below) parallel to the floor of the nose. Advance it into the nasopharynx, inspecting the eustachian tube opening in the lateral nasopharynx and the adenoid tissue on the posterior wall. Tell the patient to breathe through the nose (which makes the soft palate drop). Use the thumb control on the laryngoscope to flex the tip down to go past the palate, and then straighten to avoid curling forward into the uvula. Inspect the base of the tongue, valleculae, epiglottis, piriform sinuses, arytenoids, false and true vocal cords, and the larynx below the vocal cords. Do not pass the laryngoscope through the vocal cords because contact can cause laryngospasm. Fully inspect the vocal cords. Instruct the patient to say "eeee," which will contract the vocal cords and allow more thorough inspection. Avoid touching the mucosa or epiglottis because this may provoke a gag reflex. Gently withdraw the laryngoscope. 