WMMH

Cleft Palate Program

Nasoendoscopy Procedure

Nasoendoscopy is a procedure that examines the anatomy and physiology of the velopharynx during speech by using a flexible endoscope via the nose. The purpose of the procedure is to evaluate speech and velopharyngeal function as a baseline for clinical management and outcome measurement and to determine type of treatment modalities for a patient.

The indications for nasoendoscopy procedure includes:

  • Abnormal speech characteristics: hypernasal resonance, excessive nasal airflow including nasal air escape and nasal turbulence, and absence of or weak intra-oral air pressure for oral pressure consonants.
  • Limited progress with speech therapy to establish oral pressure sounds.
  • Difficulty maintaining intra-oral air pressure and velopharyngeal closure during speech.
  • Patient has known or suspected abnormality of palate/velopharynx.
  • Patient is being considered for pharyngoplasty, maxillary advancement or speech prosthesis.

Procedures:

  • Obtain written consent.
  • Explain procedure to patient and parents.
  • Perform a sniff test to determine patency of nostril. Nasal decongestant spray (Oxymetazoline HCL nasal solution) then topical anesthesia (Lidocaine oral topical solution USP viscous 2%) to the better nostril.
  • Position of comfort, with head elevated. Dental chair is ideal.
  • The fiberoptic nasendoscope is passed transnasally to the nasopharynx, where the soft palate, lateral and posterior pharyngeal walls surrounding structures can be viewed. Ideally, the moveable tip should be angled and rotated so that at rest the velopharynx is in full view.
  • Nasendoscope must be decontaminated by Central processing per hospitals infection control guidelines.
  • Speech sample and consonants-vowels elicited using Nasal Endoscopic Evaluation Protocol form.
  • Record all findings, and save in the hospital shared drive.
  • Oral/written reports of nasendoscopy findings and their interpretation for discussion with surgeons whether a secondary surgery pharyngoplasty or pharyngeal flap (link to Cleft Surgery) is necessary. Keep written reports in patients chart.

Precautions/Contraindications
The Speech and Language Pathologists take the responsibility for the Endoscopy procedure. The ultimate medical and legal responsibility for the patient is that of the surgeon and/or Otolaryngologist.

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