1. How to get a better view during rigid oesophagoscopy?
Traditionally, rigid oesophagoscope illumination is provided by the light carrier at its side wall. The mouth of the oesophagoscopy is then viewed directly as the procedure progress. However, the view can be limited especially if smaller size oesophagoscope being used. The view can be enhanced by inserting rigid endoscope into the lumen with the length adjusted just before the tip. With current endoscope technology, the findings can be recorded and different light wavelength can be utilized e.g, autoflourescence etc.
2. How to visualize the hypopharyngeal area better when performing flexible transnasal laryngoscopy?
Good local anaesthetic spray to the throat and nasal decongestion is ideal prior to examination. When the tip of the scope has passed beyond the velopharyngeal isthmus, the patient is instructed to blow out while his/her mouth closed and nose pinched. This will transmit the positive air pressure to expand the soft tissue in the hypopharynx laterally. The exception is the postcricoid area of hypopharynx which should be assessed by other technique if indicated. Thus, the pyriform fossae, posterior pharyngeal wall, and posterior surface of the arytenoids are made more clearly visible. This adds-on technique is of value in case of suspected foreign body impaction and during office assessment of hypopharyngeal tumours. In thyroplasty, similar action (without the scope in-situ) is very hepful to avoid puncturing the hypopharyngeal mucosa when arytenoidpexy is performed.