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LETTERS: John Shneerson, Ian Smith, Allan I Pack, Terry Young, J R Stradling, R J O Davies, G J Gibson, K Prowse, S J G Semple, D R London, H M Engleman, S E Martin, I J Deary, N J Douglas, John Wright, and Trevor Sheldon Obstructive sleep apnoea BMJ 1997; 315: 367 [Full text]

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Flexible nasopharyngoscopy

Murat Enoz   (23 March 2005)

Flexible nasopharyngoscopy 23 March 2005
Murat Enoz, Department of Otolaryngology, Head&Neck Surgery Istanbul University, School of Medicine, Turkey. Send response to journal: Re: Flexible nasopharyngoscopy	Dear Editor Flexible nasopharyngoscopy is popular for OSA examination. It allows examination of the nose, all portions of the pharynx, and the larynx all in one procedure. When performing the nasopharyngoscopy, dynamic tests are possible. The study of upper airway dynamics in obstructive sleep apnea syndrome (OSAS) has always posed a challenge to the interested clinician. Until the dynamics of obstructive sleep apnea are well understood, the treatment options cannot be comprehensive. To date, continuous positive airway pressure (CPAP) remains the most efficacious first-line treatment because it stents open the entire upper airway without a need to know. Many patients are, nevertheless, not amenable to its lifelong use. They should not be disregarded, particularly if surgical or nonsurgical options other than CPAP can alleviate, if not cure, the symptoms caused by their condition. The much–disfavored tracheostomy, with its associated problems, always helps in treating OSAS and has achieved the best long- term survival rate [1, 2, 3]. This finding confirms the importance of understanding the dynamics of the upper airway above the glottis in OSAS, especially if effective surgery is to be designed. Advantages of nasopharyngoscopy • It does not involve radiation exposure. • Performance of dynamic tests is possible. • It is useful to evaluate the obstruction at the retropalatal and retroglossal levels. • It is easily reproducible preoperatively and postoperatively. • The test may be performed with the patient in sitting or supine position. • The test may be performed with the patient awake or sleeping. • The test is widely available and relatively inexpensive. Disadvantages of nasopharyngoscopy • It is an invasive technique. It can produce some discomfort when introducing the nasopharyngoscope into the nose. • It gives an approximate idea of the pharynx because making any measurements is impossible. • The evaluation depends on the experience of the examiner. Sincerely Dr. Murat Enoz References 1- Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest. 1988 Dec;94(6):1200-4. 2- Guilleminault C, Simmons FB, Motta J, Cummiskey J, Rosekind M, Schroeder JS, Dement WC. Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience. Arch Intern Med. 1981 Jul;141(8):985-8. 3- Skatvedt O: Localization of site of obstruction in snorers and patients with obstructive sleep apnea syndrome: a comparison of fiberoptic nasopharyngoscopy and pressure measurements. Acta Otolaryngol (Stockh) 113:206-209, 1993. Competing interests: None declared