The Vancouver Sleep and Breathing Centre

NASOPHARYNGOSCOPY

Dynamic nasopharyngoscopy (DN) is a simple method of:

Identifying which anatomic factors are contributing to obstructive sleep-disordered breathing in a particular patient

Determining if the upper airway is unstable and susceptible to collapse during sleep

Determining which treatments will most likely be effective for a particular patient.

The examination is performed with the patient lying on their back and under local anesthetic with topical Lidocaine that is sprayed onto the back of the throat and into the nasal passages. The flexible fiberoptic endoscope is introduced through the nose and advanced into the pharynx. Note is taken of any fixed obstructions such as a deviated septum, nasal polyps, and enlarged adenoids and tonsils. The tip of the endoscope is then positioned at the level of the hard palate and the patient is asked to perform a series of maneuvers.

Resting airway
Note is taken of the size and shape of the airway. This patient has a heart -shaped airway because of narrow insertion of the posterior tonsillar pillars and edema.
With Muller's maneuver
Note is taken of the degree of collapse that occurs when the patient attempts to inspire with their mouth closed and nostrils pinched shut.
With jaw thrust
This simulates the wearing of a dental appliance that advances the mandible. This patient could use such a device if the overnight oximetry shows mild disease.
With slight opening of the jaw
Opening the mouth to breathe relaxes the pharynx and promotes backward collapse of the tongue. This increases the likelihood of apnea.

Interpretation of the findings requires a detailed knowledge of the anatomy of the upper airway and a good understanding of the physical principles that determine why certain structures are stable and others are not.

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Resting airway Note is taken of the size and shape of the airway. This patient has a heart -shaped airway because of narrow insertion of the posterior tonsillar pillars and edema.	With Muller's maneuver Note is taken of the degree of collapse that occurs when the patient attempts to inspire with their mouth closed and nostrils pinched shut.	With jaw thrust This simulates the wearing of a dental appliance that advances the mandible. This patient could use such a device if the overnight oximetry shows mild disease.	With slight opening of the jaw Opening the mouth to breathe relaxes the pharynx and promotes backward collapse of the tongue. This increases the likelihood of apnea.