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
- Difficulty maintaining intra-oral air pressure and
velopharyngeal closure during speech.
- Patient has known or suspected abnormality of
- Patient is being considered for pharyngoplasty, maxillary
advancement or speech prosthesis.
- 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
- 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.
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