Diagnostic and Therapeutic Endoscopy, 1995, Vol. 1, pp. 153-157 Reprints available directly from the publisher Photocopying permitted by license only (C) 1995 Harwood Academic Publishers GmbH Printed in Malaysia Fiberscopic Imaging of the Pediatric Nasopharynx DEYUN WANG and PETER CLEMENT Department of Otorhinolaryngology, University Hospital Free University ofBrussels, Laarbeeklaan 101,1090 Brussels, Belgium (Received March 7, 1994; infinalform, June 29, 1994) This study describes the endoscopic findings about the size of the adenoid tissue and the condition of the nasopharyngeal orifice of the eustachian tube. Results confirmed that only fiberscopic exam- ination allows a thorough inspection of the nasopharyngeal anatomy to make a correct diagnosis and design therapeutic planning. When the presence of adenoid hypertrophy resulting in nasal obstruc- tion, snoring, and/or otitis media was confirmed endoscopically, adenoidectomy proved to be highly efficacious in relieving these symptoms. KEY WORDS: pediatric fiberscopy, nasopharynx, adenoidectomy, eustachian tubal orifice INTRODUCTION The flexible fiberscope has made accurate evaluation of the condition ofthe pediatric nasopharynx possible. It is the only means of examination that allows direct visualization of the nasopharynx and enables the definite diagnosis of adenoid hypertrophy. The findings of fiberoptic examination of the nasopharynx con’elate well with the results of tympanome- try and radiography and lead to a considerable improvement in the accuracy of the determination of indication for ade- noidectomy (1). This study discusses fiberscopic findings to assess the condition of the nasopharyngeal cavity in pediatric pa- tients. It mainly focuses on the size and shape of the ade- noid tissue and the condition ofthe eustachian tubal orifice in relation to the complaints of chronic nasal obstruction, snoring, and otitis media accompanied by effusion. MATERIALS AND METHOD Instruments A flexible fiberoptic bronchoscope (BF type 3c 10 or 3c20, Olympus, Tokyo, Japan) with a TVR 4500 color video camera (Switzerland) was used to examine the nasal cav- Address for correspondence: Deyun Wang, M.D., Department of Otorhinolaryngology, University Hospital, Free University Brussels (AZ-VUB), Laarbeeklaan 101, 1090 Brussels, Belgium. 153 ity and nasopharynx to record all examinations and to re- assess them later. Patients From December 1989 to December 1991, 371 children (227 boys and 148 girls) age 26 days to 14 years (mean age: 5.34 years) were included in this study. All patients were referred from the pediatric ENT outpatient clinic. Two hundred eighty-four children had complaints of nasal obstruction (mouth breathing, with or without snoring). The control group consisted of 91 children without complaints of nasal obstruction. In this group, fiberscopic examination of the nasal cavity and nasopharynx, and/or larynx was performed because of clinical necessity. Children with an acute infec- tion of the respiratory tract (associated with fever) were ex- cluded from this study. All parents gave their consent and were invited to attend the examination of their children. This study was approved by the local ethics committee. Anesthesia A cotton strip soaked with a mixture of 1% Novesine (oxy- buprocaine HCL) and 0.05% otrivine (xylometazoline) was applied for local anesthesia and vasoconstriction. Vasoconstriction is especially necessary in children be- cause of the narrowness of the nasal passage and the fre- quent presence ofswelling ofthe nasal mucous membrane. Most children younger than 1 year and older than 4 years can be examined in this way easily.