How we do it: The role of trans‐nasal flexible laryngo‐oesophagoscopy (TNFLO) in ENT: one year's experience in a head and neck orientated practice in the UK

Abstract

KEYPOINTS: Transnasal flexible laryngo-oesophagoscopy (TNFLO) is a safe and well-tolerated procedure that may be performed in a procedure room in the outpatient or day-case/main theatre setting. It requires a local anaesthetic and no sedation. It may be used to histologically diagnose or exclude pathology from the nose to the gastro-oesophageal junction. It provides a "one stop" diagnosis service, reducing diagnostic delays, the need for endoscopy under general anaesthesia, barium swallows and follow-up outpatient appointments. Therapeutic procedures such as vocal cord medialization, endolaryngeal laser surgery, insertion of speech prostheses and foreign body removal may be performed without general anaesthesia.

Reliability of a Transnasal Flexible Fiberoptic In-Office Laryngeal Biopsy

“…Thus, inadequate sample sizes and "off-base" specimens may bias results. Price et al 14 reviewed the findings on 18 patients who underwent transnasal flexible laryngo-esophagoscopy either for localization of a primary cancer or investigation of the upper aerodigestive tract (12 cases of laryngeal lesions). Those authors expressed concern that the size of the acquired biopsy specimen might result in underestimation of the depth of invasion.…”

Role of flexible transnasal esophagoscopy and patient education in the management of globus pharyngeus

“…17 In one study, 89% of the patients with globus were examined with TNE and discharged in a single visit to the ENT clinic, thus avoiding the additional expense and time that would be required for contrast studies and rigid endoscopy. 18 Globus is considered a symptom of laryngopharyngeal reflux and is part of the Reflux Symptom Index described by Belafsky et al 19 There is no standard protocol for managing this condition; and no controlled studies have evaluated the use of PPIs specifically for globus pharyngeus, although it is the primary symptom for which PPIs are prescribed. 20 Any improvement that does occur in laryngopharyngeal symptoms after acid-suppression therapy has been shown to be slower than that in esophageal symptoms.…”

The role of transnasal oesophagoscopy in the management of globus pharyngeus and non-progressive dysphagia

“…7,8,19 It also has clinical time benefits since TNO does not require recovery time following the procedure or theatre usage compared with the other modalities. The significant cost savings, which are not the focus of our report, have been published previously.…”

“…It requires local anaesthesia only and has been shown to be a well tolerated procedure with minimal complications. 7,8 This paper presents the results from the use of TNO in a district general hospital.…”