Examination of nasal cavity and paranasal sinuses ① Anterior nasal endoscopy. The examiner puts the front nasal endoscope into the nasal vestibule, opens the upper and lower lobes, enlarges the front nostril, and checks the nasal septum, inferior turbinate, middle turbinate, common nasal meatus, inferior nasal meatus, middle nasal meatus and olfactory cleft. ② Posterior nasal endoscopy. The examiner holds the tongue depressor in his left hand, depresses the first 2/3 of the tongue, and sends the posterior nasal endoscope between the soft palate and the posterior pharyngeal wall to examine the posterior nostril, turbinate and the posterior edge of the nasal passage, the pharyngeal orifice of the eustachian tube, the pharyngeal recess and the nasopharyngeal apex. ③ Examination of sinus. Include observing the cheek, palpating the cheek, the inner upper corner of the orbit, etc. To find out whether there is tenderness and protrusion. Maxillary sinus puncture and irrigation is helpful to diagnose maxillary sinus inflammation or other diseases. X-ray films of paranasal sinuses are often used to diagnose paranasal sinus diseases. ④ Rigid tube and flexible tube nasal endoscope. Can examine all parts of the nasal cavity in detail, can observe the opening of nasal sinuses, and can perform nasal sinus surgery.
Pharyngeal examination ① oropharyngeal examination. Gently press the front 2/3 of the patient's tongue with the tongue depressor, and check the tonsil, glossopharyngeal arch, pharyngeal arch and posterior pharyngeal wall to observe the activity of soft palate. ② Nasopharyngeal examination. See posterior nasal endoscopy. In addition, flexible photoconductive nasopharyngeal fiberscope can be used to observe the whole picture of nasopharynx, and biopsy or filming can be performed. ③ throat examination. See indirect laryngectomy.
Laryngeal examination ① Indirect laryngoscopy. Let the examinee open his mouth, stick out his tongue, hold the front part of the tongue with gauze and pull it out, put the indirect laryngoscope in the mouth and pharynx, and check the base of the tongue, tonsil of the tongue, epiglottic valley and throat, then let the patient make the sound of clothes to observe the epiglottic surface, arytenoid fold, arytenoid fossa, ventricular band and vocal cords, and ② check with direct laryngoscope. Examine under topical anesthesia or general anesthesia. The subject will lie on his back with his head down, put it in a direct laryngoscope and it will be annoying, then stir it up to check his throat. ③ Fiberoptic laryngoscopy. Pass the fibrolaryngoscope through the nasal cavity or oral cavity. This method is less painful and can examine all parts of the throat in detail. ④ Microlaryngoscopy. It is used to examine the larynx and perform fine surgery. Its advantage is that it can be operated by both hands at the same time. After tracheal intubation under general anesthesia, the operation can be performed under the operating microscope.
The otoscope examiner pulls the auricle backward and upward with one hand to straighten the external auditory canal, and pushes the tragus forward with the other index finger to enlarge the ear canal and check the ear canal and tympanic membrane. If the ear hair is long or the curvature of the ear canal is large, the otoscope can be inserted into the ear canal for inspection. The electric otoscope has a light source and a magnifying glass, which can observe the eardrum more carefully. Inflatable otoscope can observe the movement of tympanic membrane.
Tracheoscope and esophagoscope ① Rigid tube bronchoscope. It can check the openings of common trachea, left and right bronchi and lobar bronchi, and is now mostly used to take out foreign bodies. ② Fiberoptic bronchoscopy. Because the endoscope tube is thinner, the patient has less pain, so he can go into the deeper and thinner bronchus for examination and observe the bronchus of the upper lobe. It can be used to observe pathological changes, take biopsies and eliminate smaller foreign bodies. ③ Hard tube esophagoscopy. Used to observe esophageal lesions, take biopsy and take out foreign bodies. ④ Fiberoptic esophagoscopy. Because of the equipment such as inflation and irrigation, esophageal lesions can be observed more clearly and used for biopsy, and smaller foreign bodies can also be removed.
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