Naturally Nasal-esophageal Fiberscope in COVID-19 Pandemic - Prevent Sneezing Without Anesthesia

Background: We are laryngologists, to observe natural phonatory and swallowing functions, in every clinical examination with trans-nasal laryngeal berscope (TNLF), before the observation, we use epinephrine to enlarge and smoothen inside common nasal meatus (bottom of nostril), then insert wet swab inside the nose, like a swab culture in nasopharynx. In particular current COVID-19 pandemic situation, this careful technique prevents any complications even nasal bleeding, painfulness, and inducing sneezing. Here we introduce our routine to observe esophageal movement in swallowing in natural setting (sitting position) without anesthesia. Case presentation: A case was 70-year-old female who complained something stuck esophagus or strange sensation below the larynx and pharynx. After enlarge and smoothen inside common nasal meatus we insert the TNLF (slim type ⌀ 29mm berscope, VNL8-J10, PENTAX Medical, Tokyo, Japan.) in a same way. Then observe the phonatory and swallowing movement of vocal folds. To get natural movements we had never used any anesthesia. There was no pathological condition in the pyriform sinus, we asked a patient to swallow the berscope. At that timing we push the TNLF and insert the tip a bit deeper simultaneously with swallowing, which make the berscope easily enter the esophagus like the insertion of nasogastric tube. Then asked the patient to swallow sip of water or saliva, the lumen of esophagus cleared and enlarged. This makes to observe esophagus easily without any air supply. The esophagus is completely normal except glycogenic acanthosis with tone enhancement scan. Conclusions: The advance point of this examination is easily able to perform in sitting position without anesthesia, also takes only a minute and minimum invasive to observe the physiologically natural swallowing. It is also possible without anesthesia until esophagogastric junction using with a thin type exible bronchoscopy. In the future, diameter of gastric berscope even with narrow band imaging (NBI) function might be gradually getting thinner. Before that time every physician should know this technique.

strange sensation below the larynx and pharynx. After enlarge and smoothen inside common nasal meatus we insert the TNLF (slim type ⌀29mm berscope, VNL8-J10, PENTAX Medical, Tokyo, Japan.) in a same way. Then observe the phonatory and swallowing movement of vocal folds. To get natural movements we had never used any anesthesia. There was no pathological condition in the pyriform sinus, we asked a patient to swallow the berscope. At that timing we push the TNLF and insert the tip a bit deeper simultaneously with swallowing, which make the berscope easily enter the esophagus like the insertion of nasogastric tube. Then asked the patient to swallow sip of water or saliva, the lumen of esophagus cleared and enlarged. This makes to observe esophagus easily without any air supply. The esophagus is completely normal except glycogenic acanthosis with tone enhancement scan.
Conclusions: The advance point of this examination is easily able to perform in sitting position without anesthesia, also takes only a minute and minimum invasive to observe the physiologically natural swallowing. It is also possible without anesthesia until esophagogastric junction using with a thin type exible bronchoscopy. In the future, diameter of gastric berscope even with narrow band imaging (NBI) function might be gradually getting thinner. Before that time every physician should know this technique.
Just insert along the bottom of nose.

Background
We are laryngologists, to observe natural phonatory and swallowing functions, in every clinical examination with trans-nasal laryngeal berscope (TNLF), we use epinephrine to enlarge and smoothen inside common nasal meatus (bottom of nostril), then insert wet swab inside the nose, like a swab culture in nasopharynx. (Video-1) In cases of hypertension, we use physiological saline solution to get moisten inside the nose to insert the berscope smoothly because to prevent any affect for phonation and articulation.
In COVID-19 pandemic situations, the standardization of nasopharyngeal culture is necessary to get accurate Polymerase Chain Reaction (PCR) study 1 , such technique was revised and introduced 2 . To get satisfactory nasopharyngeal culture, we insert the swab along the nasal septum and bottom of nasal meatus below the inferior turbinate, with careful not to touch the inferior turbinate; it is important to never touch the inferior turbinate. We had never anesthetized patients' nose in nasopharyngeal culture. In this time of COVID-19, this careful technique prevents any complications even nasal bleeding, painfulness, and inducing sneezing. 1 . Here we introduce our routine safety technique to observe esophageal movement in swallowing without anesthesia with natural sitting position.
There was no pathological condition in the pyriform sinus, we asked the patient to swallow the berscope (0:18). At that timing, we push the TNLF and inserted the tip a bit deeper simultaneously with swallowing, which make the berscope easily enter the esophagus like the insertion of nasogastric tube. Then we asked the patient to swallow sip of water or saliva, the lumen of esophagus cleared and enlarged. showed the effect of different body postures on the self-perceived di culty while swallowing in another report. In comparison of all tested postures, self-perceived di culty for swallowing was found to be least while subjects were sitting upright. 5 The advance point of this examination is able to perform easily in natural sitting position without anesthesia, also takes only a minute and minimum invasive to observe the physiologically natural swallowing. It is also possible without anesthesia until esophagogastric junction using with a thin type exible bronchoscopy. In the future, diameter of gastric berscope even with narrow band imaging (NBI)