Nasopharyngeal fiberendoscopy in children: a diagnostic challenge in current clinical practice: how we do it

Nasopharyngeal fiberendoscopy (NFE) is the gold standard diagnostic procedure in children with suspected adenoidal disease, but it is not always easily feasible in younger children, and there is no consensus on the optimal technical approach according to children's age or disease. This paper aims to report our experience with NFE performed during routine paediatric clinical examination, also with regards to tolerability and patients' satisfaction. METHODS: NFE was performed in paediatric patients with suspected adenoidal obstruction by means of a 2.7mm-diameter flexible endoscope with the child seated in a chair or on parent's knees under outpatients basis and without administering local decongestants, anaesthetic agents, or sedatives. Relationship between possible confounders and patients' satisfaction, NFE tolerability, or needing for restraining was evaluated. RESULTS: NFE was successfully performed in all but one syndromic 2-year old patient. Analysis was conducted on 191 children (mean age=5.58; standard error, SE=2.52 years). Restraining was required more frequently (p<0.001) in younger children; NFE tolerability was good, as documented by mean visual analogue scale (VAS) values of 2.06 (SE=1.58), and a better NFE tolerance was reported more frequently (p<0.001) in older children. No significant relationship was found between needing for restraining or VAS and gender. No major or minor adverse events occurred. CONCLUSIONS: Our results support the feasibility and tolerability of flexible NFE performed by a skilled ENT specialist for nasopharyngeal evaluation in children aged more than 2 years with suspected adenoidal disease.