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“Dropping Acid” Blog

Transnasal Esophagoscopy: Revisited (over 700 Consecutive Cases)

Since the days of Chevalier Jackson, esophagoscopy has undergone numerous changes. Recently, with the introduction of the thin, high-resolution distal chip camera esophagoscope (VE-1530, Pentax Precision Instrument Corporation, Orangeburg, New York), the esophagoscope can be inserted through the nose in the upright position with topical anesthesia alone without the use of intravenous or per oral medications. This allows the otolaryngologist to perform esophagoscopy as an in-office procedure.  In addition, air insufflation, irrigation, and biopsies can be performed. The entire upper aerodigestive tract from the nasal vestibule to the gastroesophageal junction (GEJ) is easily and safely visualized.

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Transnasal esophagoscopy

The distal-lighted, rigid esophagoscope was invented by Chevalier Jackson more than a century ago, and until the 1960s, with the introduction and popularization of flexible fiberoptic endoscopy, esophagology was the domain of the  otolaryngologist. In the last 50 years, other medical specialties (eg, pulmonology, pediatric surgery, gastroenterology) have joined in the evolution of aerodigestive tract endoscopy. (See also www.transnasalesophagosocpy.com).

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Laryngeal Electromyography

Laryngeal electromyography (LEMG, EMG) provides essential clinical information about the neuromuscular status of the larynx that no other test can provide for patients with presumed neuromuscular disorders of the larynx. The state of the art of clinical LEMG has evolved at a faster pace than the otolaryngologic literature, such that many clinicians still underuse LEMG. The most important clinical applications of LEMG are:

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Unsedated Office-Based Laryngeal Laser Surgery

The spectrum of laryngological office-based procedures has expanded dramatically in the last decade since the advent of the distal-chip camera and new laser technology. These laser procedures are well-tolerated by patients and at the same time minimize morbidity and are cost saving. Topical anesthesia without sedation is used and patients may return to normal activities immediately after. This amazing technology is recommended for treatment of laryngeal papillomas, granulomas, polyps, and some cysts. Recovery time is minimized and the risk of minor complications is less than 1%. In the next generation, such procedures will continue to proliferate.

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