Pharyngoscopy

Pharyngoscopy (from the Ancient Greek φάρυγξ — “pharynx” and σκοπέω — “to look, examine”) is a method of direct visual inspection of the pharyngeal mucosa and its anatomical structures. It is a fundamental and essential clinical evaluation procedure in otolaryngology, internal medicine, pediatrics, and other medical specialties, employed when patients present with throat-related complaints.

Pharyngoscopy facilitates the assessment of various regions of the pharynx, including the oropharynx, nasopharynx, and laryngopharynx. Depending on the area being examined and the instruments used, pharyngoscopy is classified into several types listed below.

Technique and Types

The choice of technique depends on the specific region of the pharynx to be examined and the equipment available in the clinical setting.

Basic Types of Pharyngoscopy:

• Oropharyngoscopy (examination of the oropharynx): This is the most common and straightforward modality. It is performed with the patient’s mouth open, using a light source (typically a head mirror) and a medical spatula. The healthcare professional depresses the anterior two-thirds of the tongue with the spatula to visualize the palatoglossal arches, palatine tonsils, soft palate, and posterior pharyngeal wall.
• Epipharyngoscopy (posterior rhinoscopy, examination of the nasopharynx): This procedure is traditionally performed using a small mirror inserted behind the soft palate to view the reflected image of the nasopharynx. Currently, this method has been largely replaced by endoscopic examination via the nasal cavity using a flexible or rigid endoscope, which provides a direct and detailed view.
• Hypopharyngoscopy (examination of the laryngopharynx): This examination is conducted using a laryngeal mirror (indirect laryngoscopy) or, more informatively, with a flexible fiberoptic laryngoscope inserted through the nose. This allows detailed visualization of the lower pharynx, the root of the tongue, and laryngeal structures.

Diagnostic Significance

Pharyngoscopy is used to identify signs of inflammation, structural abnormalities, foreign bodies, and neoplasms.

During the examination, the following is evaluated:

• Condition of the mucosa: Color (normally pale pink), moisture, edema (if present), erythema (hyperemia), petechiae, or exudate.
• Palatine tonsils: Size (normal or hypertrophic), symmetry, color, purulent plugs in the crypts (if present), or bulging of surrounding tissues (suggestive of abscess).
• Posterior pharyngeal wall: Enlarged lymphoid follicles (cobblestone appearance typical of chronic pharyngitis) and postnasal drip.
• Mobility of the soft palate: Symmetry of movement during phonation of the sound “A,” which helps assess the function of the glossopharyngeal and vagus nerves.

Clinical Applications

Pharyngoscopy is a key diagnostic tool for conditions such as acute and chronic pharyngitis, acute tonsillitis, peritonsillar abscess, adenoiditis, fungal infections, and other specific pharyngeal infections. The procedure is indispensable when a foreign body in the pharynx is suspected. Additionally, pharyngoscopy plays a critical role in cancer screening, enabling the identification of suspicious areas (ulcers, indurations, masses) that warrant further investigation and biopsy.