When there is a sensation of something getting stuck in the throat, difficulty swallowing, unexplained reflux-like complaints, or symptoms involving both the voice and the esophagus, a conventional examination may not always be sufficient. At this point, one of the most frequently asked questions is: how is transnasal esophagoscopy performed? The answer is not limited to a brief technical description, because when the right patients are selected, this procedure both accelerates the diagnostic process and offers a more comfortable evaluation for many people.
Transnasal esophagoscopy is the detailed evaluation of the throat, pharynx, area around the larynx, and esophagus by passing a thin and flexible endoscope through the nose. In many cases, the procedure can be performed in an office setting without the need for general anesthesia. In this respect, it is a valuable method, especially in the investigation of swallowing disorders, laryngopharyngeal reflux, chronic throat complaints, and problems involving the upper esophagus.
How is transnasal esophagoscopy performed?
Before the procedure, a detailed medical history is first taken. Whether the patient describes a sensation of something getting stuck, whether they have problems with solid foods or liquids, and whether there is weight loss, painful swallowing, persistent cough, hoarseness, or reflux symptoms are evaluated. This is because endoscopic imaging becomes meaningful when considered together with the symptoms described by the patient.
A local anesthetic and, when necessary, a decongestant spray are then applied to make passage through the nose more comfortable. The aim is not to put the patient to sleep, but to make the nasal passage more comfortable. After this stage, most patients describe not significant pain, but rather a brief sensation of pressure or a foreign body.
The thin flexible endoscope is carefully advanced through the nostril. First, the nasal passage is visualized, followed by the nasopharynx, pharynx, and area around the larynx. This part is particularly important when voice and swallowing are related, because some complaints may originate not only from the esophagus but also from functional problems at the level of the larynx and pharynx.
The endoscope is then directed into the esophagus. The patient may be asked to swallow at certain points. This helps the device pass more comfortably through the natural anatomical pathways. Along the esophagus, the mucosal surface, narrowing, irritation, masses, rings, pouch formation, reflux-related changes, or other structural problems are carefully examined. When necessary, evaluation may be extended as far as the entrance to the stomach.
The procedure is usually brief. In many patients, it is completed within a few minutes to 10-15 minutes. The duration may vary not only according to the technical procedure but also depending on whether additional observation is required and on the patient’s anatomical characteristics.
What does the patient feel during the procedure?
The issue patients are most concerned about is the level of discomfort. Transnasal esophagoscopy is generally a well-tolerated procedure. Mild burning, pressure, or watering of the eyes may occur while passing through the nose. As the endoscope advances into the throat and esophagus, the gag reflex is generally less pronounced compared with conventional oral endoscopy. The main reason for this is that the nasal route is used instead of passing over the base of the tongue.
However, tolerance is not the same for everyone. The procedure may feel more difficult in people with narrow nasal anatomy, significant anxiety, or an excessively sensitive gag reflex. Therefore, good physician-patient communication is an important part of the process. Knowing what the patient may feel at each stage can significantly improve comfort.
Who is it recommended for?
This method is particularly useful in patients with difficulty swallowing, a sensation of something getting stuck in the throat, persistent complaints despite reflux treatment, suspected structural problems at the level of the upper esophagus, or symptoms in which voice and swallowing need to be evaluated together. In some patients, a long-standing unexplained need to clear the throat, chronic cough, or discomfort after meals may also require investigation.
This evaluation may also be important for professional voice users. This is because complaints related to voice use do not always originate only from the larynx; laryngopharyngeal reflux, irritation, or other causes involving the upper digestive system may accompany the condition. In such cases, examining only the vocal cords may not be sufficient.
Its use in children is planned in selected cases according to age, cooperation, and clinical necessity. It may not be suitable for every child in an office setting. Therefore, the decision in pediatric patients is made on a more individual basis.
In whom should caution be exercised?
As with every endoscopic procedure, suitability needs to be assessed. In cases of active nosebleed, severe nasal obstruction, certain recent nasal surgeries, significant coagulation disorders, or when the patient is unable to cooperate with the procedure, the approach may need to be modified. In addition, in patients with significant alarm symptoms, such as progressive difficulty swallowing, severe weight loss, anemia, or a strong suspicion of malignancy, which examination should take priority must be determined carefully.
The important point is this: transnasal esophagoscopy is a very valuable method, but it may not be the only or sufficient test for every patient. Sometimes videofluoroscopic swallowing evaluation, FEES, conventional gastroenterological endoscopy, imaging methods, or biopsy planning may be required. The appropriate method is selected according to the source of the complaint.
How is preparation for the procedure done?
Although preparation details may vary according to the center and clinical purpose, patients may generally be advised to fast for a certain period before the procedure. The duration depends on the scope of the planned evaluation. Regularly used medications, especially blood thinners, must be shared with the physician. However, no medication should be stopped by the patient’s own decision.
Evaluation of the nasal passage is also part of the preparation. If there is septal deviation, significant turbinate hypertrophy, or sensitive mucosa, the side of the nose to be used is decided during the procedure. This seemingly simple detail can significantly affect patient comfort.
What is evaluated during the procedure?
The aim is not merely to advance the endoscope into the esophagus. The color and integrity of the mucosa, areas of narrowing, secretion accumulation, indirect findings related to motility, and the appearance of the structures around the upper esophageal sphincter are important. Certain structural problems such as Zenker’s diverticulum, narrowing at the upper esophageal level, or areas of chronic irritation may be identified with this examination.
In addition, although this imaging method is not sufficient on its own, it makes a strong contribution to understanding whether the swallowing complaint is caused by a mechanical obstruction, inflammation, or rather a functional disorder. Findings obtained in experienced hands help make the subsequent treatment plan clearer.
What is the period after the procedure like?
Most patients can return to their daily activities shortly after the procedure. There may be mild nasal sensitivity, a brief feeling of numbness, or slight discomfort in the throat. If local anesthesia has been used, patients are advised not to eat or drink until the swallowing reflex has fully returned to normal. This period is usually short.
The most important issue after the procedure is monitoring for unexpected symptoms. Severe pain, significant bleeding, shortness of breath, fever, or progressively worsening difficulty swallowing are not normal and require prompt evaluation. However, such complications are rare when the right patient is selected and proper technique is used.
What are the advantages of transnasal esophagoscopy?
One of the most important advantages of this method is that it can be performed without general anesthesia in many patients. This both shortens the recovery period and saves time, especially in office-based evaluations. Compared with procedures performed through the mouth, triggering the gag reflex less intensely may also provide a significant comfort advantage.
Another advantage is that it allows the voice, throat, and swallowing system to be evaluated in relation to one another. Especially in ENT practice, this comprehensive perspective is valuable in patients whose complaints are not limited to a single anatomical region. As in the practice of Prof. Dr. Elif Aksoy, in centers that adopt an advanced evaluation approach focused on voice and swallowing, this procedure can strengthen the clinical decision-making process.
However, the advantages may not be equally significant for every patient. In some people, conventional gastroenterological endoscopy may be more appropriate because of the need for sedation, biopsy planning, or examination of the lower esophagus and stomach. In other words, the answer to which method is better varies according to the patient and the clinical question.
How is the final decision made?
Does a patient have laryngopharyngeal reflux, should structural narrowing be suspected, is the swallowing disorder neurological or mechanical, are the voice complaints related to esophageal findings? Each of these questions may require different evaluation pathways. Transnasal esophagoscopy is an extremely valuable tool when appropriately indicated, but its value comes from using it at the right time and in the right patient.
If you experience a sensation of something getting stuck while swallowing, unexplained throat complaints, a chronic reflux sensation, or symptoms that affect both voice and swallowing, the most appropriate starting point is often a detailed specialist evaluation before the procedure itself. A clear diagnosis does more than reassure the patient; it reduces unnecessary treatments and makes the path that is truly needed more visible.
