The development of endoscopy of the palatopharyngeal isthmus

Incompetence of closure of the palatopharyngeal isthmus is common to a number of medical conditions which may lead to the development of speech so distorted as to be incomprehensible. Treatment by surgery and speech therapy has so often been disappointing and this has been due in large measure to the inaccessibility of this region of the body to direct observation. In 1967 it was found that a fibre optically lighted endoscope could be passed far enough back into the naso pharynx to permit direct viewing of the isthmus during unhindered continuous speech. Information obtained made the selection of a suitable operation more rational and the cause of failure when this occurred easier to analyse. This in turn resulted in a higher percentage of successful operations. The desirability of recording the findings lead to the development of practical techniques for making cine and video-tape recordings. The need to obtain a three-dimensional concept resulted in the development of a split-screen video-tape recording system of the nasal pharyngoscopic view with a lateral fluoroscopic image. This system is now being used for clinical assessment of patients, research into the speech mechanism and for teaching.