Flexible Nasolaryngoscopy for Pulmonologists: Narrative Review

Background Flexible nasolaryngoscopy (FNL) enables dynamic visualization of the upper and ‘middle’ airways. Traditionally performed by otolaryngologists, FNL is of increasing relevance to pulmonology. Integrating FNL into everyday pulmonology practice could provide critical, management-altering data, facilitate timely diagnosis and optimized management of complex clinical presentations. Objective To delineate the role, indications, and training needs for FNL in adult pulmonology, and to summarize existing models of competency development relevant to pulmonologists. Methods A narrative review was performed using MEDLINE from database inception to November 2025. Sources included specialty guidelines, educational reports, and competency frameworks, with the aim of synthesizing evidence for pulmonology-focused training integration. Results Several indications for FNL are relevant to pulmonologists in day-to-day practice including breathlessness, chronic cough, and hemoptysis. FNL enables point-of-care evaluation of upper/middle airway pathologies. Existing competency frameworks focus on simulation, structured supervision, and workplace-based assessments rather than procedural volume. Comparable principles can inform a pulmonology-led FNL curriculum using established bronchoscopy training infrastructure. Potential gaps include simulation access, credentialing structures, and validated performance metrics. Conclusion FNL represents a natural extension of pulmonology, enabling diagnostic precision, integrated airway care, and holistic, patient-centered holistic management. Development of structured, competency-based, multidisciplinary training and assessment pathways for FNL is essential to ensure safe, standardized practice in pulmonology.