Narrow band imaging (NBI) is a tool on the Olympus endoscopic systems that uses blue and green wavelengths to enhance visualisation of mucosal vasculature. It has been used to aid in the early diagnosis of upper aerodigestive tract cancers. A similar technology is employed by Storz with SPIES and more recently SPECTRA. As this technology is becoming more widespread, clinicians have been finding more uses for it. One such example is in this paper, where NBI is used to examine lingual tonsil crypt inflammation. A grading severity score is described further in the paper. The study primarily evaluated the relationship between laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy. A total of 82 patients with a clinical diagnosis of LPR with a reflux symptom index (RSI) score of 13 or more and a reflux finding score (RFS) of seven or more were compared with 80 control patients. Interestingly, a greater RFS was associated with larger lingual tonsils and more crypt inflammation. Specifically, there was a direct correlation between the erythema/hyperaemia score in the RFS and the amount of crypt inflammation. Having obtained the SPECTRA technology recently in my clinic, I will certainly be looking to use this technology to assess the lingual tonsils to see if there is evidence of crypt inflammation in patients with suspected LPR. Visualisation may help skeptical patients accept the diagnosis.

Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngopharyngeal reflux disease. 
Galli J, Settimi S, Salonna G, et al.
2019 [Epub ahead of print].
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Sidhartha Nagala

Royal Hallamshire Hospital, Sheffield, UK.

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