Nasogastric tube position in the pharyngo-larynx: Does the side of insertion matter?

The nasogastric tube (NGT) is commonly used to provide short-term enteral nutrition in patients with swallowing disorders and/or malnutrition. Its impact on dysphagia appears to depend on its position in the pharynx. Given oesophageal anatomy, we hypothesise that the insertion side influences NGT positioning in the pharynx.

This is a monocentric, retrospective, descriptive study conducted between January 2013 and October 2025. The inclusion criteria were: 1) patients undergoing Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and 2) patients receiving an artificial nutrition 3) via a NGT or nasojejunal tube (NJT). Patients were excluded if there was no video or if the video did not show an NGT or NJT. Data collected included the nostril through which the tube was inserted, as well as the position of the NGT/NJT in the pharynx (retro-cricoid or piriform sinus), which indicates the side (left or right).

We identified 3161 swallowing evaluations, of which 1296 were FEES. Artificial nutrition was present in 244 of the evaluations, but only 52 of these involved an NGT/NJT (representing 1.1% of ward patients and 6.0% of ICU patients). Of the 47 videos reviewed, we observed that the NGT/NJT was found to be on the same side of the pharynx as the insertion nostril in 22 videos (70% on the left and 33% on the right). The position of the NGT/NJT in the pharynx was found to be related to the side of insertion (p = 0.014).

According to our results, the position of the NGT in the pharynx depends on the side of insertion. If possible, the left nasal cavity should be used for NGT insertion. Further studies are needed to confirm this finding. It would also be interesting to report the side of NGT insertion in studies on pharyngo-laryngeal complications, in order to determine its impact.