Examination of the Larynx

The visualization of the larynx is obviously of paramount importance in dealing with laryngeal disease, and several methods are available. INDIRECT LARYNGOSCOPY This is the most convenient method of examination but it requires instruction and practice. The patient protrudes his tongue, which is held gently between the examiner’s middle finger and thumb (Fig. 31.1).The forefinger is used to hold the upper lip out of the way and a warmed laryngeal mirror is introduced gently but firmly against the soft palate in the midline. By tilting the laryngeal mirror, the various structures shown in Fig. 31.2 can be inspected. Mobility of the cords is assessed by asking the patient to say ‘EE’, causing adduction, or to take a deep breath, which causes abduction. The beginner will often see only the epiglottis, with a fleeting glimpse of the cords, but continued practice will allow visualization of the larynx and hypopharynx in most subjects. In recording your findings, bear in mind that the image you see is reversed. It is advisable to label your diagram L and R in case confusion with direct examination occurs. FIBRE-OPTIC LARYNGOSCOPY In some cases the patient will not tolerate indirect laryngoscopy, or the view of the vocal cords is obstructed by an overhanging epiglottis. In these cases, fibre-optic laryngoscopy makes examination possible without recourse to general anaesthesia.The flexible fibre-optic instrument is passed through the anaesthetized nose into the pharynx. It is then manoeuvred past the epiglottis until the interior of the larynx is seen. Although the image is smaller than that obtained by mirror examination, it allows inspection of the cords during phonation and also enables a photographic record to be made. The patient can even view his own larynx through a teaching attachment. DIRECT LARYNGOSCOPY Under general anaesthesia, a laryngoscope supported by some form of suspension apparatus is introduced into the larynx.With the aid of an operating microscope, a superb binocular-magnified view of the larynx is obtained and endoscopic surgery can be carried out with precision. This technique also allows the use of a carbon dioxide laser for the treatment of such lesions as papillomata and leukoplakia. Closed-circuit television, video or still photography are simple to attach to the microscope for making a record of the findings

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