46. Examination of the larynx. Symptoms of the diseases of the larynx.

how do you inspect the larynx

• Check the up and down movement of the thyroid prominence during swallowing

• If no movement, there may be a fixation of the larynx by infection or tumor

how do you palpate the larynx

• Check for contour irregularities and sites of tenderness

what are the methods of Laryngoscopy

• Indirect method

• Direct method

what is Indirect laryngoscopy

• Requires a laryngeal mirror, light source, head mirror and a gauze sponge

what is the technique for indirect laryngoscopy

• Patients sits upright

• examiner holds tongue with a gauze sponge in the left hand

  • thumb on top of tongue

  • middle under tongue

  • index on upper teeth to retract lip

• The light from the head mirror is directed towards the uvula and the reflective surface of the laryngeal mirror

• Mirror is warmed or wet with alcohol to prevent fogging by breath

• The examiner holds the laryngeal mirror in the right hand

  • Placed beneath the palate to the uvula

  • push it backward + upward to evaluate the base of the tongue, oropharynx, hypopharynx and even the anterior wall of cervical trachea by viewing through the open glottis in the respiratory position

• The larynx should be examined in respiratory position (patient takes a deep breath) and in the phonatory position (patient says ‘’Heee’’)

what is the Direct method of laryngoscopy

• Most commonly performed under general anesthesia, using either intubation anesthesia or injector ventilation without endotracheal tube

what is the Technique of direct laryngoscopy

• With the head extended, an illuminated rigid laryngoscopy is pushed straight through the mouth into the larynx

what is Microlaryngoscopy

• A microscope is used to examine the vocal folds in detail

• Can be used with CO2 laser and a micromanipulator for tissue ablation

what is Telescopic (rigid endoscope) laryngoscopy

• Uses a rigid endoscope with a 90 degree wide angle view that can illuminate and magnify

• Replaced routine indirect laryngoscopy in most cases

• Performed in the same way as indirect laryngoscopy and yields the same findings, except that the image is not inverted as with the mirror

what is Flexible nasopharyngeal laryngoscopy

• Endoscope is placed through the nose and into the nasopharynx, without anesthesia, and then down the oropharynx and into the larynx

What are the advantages and disadvatages of flexible nasopharyngeal laryngoscopy

• Advantages: no gag reflex, combine laryngeal inspection with tracheobronchoscopy

• Disadvantages: poorer image quality than rigid telescopic laryngoscopy

what imaging do you do for larynx

• X-ray: skeletal framework, laryngeal fractures, foreign body, stenosis at the laryngotracheal junction

• US: pre-laryngeal and para-laryngeal soft tissue

• CT, MRI: extent of laryngeal masses

what are the Function tests for larynx

• Stroboscopy

• High speed glottography

• Electromyography

what is Stroboscopy

• Uses a synchronized, flashing light passed through a flexible or rigid telescope

• Visualize vocal fold vibration

what is High speed glottography

• Uses a rigid endoscope able to film with a high speed camera

• Measure laryngeal function

what is Electromyography

• Electrical recording of muscle activity in the larynx

• Determine if symptoms are due to muscle disease of neurological symptoms

what are the Symptoms of laryngeal diseases

• Inspiration stridor

• Dyspnea

• phonation problems (e.g. hoarseness)

what are the symptoms of tracheal diseases

• Cough

• sputum production,

• respiratory distress due to narrowing of the lumen

• inspiratory/expiratory stridor