What is laryngoscopy of the larynx. Laryngoscopy - what is it? Types of laryngoscopy, description of the procedure. Data obtained during the study

Content

If the patient has a sore throat, then for research on certain diseases or to confirm the diagnosis, the doctor performs a laryngoscopy procedure. It differs from the usual examination by an in-depth examination using a special instrument - a laryngoscope. During the procedure, areas of the throat are examined in order to identify pathologies.

What is laryngoscopy

A visual examination of the patient with the use of special instruments is called laryngoscopy of the larynx. To carry out the procedure, special mirrors of different sizes are used, which are heated during the process to prevent them from fogging.

To facilitate examination of the upper zone of the larynx, the doctor asks the patient to tilt his head back. To examine the posterior sections, the patient's head tilts slightly downwards. Due to its effectiveness and availability, laryngoscopy is a common method for examining the larynx.

Purpose of throat examination

Fibrolaryngoscopy of the larynx is carried out with a diagnostic or therapeutic (involves therapeutic manipulations) purpose. The doctor makes preliminary conclusions about the health of the patient by the appearance of the mucosa. In smokers and hypersthenics, the color of the mucosa may be cyanotic or red.

Asthenics have a pale pink tint. In patients of the normosthenic type - pink. Deviation from these norms indicates pathological processes. Healthy vocal cords should be white.

In addition, the doctor pays attention to their symmetry, closure and mobility during the pronunciation of sounds. He evaluates the presence of extraneous plaque and erosions on the epiglottis, pear-shaped pockets, lingual tonsil, scoop-epiglottic folds and parts of the trachea accessible for inspection.

Indications for laryngoscopy

The use of laryngoscopy is due to the following indications:

foreign bodies in the larynx;
mucosal abscess;
laryngitis;
burns of the larynx;
tumors, injuries or scars on the vocal cords;
difficulty breathing for an unexplained reason;
sore throat;
chronic cough;
aphonia;
swallowing disorder;
hoarseness of voice;
bleeding.

Contraindications to the procedure

There are no absolute prohibitions on the procedure. By decision of the attending physician, the procedure may be canceled or postponed under the following conditions:

problems with blood clotting;
obstruction of the larynx;
recent operations on the throat;
long-term non-healing wounds;
traumatic injury of the cervical spine;
significant risk of stroke;
patient's mental illness.

Methods for examining the larynx

Direct and indirect methods of laryngoscopy are in the greatest demand in medical practice. Depending on the indications, a retrograde method and microlaryngoscopy are used. Methods for examining the pharynx differ in the complexity of the procedure and the localization of the area being examined.

Direct laryngoscopy

The technique of direct laryngoscopy consists in moving the root of the patient's tongue with the help of instruments. This allows for a complete examination of the vocal cords. The procedure is performed under general anesthesia to avoid severe irritation, vomiting and aspiration (materials entering the respiratory tract).

Inspection is performed using a laryngoscope and a reflector. A light bulb is attached to it, with the help of the light of which you can examine the larynx and pharynx of the patient. During the procedure, the patient is placed on his back. After the onset of anesthesia, the doctor opens the patient's mouth. Next, a laryngoscope blade is inserted into the oral cavity, pressing the root of the tongue. When the device reaches the larynx, the edge of the blade rises the epiglottis.

Further, if necessary, therapeutic manipulations are performed or intubation is performed. After the process is completed, the doctor takes out the laryngoscope. Until the end of anesthesia, the patient's breathing is monitored. After waking up, a person remains under the supervision of outpatient workers for several hours in case of complications.

Indirect inspection method

The patient sits with his mouth wide open, sticks out his tongue, which the doctor fixes with a spatula. An anesthetic is used to prevent vomiting. The mirror is inserted into the oropharynx. During it, the doctor inserts a slightly heated mirror into the mouth, directs it down without touching the walls of the pharynx. The doctor sees the reflection of the mucosa, vocal cords and cartilage of the larynx, studies them.

The patient says the sound "A". The procedure lasts 5 minutes, the effect of anesthesia wears off after half an hour. For several hours after you need to refrain from eating. The indirect method of research is considered safe.

Retrograde laryngoscopy

The procedure is prescribed in the presence of a tracheostomy - a tube that is inserted from the throat into the trachea. Through the tube, the doctor inserts a mirror, advances it to the vocal cords, then brings it out into the larynx and pharynx.

Microlaryngoscopy

The procedure is performed using an endoscope. A device is inserted into the respiratory tract to examine the vocal cords and the walls of the larynx. The advantages of the method are safety, information content. The procedure is performed using a bronchoscope or video laryngoscope.

How to Prepare for a Throat and Larynx Exam

There are several mandatory elements of preparation for the procedure:

Stick to a diet. The day before laryngoscopy, you need to have a hearty lunch and a light dinner (it is recommended to limit yourself to kefir and a small amount of porridge). It is important to abstain from all food and liquid intake in the morning before the procedure to minimize the risk of vomiting and inhalation of food during the examination.
The morning of the laryngoscopy it is necessary to refrain from smoking in order to prevent the activation of mucus secretion in the respiratory tract, which complicates the examination process.
Teeth cleaning. This will help to neutralize bad breath, which will make the doctor's work more comfortable and of high quality. This will reduce the number of pathogens that can enter the path during the inspection.

Preparation for laryngoscopy will also depend on the following circumstances, which will be of interest to the doctor:

the presence of an allergic reaction to food or drugs;
a history of pathologies of blood clotting;
taking medication for several weeks before the procedure;
the presence of injuries in the throat and jaw.

Possible complications of laryngoscopy

The degree of risk of complications largely depends on the professionalism and experience of the doctor. Indirect laryngoscopy can be complicated by the following conditions:

cough;
vomit;
laryngospasm;
introduction of infection to the mucous membrane of the pharynx;
damage to the mucosa during the procedure (rare complication).

The direct method of laryngoscopy can lead to the following complications:

damage to the teeth;
bronchospasm;
laryngospasm;
damage to the mucous membrane of the larynx;
dislocation of the lower jaw;
the presence of a foreign body in the respiratory tract;
sore throat;
increased heart rate;
increase in blood pressure;
aspiration pneumonia.

Price

The cost of the procedure varies depending on the level of the clinic. An indirect procedure costs 600 rubles, endoscopy - 1500 rubles. The reception itself costs 1500 rubles, the instillation of medicines - 550 rubles. If the manipulation is carried out in a state clinic under the MHI policy, then it is free.

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1. As it was said, there are circumstances in which indirect laryngoscopy cannot be performed (in very young children) or must be performed so quickly that it cannot give a clear picture of the condition of the larynx. This applies primarily to young children, especially children suffering from papillomatosis of the larynx. Removal of papillomas using the method of direct laryngoscopy, especially repeated, presents a number of invaluable advantages over the method of indirect laryngoscopy. With direct laryngoscopy, papillomas are easier to remove and they can be removed in greater numbers due to better visibility of the larynx.
With direct laryngoscopy, you can see, and therefore diagnose the presence of papillomas in the trachea.

2. When help Direct laryngoscopy can not only see a foreign body in the larynx or in the upper part of the trachea, but also remove it. A number of endoscopists (Zimont, Tikhomirov, Yaroslavsky and others) recommend removing the so-called balloting, i.e. mobile, foreign bodies in the trachea using direct laryngoscopy, while bronchoscopy is performed only if the removal of a foreign body using direct laryngoscopy fails. Zimonte believes that direct laryngoscopy can almost completely replace bronchoscopy.
3. Direct laryngoscopy eliminates the need for or reduces the number of tracheobronchoscopy that is not indifferent at an early age.

4. Direct laryngoscopy significantly reduced the number of tracheotomies performed at an early age for foreign bodies in the larynx or trachea.
5. Direct laryngoscopy greatly facilitates the production of a biopsy to determine the nature of the neoplasm, especially with the so-called recumbent epiglottis that does not rise during phonation, covering the anterior part of the larynx.

6. Direct laryngoscopy facilitates the production of operations on the oral and laryngeal parts of the pharynx.
7. For disorders breathing during various surgical interventions, direct laryngoscopy allows the introduction of a catheter into the trachea under visual control, through which oxygen can be introduced into the respiratory tract.

8. Zimont with a straight line laryngoscopy opens retropharyngeal abscesses in the supine position of the child. With this method, the possibility of pus entering the respiratory tract is completely excluded.

9. Straight laryngoscopy can be used for dissection and excision of scars from the subglottic space. S. Jackson used a galvanocaustic knife for this.

10. Direct laryngoscopy used for the surgical treatment of tuberculosis of the larynx.
11. Jackson used direct laryngoscopy to provide emergency care for asphyxia during general anesthesia. Jackson notes that blowing oxygen directly into the trachea quickly restores normal breathing.

12. Direct laryngoscopy can be used when removing foreign bodies from the upper esophagus, especially in young children, in whom esophagoscopy can cause reflex sudden respiratory arrest (A. Feldman).

Contraindications for direct laryngoscopy are ulcerative processes of the epiglottis, oropharyngeal cavity, pronounced aortic aneurysm, decompensated heart disease, large edema, severe arteriosclerosis, hypertension.
For kids contraindication is sharp stenotic breathing. However, such breathing is a contraindication for direct laryngoscopy in adults as well.

A diagnostic technique with which a specialist can visually assess the condition of the patient's larynx and vocal cords is called laryngoscopy. ENT specialists use a variety of options for such methods, which will be discussed below.

A few words about classification

There are two types of laryngoscopy:

Direct (flexible) laryngoscopy. With it, a special mobile fibrolaryngoscope is used. Sometimes rigid endoscopic instruments are used during surgery. Direct laryngoscopy allows you to examine the vocal cords and throat in detail. Often this method is carried out if there is a suspicion that a foreign object has got into the throat. This method is especially effective in diagnosing cancer of the larynx.
Indirect laryngoscopy. In this case, special mirrors are inserted into the patient's throat. Such an examination must be carried out by an otolaryngologist. On his head, he installs a mirror that displays the light that will come from the laryngoscope. Due to this, the larynx area becomes illuminated. It is worth noting that this method of laryngoscopy is rarely used.

In what situations is such a diagnosis necessary?

There are a number of indications for laryngoscopy:

What can be found with laryngoscopy

This method makes it possible to establish a number of pathologies, namely:

the presence of a foreign object in the larynx and oropharynx;
the presence of inflammatory processes on the surface of the mucous membranes;
whether there is a tumor;
the presence of papillomas, polyps, nodules;
dysfunction of the vocal cords.

To obtain reliable results, specialists use modern complexes for laryngoscopy. They have special devices that allow, if necessary, to refuse emergency medical care.

Features of the diagnosis

In indirect laryngoscopy, a round mirror is used. It should be fixed on a metal rod at an angle of 120 degrees.

Laryngeal mirrors can be of various diameters - 15 - 30 mm. For convenience, they are inserted into a special handle.

The patient and the doctor sit opposite each other. The light source in this should be on the right side of the patient and at ear level. The patient opens his mouth. The tongue should stick out as far as possible. The doctor with a spatula or a special gauze napkin holds the tongue with his left hand. The right mirror is inserted into the pharynx.

This method cannot be used for all patients. For example, for small children. In this case, the direct method is used.

For the effectiveness of direct laryngoscopy, the angle between the horizontal and vertical laryngeal axes must be straightened. This is achieved thanks to a special medical spatula and a flexible tube.

Methodology

At indirect laryngoscopy the patient should be in a sitting position. He should open his mouth wide, sticking out his tongue. During the study, vomiting may occur. In order to avoid them, an anesthetic solution is used, which is sprayed into the nasopharynx. A special mirror is inserted into the oropharynx. They consider the larynx.

In some cases, the doctor needs to examine the patient's vocal cords. In this case, the patient should pronounce the extended sound "A". Approximate procedure time is about 5 minutes. It is worth remembering that the anesthetic works for about 30 minutes. During this time, you can not drink and eat.

Direct laryngoscopy uses a special, flexible instrument. Before the examination, the patient must take special drugs that suppress the production of mucus.

Local anesthesia is used to prevent vomiting. A flexible instrument is inserted through the nose, after which it is instilled with vasoconstrictor drops. This will avoid possible injuries to the nasal mucosa.

There is also rigid laryngoscopy which is carried out under anesthesia. In this case, the laryngoscope is inserted through the mouth. During the study, the doctor can take the necessary tests, remove the foreign body that is in the larynx, and remove polyps. This procedure has certain difficulties, so it takes about 30 minutes. After completion of the study, the patient should be under the supervision of doctors for some time.

During the study, swelling of the larynx may occur. That's why to prevent this phenomenon. put an ice pack on the throat. After rigid endoscopy, the patient should not eat or drink for 2 hours. if this recommendation is not followed, suffocation may occur.

In addition, after collecting materials for research, a small amount of blood clots may be released with sputum during coughing. This is considered normal and will disappear in a few days.

Study preparation

If the patient is assigned indirect laryngoscopy, then the patient after the procedure should not drink or eat for some time. This will prevent vomiting. Some patients have complete dentures. Before starting the examination, they must be removed.

Before conducting a direct laryngoscopy, the doctor must find out a detailed history of the condition. Preparation, including the refusal to drink and eat, begins 8 hours before the diagnosis.

Possible complications

Whatever technique the doctor uses, there are certain risks. For example, during the study, the patient may develop respiratory dysfunction or swelling of the larynx.

The risk group is made up of people with tumors, polyps in the respiratory organs. This group also includes those who have severe inflammation in the epiglottis.

Patients with partial obstruction of the respiratory tract must undergo trachiometry. In this case, a small incision is made in the area of the trachea, thanks to which the patient's breathing is stabilized.

Anyway, for any breathing problems, swallowing, you must immediately contact the ENT. With laryngoscopy, the doctor has the opportunity to fully assess the condition of the mucous membrane of the larynx and oropharynx. In addition, this method allows you to set the levels of functionality of the vocal cords.

In diseases of the larynx, complaints are most often made of a violation of the voice-forming function (dysphonia). Changes in the voice can be manifested in its weakness, coarseness, hoarseness or hoarseness, and even in complete aphonia. Not only the degree of hoarseness matters, but also its duration, the suddenness of the onset or its gradual development. Hoarseness can be permanent or intermittent. In some patients, it is more pronounced in the morning, in others - in the middle or at the end of the day. All these features can indicate the nature of the disease, and they should be taken into account when questioning the patient.

In addition to hoarseness, patients may have complaints of coughing, secretion of large amounts of sputum, or, conversely, a feeling of dryness and other discomfort in the throat. Such complaints are presented not only in diseases of the larynx, but also in cases of pathological processes in the pharynx, trachea, bronchi and lungs.

Pain in the larynx can be spontaneous, occur when feeling and pressing on the larynx from the outside and when its skeleton is displaced to the sides, but more often they accompany swallowing. Swallowing is especially painful with ulcers or perichondritis of those parts of the larynx with which the food bolus comes into contact before entering the esophagus. Such parts are the epiglottis, scoop-epiglottic folds and arytenoid cartilages. Ulcers on the true vocal cords are usually not accompanied by pain. Accurately localized pains at the upper outer edge of the thyroid cartilage are characteristic of neuralgia of the superior laryngeal nerve. Through the ear branch of the vagus nerve, pain from the larynx sometimes radiates to the ear. Finally, pain in the larynx is felt during inflammatory processes in neighboring organs, for example, with inflammation of the lymph nodes; with phlegmon of the neck, diseases of the cervical spine.

Hemoptysis and bleeding from the larynx, unless trauma is excluded, are rare and usually last one to two days. The long duration of bleeding in the absence of gross anatomical disorders in the larynx is a serious symptom that makes one think about the tuberculous process in a malignant neoplasm of the bronchi and lungs. Bleeding in the larynx can be not only external, but also interstitial with hemorrhagic laryngitis or a sharp overstrain of the voice.

Choking and getting food into the larynx can occur in cases of innervation disorders and pronounced infiltrative processes that involve the cartilaginous skeleton. The stench from the larynx occurs with decaying tumors.

The most formidable symptom is difficulty breathing. It is accompanied by a number of other phenomena, which will be discussed in detail in the chapter on stenosis of the larynx and trachea. Here it is only necessary to note that laryngeal-tracheal dyspnea is characterized by the presence of stridor, i.e., noise during breathing.

When questioning a patient, it is necessary to take into account his profession, past diseases, possible occupational hazards (dust, gases), and for teachers, speakers and singers - voice load. It is also important to know whether the patient abuses alcohol and tobacco smoking.

The questioning should be followed by an external examination of the larynx and palpation of it. Changes in the color of the skin, thickening of tissues, disruption of their integrity, swelling, changes in the configuration of the larynx can be very valuable for making a diagnosis. In the presence of wounds and fistulas, probing is acceptable, but in fresh cases it should be done with caution.

Internal examination of the larynx - laryngoscopy - is divided into indirect and direct.

Indirect laryngoscopy is performed using a laryngeal mirror. It was invented more than a hundred years ago by the Spanish singing teacher Manuel Garcia, applied and widely popularized in the West by Turk and Chermak, and in Russia by K. A. Raukhfus. The laryngeal mirror has a round shape, its diameter is 2-3 cm, it is enclosed in a metal frame and attached to a rod that is inserted into a special handle. Indirect laryngoscopy is performed as follows.

The subject sits opposite the doctor, opens his mouth wide, sticks out his tongue, holding it with the fingers of his right hand through a gauze napkin. The doctor takes a mirror like a writing pen, heats its mirror surface over the flame of an alcohol burner or lowers it into hot water for a few seconds; be sure to check the degree of heating by touching the back of the hand and insert a mirror up to the palatine curtain. The mirror is inserted almost horizontally, but then it is necessary to change its inclination, for which the handle is lowered by about 45 °. The tongue is somewhat moved back and up (Fig. 193), but at the same time it is impossible to touch the back wall of the pharynx and the root of the tongue, so as not to cause a pharyngeal reflex. The subject pronounces the sound e at this time.

In the laryngeal mirror, first of all, the root of the tongue appears with the fourth tonsil located on it, then the epiglottis in the form of a pale pink or yellowish cartilaginous petal. Between the epiglottis and the root of the tongue, two small depressions are visible - vallecules, limited by the median and lateral lingual-epiglottic folds.

Following the epiglottis in the mirror, the true vocal cords are shown, normally especially well visible in their white color. The edges of the ligaments at the point of departure from the thyroid cartilage form the anterior commissure. False vocal cords are visible above the true vocal cords, and between the two on each side there are small depressions - blinking ventricles. Finally, the arytenoid cartilages appear - two tubercles to which the vocal cords are attached. Outside the larynx, lateral to the scoop-epiglottic folds, piriform sinuses are available for viewing. Sometimes the whole picture of the larynx appears in the mirror at once.

If you ask the patient to breathe, then the glottis opens. At the same time, the interarytenoid space, the subglottic region and the trachea become visible to a greater or lesser extent. After inviting the subject to alternately breathe deeply and sound, one should pay attention to the mobility of both halves of the larynx. The rapid movement of the vocal cords (dance) is especially well expressed during laughter.

It must be remembered that the mirror picture and the true location of the individual formations of the larynx do not coincide, namely: the epiglottis is visible in the mirror above, but in fact it is in front, the arytenoid cartilages in the mirror are below, but in reality they are posterior; the vocal cords are stretched not from top to bottom, but from front to back. The right and left sides in the mirror actually coincide.

With mirror laryngoscopy, difficulties may sometimes occur, depending on both the subject and the examiner. Laryngoscopy is more difficult if the subject has a short and thick tongue. A tilted back, flattened epiglottis can make the larynx obscure. In this case, it is necessary to offer the patient to pronounce the sound and, when the epiglottis is more tense and straightened, opening the entrance to the larynx. If this is not enough, it may be necessary after anesthesia to pull the epiglottis anteriorly with a special spatula or probe. It is possible in this case to apply another technique: to invite the sitting patient to tilt his head back as far as possible and examine the larynx while standing. The doctor is now looking down. The need for a thorough examination of the posterior parts of the larynx sometimes requires a reverse reception - an examination of the larynx in the Killian position, when the patient is standing with his head slightly tilted, and the doctor is sitting.

An increased pharyngeal reflex sometimes forces the resort to local anesthesia of the pharynx. If the subject does not hold the tongue well, the doctor does it himself. It is more difficult to laryngoscope patients in the supine position, as well as small children. The age of the child at which it is impossible to produce mirror laryngoscopy cannot be called. Much here depends on how obedient the child is and on the tact of the doctor. In some cases, a mirror examination of the larynx is possible in children of three years of age.

Examining the larynx, after a general review, determine the condition of its individual parts. At the same time, attention is drawn to the color of the mucous membrane, its integrity, humidity, the presence of sputum, films, crusts, infiltrates, and tumors. With a large amount of viscous sputum, it is recommended to pour vaseline oil into the larynx using a laryngeal syringe, inhale or remove the crusts with a wet cotton holder.

After laryngoscopy, sputum often remains on the mirror. It can be used for bacteriological or cytological analysis.

For diagnostic purposes, a test piece of tissue (biopsy) is taken for microscopic examination. This study is of great importance, but not decisive, since a negative result may be due to superficial and not quite accurate biting of tissues. Therefore, if the pathologist's response differs from the clinical data in case of suspicion, for example, of laryngeal cancer, the biopsy should be repeated several times or performed through the laryngofissure.

Direct laryngoscopy (orthoscopy, directoscopy) is used in cases where a mirror examination of the larynx is for some reason impossible (in young children) or insufficient. It is used for biopsy and removal of benign tumors. Recently, direct laryngoscopy has almost completely replaced bloody interventions for foreign bodies in the trachea and bronchi. Finally, it is used to hold bronchoscopic tubes. This study, with the exception of emergency cases (foreign bodies), is done on an empty stomach. It is necessarily preceded by a thorough examination of the oral cavity and pharynx, the identification of loose diseased teeth. Personnel assisting during direct laryngoscopy should be well trained. In young children, no anesthesia is required; in adults, local anesthesia is performed.

In order to see the larynx in a direct image, it is necessary to straighten the angle formed by the axis of the mouth and the axis of the windpipe. This is achieved by changing the position (tilting) of the head of the subject and pulling the larynx forward. The most commonly used are the devices of domestic authors: the spatula of S. A. Tikhomirov, the orthoscope of D. I. Zimonta and the universal directoscope of V. F. Undritsa. The description of these devices and their use is given below in the presentation of the authors.

The doctor sits at the head of the patient. The assistant is on the right. The patient lies on his back, his head hangs only slightly over the edge of the table and is supported by an assistant who sits on a small bench next to the doctor performing the study. Small children are wrapped in a sheet. The doctor takes the orthoscope in his right hand, holding it by the handle, and uses this hand for all further manipulations. When the orthoscope is inserted into the mouth, the spatula should not protrude more than 2-3 cm, and the lever is removed. As soon as the end of the spatula reaches the back of the tongue and the plate of the apparatus is placed against the incisors of the upper jaw, it is necessary to gradually pull the handle of the orthoscope towards you, giving it a vertical position. Following this, with the help of a gear with the right hand, they begin to gradually advance the spatula. When it passes the root of the tongue, the epiglottis comes into view. With further rotation of the gear screw, the end of the spatula goes beyond the laryngeal surface of the epiglottis, for which it is usually necessary to slightly deflect the orthoscope handle towards the patient's chest. This movement, weakening the pressure of the spatula on the root of the tongue, facilitates its advancement inward. As the epiglottis and the root of the tongue move upwards, the arytenoid cartilages, the posterior wall of the larynx, the vocal cords and, finally, the anterior commissure appear sequentially in front of the researcher's eye. With this position of the orthoscope, the infraglottic space and trachea are also visible.

Once the orthoscope is properly positioned, a lever is inserted into the socket at the distal end of the handle and handed over to the assistant. The latter, lifting the lever with a known force, fixes the entire apparatus in the set position or changes it at the direction of the operator by lowering and raising. In this way, both hands of the surgeon are completely free. In the case of examination of the anterior commissure area, the maximum lifting of the lever upwards is required. In order to relieve the pressure on the teeth, the assistant must, while moderately raising the distal end of the lever with the second hand, apply more significant pressure from the bottom up in the region of its proximal end. The result is a movement of the spatula, as if lifting the patient up by the hyoid bone. At the end of the study or intervention, you must first remove the lever and only then remove the orthoscope from the patient's mouth.

The patient is usually in the supine position. An assistant's hand is placed under the child's shoulders. The head is at the edge of the table and tilted back so that the chin, front of the neck and chest are in a straight line. In this position, the head is fixed by assistants. In adults, it is sometimes more convenient to raise your head a little above the plane of the table.

The success of direct laryngoscopy depends on the strict implementation of all guidelines. Excessive haste, swiftness in carrying out a spatula are often the cause of errors and failures. It is necessary to strictly adhere to the midline of the body, since the deviation of the instrument to the side can lead to loss of orientation. Pushing the end of the spatula too far can cause respiratory arrest. Rapid insertion of the Zymont orthoscope without visual control can injure the posterior pharyngeal wall for beginners. Any instrument can damage the pyriform sinus. A frequent complication, especially in children, with direct laryngoscopy performed by a novice doctor is damage to the patient's front teeth. This occurs as a result of the movement of the spatula inserted into the mouth in the sagittal plane. Therefore, such movements should not be allowed; only tilts towards and away from yourself are allowed. Finally, as a result of a long and rough examination, a significant swelling of the larynx may develop, forcing even a tracheotomy to be performed. Swelling may occur very quickly or after some time. Therefore, direct laryngoscopy should be performed, as a rule, in a special room or in the dressing room at the hospital, and the patient should be closely monitored for several hours. Only in cases where the study was very short, for example, when removing a foreign body from the trachea, the patient can be released from the institution earlier.

Contraindications for direct laryngoscopy are the same as for tracheo-bronchoscopy. You can not do a direct study with a sharp stenosis of the larynx. In this case, it would be correct to first perform an operation - a tracheotomy.

Laryngoscopy is a diagnostic technique that allows you to visually assess the condition of the larynx and vocal cords. There are several types that are used by otolaryngologists.
Using a laryngoscope, the larynx and vocal cords are examined.
Some of these diagnostic techniques will be described below.

Classification of procedures

Flexible or direct laryngoscopy involves the use of a special movable fibrolaryngoscope.

In some cases, the doctor may insert a rigid, that is, rigid endoscopic instrument into the patient's larynx, but this approach is justified only during a surgical operation.

indirect method based on the introduction into the throat of special mirrors. The examination can only be carried out by an otolaryngologist.

A reflective mirror is installed on the doctor's head, which allows you to reflect the light coming from the laryngoscope and thus illuminate the larynx area.

In modern practice, this type of examination is used extremely rarely, since direct or flexible laryngoscopy is more often chosen. It allows you to examine the throat and vocal cords of the patient thoroughly.

Direct laryngoscopy a person may be prescribed if there is a suspicion of the presence of a foreign object in the throat. The examination is carried out in order to extract it.

And also for taking biological material as a biopsy, removing polyps and other formations from the mucous surface of the throat, conducting laser therapy and monitoring during other invasive procedures.

The technique is highly effective in diagnosing laryngeal cancer.

Indications for research

Indications for examination are:

Uncertain pain in the ear or throat.
Hoarse or hoarse voice, signs of obvious dysphonia or aphonia.
Cough with blood in the sputum.
Laryngeal injuries.
Suspected airway obstruction.
Difficulty swallowing while eating, discomfort from feeling a foreign body in the throat.

Characteristics

Indirect laryngoscopy is performed using a round mirror, which is fixed at an angle of 120 ° on a stable metal rod.

Laryngeal mirrors can have different diameters, from 15 to 30 mm. To make the mirror convenient to use, it is inserted into a special ergonomic handle.

During the indirect procedure, the otolaryngologist and the patient sit opposite each other, so that the light source is placed to the right of the patient, at the level of his ears. The light should come from slightly behind the patient's head.

The subject opens his mouth wide and tries to stick out his tongue as far as possible, the doctor, using a sterile gauze napkin or spatula, holds the tongue with his left hand, and the right hand is necessary to insert the laryngeal mirror into the pharynx.

Before being used for its intended purpose, the laryngeal mirrors are slightly heated on an alcohol burner or in a container of hot water.

Before the introduction, the doctor must check the degree of heating. To do this, he touches the surface of the mirror to the back of his own palms.

To determine the mobility of the larynx and the degree of closure of the vocal cords, the subject is asked to take a deep breath and alternately pronounce the sounds “i” and “e” in high tones.

The uvula and the soft palatal part are carefully pushed back and up by the mirrors. But touching the back wall or the root of the tongue is not allowed, this will cause vomiting.

Important: the mirror image of the laryngeal region does not coincide with the real location of its individual parts.

For example, in the larynx, in front, there are: the epiglottis and the anterior ends of the vocal cords, and they are displayed in the upper segment of the mirrors.

And those parts that are located further in the larynx, that is, the posterior ends of the ligaments and arytenoid cartilages, are reflected in the mirror in the lower segment.

If the patient’s throat is not examined with mirrors, and this often happens with young children, or it is not enough, which is typical for the process of extracting a foreign body or examining neoplasms, then the direct method is used.

In order for direct laryngoscopy to be effective, the angle between the horizontal axis from the mouth and the vertical laryngeal axis is straightened. This can only be achieved with medical spatulas and a flexible tube.

Execution Method

With indirect laryngoscopy, the patient should take a sitting position.

He needs to open his mouth as wide as possible and at the same time stick out his tongue. If such a need arises, the doctor himself holds the patient's tongue with a special medical spatula.

To prevent vomiting, the nasopharynx of the subject is sprayed with an anesthetic solution. A special mirror is inserted into the cavity of the oropharynx, with the help of which the doctor examines the larynx.

All manipulations usually do not take more than five minutes, and the effect of the anesthetic is designed for at least half an hour.

While the sensitivity of the oropharyngeal mucosa is reduced due to the use of anesthesia, the patient must refrain from drinking or eating.

During the examination according to the "flexible" method, the otolaryngologist uses flexible instruments. Before the manipulation, the patient must take specific medications for some time, the action of which is aimed at suppressing the production of mucus.

Gagging is controlled with local anesthesia. The laryngoscope is inserted through the nasal sinus, and before that, drops with a vasoconstrictor effect are instilled into the nostrils.

This helps to prevent injury to the mucous membranes of the sinuses during the examination.

Rigid laryngoscopy is classified as a complex research method, so this procedure is performed exclusively under general anesthesia in a stationary operating room.

A laryngoscope is inserted into the patient's mouth and an internal examination of the oropharynx begins. During the procedure, the specialist gets the opportunity to take a biopsy material, remove polyps from the surface of the vocal cords, or remove a foreign body stuck in the larynx.

Due to a certain complexity, the duration of the procedure increases to thirty minutes. And after its completion, a person must be under medical supervision for several more hours.

Sometimes swelling of the laryngeal tissues develops to prevent such a complication - an ice compress will be placed on the throat. Rigid laryngoscopy involves abstaining from food and drink for two hours after the procedure.

If this rule is neglected, an asthma attack may develop.

After the biopsy is taken, the patient may begin to cough and some blood clots will be shed along with the sputum.

This is not considered a pathological condition and all symptoms go away on their own after a few days.

Rules for preparing for the survey

When prescribing indirect laryngoscopy, the patient is forbidden to drink and eat before the procedure in order to exclude factors that provoke vomiting during laryngoscopy.

This avoids aspiration of vomit. If a person has a full-fledged denture, then before the start of manipulations, it is removed from the mouth.

Prior to direct laryngoscopy, the otolaryngologist must collect a complete history of his condition from the patient, this will help clarify the following nuances:

What medications did the patient take immediately before the study.
Does the person have an allergic reaction to medications?
Were there any suspicions of problems with blood clotting before.
Does the patient have vascular and heart diseases, cardiac arrhythmias and blood pressure indicators.
Verify pregnancy.

Direct laryngoscopy with the introduction of a rigid instrument has several direct contraindications, since the procedure is performed only under general anesthesia.

Preparatory measures, including the complete refusal of food and drink, begin at least eight hours before the examination.

What can a laryngoscopy detect?

This diagnostic method makes it possible to establish the following pathologies:

The presence of a foreign object in the cavity of the oropharynx and larynx.
Inflammatory processes on the surface of the mucous membranes.
Tumor formations.
Papillomas, polyps and nodules of unknown etiology, located on the laryngeal mucous membranes.
Dysfunction of the vocal cords.

To obtain reliable results, the otolaryngologist uses only the most modern laryngoscope complexes equipped with devices for emergency care in case the patient develops unforeseen complications.

Possible Complications

Any of the methods chosen by the doctor for diagnosis carries a certain risk for the patient.

A person may develop swelling of the laryngeal tissues and manifest respiratory dysfunction. At risk are always patients with tumors and polyps in the respiratory tract, as well as those who suffer from severe inflammation in the epiglottis.

Patients with residual airway obstruction are immediately sent for tracheotomy, which is an emergency method in cases of complications after laryngoscopy.

During a tracheotomy, a small incision is made in the trachea, which helps to stabilize the victim's breathing.

When performing a biopsy on the mucous membranes of the larynx, there is a risk of local bleeding, a third-party infection can get into microtraumas.

However, the airways are very rarely injured.

Prevention of post-procedural consequences

To avoid possible complications after the study, the patient is advised to refrain from eating and drinking, try not to cough much, and regularly treat the throat with gargles for at least a day.

When a person has undergone an operation on the vocal cords, for example, excision of polyps, then for another three days he should carefully observe a sparing conversation mode, in which you can speak briefly and only in a whisper. Loud speech prevents the rapid healing of wounds on the surface of the ligaments.

Very often, as a result of a rigid examination, nausea, general weakness, muscle soreness, hoarseness or hoarseness of the voice, a feeling of intense discomfort in the throat are observed.

To reduce these manifestations, it is enough to apply for a second consultation, during which the doctor may prescribe warm soda gargles.

If you have problems with swallowing or breathing, you should immediately contact an otolaryngologist.

In general, laryngoscopy gives the doctor the opportunity to objectively assess the condition of the mucous membrane in the oropharynx and larynx. The procedure also allows you to determine the level of functionality of the vocal cords. A biopsy performed during the procedure gives results in a few days.

What is indirect laryngoscopy, you will learn while watching the video.