Understanding Laryngoscopy

Laryngoscopy means, literally, throat viewing (laryngo = throat; scopy = viewing). Three methods of laryngoscopy are used to examine the voice box and its surrounding areas.

1. Mirror laryngoscopy
2. Flexible laryngoscopy
3. Rigid laryngoscopy

• During a mirror laryngoscopy, the examiner views the voice box by placing a mirror in the back of the patient's mouth at an angle such that light can be directed to the voice box area.
• This allows a view of the voice box – much like a car's rear-view mirror does of the area in back of a car.
• Prior to the exam, the patient is usually given surface anesthesia (topical anesthesia) to numb the back part of the throat and reduce the gag reflex.

• Rigid laryngoscopy provides the clearest magnified view of the voice box.
• This exam is done through a specialized telescope that has a light source and a magnified viewer contained within a rigid tube. This tube is passed through the patient's mouth with the patient's tongue protruded and held by the examiner.
• Because the tongue is protruded, the patient is not able to speak or sing, but is able to make sound such as "eee."

• Flexible laryngoscopy provides a view of the voice box while allowing the patient to perform voice functions such as speaking, singing, producing different vowel sounds, etc. It is also used to examine the space joining the throat and nasal cavity (nasopharynx), the soft palate, the throat and the back of the tongue.
• Flexible laryngoscopy is done through a specialized scope that has fiberoptic light and a magnified viewer contained within a flexible tube.
• Prior to the exam, the patient is usually given surface anesthesia (topical anesthesia) to numb the nasal passage through which the tube is passed. This surface anesthesia is delivered in a mist or spray. It can also be combined with another medication that shrinks the lining of the nose, making it easier to pass the flexible scope through the nasal passage.

• For a mirror laryngoscopy or a rigid telescopic laryngoscopy, the patient is usually placed in the sitting position, leaning forward from the waist, often with hands on the knees. The patient's head is kept in a neutral position, and the chin and tongue are protruded.
• The examiner will gently hold the patient's tongue with one hand, and the other hand will then pass the mirror or rigid telescope toward the back part of the mouth and throat region.
• This examination is done while the patient breathes through the mouth (or pants) and then makes sound of sustained "eee."

• Flexible laryngoscopy does not require a specific posture or head and neck position. It and can usually be done in the patient's most natural sitting position.
• During the examination the patient performs a variety of throat-related and voice-related tasks, including speaking, singing, breathing, laughing, whistling, coughing, and sniffing. These different voice and non-voice tasks allow the laryngologist to look for a variety of possible abnormalities in the throat region during each task.
• Because the transnasal flexible laryngoscope is placed through the patient's nose and does not require a restricted posture or position, most patients tolerate this procedure extremely well.

Highlights

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