Professional Documents
Culture Documents
CLINICAL EVALUATION
Enquire for:-
• Duration
• Number of attacks per month/year
• Recurrence (is there or not)
Respiratory Obstruction
Causes:
• Foreign body (Depends on site of FB, Size and Nature of FB)
• Vocal cord Paralysis
• Glottic oedema
• Laryngocele
• Malignant growth
Enquire for:
• Duration:- short term/ long term
• Onset:- Sudden or Gradual
• Progress:- Progressive or Non-Progressive
Odynophagia and Dysphagia
Causes:-
Acute epiglottitis Enquire for:-
Abcess in epiglottis Duration
Laryngeal trauma Onset- Gradual/Sudden
Contact ulcer Is it for Liquids/Solids/Semisolids
Vocal nodules Pain while swallowing
Ulceromembranous laryngitis H/O FB
• Internal Examination:
Indirect Laryngoscopy
Direct Laryngoscopy
Fibroptic Laryngoscopy
Rigid Laryngoscopy
• Imagning Techniques:
X-ray of Neck, Larynx, Pharynx
CT-scan
MRI
PET-CT & PET-MRI
EXTERNAL EXAMINATION
• Start with the Lymphnodes Examination:
Nodes are to be palpated while standing at the back of the patient. Neck is
slightly flexed to achive relaxation of muscles.
INDIRECT LARYNGOSCOPY:
Diagnostic:-
• Change in voice
• FB sensation
• Odynophagia
• Dysphagia
• Throat Pain
• Stridor, etc.
INDICATIONS
Therapautic:-
• FB removal
• Intubation
• Biopsy of growth in hypopharynx or
vocal cords
• Placing gastric tube
• Contraindication:-No absolute contraindications.
But special caution should be taken in Acute Epiglottitis.
• EQUIPMENTS REQUIRED:
Laryngeal mirror
Adequate lighting( ideally a strong headlight)
Gauze sponges
Local anesthetic (spray or viscous solution)
Spirit lamp or hot water
A B
• Technique:
This procedure works best in a brightly lit room. Use a headlight or mirror
light to direct light parallel to your field of vision.
Warm the mirror over an alcohol lamp or with warm water to prevent
fogging.
The patient should be sitting upright with a straight back, leaning slightly
toward you with chin pointing upward (“sniffing position”).
Sit to the patient’s side, and be higher than the patient.
Apply anesthetic to the patient’s pharynx and ask patient to gargle and spit.
Test the temperature of the mirror before commencing the procedure to ensure
it is not dangerously hot.
Ask the patient to relax and to protude out his or her tongue. Cover the tongue
in gauze and pull it with the thumb and middle finger of your nondominant
hand.
With the patient breathing in and out, direct the mirror into the mouth and
toward the back of the throat, making sure the glass side is downward.
At the back of the throat, press the mirror upward, against the uvula and soft
palate.
Avoid the gag reflex by not touching the posterior pharyngeal wall or tongue
base.
Slightly alter the mirror and try various angles to visualize the desired structures.
Structures to be examined:-
Base of tongue Pyriform fossa
Vallecula False cords
Epiglottis True cords
Areyepiglottic folds Upper 2-3 tracheal rings
Structures seen on I/L are:-
Ant. Part of larynx (Epiglottis, ant. Commissure)- towards top of mirror.
Post. Part of larynx ( Arytenoids and Post. Commissure)- seen at lower
portion of mirror.
Patients right vocal cord is seen on left side of mirror and vice versa.
• THINGS TO BE EXAMINED:-
Epiglottis:-
Pinkish-Normal
Bright red,swollen- Acute epiglottitis, Laryngitis.
Pale, swollen- allergic laryngitis
Turban shaped epiglottis- Tuberculosis of larynx.
V-shape epiglottis- Lupus
Ulcers over epiglottis- Corrosive poisioning,
Burns,Malignancy
Diagnostic:
Infants and young children
Strong gag reflex & overhanging epiglottis
Examine hidden areas of Hypopharynx &
Larynx
Find extent of growth and take biopsy
Symptoms- Hoarseness, Dyspnoea, stridor,
Indications dysphagia.
Therapautic:
Removal of benign lesions of larynx
FB removal
Dilatation of laryngeal strictures.
• CONTRAINDICATIONS:-
Diseases/ Injuries of cervical spine.
Stridor (Unless airway provided by tracheostomy)
Recent coronary occlusion.
Cardiac Decompensation
• ANESTHESIA:-
Usually done under general Anaesthesia.
• EQUIPMENTS:-
Consist of:- a. Handle
b. Blade
Blades:-
A. Miller blade:-
Straight blade
The size of flange is reduced to minimize trauma.
Curve at the tip is extended to improve lifting of
epiglottis.
B.Macintosh Blade:-
Curved Blade
Tip of blade rests in vallecula,
indirectly lifting epiglottis.
• POSITION:-
POSTOPERATIVE CARE:-
Patient is kept in coma position to prevent aspiration of blood or secretions.
Patients respiration should be watched for any laryngeal spasm and cyanosis.
Trauma to larynx, especially if repeated attempt at laryngoscopy have been made.
May lead to Laryngeal oedema and respiratory distress.
Bleeding may occur from operative site. Pt. may spit blood. Care should be taken
to prevent aspiration.
COMPLICATIONS:-
Injury to lips and tongue if they are nipped b/w the teeth and the laryngoscope.
Injury to teeth. They may get dislodged and fall into pharynx.
Bleeding.
Laryngeal oedema.
Flexible Fibreoptic Laryngoscopy
• It is modified technique of direct laryngoscopy.
• In difficult cases, where laryngeal examination cannot be performed with mirror
due to anatomical abnormlities or intolerance of mirror by the patient, this can be
used.
• It is passed through the nose under local anasthesia and gives a good view of
larynx, laryngopharynx, subglottis, and even upper trachea.
Rigid Endoscopy
• A rigid fiberooptic telescope is used.
• It gives a clear, wide-angle view of the larynx and laryngopharynx.
• Local anaesthesia may be required for patients with an active gag reflex.
STROBOSCOPY
• The vocal folds vibrate so fast during voice production (over one
hundred times a second in men and double that in women) that this
vibration is impossible to see clearly with the naked eye. The free
edges of the vocal folds appear as a blur.
• Stroboscopy is a special method of examination of a vibrating or
fast moving object, such as the vocal folds.
• A bright flashing light lasting a fraction of a second (10µs) is used
to illuminate the vocal folds. This flash ‘freezes’ the movement of
the vibrating vocal folds. By taking multiple snapshots at different
phases of the vibratory cycle it is possible to see details of the
change in shape of pliable surface of the vocal folds.
IMAGNING TECHNIQUES
• X-ray:-
Lateral view of neck:- In normal person it shows- outline of base of tongue,
vallecula, Hyoid bone, Epiglottis and Aryepiglottic fold, Arytenoids, False and true
cords, Cartilages, subglottic space , trachea, Cervical spine.
This view helps in diagnosis of:
FB of Larynx, Pharynx.
Laryngeal stenosis
Acute Epiglottitis (Thumb sign)
Fracture of larynx and hyoid bone and their displacement.
Caries of cervical spine,etc.