Visualization of the larynx and pharynx is an integral part of a full examination of the head and neck. Although the location of these structures often excludes direct imaging, simple methods can be used to evaluate these anatomical structures in a clinical setting.
Indirect pharyngoscopy can be performed either with a simple dental mirror or with a flexible fiber-optic endoscope. These procedures can be performed on patients without anesthesia, and are usually well tolerated. Patients with symptoms such as chronic cough, dysphonia, chronic sore throat, dysphagia, voice changes, and aspiration symptoms should undergo a thorough pharyngoscopy.
Pharyngoscopy is a special technique for visual inspection of the pharynx. The procedure is simple and does not require special training, expensive equipment and surgical intervention. This method was originally described in the 19th century by the famous singing teacher Manuel Garcia Jr.
Types of pharyngoscopy
To date, several types of pharyngoscopy are distinguished. In order to understand what algorithm is used for the manipulation, it is necessary to understand the anatomical structure of the pharynx.
The pharynx is a hollow organ whose walls consist of muscles and the connective tissue sheath. Inside the pharynx consists of a mucous and submucosal layer. The pharynx is one part of the digestive tract, through which food from the mouth enters directly into the esophagus. The pharynx is also part of the respiratory system, air is circulated from the nose to the lungs and vice versa.
Anatomically, the pharynx consists of three parts: the larynx; oropharynx; nasopharynx.
Based on the structure of the organ, three types of procedures are distinguished: hypopharyngoscopy (examination of the larynx), mesopharyngoscopy (examination of the oropharynx); back rhinoscopy (examination of the nasopharynx).
Each type of procedure has its own indications, contraindications and features.
This type of examination is recommended in the presence of: pathologies of the nasopharyngeal tonsil; foreign body; anatomical features and malformations of the Eustachian tubes, nasopharynx and nasal choanas; inflammatory processes of the mucous membranes of the Eustachian tubes, nasopharynx and nose.
For the procedure, you need a nasopharyngeal special mirror and a spatula. The doctor presses the tongue with a spatula and inserts a mirror. It is worth noting that the mirror does not make contact with the walls of the pharynx, since it is possible to provoke the appearance of an emetic reflex. If the patient has an increased vomiting reflex, the doctor irrigates the throat with a local antiseptic before the procedure, and then proceeds to the main diagnostic procedures.
This procedure is indicated in the presence of: a foreign body in the nasopharynx; paratonsillar or tonsillar abscess; neoplasms in the oropharynx; tonsillitis; pathology of the tonsils; malformations of the oral cavity and oropharynx; inflammatory processes in the throat and oral cavity.
The procedure is most often used by doctors for examination. The ENT doctor uses special tools for manipulations that are available to both therapists and pediatricians. For the procedure you need:
- artificial or natural light source;
- spatula (for pressing the root of the tongue during the examination).
The doctor examines the condition of the soft and hard palate, tonsils, teeth, mucous membranes, gums and tongue. In order to determine the presence of a pathological content in the gaps of the tonsils, the doctor with a spatula presses them and observes the secretions. If necessary, the doctor can send the discharge to an additional chemical analysis.
Examination is carried out in the presence of: a pharyngeal abscess; congenital malformations; laryngeal stenosis; various pathologies of the vocal cords; neoplasms in the larynx or pharynx; foreign body; inflammatory processes on the hypopharynx, epiglottis, or laryngeal mucosa; pathologies of the lingual tonsil.
The patient sits comfortably on a couch so that there is a table with tools to his left and a powerful light source on his right. For the procedure, a guttural mirror is used. The patient sticks out his tongue and holds it with his hand (there is a rubber glove on his hand). The doctor gently irrigates the throat with an anesthetic and performs the procedure by inserting a mirror. The patient during the procedure must perform respiratory manipulations through the nose.
The procedure allows you to inspect the initial section of the trachea, vocal cords, glottis, lingual tonsils, root of the tongue, epiglottis.
Contraindications and complications after the diagnosis of the larynx
It is worth noting that this procedure has contraindications, among which are: congenital diseases of the oral cavity; disorders of the central nervous system, convulsions, epilepsy attacks, diabetes mellitus.
Usually, the procedure, regardless of its type, does not cause any complications and side effects. In rare cases, an anesthetic allergy may occur. Since the procedure involves irritation of the mucous membranes of the oral cavity and larynx, after examination for several hours there will be slight discomfort in the mouth and throat.
Pharyngoscopy is a safe, simple and at the same time effective way to diagnose the larynx without surgery.
If the doctor is not satisfied with the results of the examination, he may additionally prescribe a number of procedures that will help make the correct diagnosis. Among the additional diagnostics, ultrasound, CT, MRI, larynx examination with an endoscope, etc. can be prescribed. The doctor independently determines the type of examination.
Before undergoing the procedure, consultation is mandatory not only with the therapist / pediatrician, but also with the ENT doctor and surgeon.