Laryngoscopy

"The use of modern technology has extraordinarily modified the visual assessment of the larynx, making it possible to observe both the state and behaviour of the larynx".

DR. JUAN MANUEL ALCALDE NAVARRETE
SPECIALIST. OTORHINOLARYNGOLOGY DEPARTMENT

Laryngoscopy is the technique used to explore the larynx and vocal cords.

There are several methods. Some allow the visualization of the vocal cords, while others allow the recording of the aerodynamic, vibratory or acoustic mechanisms that take place in the larynx.

The use of endoscopes in combination with a video camera, a video recorder and a television monitor results in what we define as videoendoscopy. It obtains the image and sound registration in real time, which means gathering an excellent visual and acoustic documentation.

Depending on the type of endoscope used, we distinguish two different methods: flexible endoscopy or fibroscopy and rigid endoscopy or telelaryngoscopy.

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When is laryngoscopy indicated?

It will be performed in all cases in which a vocal, phonatory or upper air-digestive tract disorder is consulted or detected, or in subjects who are asymptomatic but at risk of suffering some type of injury in this area.

Most frequent indications of this test:

  • Larynx cancer.
  • Vocal cord polyps.
  • Dysphonia.
  • Discomfort or problems in the voice.

Do you have any of these diseases?

It may be necessary to perform a laryngoscopy

Types of laryngoscopy

Conventional reflex laryngoscopy is the method usually used to observe both the margins and the lower larynx in its entirety. The simplicity of this method of exploration, as well as the quality and precision of the images it allows to be obtained, has meant that, despite the technology available today, it has not disappeared.

Reflex or indirect laryngoscopy consists of introducing a circular laryngeal mirror with an approximate diameter of 21 to 25 mm into the bottom of the patient's oropharynx, which has previously been grasped and pulled outwards by the tongue. A beam of light is then passed over this mirror (by means of a front reflector, front mirror or operating microscope). In this way, the vision of the larynx reflected in the mirror is obtained.

This type of indirect laryngoscopy combines the use of the laryngeal mirror with the magnified vision and direct light provided by the operating microscope.

With the indirect micro-laryngoscopy, the stereoscopic vision is excellent and the degree of magnification can be regulated at the will of the observer.

These characteristics make it possible not only to perform a highly descriptive examination, but also to perform some surgical procedures on the larynx under really good conditions.

In addition, the microscope can be fitted with side viewfinders and a television or camera, and conventional lighting can be replaced with stroboscopic light, thus obtaining highly demonstrative images.

For this exploration, the patient's position must be the same as in conventional reflex laryngoscopy.

Fiberscopes are endoscopes made up of two flexible optical fiber beams (one for image transmission and the other for light transmission) which, by means of a common casing, form a kind of cable. A manual control system makes it possible to incurvate the distal end, which allows a great amplitude and orientation of the objective and, therefore, maneuvering, which facilitates its introduction and the observation of different regions.

Before beginning the exploration, the patient will be explained what it consists of and what sensations he can feel, which are neither extremely unpleasant nor painful.

The fibroscope is introduced through the nose. At a certain point, you will be asked to breathe through your nose in order to proceed with the incurvation of the tip of the fibroscope and progress towards the mesopharynx. From that moment on, the observation of the different areas is conditioned by the degree of introduction of the fiberscope.

One can opt for an overall view or continue the descent to observe the vocal cords from a very close distance that offers a magnified view of them.

During the fibroendoscopic exploration, the patient is asked to emit the different vowels as well as to initiate a few moments of normal conversation, abrupt nasal inspiration, whispered voice, whistling, etc. in order to observe the physiological mechanisms that take place during the different types of phonation.

The fibroendoscopic exploration allows an exploration of the physiological larynx without it being altered by resorting to strange maneuvers, as could be the case with the traction of the tongue in the case of conventional laryngoscopy.

In most patients it is possible to introduce the fibroscope without the need for vasoconstriction or topical anesthesia.

The optical system of the tele-laryngoscopes is formed by round glass segments, whose ends are optically cut to generate a concave or convex surface that configures them as a lens.

The light conduction system uses, as the fiberscope, a bundle of disordered fibers whose distal end can be configured in different ways and placed in different positions looking for the best distribution of light in the field.

The optical performance of tele-laryngoscopes greatly exceeds that of fiberscopes, especially in terms of magnification, ocular illumination and definition, allowing good photographs and highly expressive video images to be obtained.

Prior to the exploration, the patient is explained what it consists of and what sensations can be felt. Likewise, they are instructed on how to control their breathing and how to phonate.

The exploration of the larynx by means of rigid telelaryngoscopy is performed using the oral cavity as an introduction route and the use of topical anesthesia is relatively frequent due to the nauseous reflex that occurs when the rigid endoscope is inserted.

Both fibroendoscopy and tele-laryngoscopy can be performed with halogen light (the usual) or with stroboscopic light. The latter allows the visualization of mucosal undulation phenomena in slow motion, which in many cases makes an extremely precise diagnosis possible.

Likewise, the new technologies that allow the digitalization of images in real time and their subsequent treatment make it possible to extract quantitative parameters as regards the dynamics, morphology and color of the laryngeal structures, facilitating much earlier and more precise diagnoses than can be made with the usual techniques. 

Where do we do it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM

Specialists from the Department of Otolaryngology

The Department of Otorhinolaryngology of the University of Navarra Clinic is a national and world reference in numerous highly specialized surgical procedures.

We have the latest technology and we perform all diagnostic tests in less than 48 hours in order to offer our patients the best solution in the shortest time possible.

We were one of the first centers in Spain to use robotic surgery in the surgical treatment with the Da Vinci® System. 

Organized in specialized units:

  • Otology - Hearing.
  • Rhinology - Nose.
  • Pharyngology - Throat.
  • Laryngology - Voice.
  • Balance disorders.
  • Head and neck problems.
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Why at the Clinica?

  • Experts in the treatment of hearing problems.
  • Pioneers in axillary surgery to avoid scarring.
  • National reference center in tissue sealing for tonsil removal.

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