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Visualization of the larynx and pharynx is an integral part of a complete head and neck examination. Although the location of these structures often precludes direct visualization, simple techniques can be used to evaluate these anatomical structures in the 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 symptoms of aspiration should undergo a thorough pharyngoscopy.
Pharyngoscopy is a special technique for visual examination 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, there are several varieties of pharyngoscopy. In order to understand what algorithm the manipulation takes place, it is necessary to understand the anatomical structure of the pharynx.
The pharynx is a hollow organ, the walls of which consist of muscles and a connective tissue membrane. Inside the pharynx consists of a mucous and submucosal layer. The pharynx is the part of the digestive tract that carries food from the mouth directly into the esophagus. Also, the pharynx is also part of the respiratory system; air circulates through it from the nose to the lungs and vice versa.
Anatomically, the pharynx consists of three parts: hypopharynx; oropharynx; nasopharynx.
Based on the structure of the organ, there are three types of procedures: hypopharyngoscopy (examination of the laryngopharynx), mesopharyngoscopy (examination of the oropharynx); posterior rhinoscopy (examination of the nasopharynx).
Each type of procedure has its own indications, contraindications and features of the procedure.
Posterior rhinoscopy
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 choanae; inflammatory processes of the mucous membranes of the Eustachian tubes, nasopharynx and nose.
For the procedure, you need a special nasopharyngeal 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 touch the walls of the pharynx, as it can provoke the appearance of a gag reflex. If the patient has an increased gag reflex, the doctor irrigates the pharynx with a local antiseptic before the procedure, and then proceeds to the main diagnostic manipulations.
Oropharyngoscopy
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 palatine 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. An ENT doctor uses special tools for manipulations, which both therapists and pediatricians have. 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 pathological content in the lacunae of the tonsils, the doctor presses them with a spatula and observes the discharge. Allocations, if necessary, the doctor can send for additional chemical analysis.
Indirect pharyngoscopy
Examination is carried out in the presence of: pharyngeal abscess; congenital malformations; stenosis of the larynx; various pathologies of the vocal cords; neoplasms in the larynx or pharynx; foreign body; processes of an inflammatory type on the laryngopharynx, epiglottis or on the mucous membrane of the larynx; pathologies of the lingual tonsil.
The patient sits comfortably on the couch in such a way that there is a table with instruments to the left of him, and a powerful light source on the right side. For the procedure, a laryngeal mirror is used. The patient sticks out his tongue and holds it with his hand (rubber glove on hand). The doctor gently irrigates the pharynx with an anesthetic and performs the procedure by introducing a mirror. The patient during the procedure must perform respiratory manipulations through the nose.
The procedure allows you to examine 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 should be noted that this procedure has contraindications, including: congenital pathologies of the oral cavity; disorders of the central nervous system, convulsions, seizures of epilepsy, diabetes mellitus.
Usually, the procedure, regardless of its type, does not cause any complications and side effects. In rare cases, an allergy to the anesthetic may occur. Since the procedure involves irritation of the mucous membranes of the oral cavity and larynx, after the examination, there will be slight discomfort in the mouth and throat for several hours.
Pharyngoscopy is a safe, simple and at the same time effective way to diagnose the larynx without surgical intervention.
If the doctor is not satisfied with the results of the examination, he can additionally prescribe a number of procedures that will help make the correct diagnosis. Additional diagnostics may include: ultrasound, CT, MRI, checking the larynx through an endoscope, etc. The doctor independently determines the type of examination.
Before undergoing the procedure, it is mandatory to consult not only with the therapist / pediatrician, but also with the ENT doctor and surgeon.