The purpose of this booklet is to acquaint the reader with the need and procedure for examining the Larynx and Nasopharynx areas. It will reveal the true nature of hoarseness, and when regularly employed, the physician can confidently diagnose and advise treatment or consultation early in the course of a laryngeal disease. The early recognition of laryngeal abnormalities permits conservative therapy with maximum preservation of laryngeal tissue and the patient’s voice.
“I I advantages of the head mirror system and may be employed with minimum difficulty. Mirror Light Emission Figure 1 Halogen Larynx Illuminator Light passing through the aperture will illuminate the palate and pharynx to assist in positioning the mirror. The metal sleeve and mirror are removable for sterilization.
The Nasopharynx Illuminator The nasopharyngeal mirror is identical to the laryngeal mirror except that it is round and smaller.
Superior I nasal turbinate Sphenoid sinus Adenoids Opening of Laryngopharynx (Hypopharynx) Esophagus Figure 3 The pharynx has three divisions: the nasopharynx located between the base of the skull and the palate; the oropharynx between the palate and base of the tongue; and the laryngopharynx between the base of the tongue and the esophagus.
To successfully examine the laryngopharynx with the illuminated Welch Allyn mirror, it is desirable for the light in the examining area to be subdued. The patient is reassured and asked to breathe though his mouth. Sedation may be required in apprehensive patients or topical anesthesia to the palate and pharynx in patients whose gag reflex is excessive.
5. The mirror is inserted into the mouth. Light passing through the light aperture facilitates positioning the mirror so it passes between the tonsils and elevates the soft palate. The patient is encouraged to breathe deeply through his mouth and relax. A topical anesthetic may be applied should there be excessive gagging. 1 6. The reflected light in the mirror now illuminates the base of the tongue and the laryngopharynx.
of the right and left false vocal cords, true vocal cords, anterior and posterior commissures. The mobility of each true cord is then evaluated.
Indirect Nasopharyngoscopy Indirect nasopharyngoscopy (posterior rhinoscopy) is accomplished with the Nasopharynx Illuminator. Of interest is the “vault” of the nasopharynx and eustachian tubes, adenoid tissue, polyps and tumors. The following steps will produce satisfactory examination results: 1. The examiner should sit to one side (patient’s left) or in front of the patient to be examined. 2. The Welch Allyn hand piece with attached nasopharyngeal mirror is held in the examiner’s right hand.
Figure 5 Reflected light in the mirror will illuminate the posterior nose and nasopharynx. 7. Should the space between the palate and pharyngeal wall be too narrow for examination, a soft palate retractor may be required. 8. Variations in color and contour of each side of the nasopharynx when compared with identical structures of the opposite side should arouse suspicion that an abnormality exists. 9.
The instructions given in this manual are presented as a guide to successful laryngeal and nasopharyngeal examinations. These examinations should always be included in a complete physical examination. In addition to revealing the true nature of hoarseness, the physician can confidently diagnose and advise treatment or consultation in the earliest stages of disease. Early recognition of abnormalities permits conservative therapy with maximum preservation of tissue.
