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Endoscopic procedures are widely used to diagnose various human diseases, including to identify diseases of the larynx and pharynx. Endoscopy of the larynx and pharynx with a flexible laryngoscope (direct laryngoscopy) allows the attending physician to conduct a visual examination of their condition, as well as perform a number of simple manipulations, such as a biopsy or removal of polyps. This type of examination rarely leads to the development of complications, but is highly effective, which is why it is widespread. The procedure is carried out using a flexible endoscope, which has a light source and a video camera at its end. Organizing the correct preparation of the patient and following the technique for examining the organs of the upper respiratory system helps prevent the occurrence of negative consequences.

Flexible video laryngoscope

Endoscopy is a modern technique for visual examination of internal organs, which can be combined with minimally invasive surgical procedures and biopsy.

general description

The larynx and pharynx are the most important organs of the upper respiratory system, performing several functions in the human body. Their diseases are very common in the human population, and are accompanied by a number of unpleasant symptoms: pain, cough, voice change, etc. Endoscopy of the throat and larynx involves visual inspection of the internal surface of these organs using a special laryngoscope.

A flexible laryngoscope is a type of endoscopic instrumentation, which is a flexible probe with a camera and a light bulb at one of its ends. There are several types of devices, differing in diameter and length, which allows you to select a laryngoscope for the age and characteristics of each patient.

How is the examination carried out correctly?

Carrying out an inspection requires several preliminary manipulations. First, the attending physician should examine the patient and carefully question him about any allergies he has, since local anesthetics may be used during the procedure to suppress the gag reflex. In this case, it is very important to identify diseases associated with blood clotting disorders, as well as severe pathologies of the cardiovascular and respiratory systems.

A thorough examination of the patient and testing allows us to identify hidden diseases of the internal organs, thereby preventing their complications.

When using flexible types of endoscopes, no special preparation measures are required, since direct laryngoscopy is performed under local anesthesia. The patient should only refuse food 3-4 hours before the test. This compares favorably with the procedure performed using a rigid laryngoscope, in which the patient must not consume food or water for 10-12 hours before the examination due to the required use of general anesthesia.

Carrying out the procedure

The design of the laryngoscope is based on modern developments in this field

The examination is carried out in a special endoscopy room. The patient is placed on the table on his back. After administering local anesthesia and suppressing the gag reflex, the doctor inserts a laryngoscope through the nose and carefully examines the oral cavity and pharynx for structural abnormalities.

Proper anesthesia can reduce patient discomfort and speed up recovery.

The introduction of a laryngoscope allows the attending physician to examine the mucous membrane of the organs being examined, as well as the patient’s vocal cords. If it is difficult to make a diagnosis, the attending physician may perform a biopsy followed by morphological analysis. This makes it possible to identify rare diseases or help in differential diagnosis, which is critical for prescribing subsequent rational treatment.

In addition, during the examination a number of simple surgical procedures can be performed - removal of polyps, stopping bleeding, etc. It is very important to take into account whether the patient has diseases of the internal organs (coronary heart disease, respiratory failure, etc.).

A flexible laryngoscope is used for diagnostic procedures

When conducting an examination with a flexible endoscope, it is very necessary to perform the procedure within 6-7 minutes, since after this time the anesthetic ceases to act. The short duration is a kind of disadvantage of this method. Since if the examination was carried out using a rigid laryngoscope, then after giving general anesthesia the doctor would have much more time. He would have the opportunity to work for 20 or 40 minutes, and if necessary, longer.

Complications of endoscopy

Endoscopy is a safe examination method, however, during the examination, the patient may develop a number of adverse events. The most common of these is an allergic reaction to the local anesthetics used, which can be prevented by careful questioning of the patient before the procedure.

The introduction of a foreign body into the pharynx and larynx can lead to the development of a reflex spasm of the glottis, which is manifested by the development of asphyxia and respiratory failure. However, proper endoscopy and careful preparation of the patient make it possible to cope with this complication before it begins.

When performing a biopsy or other manipulations from the vessels of the mucous membrane, slight bleeding may begin, which can lead to blood entering the final sections of the respiratory tract with the development of pneumonia and other pulmonary complications.

A laryngoscope is used to visually examine the condition of the larynx and vocal cords

But in general, the high efficiency of the procedure, combined with a low risk of early and late complications, makes endoscopic examination of the larynx and pharynx a frequently used method for examining these organs. The development of negative consequences can be prevented by the selection of suitable instruments and the high qualifications of the doctor. Also, before the examination, it is important to consult with your doctor and undergo a number of procedures: a clinical examination, a general blood and urine test, and a study of the blood coagulation system.

A necessary condition for complete visualization of the clinical picture, assessment of the adequacy of the therapeutic effect, and the dynamics of the pathological process is early and complete diagnosis.

Ultrasound examination has become widespread in otolaryngology due to its easy-to-use, non-traumatic, and highly informative technique. Due to the high prevalence of diseases of the oropharynx, the relevant questions will be what does ultrasound of the throat and larynx show, where to undergo the examination, when is it prescribed?

To identify pathology and develop treatment tactics, the doctor conducts a physical examination, collecting anamnesis, and analyzing the patient’s subjective sensations. In a number of clinical cases with an unknown genesis of the disease, ultrasound scanning of the cervical spine is prescribed.

Do they do ultrasounds of the throat and larynx? Naturally, however, this term will not be entirely correct; it is correct to say “ultrasound of the neck,” where during the study the condition of the laryngopharyngeal complex and nearby structures is assessed.

The essence of the technique is to move an ultrasonic sensor along the surface of the skin, as a result of which sound impulses are sent to tissues and organs, reflected from them, and an image of their condition, density, and parameters is projected onto the screen.

Indications for the procedure are patient complaints about pathological signs:

• pain, discomfort and;
• sensation of aspiration of a foreign substance;
• recurrent;
• mucous discharge with blood streaks, admixtures of exudate, sputum with a fetid odor;
• rapid and difficult breathing.

It is recommended to do an ultrasound when visualization of additional formations in the cervical region, enlargement and pain of lymph nodes, hyperemia and swelling of tissue structures. The presence of a history of chronic inflammatory processes in the laryngeal-pharyngeal complex, previously suffered oncology of the cervical spine, abscesses, cysts require an ultrasound scan as prescribed by a doctor.

Using ultrasound mainly diagnose the following pathologies and conditions:

• polypous formations of the larynx;
• malignant and benign neoplasms;
• location of secondary foci of cancer growth;
• oncology of lymphatic tissue (lymphoma, lymphogranulomatosis);
• endocrine organ dysfunction;
• purulent abscess;
• anatomical changes in the trachea and esophagus.

For reference! Ultrasound is considered a non-invasive, safe research technique, and therefore is allowed for children in the first days of life and women at all stages of gestation.

How to check the laryngopharyngeal apparatus

Ultrasound examination does not require preliminary preparation, therefore it is performed both routinely and in emergency clinical cases.

The technique has built algorithm of actions:

1. Before checking the throat, the patient provides access to the cervical region, removes clothing and jewelry.
2. Takes a horizontal position.
3. The area being examined is treated with a special transparent gel, which prevents air from penetrating between the sensor and the skin.
4. By sliding the ultrasonic sensor on the monitor, the condition of the internal organs and tissues of more or less intense color is displayed. The total duration of the procedure varies between 15-20 minutes.
5. The study data is recorded and given to the patient.

The diagnostic procedure has no contraindications, with the exception of an open wound site. Then ultrasound scanning is carried out until complete tissue regeneration.

What does an ultrasound of the cervical spine show?

• size, acoustic density of organs;
• specificity of regional lymph nodes;
• the state of the surrounding fiber;
• localization of the inflammatory process;
• additional education;
• change in gland size;
• location of foreign substances.

Particular attention is paid to hypoechoic areas, which describe a structure with lower density compared to the parameters of healthy organs. On the screen they are visualized as darkened, almost black zones (hyperechoic zones are light, white).

Their appearance is often associated with the growth of malignant tumors. Difficulties for diagnosis are caused by the asymptomatic course of the initial stage of the disease, so patients may not be aware of the development of a cancer process. An ultrasound examination of the throat and larynx does not provide reliable information about the genesis of a tumor formation, but it allows it to be determined at an early stage.

For reference! Timely diagnosis of throat (larynx) oncology increases the likelihood of a favorable outcome and allows you to prolong life by 5 years or more in 75-90% of clinical cases.

Ultrasound scanning data is studied by highly specialized specialists (otolaryngologist, endocrinologist, oncologist). In a number of clinical cases, a differential approach to visualizing the pathological process with histological examination of biopsy specimens is required.

Where to do it and how much does it cost?

Diagnosis of the laryngopharyngeal complex is performed in municipal medical institutions and private clinics. The location (city), level and prestige of the clinic determine the price range. The average price of the procedure is 500 rubles.

Advice! It is better to give preference to medical institutions with modern equipment, qualified specialists who systematically improve their skills. When choosing a clinic, you can be guided by patient reviews and doctor’s advice.

Conclusion

Ultrasound examination of the larynx and pharynx allows not only to determine the genesis of the pathology, but also to adjust the therapeutic regimen and monitor the effectiveness of the chosen treatment tactics. The advantage of ultrasound is that it is informative, safe, non-traumatic, along with an affordable price, and the absence of contraindications to the procedure.

Endoscopic examinations of the larynx and pharynx have come into use relatively recently and are gaining increasing popularity among patients. Using this technique, it is possible to completely examine the throat. The analysis is prescribed when the patient complains about the functioning of the ENT organs. Endoscopy of the larynx makes it possible to take smears for microflora analysis, as well as assess the condition of mucous tissues and take a tissue fragment for further histological examination.

When should the procedure be done?

Endoscopy of the throat is prescribed in cases of soreness of the throat and respiratory tract, difficulty swallowing, or difficulty speaking normally. Patients are referred for examination if they exhibit the following symptoms:

• obstructed airway and mechanical damage to the larynx;
• swallowing dysfunction;
• loss of voice, hoarseness;
• pain in the throat, periodic or constant;
• foreign objects entering the larynx area;
• hemoptysis.

With careful preparation of the patient and detailed implementation of all points of the examination, the attending doctor is able to prevent many negative consequences associated with diseases of the ENT organs.

What is manipulation

Carrying out an endoscopic examination of the larynx requires several steps in advance. First, the attending physician examines the patient and carefully questions him about all kinds of allergic reactions, since the procedure may require the use of local anesthetics to suppress the gag reflex.

The procedure is performed for both adult patients and children

A very important aspect is also the identification of possible diseases associated with blood clotting, various abnormalities in the functioning of the respiratory organs and heart. In cases where a procedure is performed using a flexible endoscope, the patient is not prescribed any special preparation measures. The only thing you need to do is stop eating four hours before the upcoming examination procedure.

Rules

There are several types of endoscopy:

• laryngoscopy;
• pharyngoscopy;
• rhinoscopy;
• otoscopy.

In flexible direct laryngoscopy, a pharyngoscope is inserted into a person's larynx through the nose. The medical device is equipped with a backlight and a camera, with which the doctor can watch a video of the ongoing operation through the monitor. This procedure uses local anesthesia and is performed in a hospital doctor's office. Rigid endoscopy is a more complex procedure that requires general anesthesia.

During the examination, the specialist performs the following:

• examines the condition of the larynx;
• collects material for further research;
• removes all kinds of growths, papillomas;
• removes foreign objects;
• affects pathology with ultrasonic waves or laser.

The latter methods are used when cancerous tumors and the presence of pathological growths are suspected.

How to do it

An endoscopic examination of the pharynx can be performed for the patient both standing and in a supine position. The specialist carefully inserts a medical instrument into the patient’s throat.

Unpleasant sensations may be caused by the fact that the procedure is performed through the nose. Next, the specialist performs an inspection. To look at some hard-to-reach areas, the doctor asks the patient to make certain sounds, which makes the task much easier.

When performing direct endoscopy, the Undritz directoscope can be used. The patient must be in a supine position during the examination. Using this instrument, the doctor examines a person’s larynx. Sometimes a microscopic tube is inserted into the cavity of the device to perform bronchoscopy. The process of performing rigid endoscopy takes place in the surgical room using general anesthesia.

Using a rigid endoscope, which is inserted through the oral cavity into the lower parts of the larynx, the doctor performs an examination. After the procedure is completed, the attending physician observes the patient for several more hours. To avoid the formation of edema, apply a cooling bandage to the patient’s neck and apply ice, providing him with rest.

After endoscopy, the patient should not:

• Eating;
• drink;
• clear your throat and gargle.

After an endoscopic examination, you may experience discomfort in the throat

The patient may feel nauseated for some time and experience discomfort when swallowing. This happens after treating the mucous surface with antisthetics. After rigid endoscopy, patients often suffer from hoarseness, sore throat and nausea, and some blood is released after a piece of tissue is taken for biopsy. Usually, unpleasant symptoms disappear after two days, and in cases where symptoms persist longer, you should consult a doctor.

Conclusion

Examination of the larynx using an endoscopy procedure is a modern method for diagnosing various pathological conditions of the respiratory tract, with the help of which it is possible to determine and identify early pathologies with maximum accuracy, perform a diagnostic examination of soft tissues, remove foreign objects and collect tissue fragments for further histological examination. This method is chosen for each person personally, taking into account the characteristics of his body and various medical indications and contraindications.

The examination of the larynx begins with external examination and palpation. During examination, the external condition of the surface, the configuration of the larynx, its cartilages (cricoid and thyroid), and the crunch of the cartilage of the larynx by moving it to the sides are determined. Normally, the larynx is painless and passively moves from right to left. After this, according to the method described above, the regional lymph nodes of the larynx are palpated: submandibular, deep cervical, posterior cervical prelaryngeal, pretracheal, paratracheal in the supra- and subclavian fossae.

In modern practical medicine, three methods of indirect laryngoscopy are used:

mirror laryngoscopy using a laryngeal mirror;

rigid (rigid) laryngo-pharyngotelescope with a viewing angle of 70°, 90°;

fiberoptic laryngoscope (soft fiberoptic laryngoscope).

Indirect (mirror) laryngoscopy. Take a laryngeal mirror with a diameter of 15 to 23 mm, heat it and wipe it with a napkin. The degree of heating of the mirror is determined by applying it to the back of the hand to avoid burns to the mucous membrane of the pharynx. The patient is asked to open his mouth, stick out his tongue and breathe through his mouth. Having wrapped the tip of the tongue above and below with a gauze napkin, take it with the fingers of the left hand so that the first finger is located on the upper surface of the lower tongue, the third on the lower surface, and the second finger pushes the upper lip away. The tongue is slightly pulled forward and downwards.

Fig.6. Indirect laryngoscopy.

The laryngeal mirror is taken by the end of the handle in the right hand like a pen for writing, inserted into the oral cavity with the mirror plane downwards, parallel to the plane of the tongue, without touching the root of the tongue and the back wall of the pharynx to the soft palate. Having reached the soft palate, place the plane of the mirror at an angle of 45º to the median axis of the pharynx; if necessary, you can slightly lift the soft palate upward and backward, and accurately direct the light from the reflector onto the mirror. Carefully, with small movements, the position of the mirror must be corrected until the picture of the larynx is reflected in it (Fig. 6). The study of the larynx consists of three points. First - examination during quiet breathing. In this case, the glottis gapes moderately in the form of a triangle with the apex of the base of the epiglottis. Above the vocal folds (normally pearly white) and parallel to them, pink vestibular folds are defined; between the vocal and vestibular folds, on each side there are depressions - the laryngeal ventricles. In the front, in the mirror, the larynx is visible in the form of two tubercles - arytenoid cartilages, covered with a pink smooth mucous membrane; the posterior ends of the vocal folds are attached to the vocal processes of these cartilages; the interarytenoid space is located between the bodies of the cartilages. From the arytenoid cartilages upward to the lobe of the epiglottis there are aryepiglottic folds; they are pink in color with a smooth surface. Lateral to the aryepiglottic folds are the pyriform sinuses, the mucous membrane of which is pink and smooth. . Second The point is that the patient is asked to produce the sound “e” or “i” , at the same time, the vocal folds approach one another and the gap between them, called the glottis, disappears. Finally, the patient is asked to take a deep breath - third moment. In this case, it is possible to see a wide divergence of the vocal folds, under which the anterior wall of the larynx and trachea becomes clearly visible. In some people, mainly men, even a bifurcation of the trachea is visible when taking a deep breath.

The method is called indirect laryngoscopy due to the fact that an image is visible in the laryngeal mirror, which differs from the true one in that the anterior parts of the larynx in the mirror are visible below, so they appear behind, and the posterior parts appear above and appear to be located in front. The right and left sides in the mirror correspond to reality.

During laryngoscopy, the main attention is paid to the symmetry and mobility of all parts of the larynx, the color of the mucous membrane, the volume and color of both true and false vocal folds, the nature and severity of closure during phonation of the true vocal folds and the condition of their inner edges.

When performing indirect laryngoscopy, there can be significant difficulties, due, for example, to the patient having an increased protective reflex of the pharyngeal mucosa. In such cases, just opening the mouth and sticking out the tongue causes nausea or even vomiting. If the patient takes several deep breaths through his nose or sips of cold water, the sensitivity of the mucous membrane often decreases. More often, this interference during laryngoscopy has to be eliminated by lubricating the pharyngeal mucosa with a 10% lidocaine solution. Significant obstacles can also be caused by individual anatomical features, among which it is necessary to eliminate a thick, short and inactive tongue, a narrow and backwards thrown back epiglottis, which covers the entrance to the larynx. Laryngoscopy in children presents great difficulties.

Laryngoscopy with a rigid telescope is an expensive routine method for examining the larynx. The method is considered ideal for photographic documentation, and the image can be displayed on a monitor. This type of telescope is also used for stroboscopy. The method is ideal for a thorough examination of the base of the tongue, the vallecula, the entrance to the larynx and the lower part of the pharynx, as well as for the study of the vocal folds and their displacement.

Fibrolaryngoscopy. The fibrolaryngoscope is passed through the nasal cavity, so preliminary anesthesia of the nasal cavity is required. This method is recommended for use in young children, including infants, to diagnose dysfunctions. The method allows you to easily visualize the larynx, determine the mobility of the vocal folds, and diagnose congenital pathology, including laryngomalacia.

Direct laryngoscopy. In cases where, for one reason or another, it is impossible to examine the larynx through indirect (mirror) laryngoscopy, as well as to remove foreign bodies from the trachea and bronchi and perform surgical manipulations in the larynx, direct laryngoscopy is performed. To perform this, it is necessary to mechanically straighten the angle between the axis of the oral cavity and larynx. Typically, the study is performed with the patient lying down with his head thrown back under general anesthesia. Devices for direct laryngoscopy (laryngoscopes) are varied in design. The illumination source can be mounted in their proximal or distal parts. Until now, the universal Undritz directoscope has been widely used, consisting of three removable spatulas, at the distal end of which a light bulb is mounted, and a removable handle to which spatulas are attached at right angles: respectively, for children, adults, intratracheal anesthesia and intubation. The spatula is inserted into the oral cavity along the tongue and when it reaches the root of the tongue, the latter is pressed until the epiglottis becomes visible. Then, keeping strictly to the midline, pass the end of the spatula behind the epiglottis and gradually increasing pressure on the root of the tongue, move the instrument deeper until the arytenoid cartilages, and then the entire laryngeal cavity, appear in the field of view.

Fig.7. Riecker-Kleinsasser support system.

Special types of direct laryngoscopy include suspension and support laryngoscopy. In recent years, indications for direct laryngoscopy have significantly expanded due to the creation of new models of bronchofiberscopes based on fiber optics and the widespread use of endolaryngeal microsurgery using an operating microscope and microsurgical instruments.

Stroboscopy - a research method that allows you to determine subtle functional disorders of the mobility of the vocal folds, which cannot be determined by laryngoscopy, since the human eye does not detect vibrations with a frequency of more than 16 per second. The essence of the method is that the vocal folds vibrating during phonation are illuminated by intermittent light, the frequency of which coincides with the frequency of vibration of the vocal folds. Since the larynx is illuminated at approximately the same moment, a stroboscopic effect is created, that is, the apparent immobility of the vocal folds at a certain moment of phonation. The electronic strobe is automatically adjusted through a microphone to the fundamental frequency of the subject’s voice (Fig. 8).

Fig.8. Video stroboscopy.

X-ray examination of the larynx. X-ray of the larynx, as an additional research method, is successfully used in the diagnosis of many diseases of the larynx, especially malignant tumors. X-ray of the larynx in a lateral projection, supplemented by anterior direct tomography, allows one to judge the configuration of the cartilages of the larynx, the degree and type of their ossification; the shape of the air column of the hypopharynx, laryngeal tube and the initial part of the trachea; the shape and size of the laryngeal (Morgani) ventricles; the size of the vocal folds and the width of the glottis.

X-ray methods, as well as computed tomography and MRI, are of greatest clinical importance in the diagnosis of laryngeal cancer. They make it possible to judge the position, size, shape and contours of the tumor, as well as the degree of narrowing of the lumen of the larynx (its asymmetry) and the initial part of the trachea. Changes in the tomogram may manifest as narrowing of the pyriform sinus or laryngeal ventricle, or an increase in the size of the vestibular or vocal folds. Tomography data significantly complements the picture of indirect laryngoscopy and serves for a more accurate diagnosis of the pathological process.

Smear from the mucous membrane of the larynx performed under local anesthesia with a 10% lidocaine solution using a laryngeal probe. Indications: fungal infections of the larynx, diphtheria, tuberculosis and others.

Biopsy performed under local superficial anesthesia of the laryngeal mucosa with a 10% lidocaine solution. The pathologically altered tissue is taken endolaryngeally with laryngeal forceps and sent to the pathology laboratory. Biopsy data allows for differential diagnosis between benign and malignant tumors and specific lesions of the larynx.

There is a method of mirror (indirect, or reverse) laryngoscopy (Fig. 47, 48). It was developed in 1854 by the Spanish singer and famous vocal teacher Manuel Garcia. A year later, other doctors began to use this technique in their practice.

Mirror laryngoscopy is performed using a round laryngeal mirror attached at an angle of 125° to a straight metal rod. To prevent the mirror from fogging up during inspection, its reflective surface must be slightly heated using an alcohol lamp. The back surface of the mirror should not be hot to avoid burns to the throat. The doctor controls this by applying the back surface of the mirror to the back surface of his hand.
The laryngeal mirror is taken in the right hand, with the fingers of the left hand holding the tip of the tongue through the napkin. In this case, the doctor’s thumb lies on top, the middle finger lies below the tip of the tongue, and the index finger slightly moves the upper lip. The mirror is inserted into the oral cavity and pressed against the soft palate. You should not touch the root of the tongue and the back of the pharynx with the mirror so as not to cause a gag reflex. Carrying out mirror laryngoscopy includes three main points: free breathing, phonation of the sounds “i” or “e”, and a deep breath. During the first of them, attention is paid to the condition of the epiglottis, aryepiglottic, vestibular and vocal folds, pyriform recesses, and the condition of the root of the tongue, lingual tonsil, and vallecules is assessed.

Rice. 47.

Rice. 48.

The glottis has the shape of an isosceles triangle. During the second moment, the closure of the vocal folds is determined. Changing phonation and inspiration allows you to determine the symmetry of the mobility of the halves of the larynx. During the third moment (deep inspiration), the subglottic space and the upper trachea are examined.
In most people, mirror laryngoscopy can be performed relatively easily.
If laryngoscopy cannot be performed due to a significant pharyngeal reflex, then the following technique is used: the patient is examined on an empty stomach (after eating, the pharyngeal reflex is more pronounced), and, if necessary, local superficial anesthesia of the pharynx is performed. An examination of the larynx can only be considered high-quality if its anterior commissure (anterior angle of the glottis) is clearly visible. For a thorough examination of the larynx, it is necessary to use local superficial anesthesia more widely and move the epiglottis forward using a laryngeal probe or an elevator specially designed for this purpose.
If indirect laryngoscopy does not satisfy the doctor, direct laryngoscopy is performed.
The essence of the direct laryngoscopy method is to use the laryngoscope blade to straighten the angle between the oral cavity and the pharyngeal cavity, which will make it possible to examine the larynx and trachea. Laryngoscopes used in otorhinolaryngology can be divided into 2 groups: 1st - laryngoscopes, which are held by the hand of the doctor performing direct laryngoscopy; 2nd - laryngoscopes, which are held independently, and the hand of the doctor performing the manipulation remains free. This type of laryngoscopy is called supporting or hanging (see inset, Fig. 49).

Direct laryngoscopy technique. The patient lies on his back. His head is slightly thrown back, his neck is extended. The doctor sits near his head. The laryngoscope blade is inserted strictly along the midline of the tongue until the epiglottis appears, then it is inserted behind the epiglottis and pulled upward.

Microlaryngoscopy - This is a method of examining the larynx using a surgical microscope with a focal length of 300-400 mm. It can be used for both mirror and direct laryngoscopy (see insert, Fig. 50). Thanks to microlaryngoscopy, microsurgery of the larynx has developed.

Indirect microlaryngoscopy carried out with the patient sitting. This research method should also be recommended for outpatient practice, which may contribute to earlier detection of laryngeal cancer.

Direct microlaryngoscopy allows the surgeon to work with both hands and use a straight instrument. The patient lies on his back with his neck straightened. After the patient is put under anesthesia, direct laryngoscopy is performed. The laryngoscope is fixed using a special device on the patient's chest. The microscope is pointed at the area of ​​the larynx. At the otorhinolaryngology clinic
The National Medical University developed (L.P. Yuriev, 1978) and widely used light and fluorescent microlaryngoscopy. Light microlaryngoscopy is a study in light of different spectral composition (green, yellow, without red and red). Low-contrast details become more contrasting in certain light.

Fluorescence microlaryngoscopy - This is an examination of the larynx after the introduction of one of the fluorochromes, in particular sodium fluorescein, into the patient’s body. To observe the luminescence of fluorescein, a blue filter is used. Using this research method, the size, shape of blood vessels, and their atypia are more intensively and clearly determined. Fluorescein is absorbed differently by laryngeal tissues.
Laryngostroboscopy occupies an important place in the study of the larynx. The method consists of examining the larynx in intermittent light, which allows you to see individual vibrations of the vocal folds.
A technique has been developed that involves the use of an operating microscope in combination with an electronic stroboscope - microlaryngostroboscopy. The flashing strobe lamp is placed in place of the usual incandescent lamp of the microscope. In the mode of continuous illumination with a strobe lamp, the microscope can be used as a regular operating room.
An achievement of medical technology in recent years is the development of fibrolaryngoscopy. Thanks to the 270° mobility of the flexible end of the fiberscope, all parts of the larynx become accessible for inspection. Manipulations are carried out under local anesthesia. Fibrolaryngoscopy allows for targeted biopsy and high-quality endophotography of the larynx.
X-ray diagnostics occupies a special place among the methods of studying the larynx. In the otorhinolaryngology clinic, conventional radiography and tomography are used - in anteroposterior and lateral projections.
The most widely used in radiography of the larynx are images in the lateral projection, which make it possible to see the main details of the larynx and periglottic soft tissues: the epiglottis, aryepiglottic folds, arytenoid cartilages, air-filled laryngeal ventricles, the laryngeal part of the pharynx and the root of the tongue.

Tomography is a mandatory component of the X-ray examination of patients who are suspected of having a tumor of the larynx or have chronic stenosis of the larynx and trachea. Tomography allows you to obtain frontal images of the larynx, on which you can determine the condition of the epiglottis, aryepiglottic, vestibular and vocal folds, laryngeal ventricles, subglottic space, as well as the cervical trachea.