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 of the National Medical University, light and fluorescence microlaryngoscopy has been developed (L.P. Yuryev, 1978) and is widely used. 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.
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.
The following pathologies and conditions are mainly diagnosed using ultrasound:
:
- 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 a built-in algorithm of actions
:
- Before checking the throat, the patient provides access to the cervical region, removes clothing and jewelry.
- Takes a horizontal position.
- The area being examined is treated with a special transparent gel, which prevents air from penetrating between the sensor and the skin.
- 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
. - 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 cost 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.
How to diagnose throat cancer?
- Perform laryngoscopy, examination of the larynx with a special mirror, laryngoscope. Laryngoscopy will help detect the tumor. Also inspect the throat cavity and nasal folds. A laryngoscope is a tube with one end equipped with a video camera. In addition, laryngoscopy is used to collect tissue for biopsy.
- A biopsy allows you to identify throat cancer and make a more accurate diagnosis. A biopsy can not only identify cancer, but also its histological type. With the help of this information, it is possible to effectively treat the disease.
- There are some other methods for diagnosing throat cancer, imaging methods. These are such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET).
- If several signs are present, direct laryngoscopy is necessary, using special devices (laryngoscope), possibly indirect laryngoscopy. Together with radiography, it is leading in detecting laryngeal cancer.
- Stroboscopy is an additional study.
- An X-ray diagnostic method is very common, since the larynx is a hollow organ with its own distinctive properties and is clearly visible in photographs without special contrast.
- X-ray of the throat is the most accessible and effective way to detect cancer, and at the same time, it is quite informative. With its help, you can get a complete picture of the condition of the larynx and surrounding tissues. Chest X-ray assesses the extent of the neoplasm, and with the help of computed tomography, it is possible to obtain detailed information about it.
- In examining the subglottic area, the direct fibrolaryngoscopy method is used.
- Clinical blood tests and blood tests for tumor markers are integral in the diagnosis of cancer.
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Laryngoscopy of the throat
Indications for laryngeal endoscopy
Indications for endoscopic examination of the larynx are a variety of ENT diseases that affect the functioning of this part of the body:
- with obstructive processes in the upper respiratory tract;
- to examine the mucous membrane of the nose and pharynx if polyposis of the throat and larynx, vocal cords, etc. is suspected;
- with cyanosis of the lips and difficulty breathing, not associated with serious pulmonary pathologies and diseases of the cardiovascular system;
- in inflammatory processes (laryngitis, including subglottic);
- when the throat hurts and the cause of the symptom cannot be identified;
- with paresis of the vocal cords and dysphonia;
- with progressive and congenital stridor.
Endoscopy is also carried out in patients diagnosed with chronic tonsillitis, sinusitis to clarify the clinical picture, to identify the causes of constant nasal congestion, from which vasoconstrictor drops do not help. The method is used to diagnose and treat polyps on the vocal cords and papillomas in the pharynx.
Important! Endoscopy is used in ENT practice to remove foreign objects from the throat that have been swallowed or accidentally entered there.
What does an MRI of the larynx show?
MRI of the larynx and throat allows you to detect emerging pathologies of the upper respiratory tract. This test is used to identify malignant tumors and is considered one of the most accurate. The principle of its operation is based on capturing vibrations of molecules in a created magnetic field and subsequent processing of the obtained data with a special program. The result is an image that allows you to detect pathologies of any tissue. Using magnetic resonance imaging of the throat, diseases such as:
- neck injuries and their consequences;
- pathologies of the thyroid gland and vocal cords;
- phlegmon of soft tissues of the cervical region;
- inflammation of the lymph nodes;
- congenital soft tissue cysts.
Laryngeal edema is not an independent disease, but it is a symptom that indicates various abnormalities that have occurred in the body. Laryngeal swelling may be due to injury, infection, allergic reactions, or tumor.
In addition, an MRI of the larynx is prescribed if the following symptoms are present:
- difficulty breathing or swallowing;
- attacks of suffocation;
- pain and burning in the throat;
- constant (or periodically occurring) hoarseness;
- Asymmetry in the neck, asymptomatic swelling.
Also, MRI of the throat makes it easy to determine the presence of foreign bodies that do not contain metal in the larynx. The resulting image shows all tissues, unlike other hardware studies. In addition, magnetic resonance imaging is completely safe, which distinguishes it from, for example, radiography.
One of the indications for magnetic resonance imaging of the throat is a suspicion of a tumor or the need to assess the effectiveness of antitumor therapy.
Many specialists can prescribe an MRI of the throat, including: otolaryngologist, surgeon, neurologist, oncologist.
How the procedure is performed
Endoscopy of the throat and larynx does not require hospitalization. The procedure takes place on an outpatient basis in a specially equipped room. The patient is placed on his back or seated on a chair. Before the examination, an anesthetic spray is used to reduce the sensitivity of the root of the tongue and throat. This will help avoid coughing and gagging during the examination.
A device with flexible tubes is inserted through the nasal passage, and an endoscope with a straight tip is inserted through the mouth. Slowly advancing the device, the doctor records changes in the mucous membranes of the pharynx and larynx and examines the vocal cords. For a better and more detailed examination, the specialist asks the patient to make sounds (phonation). If necessary, the doctor takes biomaterial: pinches off an area of the mucous membrane or tumor.
Rigid endoscopy of the larynx is somewhat different. It is carried out if malignant tumors are suspected. It is carried out in a hospital setting in an operating room using a rigid endoscope, and the patient is immersed in a medicated sleep (general anesthesia). Before starting the procedure, the patient is placed on his back with his head tilted back. Endoscopy is performed under the supervision of a team of medical professionals. During the procedure, the tumor is examined, tissue is taken for further histological examination, and, if necessary, laser or ultrasound removal of the tumor is performed.
After the procedure, the patient is transferred to the general ward or remains for some time in the clinic under the supervision of a doctor. To prevent swelling of the larynx, cold is applied to the neck in the first 2 hours. You should not eat or drink for 2 hours.
Important! Immediately after the procedure, the patient may feel a sore throat or nausea. This is considered normal and does not require additional action.
Features of the study for children
Features of laryngeal endoscopy for children include establishing contact between the doctor and the patient. The specialist must take into account the patient’s psychosomatics, his age and build, and mood for the procedure in order to select the most effective and safe anesthetics and endoscopic device. Before starting the examination, the endoscopist explains in detail to the baby what the essence of the examination is and what sensations he will experience.
For young children, the examination is carried out using a flexible endoscope, as it is smaller. For patients over 6 years of age, a straight endoscope can be used if necessary. In this case, they try to carry out the procedure under general anesthesia. Children 1-3 years old are examined using a flexible endoscope of minimal size. It is administered through the nose.
What kind of anesthesia is used?
To examine the condition of the larynx, in most cases, local anesthesia with lidocaine in aerosol form is sufficient. Before using it, it is necessary to conduct a drug tolerance test. In case of intolerance, local anesthetics based on diphenhydramine are used in combination with hydrocortisone.
For adults and older children, if the patient’s well-being and characteristics allow, the examination can be performed without local anesthesia. This usually occurs when thin angled endoscopes are used, as well as with an increased pain threshold and the absence of pronounced gag reflexes.
Important! Under general anesthesia, the procedure is carried out only if it is necessary to carry out treatment or take a piece of mucous membrane for histology, since these manipulations are quite lengthy and cause discomfort.
Instrumental examination methods
Currently, indirect laryngoscopy, fibrolaryngoscopy, endoscopy with targeted biopsy, radiography, computed tomography of the affected area, ultrasound, and aspiration puncture of regional lymph nodes are widely used.
Indirect laryngoscopy is used to determine the location and extent of the tumor, visual assessment of the mucous membrane of the larynx and glottis, and attention is paid to the level of mobility of the vocal cords.
Fibrolaryngoscopy is considered the method of choice for trismus to diagnose throat cancer; it can be used to determine the condition of the fixed area of the epiglottis and subglottic region. When using endoscopy, it is advisable to conduct a targeted biopsy to determine the degree of malignancy of the formation.
Diagnosis of throat cancer, like the examination of any other organs suspicious for cancer, is very doubtful without histological examination. If the secondary biopsy does not show oncology, and the clinic can diagnose cancer, intraoperative diagnosis is used with mandatory histological examination to confirm or refute cancer.
Detection of metastases in regional lymph nodes gives a disappointing prognosis, so it is important to be able to detect them in a timely manner. During ultrasound, nodes with existing hypoechoic areas will be suspected. When such nodes are found, it is necessary to perform a fine-needle aspiration puncture, the taken biological material is subjected to histological examination, and a repeat puncture will be required to be convincing. The accuracy of the method with a positive result is 100%.
Methods of detection and survey
Where does the examination begin?
- examination of the patient;
- neck examination;
- palpation (feeling) of the cervical lymph nodes.
Before the examination, the doctor asks the patient to tilt his head forward, after which he begins to feel the cervical lymph nodes, as well as the sternocleidomastoid muscle. This helps him assess the condition of the lymph nodes and make a preliminary assumption about the presence of metastases.
Indirect laryngoscopy
Indirect laryngoscopy
Indirect laryngoscopy is an examination of the larynx, which is performed directly in the doctor’s office. The technique is quite simple, but outdated, due to the fact that the specialist cannot fully examine the larynx. In 30–35% of cases, the tumor is not detected at an early stage.
With indirect laryngoscopy, the following is determined:
- tumor location;
- tumor boundaries;
- growth pattern;
- condition of the laryngeal mucosa;
- condition (mobility) of the vocal cords and glottis.
Before the study, you should not consume (drink) liquids or eat food for some time. Otherwise, during laryngoscopy, a gag reflex may occur and vomiting may occur, and vomit may enter the respiratory tract. It should also be noted that it is recommended to remove dentures before the examination.
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Research process by a specialist:
- the doctor sits the patient opposite him;
- Using a spray, local anesthesia is administered to prevent vomiting;
- the doctor asks the patient to stick out his tongue and holds it with a napkin, or presses on it with a spatula;
- with the other hand, the doctor inserts a special mirror into the patient’s mouth;
- using a second mirror and lamp, the doctor illuminates the patient’s mouth;
- During the examination, the patient is asked to say “a-a-a” - this opens the vocal cords, which makes the examination easier.
The entire period of indirect laryngoscopy examination takes no more than 5–6 minutes. The anesthetic loses its effect after about 30 minutes and during this time you should not eat or drink.
Direct laryngoscopy
Direct Laryngoscopy
When performing direct laryngoscopy, a special flexible laryngoscope is inserted into the larynx. Direct laryngoscopy is more informative than indirect. During the study, you can clearly see all three sections of the larynx. Today, most clinics adhere to this particular examination technique.
With direct laryngoscopy, you can take a fragment of the tumor for a biopsy and remove the papilloma. A flexible laryngoscope is a type of tube.
Before the study, the patient is prescribed medications to suppress the formation of mucus. Using a spray, a specialist administers local anesthesia and instills vasoconstrictor drops into the nose, which reduce swelling of the mucous membrane and facilitate the passage of the laryngoscope. The laryngoscope is inserted through the nose into the larynx and examined. During direct laryngoscopy, some discomfort and nausea may occur.
Biopsy
Biopsy
A biopsy is the removal of a piece of a tumor or lymph node to be examined under a microscope. This study makes it possible to fairly accurately diagnose the malignant process, its type and stage.
If malignant cells are found during examination of the lymph node, then the diagnosis of laryngeal cancer is considered 100% accurate. Typically, the biopsy is taken with a special instrument during direct laryngoscopy.
Oncological lesions removed during surgery are also required to be sent to the laboratory for examination. To identify metastases, a puncture biopsy of the lymph nodes is performed. The material is obtained using a needle that is inserted into the lymph node.
Ultrasound of the neck
Ultrasound
An ultrasound of the neck helps the specialist evaluate the lymph nodes. Using ultrasound, the smallest lymph nodes with metastases are identified that are not detected during palpation (palpation with hands). To perform a biopsy, the doctor identifies the most suspicious lymph nodes.
Ultrasound examination of the neck for laryngeal cancer is carried out using conventional devices designed for ultrasound diagnostics. Based on the image on the monitor, the doctor assesses the size and consistency of the lymph nodes.
Chest X-ray
Chest X-ray
Chest X-ray helps identify tumor metastases in the lungs and intrathoracic lymph nodes. X-ray photographs of the chest are taken in frontal (full face) and lateral (profile) projections.
Computed tomography (CT) and magnetic resonance imaging (MRI)
CT scan
CT and MRI are modern diagnostic methods that can be used to obtain high-quality three-dimensional images or layer-by-layer sections of an organ.
Using CT and MRI, you can determine:
- position of the tumor;
- its dimensions;
- prevalence;
- germination into neighboring organs;
- metastases to lymph nodes.
These techniques provide a more accurate picture compared to radiography.
The principles of CT and MRI are similar. The patient is placed in a special apparatus, in which he must remain motionless for a certain time.
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Both studies are safe, since there is no radiation exposure to the patient’s body (MRI), or it is minimal (CT). During an MRI, the patient should not have any metal objects with him (the presence of a pacemaker and other metal implants is a contraindication for MRI).
Electrocardiography (ECG)
Electrocardiography
First of all, this study is intended to assess the condition of the heart in laryngeal cancer, which is included in the mandatory diagnostic program.
The patient is placed on a couch, and special electrodes are placed on the arms, legs and chest. The device records the electrical impulses of the heart in the form of an electrocardiographic curve, which can be displayed on tape or, in the presence of modern devices, on a computer monitor.
Bronchoscopy
Bronchoscopy
Endoscopic examination of the bronchi is carried out using a special flexible instrument - an endoscope. This study is carried out only when indicated. For example, if changes are detected during a chest x-ray.
What needs to be done before preparing the patient for the study:
- as prescribed by the doctor, some time before the study, the patient is administered medications;
- it is necessary to remove dentures and piercings;
- the patient is seated or laid on the couch;
- local anesthesia is administered: the mucous membranes of the mouth and nose are irrigated with an aerosol of anesthetic;
- the bronchoscope is inserted into the nose (sometimes into the mouth), advanced into the larynx, then into the trachea and bronchi;
- examine the bronchial mucosa. If necessary, a photo is taken and a biopsy is taken.
Possible complications after the study
If you follow the endoscopy technique and proper rehabilitation, the likelihood of complications is minimal. Slightly increased rates are observed after removal of polyps, tumor biopsy, and examination of the larynx with severe inflammation. Patients with anatomical features are also at risk: a large tongue, a short neck, an arched palate, and so on. Disturbances in the form of laryngeal edema may appear during the procedure. Applying a tracheostomy and applying cold to the neck can cope with this complication.
In all patients, without exception, an examination done even according to the rules provokes a sore throat of mild or moderate intensity. It is especially acute when swallowing, coughing, or trying to speak. In rare cases, scanty bleeding occurs (streaks and droplets of blood are visible in the expectorated secretion). All this is considered normal if it persists for no longer than 2 days. Otherwise, there is a possibility of developing an infection that will require special therapy.
2311 09/11/2019 5 min.
An endoscopic examination is a diagnostic procedure performed in an inpatient setting on an outpatient basis. The study involves analyzing the condition of the mucous membrane, assessing the degree of curvature of the septum, the presence or absence of formations in the sinus cavity. The procedure involves taking biological material for analysis and is done only if indicated. We also recommend that you familiarize yourself with. But why dry throat and nasopharynx can occur and what can be done about such a problem is indicated in detail
What can an ultrasound show?
What does an ultrasound show? Using the method, you can evaluate the condition of subcutaneous tissue, muscles, lymph nodes, cysts and abscesses. The condition of the initial sections of the esophagus and trachea, their curvature, narrowing, and the presence of foreign bodies are also determined. The study can show the condition of the vocal cords, subglottic and supraglottic parts of the larynx. If necessary, a thyroid test may be prescribed. Ultrasound evaluates its size, structure of the lobes and isthmus, blood supply, and the presence of nodes. After the procedure, the following pathologies can be identified:
- Neoplasm (shape, size, germination into surrounding tissues, involvement of lymph nodes).
- Foreign body (with exact location, size, complications).
- Purulent abscess.
- Consequences of injuries (deformations, ruptures, perforations).
The method also allows you to monitor treatment, differentiate the pathology of the larynx from other organs of the neck, and select the appropriate treatment method. Under ultrasound control, cyst puncture and tumor biopsy can be performed. If it is necessary to determine blood flow in the vessels of the neck, Doppler measurements are performed.
Description of the procedure
An otolaryngologist prescribes an endoscopic examination for the child; he recommends going through the procedure if there are difficulties in making a diagnosis.
The study is carried out in compliance with several rules, in order for it to take place it is necessary:
- Explain to the child why he is being examined.
- Explain the mechanism of action and manner of behavior.
The child must understand how to behave and that attempts to contact the doctor will lead to an increase in the duration of the examination, and undesirable consequences will arise at the time of its conduct.
Indications
Endoscopic examination is carried out if indicated. These include:
- frequent pain in the frontal or temporal lobe of the skull;
- bleeding from the sinuses;
- discharge of purulent secretion from the sinuses;
- violation of the breathing process (on one or both sides);
- inability to breathe through the nose, the appearance of snoring at night (described in the link);
- decreased sense of smell or its complete absence;
- impaired perception of taste;
- frequent rhinitis of unknown cause (see the link).
The procedure is also carried out if the doctor for some reason cannot (finds it difficult) diagnose the patient. If there are indications, and there are no contraindications to an endoscopic examination, an ENT specialist may recommend a procedure in order to make an accurate diagnosis.
An otolaryngological operation can also be considered an indication; the procedure can be performed before surgical procedures, as well as after. This allows you to track the effectiveness of treatment, as well as identify the presence or absence of indications for surgical procedures.
The video contains detailed information about that. Why this procedure is carried out:
What can be seen on an ultrasound and what diseases can be diagnosed?
Ultrasound examination is done using a special sensor. It conducts ultrasound waves through the tissues and other anatomical structures of the throat and larynx. The results are displayed on the monitor.
With the help of an examination, you can evaluate the structure and size of the lumen of the lower parts of the throat and larynx, clarify the thickness and degree of homogeneity of the walls of organs, and determine the presence or absence of nodules and atypical growths. The cellular spaces located nearby, the superficial and deep cervical lymph nodes, their size and number are examined.
Based on the results of the examination, it is possible to determine acute or chronic inflammatory processes of the mucous membrane of the throat, larynx and other structures, establish oncological diseases and differentiate tumor-like formations in the form of an abscess, adenoma, cancer, cyst, etc.
The following diseases are determined using ultrasound:
- disorders of the thyroid gland - hyperthyroidism, etc.;
- cyst;
- abscess;
- the presence of a foreign body and its location;
- tumors, their size, number, mobility, adhesion to surrounding tissues;
- traumatic injuries;
- complications after chronic inflammatory processes;
- diseases of the cervical lymph nodes (lymphadenopathy, lymphadenitis, etc.).
Do they do ultrasounds of the throat for children?
This procedure is completely safe and painless, is not accompanied by any other unpleasant sensations, and does not require special preparation for diagnostics. Babies tolerate ultrasound of the throat and larynx very well. This is the optimal examination method that allows us to identify many diseases of the ENT organs. The duration of the procedure does not exceed 15-20 minutes.
Ultrasound has no contraindications for its use. The exception is the presence of damage to the integrity of the skin at the site of application of the sensor. This can significantly distort the results, therefore, if possible, the date of the study should be postponed until the epidermis is completely healed.
How is the procedure performed?
An endoscopic examination is done following certain rules. It all starts with a visit to an ENT doctor.
If there is evidence, he recommends the procedure, finds out from the parents or the child himself:
- Are there any complaints that may indirectly or directly indicate the presence of indications for an examination?
- The presence of allergic reactions to lidocaine or novocaine.
It is worth noting that the procedure may cause certain sensations, including pain, provided that the child’s nasal passages are narrowed. This is considered an anatomical feature of the structure of the nasopharynx. In this case, the procedure is called into question.
How is the examination carried out?
- the endoscope is treated with an anesthetic and antiseptic solution;
- then they gradually introduce it into the nasal sinus, examining it with a camera;
- The doctor examines the result personally and makes a diagnosis for the little patient.
On average, the study lasts from 2 to 5 minutes; if it is performed on an infant, then the parents record the position of the baby.
It is important that the baby does not move and does not create unnecessary interference. Otherwise, the child risks injury and damage, and the procedure may be disrupted.
Preparation for the event
It involves direct communication with the child. You can tell him the essence of the procedure, the scheme of its implementation and the algorithm of the doctor’s action.
If the small patient cooperates with the doctor, then the study:
- It won't take long.
- It will pass without consequences or complications.
- It will allow you to obtain data on the condition of the nasal mucosa, the presence of polyps and formations.
If the baby is afraid of pain, then you should explain to him that the procedure may be accompanied by unpleasant sensations. But if you are worried about severe pain, then you should notify the doctor about it.
The examination does not require any specific preparation; you should not deny your child food or drink. Since a local anesthetic is used, it is well tolerated and rarely leads to the development of unwanted side effects. The drug acts only on the mucous membrane, it does not penetrate into the general bloodstream.
X-ray examination
This type of diagnosis is used to examine patients with laryngeal cancer. If the accuracy of conventional radiography is not enough, contrast is added.
Indications for X-ray examination
X-rays of the larynx are used for:
- determining the boundaries of the tumor;
- observations .
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Niobium is used as a contrast agent. Indications for radiography with contrast are:
- vestibular tumors ;
- determining the distance from the lower pole of the tumor to the anterior commissure of the larynx;
- diagnosis of tumors of the subcommissural region and infiltrates of the fixed part of the epiglottis;
- study for severe inflammatory processes in the larynx, when the contours of the cartilage on the x-ray become unclear.
Method capabilities
X-rays are performed in frontal and lateral projections. This makes it possible to assess the condition of various parts of the larynx. If you perform functional tests, for example, asking the patient to pronounce various sounds, you can study the mobility of the larynx.
Using radiography, disorders of the mobility and elasticity of the larynx, tumors growing into the cartilage or into the lumen of the larynx, and ulceration of tumors are detected.
X-ray examinations do not take much time and are well tolerated. With their help, you can check the larynx for cancer both in a hospital and on an outpatient basis.
Indications and contraindications for throat endoscopy
| Indications | Contraindications |
The study is carried out if the patient suffers from:
Sensation of a foreign body in the throat; The appearance of blood inclusions in the cough sputum; Unpleasant sensations when swallowing. Diagnostics is mandatory for patients who have been diagnosed with:
Inflammation of the larynx - laryngitis; Dysphonia. In addition, it is indicated for those who have suffered throat injuries. | Endoscopy of the throat and larynx is not performed in the following pathological conditions:
CVD diseases; Acute inflammatory processes of the larynx; Inflammatory processes of the nasal cavity. The procedure is not performed for traumatic injuries of the cervical spine, or for women during pregnancy. |
About the tomograph
An MRI examination is carried out using a special machine - a tomograph. Depending on the model and design, the devices have certain characteristics. There are open and closed tomographs.
For MRI of the larynx, as a rule, a modern open design is used, since the use of a closed circuit is not justified for this study. The device is a ring that generates a magnetic field. The patient is placed into the ring cavity using a moving table. It is important that the device is located exactly above the neck area, without leaving the patient with a feeling of enclosed space. This procedure does not cause fear or discomfort; accordingly, the patient can calmly spend the necessary time for the examination without moving, which helps to obtain the most accurate diagnostic result.
Endoscopy of the throat and larynx
The patient is asked to take a sitting or lying position and local anesthesia of the mucous membranes is performed. An anesthetic gel is also applied to the tip of the endoscope so that the procedure does not cause discomfort.
After the anesthesia has taken effect, the doctor begins to insert the endoscope, observing the image that appears on the screen. Thanks to its magnification many times over, he is able to carefully examine all the anatomical structures of the throat and identify any abnormalities.
If there are indications, the procedure may be accompanied by the collection of samples of affected tissue for cystological or histological examination. Simple surgical procedures can also be performed to remove the polyp or stop the bleeding.
Endoscopy of the throat and larynx for children
The effectiveness of throat and larynx endoscopy in young patients depends on how calm they are. In order for the procedure to take a minimum of time and be as accurate as possible, parents need to prepare the child for it, explaining why it is needed.
Diagnosticians at Doctor Nearby clinics also tell the child how the test is carried out and that during it you need to be calm and not disturb the doctor in order to avoid unpleasant consequences.
To whom and when is it assigned?
The indications that serve as a reason for performing an ultrasound scan of the neck, including examination of the throat and larynx, are given in the table.
| Indication group | Possible symptoms and clinical findings |
| Patient's complaints |
|
| Inspection data |
|
| Anamnesis of life |
|
In fact, an examination of the larynx and throat, carried out using ultrasound, shows indicative information on the basis of which further diagnostic search is based. This means that this study, due to its safety and speed of implementation, combined with a relatively low cost, can be performed on patients of all ages in the presence of any complaints and pathological processes in the throat and larynx.
Important to remember! Ultrasound of the neck, during which the throat and larynx are assessed, belongs to the group of screening methods for the early detection of malignant tumors of this location. Although such diagnostics do not provide 100% information about the nature of the tumor formation, it is capable of identifying it at an early stage!
What does endoscopy of the throat and larynx show?
This diagnostic method allows you to identify and confirm a number of pathological conditions of the throat and larynx, namely:
- Neoplasms of benign or malignant nature;
- Laryngitis;
- Purulent processes - abscesses;
- Congenital and acquired diseases of the vocal cords.
Thanks to it, it is possible to identify burns of various natures and assess the degree of damage, as well as detect foreign bodies that have entered the larynx during food consumption or through negligence.
Methods for detecting oncology in the throat
At the first manifestations of discomfort, it is important to consult an otolaryngologist. The doctor will conduct a survey and an initial examination. If necessary, he will refer you for a general blood test. If additional suspicious manifestations are detected and the test results are disappointing, the ENT will give the patient a referral to an oncologist, who will determine the full range of necessary diagnostic procedures.
Examination and interview of the patient
The first thing the oncologist does is ask the patient questions regarding the symptoms that are troubling him, and then palpate the neck and assess the following parameters:
- shape, contours of the neck;
- skin changes;
- mobility of the larynx.
Palpation allows you to determine the location and size of the tumor and predict the degree of development of the oncological process. The main diagnostic signs by location are deciphered in the table:
| Place | Specific symptoms |
| Vestibular region of the pharynx | Feeling of a coma |
| Constant pain when swallowing | |
| Lateral wall | Pain in the ear, throat |
| Vocal cords | Changes in voice timbre: hoarseness, hoarseness |
| Constant tickling when trying to speak |
The presence of pathology is accompanied by enlargement of the lymph nodes, since they are the first to metastasize.
The lymph nodes must be palpated, since they are the first to metastasize, and the voice and breathing are listened to, because it is necessary to determine the degree of stenosis (narrowing) of the larynx by the growing tumor. To make a final diagnosis, a more thorough analysis is necessary.
Laryngoscopy
The following techniques are distinguished:
- Indirect.
- Straight: classic;
- retrograde;
- microlaryngoscopy.
The first procedure is usually performed by an ENT specialist without preparing the patient. Your only request would be to refrain from eating and drinking before the procedure to avoid vomiting. The inspection is carried out according to the following scheme:
- The doctor presses the tongue with a spatula.
- Inspects the oral cavity and pharynx with a mirror.
Diagnosis of laryngeal cancer in this way is effective only in 30% of cases, which is a disadvantage of the technique. Direct laryngoscopy has greater capabilities. Examination of all parts of the larynx is carried out under local anesthesia using a special flexible tube with fiber LEDs. Often this method is combined with microlaryngoscopy, when a special microscope with a focus of 350-400 mm is used. Retrograde manipulation is used if there is difficulty in inserting the tube through the mouth. Then the supply is carried out through the nasal cavity. Pros of direct methods:
A hardware examination of the throat allows you to obtain data on the manifestation and collect material for research.
- information content;
- safety;
- the possibility of selecting suspicious tissues for analysis.
The following symptoms are considered suspicious:
- changes in the quality of the mucosa - bleeding, erosion;
- the presence of tubercles and irregularities in different places of the larynx;
- thickening of the vocal cords.
Hardware techniques
These techniques include ultrasound, x-ray, CT and MRI. Each method is good in its own way and allows you to accurately determine the location of the tumor, its structure, density and size. Additionally, metastases are detected, that is, the extent of spread of the oncological process throughout the body. Ultrasound and MRI are the safest, and tomography makes it possible to find even the smallest foci of secondary tumors.
Hardware methods make it possible to determine whether a tumor in the larynx is primary or secondary, because the lesion can appear as a result of cancer of the brain, breast, bones and cartilage.
Biopsy and biopsy analysis
Selected tissues are sent for histological analysis, which will indicate the nature of the cancer and its type.
A reliable result on the structure, type, stage and aggressiveness of the tumor is obtained by examining selected pieces of suspicious throat tissue. Selection is carried out with a thin needle during laryngoscopy. The biopsy is sent to the laboratory for histological and cytological analysis. Based on the results obtained, a decision is made on the treatment regimen. If the lymph nodes are affected, a biopsy is performed in these areas, which confirms the diagnosis and determines the severity of the process.
Laboratory research
The patient is prescribed tests for general blood and urine indicators to identify the level of ESR, leukocytes, erythrocytes and platelets, as well as biochemical tests, which may indicate the location of cancer and liver damage. An analysis is required - tumor markers for cancer of the throat and larynx, the principle of which is to take blood over a certain period of time in order to detect specific proteins for the localization of the malignant process in question. If there is a tumor in the pharynx, pay attention to the tumor markers presented in the table:
| Index | Type of cancer being determined | Norm |
| CSS | Squamous | 1.5 ng/ml |
| CYFRA 21—1 | Almost all types | 2.6 ng/ml |
| CA 19—9 | Any in the digestive organs, throat and neck | 37 units/ml |
