A Closer Look at the Larynx

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		The Larynx
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Patients are encouraged to participate in the decision making.

The larynx (voice box) can be difficult to examine due to its location in the lower throat. Special instrumentation may be needed to obtain close-up views of the larynx.

There are three primary means to examine the larynx during an office visit. Your doctor will decide which examination is appropriate for you.

1. Indirect Laryngoscopy

During indirect laryngoscopy, a small mirror is placed in the upper portion of the throat (just beyond the tongue). A light is directed at the mirror and a reflected image of the larynx can then be viewed "indirectly" via the mirror. This exam is quick to conduct and provides the physician with a clear image and natural coloration. Sustained vowels sounds are observed as the mirror restricts observation of speech. Slight gagging may occur during this procedure.

2. Nasopharyngoscopy

The flexible tubing of the nasopharyngoscope is passed through the nasal passage to the back of the throat, just above the vocal folds. This procedure causes very little gagging and can be used to study the vocal folds during speech. The picture clarity obtained with this examination may be reduced due to the relatively thin scope used. This instrument is coupled to a recording system which may allow closer post-examination inspection.

3. Rigid Laryngoscope

The rigid laryngoscope provides a more clearly magnified image of the larynx. During this procedure the rigid scope is placed at the back of the mouth. The lens (on the underside of the scope) is directed at the larynx. Much like the mirror examination, the rigid laryngoscope may cause slight gagging and it cannot be used to assess the larynx during speech. This examination is also recorded.

Specialty Equipment-Strobe

A special light source called a strobe can be coupled with the nasopharyngoscope or the rigid laryngoscope. Human vocal folds may vibrate across an approximate range of 60-1400 times per second which correlates to the pitch span from low bass to high soprano. This is too fast for the human eye to detect. The strobe helps the examiner study the function of the vocal folds in a simulated slow-motion, making it possible to detect abnormalities which might otherwise not be observed.

Most patients tolerate these examinations without topical anesthetic and fasting is not required prior to these procedures. Comprehensive reports, including photo-documentation, are typically sent to referring physicians.