In what cases is an ultrasound of the throat and larynx prescribed. What is the result of the procedure? All about modern endoscopy of the larynx and its features Indications and contraindications

Throat is an organ respiratory system located between the pharynx and trachea. The throat performs respiratory, swallowing and voice-forming functions in the body. Throat cancer is a malignant tumor, mostly of the squamous cell type. What methods of diagnosing cancer of the throat and larynx are considered the most effective and what first symptoms should be paid special attention to when detecting throat cancer at an early stage?

Diagnosis of throat cancer early stages tumor development is the main task of doctors. For the timely detection of a malignant focus, efforts must be made both by the person himself and by doctors. It is necessary to closely monitor the slightest deterioration in well-being in the throat area.

Throat cancer is a pathology that is very common in the system. Among all low-quality formations, 2.5% go to the share of the throat. Among oncology of the head and neck, the throat leads in terms of the number of its detection.

Such a high risk of disease is important in diagnosis. According to statistics, this disease is more often observed in women, so there are 10 men per patient. The peak of the disease in men occurs at the age of 70 - 80 years; in women, 60 - 70 years.

With a poor-quality formation of the vestibule of the larynx, or subglottic area, cancer is often asymptomatic. In comparison with them, the pathology of the glottis is detected at an earlier stage with signs of dysphonia, in which the cure for the disease can be complete with effective and high-quality treatment.

Symptoms of cancer of the throat and larynx

Doctors of various specializations need to understand that with long-term hoarseness, more than 15-20 days, in mature men, in the absence of other symptoms, it is possible to determine the development of laryngeal cancer.

Optimal, requiring attention, signs can serve as:

persistent cough;
sensation of a lump in the throat;
problems with swallowing;
pain in the hearing aid;
easily palpable The lymph nodes.

How to identify throat cancer?

Diagnosis of throat cancer begins with a questionnaire, visual examination, or palpation of the neck. Particular attention should be paid to the patient's complaints, they can be used to suggest the location of the swelling and the duration of its development.

All this is important for predicting the subsequent development of a tumor formation and its perception of radiation. For example, the formation of the vestibular region of the larynx can be characterized by the patient as a sensation of an interfering object in the throat and constant pain when swallowing.

When pain in the ear joins these inconveniences, it is possible to diagnose cancer on the lateral wall of the larynx on one side. A change in the background of the voice signals an intervention in the malignant process of the vocal department.

Sore throat, together with shortness of breath, suggests stenosis of the larynx, which means the neglect of the disease, and if the hoarseness of the voice also increases, we can state the defeat of the subvocal part. When examining a patient, the doctor carefully evaluates the shape and contours of the neck, appearance skin, laryngeal mobility.

As mentioned above, for the diagnosis of cancer of the throat (larynx), palpation gives a significant part of the information to the doctor:

the configuration and volume of the tumor are assessed;
its displacement relative to neighboring tissues;
while listening to the patient's breathing and voice, so as not to miss possible symptoms of stenosis and dysphonia. Thorough palpation of the lymph nodes is required.

With cancer, metastases can spread to everything. To determine the final diagnosis, it is important to conduct a general clinical examination.

How does throat cancer begin and how is it diagnosed?

It is necessary to do laryngoscopy, examination of the larynx with a special mirror, laryngoscope. Laryngoscopy can help detect the tumor. Also inspect the throat cavity and nasal folds. A laryngoscope is a tube that has a video camera on one end. In addition, with the help of laryngoscopy, tissues are taken for biopsy.
A biopsy allows you to determine and more accurately diagnose. Due to the biopsy, it is possible not only to identify cancer, but also its histological type. With this information, it is possible to effectively treat the disease.
There are other methods for diagnosing throat cancer. This ultrasound procedure(ultrasound), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET).
If there are several signs, direct laryngoscopy is necessary, using special instruments (laryngoscope), possibly indirect laryngoscopy. Together with radiography, it is leading in the detection of cancer of the larynx.
Stroboscopy is an additional study.
The radiographic diagnostic method is very common, since the larynx belongs to hollow organs with its own distinctive properties, it is clearly visible in the pictures without special contrasting.
Throat x-ray - the most affordable and effective method detection of cancer, while quite informative. With its help, you can get a complete picture of the state of the larynx and its surrounding tissues. Chest X-ray gives an assessment of the extent of the neoplasm, and with the help of computed tomography possibly get detailed information about it.
In the examination of the subglottic area, the method of direct fibrolaryngoscopy is used.
Clinical and blood tests are essential in the diagnosis of cancer.

Methods for diagnosing throat cancer and their implementation

Where does the diagnosis begin?

examination of the patient;
neck examination;
palpation (palpation) 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.

Instrumental methods of examination

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, attention is paid to the level of mobility vocal cords.

Fibrolaryngoscopy is considered to be the method of choice for trismus for diagnosing throat cancer, with its help it is possible to determine the condition of the fixed area of the epiglottis and the subglottis. 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 study of any other organs suspicious of cancer, is very doubtful without a histological examination. If the secondary biopsy does not show oncology, and the clinic can diagnose cancer, intraoperative diagnostics 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. With ultrasound, nodes with existing hypoechoic areas will fall under suspicion. When such nodes are found, it is necessary to perform a fine-needle aspiration puncture, the taken biological material is subjected to histological examination, for persuasiveness the repeated puncture is required. The accuracy of the method with a positive result is 100%.

Indirect laryngoscopy

Indirect laryngoscopy is an examination of the larynx, which is carried out 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, determine:

the location of the tumor;
tumor borders;
nature of growth;
condition of the mucous membrane of the larynx;
condition (mobility) of the vocal cords and glottis.

Before the study, you should not drink (drink) liquids and eat food for some time. Otherwise, during laryngoscopy, a gag reflex may occur and vomiting may occur, and vomit may enter the Airways. It should also be noted that before the study, it is recommended to remove dentures.

Research process by a specialist:

the doctor seats the patient in front of him;
with the help of a spray, to prevent vomiting, conducts local anesthesia;
the doctor asks the patient to stick out his tongue and with the help of a napkin holds it, or presses on it with a spatula;
with the other hand, the doctor inserts a special mirror into the patient's mouth;
with the help of a second mirror and a lamp, the doctor illuminates the patient's mouth;
during the examination, the patient is asked to say "ah-ah" - this opens the vocal cords, which facilitates examination.

The entire period of diagnostics of the larynx takes no more than 5-6 minutes. The anesthetic loses its effect after about 30 minutes and during this time you can not eat or drink.

Direct laryngoscopy

During direct laryngoscopy, a special flexible laryngoscope is inserted into the larynx. Direct laryngoscopy is more informative than indirect laryngoscopy. In the course of the study, all three sections of the larynx can be well examined. To date, most clinics adhere to this particular examination methodology.

With direct laryngoscopy, you can take a fragment of the tumor for a biopsy, remove the papilloma.

A flexible laryngoscope is a type of tube.

Before the study, the patient is prescribed to suppress the formation of mucus medical preparations. With the help of a spray, a local anesthesia is performed by a specialist and instilled into the nose vasoconstrictor drops, which reduce swelling of the mucous membrane and facilitate the passage of the laryngoscope. A laryngoscope is inserted through the nose into the larynx and examined. Some discomfort and nausea may occur during direct laryngoscopy.

Biopsy

This is the removal of a fragment of a tumor or lymph node for examination under a microscope. This study allows you to accurately diagnose the malignant process, its type and stage.

If malignant cells are found during the study of the lymph node, then the diagnosis of laryngeal cancer is considered 100% accurate. Usually, a biopsy is taken with a special tool during direct laryngoscopy.

An oncological formation removed during the operation is also mandatory sent to the laboratory for examination. To detect metastases, lymph nodes are performed. The material is obtained using a needle that is inserted into the lymph node.

neck ultrasound

An ultrasound of the neck helps the specialist assess the lymph nodes. With the help of ultrasound, the smallest lymph nodes with metastases are detected, which are not determined during palpation (palpation by hand). For a biopsy, the doctor identifies the most suspicious lymph nodes.

Ultrasound examination of the neck in cancer of the larynx is carried out using conventional devices designed for ultrasound diagnostics. According to the image on the monitor, the doctor evaluates the size and consistency of the lymph nodes.

Chest x-ray

Chest x-ray helps to identify metastases and intrathoracic lymph nodes. X-rays of the chest are taken in frontal (frontal) and lateral (profile) projections.

CT and MRI

CT and MRI are modern methods diagnostics of both throat cancer and tumors of other localization, with the help of which it is possible to obtain a high-quality three-dimensional image or layer-by-layer sections of an organ.

With the help of CT and MRI, you can determine:

the position of the tumor;
its dimensions;
prevalence;
germination in neighboring organs;
metastases to the lymph nodes.

These techniques allow you to get 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.

Both studies are safe, since there is no radiation exposure to the patient's body (MRI), or it is minimal (CT). During the MRI, the patient should not have any metal objects with him (the presence of a pacemaker and other metal implants is a contraindication to MRI).

Electrocardiography (ECG)

First of all, this study is intended to assess the state of the heart in laryngeal cancer, which is included in the mandatory diagnostic program.

The patient is laid on the couch, special electrodes are placed on the arms, legs and chest. The device captures the electrical impulses of the heart in the form of an electrocardiographic curve, which can be displayed on a tape or, if modern devices are available, on a computer monitor.

Bronchoscopy

Endoscopic examination of the bronchi is carried out using a special flexible instrument - an endoscope. This study is carried out only by indications. For example, if changes are detected during a chest x-ray.

What should be done before preparing the patient for the study?

according to the doctor's prescription, some time before the study, the patient is administered medications;
it is necessary to remove dentures, piercing;
the patient is seated or laid on the couch;
carry out local anesthesia: the mucous membranes of the mouth and nose are irrigated with an anesthetic aerosol;
a bronchoscope is inserted into the nose (sometimes into the mouth), advanced into the larynx, then into the trachea and bronchi;
examine the mucous membrane of the bronchi. If necessary, take a photo, take a biopsy.

Lab tests

Laboratory diagnosis of throat cancer includes general clinical examinations, which include general analysis blood, urine, blood sugar test, RV, determination of blood group and Rhesus.

When metastases are detected, it is also prescribed biochemical analysis blood, which makes it possible to judge metabolic processes occurring in the body, the functioning of the digestive tract, kidneys, endocrine system.

Worth knowing! An increase in ESR and leukocytosis without signs of inflammation indicates a possible malignant process in the body.

The presence of a change in laboratory examinations, combined with the patient's complaints, is an indispensable condition for contacting a doctor to clarify the diagnosis. Clarifying cancer of the larynx, the diagnosis of which is often based on additional examinations, can be a time-consuming process. However, to diagnose early dates- is quite important, as it can lead to a complete recovery or to the prolongation of the patient's life.

Throat cancer stages, course and prognosis

Depending on the location and spread of the malignant lesion, the stages of the development of the disease are distinguished:

Stage 0 - Diagnosing throat cancer at stage zero is extremely rare, since there are almost no symptoms during this period. And yet, if the diagnosis of cancer is made precisely at this stage, then the successful disposal of it is quite large, while the survival of patients over the next five years corresponds to 100%;
Stage 1 - the tumor goes beyond the boundaries of the mucous membrane of the larynx. But, it does not apply to neighboring tissues and organs. With cancer of the larynx of the first degree, vibration of the vocal folds and the generation of sounds are observed. Successfully chosen treatment gives patients a chance to live another 5 years, the number of such people corresponds to 80%;
Stage 2 - cancer passes to one of the sections of the larynx and completely affects it. He does not leave the boundaries of his occupied site. The vocal cords remain mobile. Metastases at this stage are not yet formed, or are isolated in the lymph nodes. With an adequate choice of treatment, second-degree laryngeal cancer allows the patient to live another five years in 70% of cases;
Stage 3 - a malignant formation has a large volume and already damages nearby tissues and neighboring organs. The tumor gives single or multiple metastases. The vocal cords lose their mobility. A person's voice becomes hoarse or absent altogether. With optimal treatment, the five-year survival prognosis for patients with this stage cancer is 60%;
Stage 4 - the tumor reaches an impressive size, affects all neighboring tissues. It acquires such volumes that it can fill almost the entire larynx. Stage 4 laryngeal cancer is no longer treatable. All adjacent tissues are affected, the tumor has deepened too much. Some organs are affected by cancer, for example, and. At this interval, many regional and distant metastases are found. Here, only supportive treatment and pain relief will help alleviate the suffering of the patient. The prognosis for the survival of such patients over the next five years gives only 25%.

Each disease requires a detailed study, and the pathology of the larynx is no exception. Examination of the larynx is an important process for establishing the correct diagnosis and appointment. the right treatment. There are different methods for diagnosing this organ, the main one of which is laryngoscopy.

Direct and indirect laryngoscopy

The procedure is carried out using a special device - a laryngoscope, which shows in detail the condition of the larynx and vocal cords. Laryngoscopy can be of two types:

straight;
indirect.

Direct laryngoscopy is performed using a flexible fibrolaryngoscope, which is inserted into the lumen of the larynx. Less often, endoscopic equipment can be used, this instrument is rigid and, as a rule, is used only at the time of surgery. The examination is performed through the nose. A few days before the procedure, the patient is asked to take certain drugs that suppress the secretion of mucus. Before the procedure itself, the throat is sprayed with an anesthetic, and the nose is dripped with vasoconstrictor drops to avoid injury.

Indirect laryngoscopy - such an examination of the larynx is performed by placing a special mirror in the pharynx. The second reflecting mirror is located on the head of the otolaryngologist, which allows you to reflect and illuminate the lumen of the larynx. This method in modern otolaryngology is used extremely rarely, preference is given to direct laryngoscopy. The examination itself is carried out within five minutes, the patient is in a sitting position, the pharyngeal cavity is sprayed with an anesthetic to remove the urge to vomit, after which a mirror is placed in it. To inspect the vocal cords, the patient is asked to pronounce the sound "a" for a long time.

There is another type of laryngoscopy - this is a rigid study. This procedure is quite difficult to perform, it is done under general anesthesia, takes about half an hour. A fibrolaryngoscope is inserted into the pharyngeal cavity and examination begins. Rigid laryngoscopy allows not only to examine the condition of the larynx and vocal cords, but also to take a sample of material for a biopsy or remove existing polyps. After the procedure, an ice bag is placed on the patient's neck to avoid swelling of the larynx. If a biopsy was performed, sputum mixed with blood may come out within a few days, this is the norm.

Laryngoscopy or fibroscopy allows you to identify such pathological processes:

neoplasms in the larynx, and a biopsy already reveals a benign or malignant process;
inflammation of the mucous membrane of the pharynx and larynx;
fibroscopy will also help to see the presence of foreign bodies in the pharynx;
papillomas, nodes and other formations on the vocal cords.

Complications with fibroscopy

Examination of the larynx in this way can cause certain complications. Regardless of what type of laryngoscopy the larynx was examined, edema of this organ may occur, and with it respiratory disorders. The risk is especially high in people with polyps on the vocal cords, a tumor in the larynx, and with a pronounced inflammatory process of the epiglottis. If asphyxia develops, an urgent tracheotomy is required, a procedure during which a small incision is made in the neck and a special tube is inserted to allow breathing.

Pharyngoscopy

Such a procedure as pharyngoscopy is familiar to absolutely everyone since childhood. This is a doctor's examination of the mucous membrane of the throat. Pharyngoscopy does not require preliminary preparation, but is performed using a frontal reflector. Such methods of studying the pharynx are familiar not only to the otolaryngologist, but also to the pediatrician, as well as to the therapist. The technique allows you to examine the upper, lower and middle parts of the pharynx. IN
depending on which part needs to be examined, the following types of pharyngoscopy are distinguished:

posterior rhinoscopy (nasal part);
mesopharyngoscopy (directly throat or middle section);
hypopharyngoscopy (lower pharynx).

The advantage of pharyngoscopy is the absence of any contraindications and complications after the procedure. The maximum that can occur is a slight irritation of the mucous membrane, which disappears on its own after a few hours. The disadvantage of pharyngoscopy is the inability to examine the parts of the larynx and perform a biopsy if necessary, as is possible with endoscopic methods.

Computed tomography and MRI

CT of the larynx is one of the most informative research methods. Computer sections allow you to get a layered picture of all anatomical structures in the neck: larynx, thyroid gland, esophagus. Computed tomography reveals:

various injuries and injuries of the larynx;
pathological changes in the lymph nodes in the neck;
the presence of goiter in the tissues of the thyroid gland;
the presence of various neoplasms on the walls of the esophagus and larynx;
the state of the vessels (topography of the larynx).

The procedure is considered safe for the patient, since, unlike conventional x-rays, computed tomography has significantly less radiation and does not harm a person. Unlike x-rays, radiation exposure during tomography is ten times less.

A feature of the procedure is the ability to view the state of the body without interfering with it. Computed tomography plays an important role in the detection of cancer. In this case, a contrast agent is used to examine the esophagus, larynx, and other nearby anatomical structures. With its help, X-rays show pathological places in the pictures. The quality of x-rays with the help of computed tomography is improved.

MRI of the larynx is similar in principle to CT, but is considered an even more advanced method. MRI is the safest non-invasive diagnostic method. If CT is allowed to be done only after certain intervals, although the X-ray beams are not very strong during this procedure, there is still such a limitation. In the case of MRI, there is no such problem, it can be repeated several times in a row without harm to health. The difference between the procedure is that CT uses X-rays, or rather its rays, and MRI uses a magnetic field, and it is completely harmless to humans. In any of the options, tomography of the larynx is a reliable and effective method for detecting pathologies.

stroboscopy

X-ray, ultrasound, tomography and laryngoscopy cannot fully assess the condition of the vocal cords; their study requires stroboscopy of the larynx. This method consists in the occurrence of flashes of light that coincide with the vibrations of the ligaments, creating a kind of stroboscopic effect.

Pathologies such as an inflammatory process in the ligaments or the presence of neoplasms are detected according to the following criteria:

non-simultaneous movement of the vocal cords. So one fold starts its movement earlier, and the second is late;
uneven movement, one fold goes more to the middle line than the second. The second fold has limited movement.

ultrasound

Such a study as an ultrasound of the neck area can first reveal a number of pathologies, such as:

hyperthyroidism;
neoplasms in the neck, but only a biopsy can confirm malignancy;
cysts and nodes.

Also, ultrasound will show purulent inflammatory processes. But according to the conclusion of the ultrasound, the diagnosis is not installed and further diagnostic procedures are required. For example, if an ultrasound revealed a formation in the esophagus, an endoscopic examination method with a biopsy will be prescribed. If the lymph nodes in the neck are affected or there is a suspicion of a tumor in the larynx, CT or MRI will be prescribed, since these methods give a more extensive picture of what is happening than ultrasound.

Methods for examining the larynx are varied, the use of one or another depends on the alleged pathology and the affected organ. Any symptoms that do not go away should alert and become a reason to visit an otolaryngologist. Only a specialist, after conducting the necessary examination, will be able to accurately establish the diagnosis and prescribe the appropriate treatment.

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Every day, tens of thousands of people turn to medical centers complaining of problems with their throat or larynx. Patients experience some discomfort or suffer from frequent sore throats. The reasons for applying may be different, often ENT doctors have to prescribe an ultrasound of the throat and larynx to make or clarify the diagnosis. What does this study show? How is the procedure carried out?

Referral for ultrasound

Although ultrasound is considered one of the best practices diagnostics, otolaryngologists do not have a separate procedure for scanning ENT organs. A logical question arises, do they do ultrasound of the throat and larynx? Of course, they do, because this is the most inexpensive and safe method of examination. But doctors have to issue a referral for a neck or thyroid scan. But, despite this, the result obtained makes it possible to identify the problem and start fighting it. Diagnostic centers repeatedly scan the neck during the day, and in fact, ultrasound of the throat and larynx. Which shows how much this procedure is in demand. So do not be surprised to read in the direction of the appointment for a neck or thyroid examination.

Indications for ultrasound of ENT organs

The need for ultrasound scanning arises if the patient came with the following complaints:

the appearance of hardening in the throat area;
constant;
tumors of an oncological nature in the neck, which affect the condition of the throat or larynx;
discharge of pus, heavy odor when breathing;
severe pain with fever;
inflammatory processes in acute or chronic form;
change in voice timbre;
prolonged dry cough.

Holding ultrasound diagnostics helps to cast aside doubts and confirm or refute the diagnosis.

What can an ultrasound of the neck show?

The otolaryngologist prescribes an examination of the neck, and not an ultrasound of the throat and larynx, which shows the state of all structures of the problem area, and not just the ENT organs. During the diagnosis, the following indicators are evaluated:

the internal surface and structure of the lower throat regions and larynx, with a description of any seals or neoplasms;
the size of the clearance and its uniformity;
the state of the walls of the organs under study, the presence of nodes or tumors;
cellular spaces around the throat and larynx;
condition of the cervical lymph nodes;
confirmation of neoplasms in the throat, an approximate definition of their nature (cyst, adenoma, cancer, abscess);
the presence of inflammatory processes.

Ultrasound data of the throat and larynx allow you to supplement the information obtained during the examination. The doctor may prescribe or adjust the treatment, as well as decide on the appointment of new studies, such as a biopsy.

How is the procedure

The examination of the neck takes place according to a certain algorithm. There is nothing terrible or painful about this. The patient must free the neck from scarves, collars and jewelry. Then lie down comfortably on the couch, after which the doctor will apply a conductive gel to the skin. The sonologist starts moving the transducer along the neck, observing the image on the screen. Based on the results of the examination, a special protocol is issued, in which all indicators are described and deciphered. The procedure does not take much time, on average its duration does not exceed 20 minutes.

What's next?

With the result of the examination on hand, the patient returns to the attending physician. He studies the examination protocol and prescribes therapy. If hypoechoic nodules are found, then diagnosis should be continued.

Patients should not panic when reading the phrase "hypoechoic formation" in the protocol. This is not a diagnosis, but a description of the density of the structure. In this place, the tissue structure is less dense than around, and the ultrasonic pulse moves more slowly. This means that the doctor will have to identify whether this is a pathology or the norm for this area. Sometimes the results obtained are simply incorrect when performing an ultrasound of the throat and larynx, which does not show the presence of serious health abnormalities, but the low qualification of the sonologist (the specialist who performed the ultrasound).

And one more clarification. Structures with low density may be a cyst. This is a cavity with thin walls, the tissue of which resembles a mucous membrane. Inside the cavity is a liquid. However, the term "cyst" is never written in the ultrasound protocol. Since a biopsy is necessary to establish such a diagnosis. The procedure can be performed with a special needle or other medical devices.

How to Prepare for a Neck Ultrasound

Ultrasound of the throat and larynx is not difficult to do. With an appointment in hand, you must sign up for a scan. You do not need to follow a diet or a special drinking regimen. The main thing is not to delay the fulfillment of the appointment, so as not to miss the time.

Main danger

Practice shows that in men after 60 years of age, the risk of detection is significantly increased. According to statistics, it ranks 11th in the causes of male mortality. Women also should not relax, for them this reason is in 19th place. Oncology of the throat and larynx is most often associated with excesses and abuse. People don't want to hear that alcohol and tobacco are slow killers. In addition, working in hazardous conditions, which include exposure to asbestos, acids or nickel, has a strong impact.

With increased fatigue, a change in the timbre of the voice, shortness of breath and an incessant dry cough, it is necessary to diagnose the condition of the throat and larynx as soon as possible. Detection of oncology in the early stages allows, at least, to extend the life of the patient by 5-7 years.

If you need an ultrasound of the throat and larynx, where to do it? Diagnosis is carried out in municipal and private clinics.

It is located on the front surface of the neck under the hyoid bone. Its boundaries are determined from the upper edge of the thyroid cartilage to the lower edge of the cricoid. The size and location of the larynx depend on gender and age. In children, young people and women, the larynx is located higher than in the elderly.

When examining the area larynx the patient is offered to raise his chin and swallow saliva. In this case, the larynx moves from bottom to top and from top to bottom, the contours of both it and the thyroid gland, which is located slightly below the larynx, are clearly visible. If you put your fingers on the area of the gland, then at the moment of swallowing, the thyroid gland also moves along with the larynx, its consistency and the size of the isthmus are clearly determined.

After that feel larynx and the region of the hyoid bone, displace the larynx to the sides. Usually there is a characteristic crunch, which is absent in tumor processes. Somewhat tilting the patient's head forward, they feel the lymph nodes located on the anterior and posterior surfaces of the sternocleidomastoid muscles, the submandibular, supraclavicular and subclavian regions, and the region of the occipital muscles. Their size, mobility, consistency, pain are noted. Normally, the lymph glands are not palpable.

larynx

Mirror warm up so that the vapors of exhaled air do not condense on the mirror surface of the mirror. The degree of heating of the mirror is determined by touching it. When examining the region of the larynx, the patient is offered to raise his chin and swallow saliva. In this case, the larynx moves from bottom to top and from top to bottom, the contours of both it and the thyroid gland, which is located slightly below the larynx, are clearly visible.

If we put fingers on the region of the gland, then at the moment of swallowing, the thyroid gland moves along with the larynx, its consistency and the size of the isthmus are clearly determined. After that, the larynx and the area of the hyoid bone are felt, the larynx is displaced to the sides. Usually there is a characteristic crunch, which is absent in tumor processes. Somewhat tilting the patient's head forward, they feel the lymph nodes located on the anterior and posterior surfaces of the sternocleidomastoid muscles, the submandibular, supraclavicular and subclavian regions, and the region of the occipital muscles.
Their size, mobility, consistency, pain are noted. Normally, the lymph glands are not palpable.

Then proceed to inspect the inner surface larynx. It is carried out by indirect laryngoscopy using a laryngeal mirror heated on the flame of an alcohol lamp and inserted into the cavity of the oropharynx at an angle of 45 ° with respect to an imaginary horizontal plane, with a mirror surface downwards.

Mirror heated so that the vapors of exhaled air do not condense on the mirror surface of the mirror. The degree of heating of the mirror is determined by touching it to the back surface of the examiner's left hand. The patient is asked to open his mouth, stick out his tongue and breathe through his mouth.

doctor or self patient With the thumb and middle fingers of the left hand, he holds the tip of the tongue, wrapped in a gauze napkin, and slightly pulls it out and down. The index finger of the examiner is located above the upper lip and rests against the nasal septum. The subject's head is slightly tilted back. The light from the reflector is constantly directed exactly at the mirror, which is located in the oropharynx so that its back surface can completely close and push the small uvula upwards without touching the back wall of the pharynx and the root of the tongue.

As in the back rhinoscopy, for a detailed examination of all parts of the larynx, light swaying of the mirror is necessary. The root of the tongue and the lingual tonsil are sequentially examined, the degree of disclosure and the contents of the valecules are determined, the lingual and laryngeal surface of the epiglottis, aryepiglottic, vestibular and vocal folds, piriform sinuses, and the visible section of the trachea under the vocal folds are examined.

Fine mucous membrane of the larynx pink, shiny, moist. Vocal folds are white with even free edges. When the patient pronounces the lingering sound “and”, the pear-shaped sinuses located laterally to the arytenoid-epiglottic folds open, and the mobility of the elements of the larynx is noted. The vocal folds are completely closed. Behind the arytenoid cartilages is the entrance to the esophagus. With the exception of the epiglottis, all elements of the larynx are paired, and their mobility is symmetrical.

Above vocal folds there are light depressions of the mucous membrane - this is the entrance to the laryngeal ventricles, located in the side walls of the larynx. At their bottom there are limited accumulations of lymphoid tissue. When conducting indirect laryngoscopy, difficulties sometimes occur. One of them is related to the fact that a short and thick neck does not allow the head to be thrown back sufficiently. In this case, examining the patient in a standing position helps. With a short bridle and a thick tongue, it is not possible to capture its tip. Therefore, it is necessary to fix the tongue for its lateral surface.

If during an indirect laryngoscopy difficulties are associated with an increased pharyngeal reflex, resort to anesthesia of the pharyngeal mucosa.

Endoscopic research methods are becoming more and more widespread in clinical and outpatient practice. The use of endoscopes has significantly expanded the ability of an otorhinolaryngologist to diagnose diseases of the nasal cavity, paranasal sinuses, pharynx and larynx, as they allow atraumatic study of the nature of changes in various ENT organs, as well as perform, if necessary, certain surgical interventions.

Endoscopic examination of the nasal cavity with the use of optics is indicated in cases where the information obtained from traditional rhinoscopy is insufficient due to a developing or developed inflammatory process. To examine the nasal cavity and paranasal sinuses, sets of rigid endoscopes with a diameter of 4, 2.7 and 1.9 mm, as well as fiber endoscopes from Olimpus, Pentax, etc. are used. anesthesia, usually 10% lidocaine solution.

During the study, examine vestibule of the nasal cavity, the middle nasal passage and the places of the natural openings of the paranasal sinuses, and further - the upper nasal passage and the olfactory fissure.

Straight laryngoscopy performed in the position of the patient, either sitting or lying down, in cases of difficulty in conducting indirect laryngoscopy. In an outpatient setting, the examination is most often performed while sitting with a laryngoscope or fibrolaryngoscope.

To perform direct laryngoscopy it is necessary to perform anesthesia of the pharynx and larynx. During anesthesia, the following sequence is followed. First, the right anterior palatine arches and the right palatine tonsil, the soft palate and the small uvula, the left palatine arches and the left palatine tonsil, the lower pole of the left palatine tonsil, the back wall of the pharynx are lubricated with a cotton pad. Then, using indirect laryngoscopy, the upper edge of the epiglottis, its lingual surface, valecules, and laryngeal surface of the epiglottis are lubricated, a cotton pad is inserted into the right and then into the left piriform sinus, leaving it there for 4-5 s.

Then probe with a cotton pad injected for 5-10 seconds behind the arytenoid cartilages - into the mouth of the esophagus. For such thorough anesthesia, 2-3 ml of anesthetic is required. 30 minutes before local anesthesia of the pharynx, it is advisable for the patient to inject 1 ml of a 2% solution of promedol and a 0.1% solution of atropine under the skin. This prevents tension and hypersalivation.

After anesthesia the patient is seated on a low stool, behind him a nurse or nurse sits on a regular chair and holds him by the shoulders. The patient is asked not to strain and to lean on a stool with his hands. The doctor captures the tip of the tongue in the same way as with indirect laryngoscopy and, under visual control, inserts the laryngoscope blade into the pharynx, focusing on the small tongue and raising the subject's head up, the laryngoscope's beak leans down and the epiglottis is detected. The root of the tongue, valecules, lingual and laryngeal surface of the epiglottis are examined.

Is the 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 laryngeal mirror round shape attached at an angle of 125° to a straight metal rod. So that the mirror does not fog up during the inspection, its reflective surface must be slightly heated on a spirit lamp. The reverse surface of the mirror should not be hot to avoid burning the throat. The doctor controls this by applying the back surface of the mirror to the back of his hand.
The laryngeal mirror is taken in the right hand, the fingers of the left hand hold the tip of the tongue through a napkin. Wherein thumb the doctor lies on top, the middle finger is below the tip of the tongue, and the index finger slightly pushes upper lip. The mirror is inserted into the oral cavity and pressed against the soft palate. Do not touch the root of the tongue and the back of the throat with a mirror, so as not to cause a gag reflex. Conducting mirror laryngoscopy includes three main points: free breathing, phonation of the sounds “and” or “e”, deep breath. During the first of them, attention is paid to the condition of the epiglottis, scoop-epiglottic, vestibular and vocal folds, pear-shaped pockets, the condition of the root of the tongue, lingual tonsil, valeculae is assessed.

Rice. 47.

Rice. 48.

The glottis in this case has the form of an isosceles triangle. During the second moment, the closure of the vocal folds is determined. The change in phonation and inspiration allows you to determine the symmetry of the mobility of the halves of the larynx. During the third moment ( deep breath) inspect the subglottic space and the upper trachea.
In most individuals, mirror laryngoscopy can be performed relatively easily.
If, due to a significant pharyngeal reflex, it is not possible to perform laryngoscopy, 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. Examination of the larynx can only be considered qualitative if its anterior commissure (anterior corner of the glottis) is clearly visible. For a thorough examination of the larynx, it is necessary to apply local superficial anesthesia more widely and take the epiglottis forward using a laryngeal probe or a specially designed elevator.
If indirect laryngoscopy does not satisfy the doctor, direct laryngoscopy is performed.
The essence of the method of direct laryngoscopy is to straighten the angle between 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 a doctor performing direct laryngoscopy; 2nd - laryngoscopes, which are held independently, and the hand of the doctor conducting the manipulation remains free. This type of laryngoscopy is called support, or suspension (see insert, 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 been developed.

Indirect microlaryngoscopy carried out in the position of 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, straightening his neck. After the introduction of the patient into anesthesia, direct laryngoscopy is performed. The laryngoscope is fixed with a special device on the patient's chest. The microscope is aimed at the region 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 the light of different spectral composition (green, yellow, without red and red). Low-contrast details in certain light become more contrast.

Fluorescence microlaryngoscopy - this is an examination of the larynx after the introduction of one of the fluorochromes, in particular fluorescein sodium, into the patient's body. A blue light filter is used to observe the luminescence of fluorescein. According to this method of research, the size, shape of the vessels, their atypia are more intensively and clearly determined. Fluorescein is differently absorbed by the tissues of the larynx.
An important place in the study of the larynx is occupied by laryngastroboscopy. The method consists in 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 flash lamp of the stroboscope is placed in place of the usual incandescent lamp of the microscope. In the continuous illumination mode with a strobe lamp, the microscope can be used as a normal operating microscope.
Achievement of medical technology in recent years is the development of fibrolaryngoscopy. Due to the mobility of the flexible end of the fiberscope by 270°, all parts of the larynx become available for inspection. Manipulations are carried out under local anesthesia. Fibrolaryngoscopy allows 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 otorhinolaryngological clinic, conventional radiography and tomography are used - in the anteroposterior and lateral projections.
The most common radiography of the larynx received pictures in the lateral projection, which make it possible to see the main details of the larynx and peri-laryngeal 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 an obligatory component of the X-ray examination of patients who suspect a tumor of the larynx or have chronic stenosis of the larynx and trachea. Tomography allows you to get frontal pictures of the larynx, which can determine the condition of the epiglottis, aryepiglottic, vestibular and vocal folds, laryngeal ventricles, subglottic space, as well as the cervical trachea.