In what cases is an ultrasound of the throat and larynx prescribed? What does the result of the procedure show? Modern methods for diagnosing diseases of the larynx Endoscopic examination of the throat and larynx

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

Flexible video laryngoscope

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

general description

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

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

How is the examination carried out correctly?

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

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

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

Carrying out the procedure

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

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

Proper anesthesia can reduce patient discomfort and speed up recovery.

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

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

A flexible laryngoscope is used for diagnostic procedures

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

Complications of endoscopy

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

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

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

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

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

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When meeting a patient who complains of a sore throat or difficulty breathing, the doctor first of all evaluates his general condition, the respiratory function of the larynx, predicts the possibility of acute stenosis and, if indicated, provides emergency care to the patient.

Anamnesis

Already from the first words, by the nature of the sound of the patient’s voice (nasality, hoarseness, aphonicity, voice rattling, shortness of breath, stridor, etc.), one can get an idea of a possible disease. When assessing a patient’s complaints, attention is paid to their nature, duration, frequency, dynamics, dependence on endo- and exogenous factors, and concomitant diseases.

Visual inspection. The area of the larynx, which occupies the central part of the anterior surface of the neck, the submandibular and suprasternal areas, the lateral surfaces of the neck, as well as the supraclavicular fossa, is subjected to external examination. During the examination, the condition of the skin, the condition of the venous pattern, the shape and position of the larynx, the presence of swelling of the subcutaneous tissue, swelling, fistulas and other signs indicating inflammatory, tumor and other lesions of the larynx are assessed.

Palpation

Palpation of the larynx and the anterior surface of the neck is carried out with the head in the usual position and when it is thrown back, while the relief of the palpated area is assessed (Fig. 1).

Rice. 1. Protrusions and depressions of the preglottic region: 1 - protrusion of the hyoid bone; 2 - hypoglossal-thyroid cavity; 3 - protrusion of the thyroid cartilage (Adam's apple, Adam's apple); 4 - intercricoid-thyroid fossa; 5 — protrusion of the cricoid cartilage arch; 6 - subglottal protrusion formed by the first rings of the trachea; 7 - suprasternal cavity; pyak - hyoid bone; schkh - thyroid cartilage; px - cricoid cartilage; gr - sternum

At superficial palpation evaluates the consistency, mobility and turgor of the skin covering the larynx and surrounding areas. At deep palpation examines the area of the hyoid bone, the space near the corners of the lower jaw, then descends along the anterior and posterior edges of the sternocleidomastoid muscle, determining the condition of the lymph nodes. The supraclavicular fossa and attachment areas of the sternocleidomastoid muscle, lateral and occipital surfaces of the neck are palpated, and only then proceed to palpation of the larynx. It is covered on both sides with the fingers of both hands, fingering its elements. The shape, consistency are assessed, and the possible presence of pain and other sensations is determined. Then the larynx is shifted to the right and left, assessing its mobility, as well as the possible presence of sound phenomena - crunching (for cartilage fractures), crepitus (for emphysema). When palpating the area of the cricoid cartilage and conical ligament, the isthmus of the thyroid gland covering them is often revealed. Feeling the jugular fossa, ask the patient to make a swallowing movement: if there is an ectopic lobe of the thyroid gland, its push may be felt.

Laryngoscopy

Laryngoscopy is the main type of examination of the larynx. The complexity of the method lies in the fact that the longitudinal axis of the larynx is located at a right angle to the axis of the oral cavity, which is why the larynx cannot be examined in the usual way. Inspection of the larynx can be done either using a laryngeal speculum ( indirect laryngoscopy), when using which the laryngoscopic picture is presented in the form of a mirror image, or using special directoscopes designed for direct laryngoscopy.

For indirect laryngoscopy, flat laryngeal mirrors are used, similar to those used for posterior mirror epipharyngoscopy. To avoid fogging of the mirror, it is heated on an alcohol lamp with the mirror surface facing the flame or in hot water. Before inserting the mirror into the oral cavity, check its temperature by touching the back metal surface to the skin of the dorsal surface of the examiner’s hand.

Indirect laryngoscopy is carried out in three positions of the subject: 1) in a sitting position with the body slightly tilted forward and the head slightly tilted backward; 2) in Killian’s position (Fig. 2, a) for a better overview of the posterior parts of the larynx; in this position, the doctor examines the larynx from below, standing in front of the person being examined on one knee, and he tilts his head down; 3) in the Turk position (b) to examine the anterior wall of the larynx, in which the examinee throws back his head, and the doctor examines from above, standing in front of him.

Rice. 2. The direction of the rays and the axis of vision during indirect laryngoscopy in the position of Killian (a) and Turk (b)

The doctor with his right hand takes the handle with a mirror fixed in it, like a writing pen, so that the mirror surface is directed at an angle downward. The subject opens his mouth wide and sticks out his tongue as much as possible. The doctor, with the first and third fingers of the left hand, grabs the tongue wrapped in a gauze napkin and holds it protruded, at the same time, with the second finger of the same hand, lifts the upper lip for a better view of the area being examined, directs a beam of light into the oral cavity and inserts a mirror into it. The back surface of the mirror presses against the soft palate, moving it backwards and upwards. When introducing a mirror into the oral cavity, you should not touch the root of the tongue and the back wall of the pharynx, so as not to cause a pharyngeal reflex. The rod and handle of the mirror rest on the left corner of the mouth, and its surface should be oriented so that it forms an angle of 45° with the axis of the oral cavity. The light flux directed at the mirror and reflected from it illuminates the cavity of the larynx. The larynx is examined during quiet and forced breathing of the subject, then during phonation of the sounds “i” and “e”, which facilitates a more complete examination of the supraglottic space and larynx. During phonation, the vocal folds close.

The most common obstacle to indirect laryngoscopy is a pronounced pharyngeal reflex. There are some techniques to suppress it. For example, the subject is asked to mentally count down two-digit numbers or, clasping his hands, pull them with all his might. The subject is also asked to hold his tongue himself. This technique is also necessary when the doctor needs to perform some manipulations in the larynx, for example, removing fibroids on the vocal fold.

In case of an indomitable gag reflex, they resort to topical anesthesia of the pharynx and root of the tongue. In young children, indirect laryngoscopy is practically impossible, therefore, if a mandatory examination of the larynx is necessary (for example, with its papillomatosis), they resort to direct laryngoscopy under anesthesia.

Laryngoscopy picture larynx with indirect laryngoscopy, it appears in a mirror image (Fig. 3): the anterior parts of the larynx are visible from above, often covered at the commissure by the epiglottis; the posterior sections, including the arytenoid cartilages and the interarytenoid space, are displayed in the lower part of the speculum.

Rice. 3. Internal view of the larynx during indirect laryngoscopy: 1 - root of the tongue; 2 - epiglottis; 3 - tubercle of the epiglottis; 4 - free edge of the epiglottis; 5 - aryepiglottic fold; 6 - folds of the vestibule; 7 - vocal folds; 8 - ventricle of the larynx; 9 - arytenoid cartilage with corniculate cartilage; 10 - wedge-shaped cartilage; 11 - interarytenoid space

With indirect laryngoscopy, examination of the larynx is possible with only one left eye looking through the opening of the frontal reflector (which is easy to verify when this eye is closed). Therefore, all elements of the larynx are visible in the same plane, although the vocal folds are located 3-4 cm below the edge of the epiglottis. The lateral walls of the larynx are visualized sharply shortened. From above, that is, actually from the front, part of the root of the tongue with the lingual tonsil (1) is visible, then the pale pink epiglottis (2), the free edge of which rises when the sound “i” is phonated, freeing up the laryngeal cavity for viewing. Directly below the epiglottis, in the center of its edge, you can sometimes see a small tubercle of the epiglottis (3), formed by the stalk of the epiglottis. Below and posterior to the epiglottis, diverging from the angle of the thyroid cartilage and commissure to the arytenoid cartilages, there are vocal folds (7) of a whitish-pearlescent color, easily identified by characteristic tremulous movements, sensitively reacting even to a slight attempt at phonation.

Normally, the edges of the vocal folds are even and smooth; when inhaling, they diverge somewhat; during a deep breath, they diverge to the maximum distance and the upper rings of the trachea, and sometimes even the keel of the tracheal bifurcation, become visible. In the superolateral regions of the laryngeal cavity, pink and more massive folds of the vestibule are visible above the vocal folds (6). They are separated from the vocal folds by the entrance to the ventricles of the larynx. The interarytenoid space (11), which is like the base of the triangular slit of the larynx, is limited by the arytenoid cartilages, which are visible in the form of two club-shaped thickenings (9), covered with pink mucous membrane. During phonation, you can see how they rotate towards each other with their front parts and bring the vocal folds attached to them closer together. The mucous membrane covering the posterior wall of the larynx becomes smooth when the arytenoid cartilages diverge during inspiration; during phonation, when the arytenoid cartilages come together, it gathers into small folds. In some individuals, the arytenoid cartilages touch so closely that they seem to overlap each other. From the arytenoid cartilages, the aryepiglottic folds (5) are directed upward and forward, which reach the lateral edges of the epiglottis and together with it serve as the upper boundary of the entrance to the larynx. Sometimes, with a subatrophic mucous membrane, in the thickness of the aryepiglottic folds you can see small elevations above the arytenoid cartilages - these are corniculate (Santorini) cartilages; Lateral to them are the Wriesberg cartilages (10).

The color of the laryngeal mucosa must be assessed in accordance with the medical history and other clinical signs, since normally it is not constant and often depends on bad habits and exposure to occupational hazards. In hypotrophic individuals of asthenic physique, the color of the mucous membrane of the larynx is usually pale pink; for normosthenics - pink; in obese, overweight people (hypersthenics) or smokers, the color of the mucous membrane of the larynx can be from red to bluish without pronounced signs of disease of this organ. When exposed to occupational hazards (dust, vapors of caustic substances), the mucous membrane acquires a varnished tint - a sign of the atrophic process.

Direct laryngoscopy

Direct laryngoscopy allows you to examine the internal structure of the larynx in a direct image and perform various manipulations on its structures to a fairly wide extent (removal of polyps, fibroids, papillomas using conventional, cryo- or laser surgical methods), as well as carry out emergency or planned intubation. This method was introduced into practice by M. Kirshtein in 1895 and was subsequently improved several times. The method is based on the use of hard directoscope, the introduction of which into the hypopharynx through the oral cavity becomes possible due to the elasticity and pliability of the surrounding tissues.

Indications to direct laryngoscopy are numerous, and their number is continuously growing. This method is widely used in pediatric otorhinolaryngology. For young children, a one-piece laryngoscope with a non-removable handle and a fixed spatula is used. For adolescents and adults, laryngoscopes with a removable handle and a retractable spatula plate are used.

Contraindications severe stenotic breathing, cardiovascular insufficiency, epilepsy with a low threshold of convulsive readiness, lesions of the cervical vertebrae that do not allow the head to be thrown back, and aortic aneurysm. Temporary or relative contraindications are acute inflammatory diseases of the mucous membrane of the oral cavity, pharynx, larynx, bleeding from the pharynx and larynx.

In young children, direct laryngoscopy is performed without anesthesia; in young children - under anesthesia; older people - either under general anesthesia or under local anesthesia with appropriate premedication, as in adults. For local anesthesia, various topical anesthetics can be used in combination with sedatives and anticonvulsants. To reduce general sensitivity, muscle tension and salivation, the subject is given one tablet 1 hour before the procedure phenobarbital(0.1 g) and one tablet sibazon(0.005 g). 0.5-1.0 ml of 1% solution is injected subcutaneously over 30-40 minutes promedola and 0.5-1 ml of 0.1% solution atropine sulfate. 10-15 minutes before the procedure, topical anesthesia is performed (2 ml of a 2% solution dicaine). 30 minutes before the specified premedication, in order to avoid anaphylactic shock, intramuscular injection of 1-5 ml of a 1% solution is recommended diphenhydramine or 1-2 ml of 2.5% solution diprazine(pipolfen).

The position of the subject can be different and is determined mainly by the condition of the patient. The study can be carried out in a sitting position, lying on your back, less often in a position on your side or stomach.

The direct laryngoscopy procedure consists of three stages (Fig. 4).

Rice. 4. Stages of direct laryngoscopy: a - first stage; b - second stage; c - third stage; The circles show the endoscopic picture corresponding to each stage; arrows indicate the directions of pressure on the laryngeal tissue of the corresponding parts of the laryngoscope

First stage(a) can be carried out in three ways: 1) with the tongue protruding, which is held with a gauze napkin; 2) with the normal position of the tongue in the oral cavity; 3) when inserting a spatula from the corner of the mouth. With all options, the upper lip is pushed upward and the patient's head is tilted slightly back. The first stage is completed by pressing the root of the tongue down and passing the spatula to the edge of the epiglottis.

On second stage(b) the end of the spatula is slightly raised, placed over the edge of the epiglottis and advanced 1 cm; after this, the end of the spatula is lowered down, covering the epiglottis. During this movement, the spatula puts pressure on the upper incisors (this pressure should not be excessive; if you have removable dentures, they are removed first). The correct insertion of the spatula is confirmed by the appearance of the vocal folds in the field of view.

Before third stage(c) the patient’s head is tilted back even more. The tongue, if held, is released. The examiner increases the pressure of the spatula on the root of the tongue and the epiglottis (see the direction of the arrows) and, adhering to the median plane, places the spatula vertically (if the subject is sitting) or according to the longitudinal axis of the larynx (if the subject is lying down). In both cases, the end of the spatula is directed to the middle part of the respiratory gap. In this case, the posterior wall of the larynx comes into view first, then the vestibular and vocal folds, and the ventricles of the larynx. For a better view of the anterior parts of the larynx, the root of the tongue should be slightly pressed downwards.

Special types of direct laryngoscopy include supporting And hanging laryngoscopy(Fig. 5).

Rice. 5. Devices for supporting (a) direct laryngoscopy; b - schematic representation of direct suspension laryngoscopy

Modern laryngoscopes for suspension and support laryngoscopy are complex complexes that include spatulas of various sizes and sets of various surgical instruments specially adapted for endolaryngeal micromanipulation. These complexes are equipped with devices for injection ventilation of the lungs, anesthesia and video equipment that allows surgical interventions to be performed using an operating microscope and a video monitor.

For visual examination of the larynx, the method is widely used microlaryngoscopy, allowing you to enlarge the internal structures of the larynx. More convenient for examining hard-to-reach areas are fiber-optic devices, which are used, in particular, for functional disorders of the larynx.

Indications Microlaryngoscopy includes: doubt in the diagnosis of precancerous formations and the need for a biopsy, as well as the need for surgical elimination of defects that impair vocal function. Contraindications the same as with conventional direct laryngoscopy.

The use of microlaryngoscopy requires endotracheal anesthesia using a small caliber intubation catheter. Jet ventilation of the lungs is indicated only in particularly cramped anatomical conditions.

X-ray examination of the larynx

Due to the fact that the larynx is a hollow organ, there is no need for contrast during X-ray examination, but in some cases this method is used by spraying a radiopaque substance.

At overview And tomographic radiography is used direct And lateral projections. With a direct projection, the overlap of the spine on the cartilages of the larynx almost completely obscures them, therefore, in this projection, X-ray tomography is used, which removes the shadow of the spine beyond the image plane, keeping only the radiopaque elements of the larynx in focus (Fig. 6).

Rice. 6. X-ray tomographic image of the larynx in a direct projection (a) and a diagram of identifying elements (b): 1 - epiglottis; 2 - folds of the vestibule; 3 - vocal folds; 4 - pyriform sinuses

Using a tomographic examination, clear radiographs of frontal sections of the larynx are obtained, and it becomes possible to identify space-occupying formations in it. With functional radiography (during deep inspiration and phonation), the symmetry of her motor function is assessed.

When analyzing the results of an X-ray examination of the larynx, one should take into account the patient’s age and the degree of calcification of its cartilage, islands of which can appear from 18-2 years of age. The thyroid cartilage is most susceptible to this process.

As already noted, in some cases they resort to contrast radiography using aerosol spraying of a radiopaque substance (Fig. 7).

Rice. 7. X-ray of the larynx using a radiopaque substance by spraying: a - X-ray in a lateral projection and a schematic representation of its identifying features (b): 1 - oropharynx; 2 - laryngopharynx; 3 - supraglottic space; 4 - sub-fold space; 5 - interfold space; 6 - trachea; 7 — contours of the larynx, visualized by aerosol spraying of a contrast agent; c - X-ray of the larynx with spraying in a direct projection

Methods for functional research of the larynx

Voice function test begins already during a conversation with the patient when assessing the timbre of the voice and sound paraphenomena that arise when respiratory and vocal functions are impaired. Aphonia or dysphonia, stridorous or noisy breathing, distorted voice timbre and other phenomena may indicate the nature of the pathological process.

At volumetric processes In the larynx, the voice is compressed, muffled, its individual timbre is lost, and the conversation is often interrupted by a slow, deep breath. At “fresh” constrictor paralysis glottis, the voice loses sonority, a large amount of air is spent through the gaping glottis to pronounce a word, so the patient does not have enough air in the lungs to pronounce a whole phrase, which is why his speech is interrupted by frequent breaths, the phrase is fragmented into individual words and during a conversation hyperventilation occurs with respiratory pauses.

With chronic dysfunction of the vocal folds, when compensation of the vocal function occurs due to the folds of the vestibule, the voice becomes rough, low, hoarse. If there is a polyp, fibroma or papilloma on the vocal fold, the voice becomes as if cracked, rattling with admixtures of additional sounds resulting from vibration of the formation located on the vocal fold. Laryngeal stenosis is recognized by the stridor sound that occurs during inspiration.

Study of the vocal function of the larynx

Vibrometry- one of the most effective methods for studying the vocal function of the larynx. For this they use accelerometers, in particular the so-called maximum accelerometer, measuring the moment a vibrating body reaches a given sound frequency or maximum acceleration in the range of phonated frequencies, that is, vibration parameters. The condition and dynamics of these parameters are assessed both normally and in various pathological conditions.

Rheography of the larynx (glotography)

The method is based on recording changes in ohmic resistance to electric current that occur when the vocal folds approach and diverge, as well as when their volume changes during phonation. Changes in resistance to electric current occur synchronously with the phonatory vibration of the vocal folds and are recorded in the form of oscillations (rheogram) using a special electrical device - a rheograph. The shape of the rheolaringogram reflects the state of the motor function of the vocal folds. During quiet breathing (without phonation), the rheogram appears as a straight line, slightly undulating in time with the respiratory excursions of the vocal folds. During phonation, oscillations arise that are close in shape to a sinusoid, the amplitude of which correlates with the volume of the sound emitted, and the frequency is equal to the frequency of this sound. Normally, the glotgram parameters are characterized by high regularity (constancy). In case of disturbances in motor (phonatory) function, these disturbances are displayed on recordings in the form of characteristic changes characteristic of organic and functional disorders. Often glotography is carried out simultaneously with registration phonograms. This type of research is called phonoglotography.

Stroboscopy of the larynx

Laryngeal stroboscopy is one of the most important methods of functional research, allowing visualization of the movements of the vocal folds at different frequencies of the stroboscopic effect. This allows you to visualize the movements of the vocal folds during phonation at a slow pace or even “stop” them in a certain state of spreading or collapsing.

Stroboscopy of the larynx is performed using special devices called strobe lights(from Greek strobos- whirling, erratic movement and skopo- I'm watching). Modern stroboscopes are divided into mechanical or optical-mechanical, electronic and oscillographic. In medical practice, video stroboscopic installations with wide multifunctional capabilities have become widespread (Fig. 8).

Rice. 8. Block diagram of a video stroboscopic installation (model 4914; Brühl and Kjær): 1 - video camera with a rigid endoscope; 2 — software electronic stroboscopic control unit; 3 - video monitor; M - socket for connecting a microphone; P - socket for connecting the strobe control pedal; IT - indicator board

In pathological conditions of the vocal apparatus, various stroboscopic patterns can be observed. When assessing these pictures, it is necessary to take into account visually the level of position of the vocal folds, the synchronicity and symmetry (mirroring) of their vibrations, the nature of their closure and auscultation the timbre color of the voice. Modern video stroboscopes make it possible to simultaneously record in dynamics the stroboscopic picture of the larynx, the amplitude-frequency characteristics of the phonated sound, the phonogram of the voice, and then perform a correlation analysis between the recorded parameters and the video stroboscopic image. In Fig. 9, a photograph of a stroboscopic picture of the larynx is shown.

Rice. 9. Videolaryngostroboscopic images of the vocal folds during normal phonation (according to D. M. Tomassin, 2002): a - phase of closure of the vocal folds: b - phase of opening of the vocal folds

Otorhinolaryngology. IN AND. Babiyak, M.I. Govorun, Ya.A. Nakatis, A.N. Pashchinin

Symptoms of laryngeal cancer must be confirmed with objective indicators, compared with test results, then a clear picture of the disease will appear before us. A disease such as cancer frightens with its incurability; the question is raised about how long the patient has left to live. In fact, cancer is not a death sentence, because in the early stages of the disease they have learned to treat it successfully.

Causes of throat cancer in women and men include:

smoking and alcohol abuse(prevention of throat cancer involves giving up these habits);
professional activity in hazardous working conditions(production of chemicals);
high concentrations of tobacco smoke, phenolic resins, benzene and other carcinogenic substances in the air;
a number of chronic inflammatory pathologies(pharyngitis, laryngitis, laryngotracheitis, syphilis);
benign neoplasms(papilloma in the throat often leads to cancer).

Smoking is a common cause of cancer

It is impossible to say exactly how long people live with throat cancer, since this pathology, if detected early, does not cause a significant reduction in life time. If the patient seeks medical help on time, then he has a high chance of continuing his usual lifestyle after correction of the condition.

Kinds

Symptoms depend on the location of the malignant process.

Depending on the affected area:

upper throat cancer– the tumor is localized above the vocal cords;
middle section– malignant neoplasm is located on the ligaments;
lower section– localized under the ligaments.

The most common type of cancer diagnosed is squamous cell carcinoma, which occurs in most cases in smokers, including passive smokers.

What causes suspicion of throat cancer?

Oncological diseases, or tumors (see), are divided into benign and malignant, with uncontrolled growth. Symptoms of throat cancer, such as laryngeal cancer, are important to notice early.

It is the early detection of this dangerous disease that is the task of otolaryngologists. Then the tumors are treated using conservative and surgical methods.

Warning signs

The first symptoms of throat and larynx cancer appear in a patient when the tumor just begins to form.

It is still unclear what this is, signs of trouble appear in the following:

hoarseness in the voice;
pain when swallowing;
sensation of a foreign body in the throat;
the appearance of white spots on the mucous membrane.

Subjective sensations

Table. Classification of unpleasant manifestations in the throat:

Cancer of the throat and larynx does not show symptoms immediately; it develops gradually. When such phenomena are observed, you should immediately consult a doctor to confirm or refute suspicions of a tumor.

Clinical picture

What manifestations should be alarming and cause you to see a doctor? There are early and late symptoms.

Early

Early clinical signs include:

constant pain and discomfort when swallowing;
feeling of a lump;
soreness;
shooting pain in the throat radiating to the ear;
persistent dry cough or coughing, mainly after eating;
sores and white spots on the lining of the throat, which sometimes bleed.

With their own hands, anyone can feel their neck for pain. If, with light pressure, you feel discomfort in the neck and the presence of a “lump,” then it is recommended to undergo an examination.

Late

Unfortunately, not every person immediately seeks medical help if they have a sore throat, even if this uncomfortable condition continues for a long time.

Late symptoms are expressed as follows:

constant pain when swallowing;
toothache – this is caused by the spread of an oncological tumor to the surrounding tissues of the pharynx and oral cavity;
hoarseness or complete aphonia (absent);
shortness of breath - this is due to the fact that the neoplasm reaches a large size and compresses the airways;
feeling of a lump in the throat;
obstruction in the pharynx - the tumor grows so much and compresses the lumen of the pharynx and esophagus that it is impossible to take even liquid food; in most cases in this situation, the patient is fed in the hospital through a gastrostomy tube (a tube inserted into the stomach through an incision in the anterior abdominal wall).

The video in this article details what should alert a person and when to see a doctor if you suspect throat cancer.

Attention! If you have a constant cough or sore throat, you should not self-medicate or take any medications without a doctor’s prescription. This is also confirmed by the instructions for the medications. Unauthorized use of various medications blurs the clinical picture of the disease and delays the correct diagnosis; meanwhile, malignant tissue will continue to grow and progress.

Methods for detecting malignant tumors in the throat

Detection of a throat tumor in the form of laryngeal cancer occurs first after the patient complains at a doctor’s appointment or during preventive examinations. It is important to prevent the development of cancer, regular examinations by an otolaryngologist, which allow timely diagnosis of pathology.

Methods of subjective medical examination

The presence of a malignant tumor in the throat is subjectively determined during the initial examination. The doctor, based on his experience and knowledge, determines with his own hands the presence of a tumor or its absence.

Wherein:

the patient is placed opposite the doctor;
local anesthesia is given by injection or spraying with an anesthetic spray;
the patient should stick out his tongue, the doctor holds it with a spatula;
a mirror is inserted into the mouth and asked to pronounce the drawn-out sound “a” to open the glottis;
upon examination, determine the size and condition of the tumor;
location of the tumor relative to other organs;
assess breathing patterns and vocal functions;
palpate the lymph nodes in the neck;
specify the location of the neoplasm and growth characteristics.

Stages of development of malignant throat tumors

Cancer of the larynx and throat produces symptoms at different stages of the disease.

Table 1: Stages of development:

Stage of development	Signs	Disease prognosis
Zero stage	The tumor is small in size, practically not diagnosed at this stage of development, the patient feels well, there are no complaints.	If at this stage the lesion is detected by chance, the prognosis is favorable. In approximately 98% of cases, complete recovery occurs
First stage	The neoplasm spreads beyond the mucous membrane of the larynx. In the early stages, manifestations include a slight change in the vibration of the voice, slight hoarseness, and soreness.	If at this stage the patient consults a doctor and is diagnosed with a tumor and treatment is started immediately, then the prognosis is favorable. Survival and recovery 75% of patients
Second stage	At this stage, the tumor is progressing in growth; when the tumor spreads to the ligaments, the voice may change, hoarseness occurs, and noisy breathing is disturbing.	Correct diagnosis and timely initiation of therapy leads to recovery in 70% of cases. Life expectancy in stage 2 patients exceeds 70% for the next 5 years
Third stage	Change in voice or its complete absence, which is caused by tumor growth in all parts of the larynx	With timely diagnosis and treatment, patient survival over the next 5 years is 60%
Fourth stage (see)	The tumor progresses, grows into nearby lymph nodes and spreads to other organs through metastasis	With properly prescribed treatment, survival rate with stage 4 in the next 5 years is about 20%

Important! With advanced cancer, there are no symptoms in the early stages; a person may not pay attention to a sore throat or slight hoarseness. If such sensations persist for more than 1 week, you should consult a doctor as soon as possible for examination.

A medical examination allows you to identify dangerous signs of the disease, but does not fully guarantee the correct diagnosis. Therefore, the patient is sent for additional examination and tests.

Laboratory methods

In order to verify the presence of a malignant tumor, a laboratory examination of the material obtained during laryngoscopy is carried out. To do this, using the same laryngoscope, a tissue sample is taken from the larynx or lymph node, which is changed by the disease. Next, the selected tissue cells are examined under a microscope.

The biopsy method is quite accurate; it detects cancer cells in 100% of cases. This method determines not only the disease itself, but also the stage and type of tumor. To obtain biological material from lymph nodes, it is collected using a needle that is inserted directly into the node.

Hardware methods

Hardware examination methods are necessary not only for diagnosing cancer, but also for clarifying the location and size of the tumor, and its characteristics.

The video in this article shows how hardware diagnostics are carried out:

microlaryngoscopy allows you to visually determine the appearance and characteristic features of the tumor in its natural form, or select material for a biopsy;
phonetography is a technique for assessing voice recordings, its acoustic analysis, which allows you to compare the pattern of a “sick” and a healthy voice;
electroglottography is an ultrasound recording of vibrations of the vocal cords, it allows you to determine how impaired the vocal function is;
stroboscopy—obtaining a visual image of the nature of vibrations of the vocal cords, which allows you to clarify the diagnosis;
X-ray is a reliable method that allows you to take a clear picture of the tumor, where its size and location are visible;
Ultrasound of the neck complements other examination methods and clarifies the picture of the disease;
MRI scanning, positron emission tomography (PET), is extremely useful in detecting stage 1 and stage 2 disease.

Modern hardware methods of examination and diagnosis remain additional, clarifying, since the first and last word in establishing a diagnosis of cancer belongs to the otolaryngologist. Symptoms of larynx and throat cancer are convincing.

Treatment methods for laryngeal cancer

In the prognosis of a disease such as laryngeal cancer, diagnosis and treatment are closely interrelated. Early diagnosis of the tumor will prevent its subsequent progression.

To improve the patient's prognosis, there are standardized methods for treating laryngeal cancer, which may be called an “algorithm” or “instruction”. They provide a clear plan for the management of cancer patients with this pathology.

Attention! Not a single protocol includes folk remedies for the treatment of laryngopharyngeal cancer; therapy requires the use of only medications with a solid evidence base.

This:

Surgical method. The surgical method of treating laryngeal cancer occupies a leading position, especially in the initial stages of the oncological process. Its main task is to maximize the removal of the pathological process with minimal damage to the surrounding tissue.

Superficial cancer confined to the free edge of the vocal cord can be successfully removed by limited resection or laser. A stage I-II tumor is removed by organ-sparing surgery, but usually, in case of ineffectiveness, radiation therapy is performed (the latter allows better preservation of phonation).

In the case of an advanced process or diagnosis in late stages, a radical surgical method is sometimes used - laryngectomy followed by laryngoplasty.

Radiation therapy method. Typically, inoperable tumors in which the risk of surgery prevails over the likelihood of successful surgery are amenable to this direction.

In addition, this type of therapy is used for stage I-II tumors that are not characterized by serious damage to the vocal cords, and the non-invasive treatment method, in turn, is able to preserve phonation.

Chemotherapy. It is used both in combination with radiation and surgical treatment, and as an independent method of palliative therapy.

For this purpose, drugs such as cisplastin, 5-fluorouracil in various combinations are used. More and more attention is being paid to medications that have a specific point of application in the pathological focus, the so-called targeted drugs.

Attention! A disease such as laryngopharyngeal cancer and treatment with traditional methods are incompatible things. When diagnosing a malignant neoplasm, do not try to cure it yourself.

Features of prevention

Disease prevention is a worthy investment in your future and health, the price of which is high.

In most cases, doctors shrug their shoulders when asking a patient about the etiology of the cancer process; they cannot be wrong. The exception is the presence of occupational risks known to the patient, as well as obligate and facultative forms of the precancerous process.

These include the following conditions:

papilloma;
leukoplakia of the laryngeal mucosa (dyskeratosis);
fibroma;
contact fibroma (develops due to increased vocal load).

Timely treatment of such diseases, preventive visits to a family doctor once a year or once every six months if there are risk factors for laryngeal cancer, as well as treatment of chronic inflammatory processes can significantly reduce the risk of a malignant tumor in the larynx.

Quitting smoking, limiting or completely eliminating exposure to occupational and household hazards are also included in the list of preventive methods.

Attention! Treatment of an oncological process is a very complex matter, which should only be dealt with by an otolaryngologist-oncologist. You should not consult friends who have cured laryngeal cancer, as it is impossible to replace the opinions of a specialist.

Prognosis after cancer treatment

The first thing that worries a person who is undergoing treatment for laryngeal cancer or has been diagnosed with it is the prognosis of its therapy. Undoubtedly, the lack of specific therapy or methods such as the use of wormwood in the treatment of laryngeal cancer cannot improve the prognosis. Cancer must be treated under the supervision of an oncologist.

The average survival times of patients during the first 1, 3 and 5 years after diagnosis were statistically calculated and adjusted depending on the therapy used.

Radical treatment provides the following five-year survival rate:

Stage I – 80-94%;
Stage II – 55-75%;
Stage III – 45-65%;
Stage IV – no more than 35%.

Attention! These figures indicate a fairly good prognosis for the patient even in the presence of distant metastases (at stage 4).

Factors that negatively affect the prognosis of a malignant tumor of the larynx:

low tumor differentiation;
infiltrative growth;
cancer of the lower (subglottic) larynx.

Among other things, the presence of metastases in regional lymph nodes worsens the patient’s prognosis by at least 2 times when using isolated surgical or combined treatment methods. In conclusion, it is important to say that measures to prevent tumor processes should always come first, since treating cancer is much more difficult than trying to prevent it.

Endoscopic methods for examining patients have become a common practice in all medical institutions. This method allows, using a thin flexible tube with a video camera, to examine the walls of complete internal organs, which are accessible through natural openings in the human body. Endoscopy of the throat also takes its place in this series. This procedure is carried out in case of hoarseness or hoarseness of the throat of unknown etiology, difficulty swallowing food, trauma to the larynx, and airway obstruction. The procedure is performed using a fibrolaryngoscope, in this case the procedure is called direct flexible laryngoscopy.

Types of throat endoscopy

The throat is a general name for a number of internal organs that perform respiratory and digestive functions. It is divided into three parts, depending on which cavity is located in one or another part of it:

nasopharynx (upper part);
oropharynx (middle part);
hypopharynx (lower part).

Based on which part of the throat needs to be examined, the following types of throat endoscopy are distinguished: posterior rhinoscopy, pharyngoscopy and indirect laryngoscopy.

Preparation for the procedure

Before carrying out this procedure, the doctor finds out from the patient whether he is allergic to medications, whether he has impaired blood clotting, or whether he has diseases of the cardiovascular system. Drugs are prescribed that reduce mucus secretion, and the pharyngeal mucosa is sprayed with a spray containing an anesthetic (usually lidocaine). The laryngoscope is inserted through the nose, where a vasoconstrictor is first instilled.

If you plan to insert a rigid laryngoscope, you must abstain from food and water for eight hours, as general anesthesia will be used, otherwise severe vomiting is possible.

How is the procedure performed?

In the case of indirect laryngoscopy, the patient must open his mouth wide and stick out his tongue. An endoscope is inserted into the throat and an examination is performed. If the vocal cords need to be examined, the doctor will ask the patient to say "Ah-ah." The procedure lasts no more than five minutes, the anesthetic lasts a little longer. The patient should not eat until the anesthetic wears off, as the mucous membrane loses its sensitivity.

In the case of rigid laryngoscopy, the doctor manipulates the mucous membrane, takes a biopsy, and removes polyps and foreign bodies. The procedure lasts about half an hour, after which doctors must monitor the patient for several more hours. To reduce swelling of the larynx after rigid laryngoscopy, an ice pack is placed on the throat. After this procedure, the patient should not take any water or food for at least two hours.

Possible complications of the procedure

Since endoscopy of the throat is associated with the penetration of a foreign body into the nasopharynx, there is a possibility of complications developing during and after the examination, namely the development of laryngeal edema and breathing problems. Complications may occur in patients with tumors or polyps in the respiratory tract, as well as in those who have significant inflammation in the larynx.

In case of rapid development of edema after endoscopy, an emergency tracheotomy is performed - that is, an incision is made in the larynx so that the patient can breathe.

When a doctor does a biopsy of the mucous membrane, there may be bleeding due to damage to blood vessels, infection can also spread to the mucous membranes of the throat, and there is also the possibility of injury to the respiratory tract.

Importance of endoscopy

Despite the risks associated with endoscopy of the throat, this procedure offers a lot to the otolaryngologist. He can instantly assess the condition of the larynx, oropharynx, vocal cords, and perform a biopsy for the presence of pathogens. The procedure reveals diseases such as inflammation of the throat mucosa, tumors, polyps, nodules, papillomas and much more.

Endoscopic examination of the throat is increasingly used in the medical practice of our country, because endoscopes significantly increase the diagnostic capabilities of the doctor, allow him to assess pathological changes in the organs of the nasopharynx without injury, and, if necessary, carry out minimal surgical procedures.

Preparation for inspection is carried out in the same way as indicated above.

EXTERNAL INSPECTION. During inspection, the condition of the surface and the configuration of the neck are determined.

Then the larynx and its cartilages (cricoid and thyroid) are palpated, the crunch of the laryngeal cartilages is determined, moving it to the sides. Normally, the larynx is painless, passively movable to the right and left. After this, according to the method described above, the regional lymph nodes of the larynx are palpated: submandibular, deep cervical, posterior cervical, prelaryngeal, pre- and paratracheal, located in the supraclavicular and subclavian fossae.

Not direct l a r i n g o s c o p i a . The laryngeal mirror is secured in the handle, heated in hot water for 2-3 s to 40-50 °C and wiped with a napkin. The degree of heating of the mirror is determined by applying it to the back surface of the hand. The patient is asked to open his mouth, stick out his tongue and breathe through his mouth. Having wrapped the tip of the tongue above and below with a gauze napkin, take it with the fingers of the left hand so that the first finger is located on the upper surface of the tongue, the third finger is on the lower surface, and the second finger is on the upper lip. The tongue is slightly pulled forward and downwards.

The laryngeal mirror is taken by the end of the handle in the right hand, like a pen for writing, inserted into the oral cavity with the mirror plane downwards, parallel to the plane of the tongue, without touching the root of the tongue and the back wall of the pharynx, up to the soft palate. Having reached it, the plane of the mirror is positioned at an angle of 45° to the median axis of the pharynx; if necessary, you can slightly lift the soft palate upward and backward, and direct the light from the reflector directly onto the mirror. Correction of the position of the mirror must be done carefully, with small movements, until the larynx is reflected in it. At this time, the patient is asked to make a long “i” sound and then take a breath. During the period of phonation, and then during inspiration, the inner surface of the larynx is visible in two phases of physiological activity (see Fig. 5.10).

After inspection, the mirror is removed from the throat, separated from the handle and dipped in a disinfectant solution.

The image visible in the laryngeal mirror differs from the true one: the anterior parts of the larynx are visible below, so it seems that they are behind, and the posterior parts are above and appear to be located in front. The image of the right and left sides in the mirror corresponds to reality.

During laryngoscopy, a general examination of the larynx should be performed and the condition of its individual parts should be determined. In the laryngeal mirror, first of all, the root of the tongue with the lingual tonsil located on it is visible, then the epiglottis in the form of an unfolded petal. The mucous membrane of the epiglottis is usually pale pink or yellowish. Between the epiglottis and the root of the tongue, two small depressions, vallecules, are defined, bounded by the median and lateral lingual-epiglottic folds. During phonation and with deep inspiration, the vocal folds are usually clearly visible; Normally they are pearly white in color. The anterior ends of the folds at the place of their origin from the thyroid cartilage form an acute angle - the anterior commissure. Pink vestibular folds are visible above the vocal folds, and between the vocal and vestibular folds there are depressions on each side - the laryngeal ventricles (see Fig. 5.11).

In front, in the mirror, the posterior parts of the larynx and arytenoid cartilages are visible in the form of two tubercles, covered with a pink smooth mucous membrane; the posterior ends of the vocal folds are attached to the vocal processes of these cartilages, and the interarytenoid space is located between the bodies of the cartilages. From the arytenoid cartilages upward to the petal of the epiglottis there are pink aryepiglottic folds with a smooth surface. Lateral to the aryepiglottic folds are the pear-shaped sinuses, the mucous membrane of which is pink and smooth.

During inhalation (Fig. 5.10, d) and phonation (Fig. 5.10, e), the mobility of both halves of the larynx is determined. When inhaling, a triangular-shaped space is formed between the vocal folds - the glottis; through it it is usually possible to see the upper rings of the trachea, covered with a pale pink membrane.

Rice. 5.11.

mucous membrane

DIRECT L A R I N G O S C O P Y. Due to the fact that in children it is difficult to perform indirect laryngoscopy, direct laryngoscopy is performed (Fig. 5.11), and lighting from a frontal reflector can be used. The principle of direct laryngoscopy underlies all methods of direct endoscopic examination of the respiratory tract and esophagus; the differences are only in the length and diameter of the tubes used.