Endoscopy of the child’s nose: how the procedure for endoscopic examination of the nasopharynx is performed. Endoscopy of the throat How to conduct the examination correctly

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 performed in case of hoarseness or hoarseness of the throat of unknown etiology, difficulty swallowing food, laryngeal injury, obstruction respiratory tract. 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 ( top part);
oropharynx ( middle part);
hypopharynx (lower part).

Based on which part of the throat needs to be examined, there are the following types endoscopy of the throat - 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 procedures

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.

To make a diagnosis when the larynx is affected, a complete examination is required. It includes an examination by a doctor, analysis of anamnestic information, on the basis of which additional laboratory and instrumental tests are prescribed. Most informative method MRI of the larynx is considered diagnostic, but examination is also carried out using X-rays and endoscopically (direct laryngoscopy).

TEST: Find out what's wrong with your throat

Have you ever had elevated temperature body on the first day of illness (on the first day of symptoms)?

In connection with a sore throat you:

How often for Lately(6-12 months) Are you experiencing similar symptoms (sore throat)?

Feel the area of the neck just below the lower jaw. Your feelings:

If your temperature suddenly rises, you took an antipyretic drug (Ibuprofen, Paracetamol). After that:

What sensations do you experience when you open your mouth?

How would you rate the effect of throat lozenges and other topical painkillers (candies, sprays, etc.)?

Ask someone close to you to look down your throat. To do this, rinse your mouth clean water for 1-2 minutes, open your mouth wide. Your assistant should shine a flashlight on himself and look into the oral cavity by pressing the root of the tongue with a spoon.

On the first day of illness, you clearly feel an unpleasant putrid bite in your mouth and your loved ones can confirm the presence unpleasant odor from the oral cavity.

Can you say that in addition to a sore throat, you are bothered by a cough (more than 5 attacks per day)?

Benefits of MRI

Due to its high information content, non-invasiveness, and painlessness, the study is widely used in medical practice. The procedure provides the maximum amount of information about the condition of soft tissues, blood vessels, lymph nodes, cartilaginous structures. Information content can be increased using intravenous contrast, which more clearly visualizes oncological, cystic formations.

Computed tomography of the larynx is prescribed by an otolaryngologist, oncologist, or surgeon to determine conservative or surgical treatment tactics.

Among the symptoms when tomography is prescribed, it is worth highlighting:

difficulty breathing, swallowing;
hoarseness of voice;
neck deformation, which is visually noticeable;
soreness when palpated;
nasal congestion in the absence of sinusitis, which indicates possible availability Thornwald cysts;
headaches, dizziness;
swelling of soft tissues.

Thanks to MRI of the throat, the following pathological conditions and diseases are diagnosed:

consequences of injuries in the form of scar changes;
presence of a foreign body;
inflammatory foci, lymphadenitis;
abscess, phlegmon;
cystic formations;
oncological diseases.

In addition, examination of the larynx with a tomograph makes it possible to track the dynamics of disease progression and evaluate the effect of treatment, including in the postoperative period.

The high resolution of the tomograph makes it possible to identify a cancer focus at the initial stage of development

The advantages of MRI of the throat are:

Limitations in the use of MRI are associated with high cost and the need for research bone structures, when MRI is not so informative.

No preparation for diagnosis is required. Before starting the examination, you must remove jewelry containing metal. 6 hours before the examination, it is forbidden to eat if contrast is to be used.

Among the contraindications to MRI of the throat it is worth noting:

presence of a pacemaker;
metal prostheses;
metal fragments in the body;
pregnancy (1st) trimester.

If there are metal elements in the human body, when exposed to a magnetic field, they can move somewhat from their place. This increases the risk of injury to surrounding structures and tissues.

Features of laryngoscopy

Laryngoscopy refers to diagnostic techniques, which make it possible to examine the larynx and vocal cords. There are several types of research:

indirect. Diagnosis is carried out in a doctor's office. A small mirror is located in the oropharynx. Using a reflector and a lamp, a beam of light hits the mirror in the mouth and illuminates the larynx. Today, such laryngoscopy is practically not used, since it is significantly inferior in information content to the endoscopic method.
Direct - performed using a flexible or rigid fiber laryngoscope. The latter is often used during surgery.

Indications for laryngoscopy include:

hoarseness of voice;
pain in the oropharynx;
difficulty swallowing;
sensation of a foreign object;
blood in the sputum.

The method allows you to determine the cause of the narrowing of the larynx, as well as assess the degree of damage after injury. Direct laryngoscopy (fibroscopy) is in most cases performed to remove foreign objects, take material for a biopsy, or remove polyps.

Indirect laryngoscopy is performed on an empty stomach to avoid aspiration (entry of gastric contents into the respiratory tract). It is also necessary to remove removable dentures.

Direct endoscopy of the larynx is performed under general anesthesia, on an empty stomach, after collecting some information from the patient, namely:

the presence of allergic reactions;
taking medications regularly;
cardiac diseases;
blood clotting disorder;
pregnancy.

Contraindications include

ulcerative lesions of the oral cavity, epiglottis, oropharynx due to a high risk of bleeding;
severe cardiac and respiratory failure;
severe swelling of the neck;
laryngeal stenosis, bronchospasm;
uncontrolled hypertension.

Indirect research is carried out in sitting position. The patient opens his mouth, the tongue is held with a napkin or fixed with a spatula.

To suppress the gag reflex, the doctor irrigates the mucous membrane of the oropharynx with an anesthetic solution.

A small mirror is placed in the oropharynx, after which the examination of the larynx and ligaments begins. A beam of light is reflected from a refractor (a mirror fixed on the doctor’s forehead), then from a mirror in the oral cavity, after which the larynx is illuminated. To visualize the vocal cords, the patient must pronounce the sound “A”.

Direct endoscopic examination is performed under general anesthesia in an operating room. After the patient falls asleep, a rigid laryngoscope with a lighting device at the end is inserted into the oral cavity. The doctor has the opportunity to examine the oropharynx, ligaments, or remove a foreign body.

When conducting a direct examination while the patient remains conscious, the mucous membrane of the oropharynx should be irrigated with an anesthetic, and a vasoconstrictor should be instilled into the nasal passages. After that flexible laryngoscope moves along the nasal passage.

The procedure takes approximately half an hour, after which it is not recommended to take food, liquid, cough heavily or gargle for two hours. This will prevent laryngospasm and suffocation.

If surgical intervention in the form of polyp removal was performed during laryngoscopy, it is necessary to follow the doctor’s recommendations for the management of the postoperative period.

After laryngoscopy, you may experience nausea, difficulty swallowing, or hoarseness.

When performing a biopsy, blood may appear in the saliva after the examination.

The risk of complications after examination increases with obstruction of the respiratory tract by a tumor formation, polyp, or in case of inflammation of the epiglottis. Bleeding may occur after the biopsy. infectious consequences or damage to the respiratory tract.

Based on the results of the study, the doctor can diagnose inflammatory diseases, detect and remove a foreign body, assess the severity of the traumatic injury, and also take a biopsy if an oncological process is suspected.

X-ray in the diagnosis of diseases of the larynx

To diagnose throat pathologies in otolaryngology, ultrasound and tomography are most often used. Despite the availability of modern instrumental examination methods, x-rays of the larynx are also used, although they are not a highly informative technique.

Typically, radiography is performed on patients when laryngoscopy is not possible. X-ray diagnostics does not require preparation. X-ray performed straight, lateral, as well as anterior and posterior.

Considering the need to obtain an image in a certain projection, the patient is placed on his side or chest. The research is carried out as follows:

X-ray tube generates a beam beam;
radiation passes through tissues of varying densities, as a result of which more or less dark shadows are visualized in the image.

Muscles transmit radiation flux well. Bones, possessing high density, block their path, which is why the rays are not displayed on the film. The more X-rays hit the image, the more intense their shadow coloring.

Hollow structures are characterized by a black shadow color. Bones, having low x-ray throughput, appear white on the image. Soft tissues are projected as a gray shadow of varying intensity. According to indications, contrast is used, which increases the information content of the method. Contrast agent in the form of a spray is sprayed onto the mucous membrane of the oropharynx.

The image evaluates the x-ray anatomy of the larynx. When viewed from the side, many anatomical structures can be seen, such as the root of the tongue, the body of the hyoid bone, epiglottis, ligamentous apparatus(vocal, epiglottal-arytenoid), ventricular fold, vestibule of the larynx, as well as the ventricles of Morgagni and the pharynx, localized behind the larynx.

High-quality radiography of the larynx allows the doctor to assess the diameter of the lumen of the hollow organs, glottis, motor ability of the ligaments, and epiglottis.

Cartilaginous structures do not reflect radiation well, so they are practically not visualized in the image. They begin to appear when they become calcified, when calcium is deposited in the tissues.

At 16-18 years of age, calcification occurs in the thyroid cartilage, then in the remaining laryngeal cartilages. By the age of 80, complete calcification of cartilaginous structures is noted.

Thanks to x-rays, displacement of the organ, changes in its shape, and reduction of the lumen are diagnosed. In addition, foreign bodies, cystic formations, and oncopathology of benign or malignant origin are visualized.

Among the indications should be highlighted:

traumatic injury;
tracheal stenosis due to diphtheria;
chemical, thermal burn;
violation of the movement of the vocal cords.

Contraindications include pregnancy, however, when using protective equipment research may be permitted.

Based clinical picture the doctor determines which methods of examining the larynx will be the most informative in in this case. Thanks to a comprehensive examination, it is possible to diagnose pathology at an early stage of development. This makes it possible to select the optimal therapeutic course and achieve complete recovery.

It is precisely because the throat is constantly in contact with the external environment and with food that frequent illnesses various ailments.

Well, who hasn’t had a sore throat after drinking cold water in the heat? Or after breathing in cold winter air through your mouth? That’s why doctors advise trying not to overcool your throat in the summer, and in winter wrap it in scarves and breathe through your nose.

Today we will look at some diseases and methods of diagnosing them in people of any gender and age. We will also focus on some aspects of the structure of the human larynx and pharynx.

Endoscopic studies

This name refers to endoscopy of the nasopharynx. The nasopharynx is a connecting channel between the nasal sinuses and the throat; various unfavorable bacteria can also settle in it. They may cause minor physical changes in the structure of the nasopharynx or inflammation.

If changes do occur, then they concern the lateral sinuses of the nose or, as they are also called, anastomosis. As a result, mucus in the nose accumulates and cannot find a way out and begins to rot, creating ideal conditions for the proliferation of unfavorable bacteria.

An endoscopic examination involves the doctor diagnosing blocked sinuses and opening them so that the person can breathe normally. The following interventions are carried out in various clinics:

A diagnostic examination is important because it allows you to identify diseases at the earliest stage. Thus, you can notice the most minor symptoms of the development of future pathologies in the body.

An initial examination can indicate the moment when treatment can be carried out with the least surgical intervention. Endoscopy of the nasopharynx can help preserve the nasal mucosa and turbinates in their original form.

This is very important for subsequent normal life and breathing. Symptoms for this operation include indistinct discharge from the nasal cavity, abnormal sense of smell or its complete absence, and hearing impairment.

The examination is performed in this way: a special device, which is called an endoscope. It looks like a tube with the thinnest optical fiber. At the end of the tube there is a tiny lens, at the other end there is an eyepiece into which the doctor looks.

This is how diagnostics are carried out: the doctor examines all the places and organs that interest him, examining everything down to the smallest detail. At the same time, the picture in the person’s nose is displayed on the computer monitor, and the doctor can tell the patient about the origin of his illness and what treatment will be taken. Thus, the most optimal solution and mutual understanding between the doctor and the patient is achieved.

The intervention of surgeons looks very similar, as it is carried out using such non-traumatic instruments. The procedure is generally very gentle; the doctor uses an endoscope to examine everything that happens in the nose and, under optical control, carries out careful removal.

Simultaneously with the removal, a complete correction of all nasal systems is carried out. After the operation there are no traces left, no scars, no scars, no incisions. The patient spends only a day in the hospital, and after a few more returns to full activity.

Diagnostics by pharyngoscopy

Another equally important method for detecting throat diseases is pharyngoscopy. This is another example of high-tech medical equipment. Pharyngoscopy is designed to diagnose various ENT diseases in the early stages and cure them without serious interference in the structure of the throat and its functions.

Pharyngoscopy, as a separate procedure, is performed for several symptoms:

A sagging voice.
Persistent pain and sore throat.
Unreasonable runny nose and cough.
Respiratory dysfunction.

All these symptoms are usually the basis for conducting research using this method. In order for pharyngoscopy to be performed correctly, the following tools are needed: a frontal reflector, a special medical spatula, laryngeal and nasopharyngeal mirrors of small diameter. In rare cases, a laryngoscope is also used, which can illuminate all channels and at the same time take samples of the mucous membrane for analysis.

No preparatory measures are needed before pharyngoscopy is performed. Of course, it is advisable to clean your teeth and mouth well so that the doctor does not feel discomfort. The whole operation takes place in several stages:

Apply lipocaine to the tongue and throat to reduce sensitivity.
Using a spatula, the doctor carefully pushes the tongue aside and places the mirror behind the soft palate.
Next, the doctor positions the mirror to assess the condition of the throat.
If it is necessary to check the condition of the tonsils, then the palate is moved to the side and pressure is applied to the tonsils.

In this case, pharyngoscopy should take place in a special chair, where the patient’s head should be fixed exactly straight. An experienced doctor spends no more than two minutes on all manipulations. During all this time, he manages to examine the walls of the pharynx, the palate, the openings of the nasal passages, all the tonsils and even the auditory tubes. Based on the operation performed, the doctor can clarify the picture of the disease. The first step is to identify the location of the negative phenomenon in the throat, the stage of its development and the type of disease.

If there is a suspicion of tonsillitis, then pharyngoscopy can confirm this if enlarged tonsils are noticed in a swollen state. If the sore throat is follicular, then a white coating on the walls of the throat will immediately become noticeable; it will be whitish-yellow in color.

With lacular sore throat, the plaque slightly changes its consistency and becomes more pronounced. After pharyngoscopy has been performed, most often prescribed additional methods examinations to more accurately localize and identify the disease. In a good clinic, any model of the disease is assessed on a 4-point scale and on its basis it is decided what exactly the treatment will be.

If the maximum score has been established, then antibacterial therapy should be carried out immediately. Before starting treatment, tests are also prescribed, which should reveal the level of development of the disease and the optimal medications that will help quickly cope with it.

Endoscopy of the larynx

Endoscopy - from the Greek endon - inside and skopeo - look - is a diagnostic method using flexible tubes that are equipped with fiber optics. Allows you to see in detail, enlarge and record information about changes in organs and tissues and take tissue samples for biopsy if necessary.

Depending on the area being examined, there are:

pharyngoscopy - examination of the oral cavity and pharynx;
laryngoscopy – examination of the laryngeal cavity;
rhinoscopy - examination of the nasal cavity;
Otoscopy – examination of the external ear and auditory canal.

In fact, endoscopic diagnosis of diseases of the ENT organs has been known for more than a hundred years. After all, a doctor’s examination of the nasal cavities, pharynx, and larynx using routine medical instruments, for example, using a nasal speculum to examine the nasal passages, is also an endoscopy method.

Only in modern medicine Diagnostic devices have become more advanced - these include advanced optics and modern photo and video systems for recording examination results. Endoscopy has experienced intensive development over the past 10 years and has become an indispensable link in the work of an otolaryngologist in diagnosing ENT diseases.

Rigid and flexible modern views endoscopes have significantly improved the quality of examination of the nasal cavity in patients. Thus, a fiberscope (endoscope with a soft and flexible tube with a diameter of 2-4 mm) allows you to examine the nasal cavity and see the anastomosis with the paranasal sinuses, small polyps of the mucous membrane, the nature of the secretion and its presence, determine the shape of the nasal turbinates and evaluate changes in their parts. If there is a suspicion of a tumor, a fiberscope will help take tissue for a biopsy.

Endoscopy is also important in the study of the larynx and vocal cords - laryngoscopy. During the routine examination method, a special instrument is used for this - a laryngeal mirror. It is used to perform indirect or mirror laryngoscopy. But in quality use This method is sometimes interfered with by physiology - the pharyngeal reflex.

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Endoscopic examination of the larynx and pharynx with a flexible laryngoscope: indications and methodology

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. Organization of proper preparation of the patient and adherence to the technique for examining the upper organs respiratory system allows you to prevent the occurrence of negative consequences.

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

general description

Larynx and pharynx - the most important organs upper parts of the 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 must examine the patient and carefully ask him about any allergies he has, since they may be used during the procedure. local anesthetics 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 hours before the examination due to the required use general anesthesia.

Carrying out the procedure

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 consider whether the patient has diseases of the internal organs ( ischemic disease heart, respiratory failure, etc.).

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.

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.

How and why is an endoscopic examination of the nose performed?

To diagnose diseases of the nasopharynx, many methods are used, from simple examination to complex instrumental studies. One of the most modern methods is nasopharyngeal endoscopy. It has a number of advantages over other manipulations.

The disadvantage of the study is that it requires special equipment and trained personnel. Not every medical institution can provide this diagnostic service.

Any endoscopic examination is carried out using a special apparatus. The general name for such equipment is endoscopes. Depending on which organ the device is used to examine, it has the appropriate name. A rhinoscope is used to examine the nasopharynx.

It is a flexible tube with an optical system and a camera at one end. The second end of the tube is connected to the device. The tube is inserted into the nasopharynx cavity and the entire image from the camera is transmitted to a large screen.

With the help of rhinoscopy, you can fully examine the entire mucous membrane of the nose and pharynx and identify the slightest changes in it. In addition to the diagnostic function, endoscopy also performs a therapeutic one. Having connected the instruments to the tube, the doctor performs the necessary surgical procedures.

The procedure is performed on an outpatient or inpatient basis. The patient is seated in a chair and asked to tilt his head up. This achieves maximum straightening of the nasopharynx.

Then the mucous membrane must be anesthetized. To do this, it is lubricated or irrigated with a solution of novocaine. After anesthesia, the endoscope tube is inserted into the nasal passage and further into the pharynx.

The doctor examines the condition of the nasal mucosa on the screen and, if necessary, performs surgical procedures. After this, the image is saved on the computer and can be printed if necessary.

All stages of rhinoscopy take 20 minutes. The advantages of rhinoscopic surgery are as follows:

minimal tissue damage;
access is carried out from the inside, so there are no cosmetic defects on the face;
bleeding is minimal;
no long rehabilitation period is required.

Today this method is preferred.

No preliminary preparation is required for rhinoscopy. Before the procedure, the doctor talks about all its stages. After rhinoscopy, the doctor explains how the recovery period goes.

If you plan to perform rhinoscopy in children, you need to explain to the child that the procedure does not hurt and it takes a little time. For children, endoscopy is performed using the thinnest and most flexible devices. The same ones are used in adults with thin and easily vulnerable mucous membranes.

Some difficulties during diagnosis arise if there is severe swelling of the mucous membrane. In this case, the endoscopic tube does not penetrate the entire depth of the nasopharynx. To eliminate swelling, vasoconstrictor solutions are instilled into the nasal passages along with an anesthetic.

As a diagnostic procedure, rhinoscopy is performed if any disease of the nasopharynx is suspected, or with complaints of:

bleeding from the nose;
feeling of nasal congestion;
hearing loss;
speech disorders;
frequent colds;
sore throat.

Endoscopic examination is also used as control after surgical interventions.

IN medicinal purposes Nasopharyngeal endoscopy is used when the diagnosis is established. It is used to remove foreign bodies, enlarged adenoids, polyps and tumors, and stop bleeding. The endoscope allows you to rinse the nasopharynx and sinuses with special medicinal solutions.

There are practically no contraindications to this technique. The only thing is an allergic reaction to lidocaine or novocaine. The procedure may cause heavy bleeding in people with bleeding disorders or who have been taking anticoagulants for a long time.

A relative contraindication is age under two years. If a young child requires diagnosis and treatment, this technique is allowed to be used.

Thanks to a light source and a camera, a specialist can completely examine the entire mucous membrane of the nose and pharynx and detect even minimal pathologies:

source of bleeding;
mucosal polyps;
tumors;
foreign bodies;
enlarged adenoids.

The condition of the nasal sinuses is assessed and, if necessary, therapeutic manipulations are performed.

After diagnostic measures The person is observed for half an hour and, if there are no complications, is sent home. After performing surgical procedures, the person must remain in the ward under observation for 24 hours. For several days, experts do not recommend intensively blowing your nose, so as not to provoke the development of bleeding.

Endoscopy of the nasopharynx - modern diagnostic and medical procedure, which allows you to establish a diagnosis with great accuracy and carry out necessary treatment. The procedure can be performed on children and adults, with virtually no contraindications.

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Endoscopy for ENT diseases: examination of the larynx

The throat plays an important role in the human organ system. IN healthy condition The laryngeal mucosa looks clean and pink, without inflammation or enlarged tonsils. At various diseases colds, nervous, tumor, traumatic nature, tissues react with certain changes. For their diagnosis they use various examinations. The most informative of them is endoscopy of the larynx, which allows you to clarify and record any deviations from the norm, as well as take a tissue sample if a biopsy is needed.

What is endoscopy used for?

The endoscopy method refers to the field of diagnostic research using flexible tubes equipped with light-fiber optics devices. The larynx area is part of the ENT system, the problems of which are dealt with by the branch of medicine - otolaryngology. In addition to a visual examination, an ENT doctor has an endoscopic diagnostic method in his arsenal, which is prescribed for problems with the voice, swallowing, and injuries. There are several types of examination, depending on the area being examined:

pharyngoscopy is used to visualize the oral cavity and the condition of the pharynx;
during laryngoscopy, the laryngeal cavity is examined;
rhinoscopy is used to view the nasal passages;
Otoscopy is necessary to view the auditory canal along with the outer ear.

Interesting fact: examination internal surfaces Doctors have been treating the ear, larynx and nose for over a hundred years. However, at the dawn of the era of endoscopic diagnosis, routine instruments were used - special mirrors. Modern diagnostics performed with perfect devices equipped with high-precision optics with the ability to record results.

Advantages of endoscopic diagnosis

If you have problems with your voice, ear and throat pain, hemoptysis, or injuries to the larynx, it becomes necessary to examine the larynx and vocal cords using laryngoscopy. A diagnostic examination of the larynx is performed with a rigidly fixed or flexible endoscope, which allows you to see the internal area of the organ in different projections on the monitor screen. Thanks to the capabilities of the video system, the doctor can examine problem areas in detail, recording the results of the endoscopic examination on a disk.

This type of diagnosis, popular in otolaryngology, has a number of advantages:

harmlessness of manipulation due to the absence of electromagnetic influence;
absence pronounced signs discomfort and pain syndrome;
endoscopy provides a reliable result and the ability to collect a tissue sample.

Diagnostic examinations are performed in modern medical centers using various instruments. Depending on the type of laryngoscopy, a vibrating fiber endoscope or laryngoscope is used for direct form diagnostics. Visual inspection is performed with a system of mirrors that reflect the light of a lamp to illuminate the larynx during indirect endoscopy. Microlaryngoscopy is carried out with a special operating microscope to identify tumor lesions of the larynx.

Endoscopic examination techniques

The examination is carried out by a doctor who treats diseases of the ears, nose and throat. The possibility of instrumental research allows you to accurately determine the diagnosis in order to prescribe the correct treatment regimen for people of different ages. What types of larynx diagnostics are prescribed?

Indirect view of laryngeal endoscopy

For the study, which is carried out in a darkened room, the patient should sit with wide open mouth and sticking out your tongue as much as possible. The doctor examines the oropharynx using a laryngeal mirror inserted into the patient’s mouth, which reflects the light of the lamp refracted by the frontal reflector. It is attached to the doctor's head.

To prevent the viewing mirror in the throat cavity from fogging up, it must be heated. To avoid gagging, the examined surfaces of the larynx are treated with an anesthetic. However, the five-minute procedure has long been outdated and is rarely performed due to the low information content of the semi-reverse image of the larynx.

Important condition: before appointment modern way diagnosing the condition of the larynx, the patient should be convinced of the need for endoscopy and familiarized with the features of preparation for it. It is also necessary to find out information about the health problems of the person being examined, it is useful to reassure the person that he will not be hurt, there is no danger of lack of air. It is advisable to explain how the manipulation is carried out.

Direct method of research

This type of laryngoscopy is flexible when a movable fiber laryngoscope is used. In the case of using a rigidly fixed device, the technique is called rigid, and is used mainly for surgical intervention. The introduction of modern equipment makes it easier to make a diagnosis and allows you to achieve the following goals:

identify the reasons for changes or loss of voice, pain sore throat, difficulty breathing;
determine the degree of damage to the larynx, the causes of hemoptysis, as well as problems with the respiratory tract;
remove a benign tumor, rid a person of a foreign body trapped in the larynx.

If the information content of indirect diagnostics is insufficient, examination by the direct method is relevant. Endoscopy is performed on an empty stomach, but under local anesthesia after taking medications to suppress mucus secretion, as well as sedatives. Before starting the procedure, the patient must warn the doctor about heart problems, blood clotting characteristics, a tendency to allergies, and possible pregnancy.

Features of direct endoscopy of the larynx

Direct flexible endoscopy method

Diagnosis is carried out under the supervision of a group of health workers. During the manipulation, the doctor uses a fiber-optic fiber endoscope equipped with a movable distal end. The optical system with adjustable focusing and illumination provides a wide range of viewing of the laryngeal cavity. To avoid gagging, the throat is treated with an anesthetic spray. To prevent injury to the nasal mucosa, the nose is instilled with vasoconstrictor drops, since the endoscopic procedure is carried out by inserting a laryngoscope through the nasal passage.

The study allows, together with examining the condition of the larynx, as well as the vocal cords, to remove polyps and take material for a biopsy. The diagnostic procedure, which lasts approximately 30 minutes, is considered particularly complex. Therefore, they are doing research in hospital operating room. When the patient lies on the operating table and falls asleep under anesthesia, the beak of a rigid laryngoscope equipped with a lighting device is inserted into his larynx through the mouth.

An important point: during the procedure, swelling of the larynx is possible, so after the examination the patient’s throat is covered with ice. If the vocal cords have been interfered with, the person will have to remain silent for a long time. Eating and liquids are allowed no earlier than two hours after the endoscopy was performed.

Possibility of complications

The use of modern medical technology in endoscopic diagnostics helps the doctor detect pathology and determine the degree of its development, which is especially important for drawing up a treatment program. In addition, this is an excellent opportunity for the patient and his relatives to visually familiarize themselves with the problem and understand the need for treatment.

If cancer is suspected, the results of autofluorescence endoscopy become the most reliable diagnosis of the problem. However, it is worth considering that any type of endoscopic diagnosis is associated with possible risk for the patient's condition.

The consequence of treatment with an anesthetic may be difficulty swallowing, a feeling of swelling of the root of the tongue, as well as the posterior pharyngeal wall. A certain risk of swelling of the larynx cannot be excluded, which results in impaired respiratory function.
For a short time after endoscopy of the larynx, symptoms of nausea, signs of hoarseness and pain in the throat, and muscle soreness may be felt. To alleviate the condition, regularly rinse the throat walls with a soda solution (warm).
If a biopsy sample was taken, a cough with bloody clots in the sputum may begin after it. The condition is not considered pathological; unpleasant symptoms will go away in a few days without additional treatment. However, the risk of bleeding, infection, and respiratory tract injury exists.

The risk of complications after endoscopy increases due to blockage of the airways by polyps, possible tumors, inflammation of the cartilage of the larynx (epiglottis). If a diagnostic examination provokes the development of airway obstruction due to spasms in the throat, it is necessary emergency help– tracheotomy. To perform it, a longitudinal dissection of the tracheal area is required to ensure free breathing through a tube inserted into the incision.

When research is prohibited

In modern otolaryngology, laryngoscopy is considered one of the most productive ways to study the disease-prone larynx. Although the direct diagnostic method provides the ENT doctor with comprehensive information about the condition of the organ, the procedure is not prescribed in the following situations:

with a confirmed diagnosis of epilepsy;
injury to the cervical vertebrae;
for heart disease, myocardial infarction in the acute phase;
in case of severe stenotic breathing;
during pregnancy, as well as allergies to medications to prepare for endoscopy.

Interesting: for a detailed overview of the vocal cords, as well as general condition larynx using microlaryngoscopy. A delicate examination is performed using a rigid endoscope equipped with a camera. The instrument is inserted through the mouth without an additional incision along the cervical area. The manipulation usually accompanies laryngeal microsurgery and is performed under general anesthesia.

Fluorescence microlaryngoscopy will require injection additional drug. Sodium fluorescein allows you to assess the condition of the laryngeal tissues based on the varying degrees of absorption of the fluorescent substance. Thanks to innovative technologies A new endoscopy method has appeared - fibrolaryngoscotch. The procedure is carried out with a fiberscope with a movable flexible end, providing an overview of all parts of the larynx.

How to examine the throat and larynx?

To make a diagnosis when the larynx is affected, a complete examination is required. It includes an examination by a doctor, analysis of anamnestic information, on the basis of which additional laboratory and instrumental tests are prescribed. MRI of the larynx is considered the most informative diagnostic method, but examination is also carried out using X-rays and endoscopically (direct laryngoscopy).

Benefits of MRI

Due to its high information content, non-invasiveness, and painlessness, the study is widely used in medical practice. The procedure provides the maximum amount of information about the condition of soft tissues, blood vessels, lymph nodes, and cartilaginous structures. Information content can be increased using intravenous contrast, which more clearly visualizes oncological and cystic formations.

Computed tomography of the larynx is prescribed by an otolaryngologist, oncologist, or surgeon to determine conservative or surgical treatment tactics.

Among the symptoms when tomography is prescribed, it is worth highlighting:

difficulty breathing, swallowing;
hoarseness of voice;
neck deformation, which is visually noticeable;
soreness when palpated;
nasal congestion in the absence of sinusitis, which indicates the possible presence of a Thornwald cyst;
headaches, dizziness;
swelling of soft tissues.

Thanks to MRI of the throat, the following pathological conditions and diseases are diagnosed:

consequences of injuries in the form of scar changes;
presence of a foreign body;
inflammatory foci, lymphadenitis;
abscess, phlegmon;
cystic formations;
oncological diseases.

In addition, examination of the larynx with a tomograph makes it possible to track the dynamics of disease progression and evaluate the effect of treatment, including in the postoperative period.

The high resolution of the tomograph makes it possible to identify a cancer focus at the initial stage of development

The advantages of MRI of the throat are:

harmlessness, since the research is carried out using a magnetic field;
non-invasiveness, which does not imply violation of tissue integrity or penetration into hollow organs;
painlessness;
high information content with the possibility of 3D image reconstruction;
the ability to differentiate between benign and malignant neoplasms.

Limitations in the use of MRI are associated with the high cost and the need to study bone structures, when MRI is not so informative.

No preparation for diagnosis is required. Before starting the examination, you must remove jewelry containing metal. 6 hours before the examination, it is forbidden to eat if contrast is to be used.

Among the contraindications to MRI of the throat it is worth noting:

presence of a pacemaker;
metal prostheses;
metal fragments in the body;
pregnancy (1st) trimester.

If there are metal elements in the human body, when exposed to a magnetic field, they can move somewhat from their place. This increases the risk of injury to surrounding structures and tissues.

Features of laryngoscopy

Laryngoscopy refers to diagnostic techniques that make it possible to examine the larynx and vocal cords. There are several types of research:

indirect. Diagnosis is carried out in a doctor's office. A small mirror is located in the oropharynx. Using a reflector and a lamp, a beam of light hits the mirror in the mouth and illuminates the larynx. Today, such laryngoscopy is practically not used, since it is significantly inferior in information content to the endoscopic method.
Direct - performed using a flexible or rigid fiber laryngoscope. The latter is often used during surgery.

Indications for laryngoscopy include:

hoarseness of voice;
pain in the oropharynx;
difficulty swallowing;
sensation of a foreign object;
blood in the sputum.

Indirect laryngoscopy is performed on an empty stomach to avoid aspiration (entry of gastric contents into the respiratory tract). It is also necessary to remove removable dentures.

Direct endoscopy of the larynx is performed under general anesthesia, on an empty stomach, after collecting some information from the patient, namely:

the presence of allergic reactions;
taking medications regularly;
cardiac diseases;
blood clotting disorder;
pregnancy.

Contraindications include

ulcerative lesions of the oral cavity, epiglottis, oropharynx due to a high risk of bleeding;
severe cardiac and respiratory failure;
severe swelling of the neck;
laryngeal stenosis, bronchospasm;
uncontrolled hypertension.

Indirect examination is carried out in a sitting position. The patient opens his mouth, the tongue is held with a napkin or fixed with a spatula.

To suppress the gag reflex, the doctor irrigates the mucous membrane of the oropharynx with an anesthetic solution.

When conducting a direct examination while the patient remains conscious, the mucous membrane of the oropharynx should be irrigated with an anesthetic, and a vasoconstrictor should be instilled into the nasal passages. After this, a flexible laryngoscope is advanced along the nasal passage.

The procedure takes approximately half an hour, after which it is not recommended to take food, liquid, cough heavily or gargle for two hours. This will prevent laryngospasm and suffocation.

If surgical intervention in the form of polyp removal was performed during laryngoscopy, it is necessary to follow the doctor’s recommendations for the management of the postoperative period.

After laryngoscopy, you may experience nausea, difficulty swallowing, or hoarseness.

When performing a biopsy, blood may appear in the saliva after the examination.

The risk of complications after examination increases with obstruction of the respiratory tract by a tumor formation, polyp, or in case of inflammation of the epiglottis. After a biopsy, there may be bleeding, infection, or damage to the respiratory tract.

X-ray in the diagnosis of diseases of the larynx

Typically, radiography is performed on patients when laryngoscopy is not possible. X-ray diagnostics do not require preparation. X-rays are taken straight, lateral, as well as anterior and posterior.

Considering the need to obtain an image in a certain projection, the patient is placed on his side or chest. The research is carried out as follows:

X-ray tube generates a beam beam;
radiation passes through tissues of varying densities, as a result of which more or less dark shadows are visualized in the image.

Muscles transmit radiation flux well. The bones, having a high density, block their path, which is why the rays are not displayed on film. The more X-rays hit the image, the more intense their shadow coloring.

Hollow structures are characterized by a black shadow color. Bones, having low x-ray throughput, appear white on the image. Soft tissues are projected as a gray shadow of varying intensity. According to indications, contrast is used, which increases the information content of the method. A contrast agent in the form of a spray is sprayed onto the mucous membrane of the oropharynx.

The image evaluates the x-ray anatomy of the larynx. When viewing the lateral image, many anatomical structures can be seen, such as the root of the tongue, the body of the hyoid bone, the epiglottis, the ligamentous apparatus (vocal, epiglottic-arytenoid), the ventricular fold, the vestibule of the larynx, as well as the ventricles of Morgagni and the pharynx, localized behind the larynx.

High-quality radiography of the larynx allows the doctor to assess the diameter of the lumen of the hollow organs, glottis, motor ability of the ligaments, and epiglottis.

Cartilaginous structures do not reflect radiation well, so they are practically not visualized in the image. They begin to appear when they become calcified, when calcium is deposited in the tissues.

Influenza calcification occurs in the thyroid cartilage, then in the remaining laryngeal cartilages. By the age of 80, complete calcification of cartilaginous structures is noted.

Among the indications should be highlighted:

traumatic injury;
tracheal stenosis due to diphtheria;
chemical, thermal burn;
violation of the movement of the vocal cords.

Contraindications include pregnancy, however, if protective equipment is used, the study may be permitted.

Based on the clinical picture, the doctor determines which methods of examining the larynx will be the most informative in this case. Thanks to a comprehensive examination, it is possible to diagnose pathology at an early stage of development. This makes it possible to select the optimal therapeutic course and achieve complete recovery.

Target. The use of endoscopic systems with video monitoring makes it possible to assess the process of voice formation and the condition of the elements of the larynx involved in breathing and phonation. At all levels of medical care for patients with laryngeal diseases, it is necessary to use endoscopic technology. Absence in many children's outpatient clinics medical institutions ultra-thin optical equipment that allows non-invasive visual endoscopic examination in early period diseases, leads to the fact that at the age of 5 years, almost 50% of children are diagnosed with organic pathology of the larynx. Children with voice production disorders must be examined in consultation and diagnostic centers equipped with special equipment (video laryngoscope, video stroboscope) to assess the degree of change in air flow.

If organic changes are detected in the larynx or the upper and lower respiratory tract adjacent to it, the endoscopic examination is continued in the hospital, under anesthesia and using a microscope, rigid and flexible endoscopes.

Indications. Indications for endoscopic examination in children are various disorders of voice production and difficulty breathing (dyspnea of inspiratory, expiratory and mixed nature). If the leading symptom is difficulty breathing, endoscopic examination of the larynx is preceded by general examination, X-ray examinations of the chest, endoscopic examination of the nasal cavity and nasopharynx.

Indications for endoscopic examination of the larynx in children:
Congenital severe or progressive stridor.
All types of airway obstruction in newborns.
Acute and recurrent inflammatory obstruction of the airways for the purpose of differential diagnosis of subglottic laryngitis and epiglottitis.
Difficulty breathing with attacks of apnea, cyanosis, aspiration (including in children in the first months of life with malnutrition).
Progressive chronic respiratory obstruction.
Any unusual changes in the voice of children (including lack of screaming, voice in children in the first months of life), prolonged mutations in boys, unusually rough voice in girls.
Progressive deterioration of breathing or voice after external or internal trauma to the larynx.
Changing the voice in the background drug therapy(for example, inhaled glucocorticoids).
Dysphonia and breathing disorders after childhood infections.

Preparing for the study. The method of pain relief for indirect laryngoscopy is application anesthesia with a 10% solution of lidocaine in the form of an official aerosol using 30-40 mg per examination. Before anesthesia of the larynx, sublingual anesthesia is required. This manipulation is a test for tolerability of the anesthetic; allows you to avoid pain when traction of the frenulum of the tongue on the child’s lower incisors. For children who cannot tolerate lidocaine, a 1% diphenhydramine solution in combination with hydrocortisone is used for local anesthesia. For older children, indirect optical laryngoscopy can be performed without local anesthesia, especially when using thin (2.7 and 4 mm in diameter) angled endoscopes.

Methodology and aftercare. A detailed examination of the structures of the larynx and assessment of vocal function is carried out using indirect endoscopic research methods - rigid optical videolaryngoscopy, fibrolaryngoscopy, or direct videoendoscopic laryngoscopy using rigid or flexible optical systems, and in some cases a microscope.

Methodology for rigid optical videolaryngoscopy. To conduct the study, a rigid endolaryngoscope with 70° lateral vision optics, 4 mm in diameter and 18 cm in length with a built-in fiberglass light guide is used. The improved 70° optical system is optimal for routine diagnostics, as it provides a good overview of all elements of not only the larynx, but also the pharynx, and the root of the tongue. The source of “cold” light is a halogen lamp, the light from which is transmitted to the rigid endoscope through a flexible fiber optic. To prevent lenses from fogging, the endoscope is preheated to a temperature of 40-45 °C. The method allows you to examine the larynx not only through an endoscope, but also display the image on a video monitor. At the same time, a video recording of the study is performed. It is possible to use optics with a viewing angle of 90°.

The study is carried out on an empty stomach. The larynx is examined with the patient sitting with the head slightly tilted forward. Older patients hold their tongue out themselves; in younger children, an assistant fixes it. The child is explained that he must relax and breathe calmly through his mouth. If the patient does not experience discomfort from the manipulation, local anesthesia is not performed. With an increased pharyngeal reflex, the pharyngeal cavity is anesthetized with a 10% lidocaine solution. This makes the examination easier and allows a more natural and detailed examination of his larynx. The endoscope is inserted midline into the cavity of the oropharynx without touching back wall pharynx, and under the control of the monitor, they are placed in the optimal position for examining the larynx.

Methodology for fibroendoscopy of the larynx. To conduct this study, fiber-optic nasopharyngolaryngoscopes are used. All types of fiberscopes have a movable distal end with a bend angle of 130° up and 130° down. The presence of adjustable focusing in the optical system allows for inspection in a wide field of view, obtaining an enlarged image of an object, and comparing the size, color and nature of tissue changes. Using a lighting cable, the endoscope is connected to a light source, which is a halogen generator of intense cold light, which allows you to examine the smallest details. All types of nasopharyngolaryngoscopes can be used to perform fibrolaryngoscopy. Fiberendoscopy of the larynx is carried out in two ways: through the nasal cavity (nasopharyngeal method) and through the oral cavity (oropharyngeal method).

When performing fibrolaryngoscopy through the oral cavity, to relieve the pharyngeal reflex, the mucous membrane of the oropharynx and the root of the tongue are irrigated with an anesthetic drug. The patient's tongue is fixed by an assistant or the patient himself, as with rigid laryngoscopy. To avoid biting the working part of the fiberscope on the outstretched tongue of restless children, a special short plastic stopper is placed that does not reach the root of the tongue, so as not to stimulate the gag reflex. Under visual control, the fiberscope is passed along the midline from the oropharynx to the hypopharynx and larynx through rotational movements and changing the viewing angle by forced bending of the controlled distal end.

When using a nasopharyngeal approach, the patient undergoes an anterior rhinoscopy to identify possible curvature of the nasal septum, which may complicate the procedure. Application anesthesia is performed with a 10% lidocaine solution and anemization with a 0.1% epinephrine solution of the mucous membrane of the wide part of the nasal cavity. The examination is carried out without protruding the patient's tongue. The fiberscope is inserted along the lower nasal meatus until it stops. At the same time, the condition of the nasal cavity and nasopharynx is assessed. The fiberscope is inserted behind the soft palate and advanced behind the root of the tongue and further behind the epiglottis to the level of optimal examination of the larynx and pyriform sinuses. This position is maintained for up to 10-15 minutes, which makes it possible to observe the process of voice formation for a long time. If it is necessary to examine the lower surface of the vocal folds and subglottic space, additional irrigation of the mucous membrane is carried out with a 2% lidocaine solution brought to the corresponding area through the manipulation channel via a catheter.

Laryngoscopy is performed through the nasal cavity rather than through the oral cavity. Passing the apparatus from the nasopharynx into the laryngeal cavity in a straightened position of the distal end without contact with the epiglottis, arytenoid cartilages, aryepiglottic and vestibular folds avoids irritation of the most sensitive reflexogenic zones and prevents coughing. This cannot always be achieved when passing the endoscope through the oral cavity, when its distal end is forced to bend.

Method of direct video endoscopic laryngoscopy. Before this study, premedication is carried out intramuscular injection atropine at a dose of 0.01 mg/kg (to reduce salivation) in combination with benzodiazepines (diazepam at a dose of 0.2-0.3 mg/kg or midazolam at a dose of 0.05-0.15 mg/kg). If necessary, premedication includes antihistamines and analgesics in age-specific dosages. The study is carried out under anesthesia (mask inhalation of a gas-narcotic mixture 02 + N20 in a ratio of 1/2 and halothane in a concentration of 1.5-2.5 vol%) in combination with local topical anesthesia of the mucous membrane of the pharynx and larynx with a 10% lidocaine solution.

It is preferable to perform endoscopic examination of the larynx in children under anesthesia without the use of endotracheal intubation in order to preserve the patient’s spontaneous breathing. To do this, after introductory mask inhalation anesthesia, a thorough local spray anesthesia of the hypopharynx and larynx is performed through the side slot of the laryngoscope. After anesthesia, manual (suspension, support) laryngoscopy is performed using rigid optics. To continuously supply a gas-narcotic mixture to the entrance to the larynx, use a wide cannula inserted into the side slot of the laryngoscope, or supply the gas-narcotic mixture through nasopharyngeal catheters. The disadvantage of deep anesthesia is the inability to examine the larynx during phonation. But this observation, including optically, can be carried out at the end of an in-depth examination of the larynx, at the moment the patient emerges from anesthesia, when muscle tone is restored.

With prolonged examination of the larynx, subglottic areas, and trachea, laryngospasm is possible. To prevent it, at the end of optical laryngotracheoscopy, a local anesthetic is once again carefully applied to the area of the reflexogenic zones of the larynx. It is always necessary to have a syringe with a solution of muscle relaxant already drawn up, which is administered urgently if prolonged laryngospasm occurs and intubation is necessary. Until the patient awakens, the catheter is not removed from the vein, and if it is removed, the muscle relaxant is administered under the tongue.

In case of a process obstructing the lumen of the larynx, nasopharyngeal intubation is preferable using two catheters at once, which are brought to the entrance to the larynx with preserved spontaneous breathing and thorough local anesthesia. After laryngoscopy, one of the catheters is inserted into the lumen of the glottis or below it, while the second catheter is clamped before entering the nose to enhance the supply of the gas-narcotic mixture. After saturating the patient with a narcotic gas mixture and adequate oxygenation, the catheter is removed from the lumen of the lower respiratory tract, fixing both conductors at the entrance to the larynx, and an endoscopic examination of the larynx is performed. For in-depth and long-term endoscopic studies, direct suspension laryngoscopy is performed according to the generally accepted method using the laryngoscope fixation with the Reicker-Kleinsasser support system. For diagnostic endoscopy, a laryngoscope with a side slot and good remote illumination (Benyamin laryngoscope) is used for more effective manipulation and simultaneous optical tracheoscopy or bronchoscopy. The use of closed stationary operating laryngoscopes according to Kleinsasser, Lindholm, Benjamin does not allow performing optical laryngotracheobronchoscopy. Depending on the objectives of the study, one or another type of pediatric laryngoscopes with total length from 15 cm for older schoolchildren and up to 9.5 cm for newborns. Thus, a laryngoscope according to Holinger and Tucker with a length of 11 cm, according to Holinger and Benjamin with a length of 9.5 cm with a side slot allows for good visualization of the area of the anterior commissure, respectively, in young and older children and newborns. The laryngoscope (subglottiscope) according to Holinger and Benjamin with a length of 9.5 cm, as well as the laryngoscope according to Parson (length 8, 9 and 11 cm), allows you to examine the larynx of newborns with very low birth weight.

These models have side slots that allow the insertion of rigid telescopes with a diameter of 1.9; 2.7 cm and 18 cm long not only into the larynx, but also into the trachea, up to the bifurcation. Models of laryngoscopes according to Parson, Lindholm, as well as the Ward sliding laryngoscope allow panoramic observation of the entire laryngopharyngeal region, vallecula, base of the tongue, and the entrance to the esophagus. To examine the larynx, rigid telescopes of 0°, 20°, 30° and 70° vision are used, with a diameter (depending on age) of 1.9, 2.7, 4, 5.8 cm and a length of 14-18 cm. Attach to the telescope endovideo camera and receive a color enlarged video image of the examined elements of the larynx on the monitor screen. For documentation, video recording is carried out using a VCR. The use of 30° and 70° telescopes allows for thorough inspection hard to reach places larynx (ventricles of the larynx, lower surface of the vocal folds and anterior commissure, subglottic region). In addition to laryngoscopy, all children must undergo tracheoscopy with a long direct vision telescope. The data from this study are especially important when detecting laryngeal papillomatosis to determine the extent of the process.

The main feature of the laryngoscopy examination method in children is an individual approach, taking into account the age and psychosomatic state of the child. The choice of anesthesia, endoscopic equipment, and rational research technique depends on these factors. A preliminary conversation between the attending physician and patients of the older age group, aimed at an accessible explanation of the essence of the manipulation and its painlessness, helps to establish contact with the child, which affects the quality and duration of the study. In 90-95% of children, as a rule, it is possible to carry out an endoscopic examination using indirect endoscopic methods of examination to examine the larynx and assess its functional state. These methods are not only informative in diagnosing diseases of the vocal apparatus, but are also safe to use, which is confirmed by the absence of any complications in the examined children. In 5-10% of children, there is a need for diagnostic direct laryngoscopy under anesthesia. These are young children, children with labile nervous system, whose psycho-emotional state does not allow us to establish contact with them necessary to carry out endoscopic examination.

One of the disadvantages of indirect rigid video endoscopy is the difficulty of performing it in children under 5-6 years of age. This is due to the need for active patient participation and anatomical features the structure of the larynx and nearby organs in young children (thick root of the tongue, narrow folded epiglottis), preventing its examination. In children under 6 years of age, difficulties may arise when performing rigid endoscopy of the larynx, associated with hypertrophy of the palatine tonsils of the third degree, a low location of the epiglottis, an increased pharyngeal reflex that is not relieved by local anesthesia, and the presence of a neoplasm of the root of the tongue. For this group of patients and most younger patients, the condition of the larynx is assessed using fibrolaryngoscopy. The most optimal method is transnasal fibrolaryngoscopy, which gives an overview of the larynx and allows one to assess its functional state during the process of phonation. A significant advantage of this method is the possibility of its implementation in children aged 1 to 3 years. The use of ultra-thin flexible endoscopes replaces direct laryngoscopy under anesthesia in patients in this age group. Fibrolaryngoscopy through the oral cavity is carried out if a child has a sharp curvature of the nasal septum or severe hypertrophy of the nasal turbinates to avoid injury to the nasal mucosa and the occurrence of nosebleeds when passing a flexible endoscope through the nose. It should be noted that after establishing a positive emotional contact with the doctor, carrying out this diagnostic procedure does not cause negative emotions in children.

An additional method of functional examination of the larynx is stroboscopy, which can be transmitted through a rigid or flexible optical system to a monitor. Due to the optical slowing of vocal fold vibrations, all types of vocal fold movements can be observed during phonation. With this method of endoscopic examination, one can see individual fragments of the vocal folds, devoid of vibrations, asymmetrical vibrations or stiffness of the vocal folds, a decrease in the amplitude of oscillatory movements, characteristic not only of various types of functional dysphonia, but also of initial stages neoplasms of the larynx. Thanks to stroboscopy, it is possible to observe the movements of the vocal folds, characteristic of the period after microsurgeries on the larynx, endoscopic manipulations, inflammatory processes, and to record transitional forms between functional and organic pathology.

Interpretation of results. When conducting a laryngoscopic examination, a thorough examination of all internal anatomical structures of the larynx is performed: the epiglottis, arytenoid cartilages, aryepiglottic folds, interarytenoid space, vestibular and vocal folds, anterior and posterior commissures, ventricles of the larynx and subglottic region. The condition of the sections adjacent to the larynx (entrance to the esophagus, pyriform sinuses, vallecula, laryngeal part of the epiglottis) is also assessed. During the study, attention is paid to the shape and mobility of the epiglottis, the color and vascular pattern of the mucous membrane of the larynx, the evenness of the edge and color, the size, tone and participation of the vestibular and vocal folds in the act of phonation, the uniformity and symmetry of the movement of each vocal fold, the state of the glottis during breathing and at the time of phonation. The functional state of the larynx is examined during quiet breathing and phonation. In order to assess the function of the larynx during phonation, the child is asked to pronounce the vowel “I” in a drawn-out manner, say his name, cough, count from 1 to 10, or recite a rhyme (depending on the age of the child).

Factors influencing the result. The skill and experience of the doctor conducting the examination, the cooperation of the child with the doctor during the procedure.

Complications. Laryngospasm.

Alternative Methods. Time-lapse endoscopy is a modification of endoscopic examination of the larynx using rigid optics. Allows examination of the larynx in children early age, as well as in children of any age group with difficulties when performing endoscopy of the larynx using standard methods. The basis of the method is experience in using various endoscopic equipment. Expanding the range of optical systems used (rigid and flexible optics with different viewing angles), the emergence of endovideo cameras that allow recording of endoscopic examinations, comparison in various ways recordings (analog, digital) makes it possible to conduct such an inspection.

Research methodology:
After fixing the child’s tongue with a metal spatula, an endoscope is inserted into the oral cavity and the doctor, under visual control, a short time displays the larynx area on the monitor screen. The criterion for successful recording is visualization of the vocal folds. Next comes the processing of digital video material using standard software. Using various programs for processing a video fragment in digital format allows you to obtain a different number of photographs. From each second of video recording, a sequence of 24 photographs is obtained, which can be viewed separately from each other or one by one (creating the effect of a “slow-motion video image”), enlarge the fragments of interest, etc. The resulting photographs (their number depends on the duration of the video fragment) are stored in the database personal computer. The doctor, having such an “endoscopic” medical history, can repeatedly review and competently evaluate the laryngoscopic picture (all structures of the larynx during inspiration and during phonation), comparing it with the data of previous or subsequent visits. The advantage of the time-lapse endoscopy technique is the absence of a time limit for image evaluation, its non-invasiveness, and the possibility of performing endolaryngoscopy using rigid optics in almost all patients.

Indications and contraindications for throat endoscopy

Indications

Contraindications

The study is carried out if the patient suffers from:

Painful symptoms of unknown etiology, localized in the throat and ears;

Sensation of a foreign body in the throat;

The appearance of blood inclusions in the cough sputum;

Unpleasant sensations when swallowing.

Diagnostics is mandatory for patients who have been diagnosed with:

Obstruction of the respiratory tract;

Inflammation of the larynx - laryngitis;

Dysphonia.

In addition, it is indicated for those who have suffered throat injuries.

Endoscopy of the throat and larynx is not performed in the following pathological conditions:

Epilepsy;

CVD diseases;

Acute inflammatory processes of the larynx;

Inflammatory processes nasal cavity.

The procedure is not performed for traumatic injuries of the cervical spine spinal column, as well as women during pregnancy.

Preparation for endoscopy of the throat and larynx

Endoscopy of the larynx and throat does not require specific preparation from the patient. It is enough for him to refrain from consuming food and water for three to four hours before the procedure in order to minimize the urge to vomit. If the patient has removable dentures, they will have to be removed.

Endoscopy of the throat and larynx

The patient is asked to take a sitting or lying position and local anesthesia of the mucous membranes is performed. An anesthetic gel is also applied to the tip of the endoscope so that the procedure does not cause discomfort.

After the anesthesia has taken effect, the doctor begins to insert the endoscope, observing the image that appears on the screen. Thanks to its magnification many times over, he is able to carefully examine all the anatomical structures of the throat and identify any abnormalities.

If there are indications, the procedure may be accompanied by the collection of samples of affected tissue for cystological or histological examination. Simple surgical procedures can also be performed to remove the polyp or stop the bleeding.

Endoscopy of the throat and larynx for children

The effectiveness of throat and larynx endoscopy in young patients depends on how calm they are. In order for the procedure to take a minimum of time and be as accurate as possible, parents need to prepare the child for it, explaining why it is needed.

Diagnosticians at Doctor Nearby clinics also tell the child how the test is carried out and that during it you need to be calm and not disturb the doctor in order to avoid unpleasant consequences.

What does endoscopy of the throat and larynx show?

This diagnostic method allows you to identify and confirm a number of pathological conditions of the throat and larynx, namely:

Neoplasms of benign or malignant nature;
Laryngitis;
Purulent processes - abscesses;
Congenital and acquired diseases of the vocal cords.

Thanks to it, it is possible to identify burns of various natures and assess the degree of damage, as well as detect foreign bodies that have entered the larynx during food consumption or through negligence.

Advantages of endoscopy of the throat and larynx at the Doctor Nearby clinic

Clinics of the Doctor Nearby network are located in all major districts of the capital, which allows our patients to reach them easily and quickly. We do not have queues, since appointments are carried out by appointment at a time convenient for the patient.

We employ experienced diagnosticians who easily find an approach to the youngest patients. When you bring your children to us, you don’t have to worry about them being in pain, because we use effective anesthetic drugs.