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Overview of Laryngeal Disorders

By Clarence T. Sasaki, MD

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The larynx contains the vocal cords and serves as the opening to the tracheobronchial tree. Laryngeal disorders include

Other disorders that affect the larynx include acute laryngotracheobronchitis (croup), epiglottitis, and laryngomalacia (see Table Some Causes of Stridor). For removal of a foreign body via the Heimlich maneuver, see Clearing and Opening the Upper Airway.

Most laryngeal disorders cause dysphonia, which is impairment of the voice (see The Professional Voice). A persistent change in the voice (eg, > 3 wk) requires visualization of the vocal cords, including their mobility. Although the voice changes with advancing age, becoming breathy and aperiodic, acute or prominent changes in the elderly should not be presumed to result from aging, and evaluation is required.

The voice should be assessed and recorded, particularly if surgical procedures are planned. Examination of the larynx includes external inspection and palpation of the neck and internal visualization of the epiglottis, false cords, true cords, arytenoids, pyriform sinuses, and subglottic region below the cords. Internal visualization is accomplished by either indirect mirror examination (see Figure: Laryngeal disorders) or direct flexible fiberoptic laryngoscopy in an outpatient setting with a topical anesthetic. Rigid laryngoscopy with the patient under general anesthesia provides the most thorough examination of the vocal cords, including

  • Visualization of the undersurfaces

  • Assessment of passive mobility when immobilized by either paralysis or fixation

  • Biopsy

Laryngeal disorders

When relaxed, the vocal cords normally form a V-shaped opening that allows air to pass freely through to the trachea. The cords open during inspiration and close during swallowing or speech. When a mirror is held in the back of a patient’s mouth, the vocal cords can often be seen and checked for disorders, such as contact ulcers, polyps, nodules, paralysis, and cancer. Paralysis may affect one (unilateral) or both vocal cords (bilateral—not shown).

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