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 Croup is acute inflammation of the upper and lower respiratory tracts most commonly caused by parainfluenza virus type 1 infection. It is characterized by a brassy, barking cough and inspiratory... read more (croup), epiglottitis Epiglottitis Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. Symptoms include severe sore throat... read more , and laryngomalacia (see table Some Causes of Stridor Some Causes of Stridor ). For removal of a foreign body via the Heimlich maneuver, see Clearing and Opening the Upper Airway Clearing and Opening the Upper Airway Airway management consists of Clearing the upper airway Maintaining an open air passage with a mechanical device Sometimes assisting respirations (See also Overview of Respiratory Arrest.) read more .
Most laryngeal disorders cause dysphonia, which is impairment of the voice. A persistent change in the voice (eg, > 3 weeks) 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 examiner should take precautions to prevent COVID-19 COVID-19 COVID-19 is an acute, sometimes severe, respiratory illness caused by the novel coronavirus SARS-CoV-2. COVID-19 was first reported in late 2019 in Wuhan, China and has since spread extensively... read more and other infectious diseases as appropriate. 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 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, allowing
Visualization of the undersurfaces
Assessment of passive mobility when immobilized by either paralysis or fixation
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).