{"id":1564,"date":"2010-12-06T11:29:10","date_gmt":"2010-12-06T11:29:10","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/indirect-laryngoscopy\/"},"modified":"2023-10-23T17:23:58","modified_gmt":"2023-10-23T16:23:58","slug":"indirect-laryngoscopy","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-ear-nose-mouth-throat-and-neck\/the-larynx\/indirect-laryngoscopy\/","title":{"rendered":"Indirect Laryngoscopy"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Required Instruments<\/strong>\u00a0<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Laryngeal mirrors, K6 to K10 <em><strong>[Figure 44]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Laryngeal mirror handle.<\/span><\/li>\n<li><span style=\"color: #003366;\">Mirror warmer or anti-condensation tissues.<\/span><\/li>\n<li><span style=\"color: #003366;\">Head lamp.<\/span><\/li>\n<li><span style=\"color: #003366;\">Large gauze dressings.<\/span><\/li>\n<li><span style=\"color: #003366;\">Lidocaine spray 10%.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><strong><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1556\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-44.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-44.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-44-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 44<\/span><\/span><\/strong><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/122522894?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">For all indirect laryngoscopies, the patient sits on a chair with adequate back support. <\/span><\/li>\n<li><span style=\"color: #003366;\">Sit on a height-adjustable stool beside or in front of the patient. <\/span><\/li>\n<li><span style=\"color: #003366;\">Your eyes should be at the same height as the patient\u2019s nose.<\/span><\/li>\n<li><span style=\"color: #003366;\">If required, prepare the patient for this examination by numbing the <span style=\"color: #33cccc;\"><strong>pharyngeal arches<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>tonsillar fossae<\/strong><\/span>, the <span style=\"color: #33cccc;\"><strong>posterior pharyngeal wall<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>base of the tongue<\/strong><\/span>, using <span style=\"color: #33cccc;\"><strong>lidocaine spray<\/strong><\/span> <em><strong>[Figure 45]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Do not apply more than 3-4 squirts.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1557\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-45.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-45.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-45-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 45<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Choose the laryngeal mirror (<em>K6 or K7<\/em>) that you will use for the examination. <\/span><\/li>\n<li><span style=\"color: #003366;\">Place it in the laryngeal mirror handle and give the mirror an \u2018<em>anti-condensation treatment<\/em>\u2019. <\/span><\/li>\n<li><span style=\"color: #003366;\">You can do this by warming it up in an electric mirror heater. The temperature of the heater can be set at exactly 37\u00b0C. An alternative option is to rub the mirror with an anti-condensation tissue.<\/span><\/li>\n<li><span style=\"color: #003366;\">Check whether the lidocaine spray has taken effect by touching the base of the tongue with a tongue spatula. If this does not elicit a gag reflex, the anaesthetic has taken sufficient effect.<\/span><\/li>\n<li><span style=\"color: #003366;\">Ask the patient to open their mouth wide and to stick out their tongue. <\/span><\/li>\n<li><span style=\"color: #003366;\">Wrap a long piece of <span style=\"color: #33cccc;\"><strong>folded gauze dressing<\/strong><\/span><em><strong> [Figure 46]<\/strong><\/em> around the <span style=\"color: #33cccc;\"><strong>patient\u2019s tongue<\/strong><\/span> <em><strong>[Figure 47]<\/strong><\/em> and hold the tongue with your non-dominant hand <em><strong>[Figure 48]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Make sure that the lingual frenulum does not become trapped between the patient\u2019s teeth, particularly if teeth are not properly aligned. <\/span><\/li>\n<li><span style=\"color: #003366;\">Aim the light from the head lamp on the posterior oropharyngeal wall <em><strong>[Figure 49]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Insert the mirror into the oropharynx with your dominant hand, whilst keeping it parallel to the palate. <\/span><\/li>\n<li><span style=\"color: #003366;\">The mirrored side should point downwards during this manoeuvre<em><strong> [Figure 50]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">The uvula will be positioned at the back of the mirror. <\/span><\/li>\n<li><span style=\"color: #003366;\">Take care not to touch the posterior oropharyngeal wall and the base of the tongue during this manoeuvre.<\/span><\/li>\n<li><span style=\"color: #003366;\"> If there is insufficient space between the base of the tongue and the pharyngeal arches, you can ask the patient to say \u201c<em>hahahahaha<\/em>\u201d whilst you insert the mirror. <\/span><\/li>\n<li><span style=\"color: #003366;\">This will pull the pharyngeal arches up slightly and the floor of the mouth will be moved downwards, creating more space.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1558\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-46.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-46.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-46-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 46<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1559\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-47.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-47.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-47-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 47<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1560\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-48.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-48.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-48-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 48<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1561\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-49.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-49.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-49-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 49<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1562\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-50.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-50.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-50-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 50<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">The light should now shine onto the mirror<em><strong> [Figure 51]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Tilt the mirror in such a way that the <span style=\"color: #33cccc;\"><strong>larynx<\/strong><\/span>, the <span style=\"color: #33cccc;\"><strong>hypopharynx<\/strong><\/span> and the <span style=\"color: #33cccc;\"><strong>vocal cords<\/strong><\/span> are visualised. <\/span><\/li>\n<li><span style=\"color: #003366;\">Assess the <span style=\"color: #33cccc;\"><strong>mucosa<\/strong><\/span> for <span style=\"text-decoration: underline;\">intactness<\/span>, <span style=\"text-decoration: underline;\">colour<\/span>, <span style=\"text-decoration: underline;\">hyperaemia<\/span> and any <span style=\"text-decoration: underline;\">swellings<\/span> or <span style=\"text-decoration: underline;\">foreign objects<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Inspect the <span style=\"text-decoration: underline;\">position<\/span> of the vocal cords.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1563\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-51.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-51.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-51-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 51<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Ask the patient to say \u201c<em>ee<\/em>\u201d and see if the vocal cords move <span style=\"text-decoration: underline;\">symmetrically<\/span> and <span style=\"text-decoration: underline;\">close fully<\/span> on the midline of the larynx. <\/span><\/li>\n<li><span style=\"color: #003366;\">Also, in this position, assess the <span style=\"text-decoration: underline;\">smoothness<\/span> of the vocal cords, their <span style=\"text-decoration: underline;\">colour<\/span>, <span style=\"text-decoration: underline;\">vessel injection<\/span> and the presence of any <span style=\"text-decoration: underline;\">swellings<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Once you have finished the examination, instruct the patient not to eat or drink for one and a half hours, until the feeling in the tongue and throat has returned (<em>risk of choking<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">The mirror should be cleaned with soap and water.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Required Instruments\u00a0 Laryngeal mirrors, K6 to K10 [Figure 44]. Laryngeal mirror handle. Mirror warmer or anti-condensation tissues. Head lamp. Large gauze dressings. Lidocaine spray 10%. Figure 44 Procedure For all indirect laryngoscopies, the patient sits on a chair with adequate back support. Sit on a height-adjustable stool beside or in front of the patient. Your [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[41],"tags":[132],"class_list":["post-1564","post","type-post","status-publish","format-standard","hentry","category-the-larynx","tag-the-examination-of-the-ear-nose-mouth-throat-and-neck"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Indirect Laryngoscopy - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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