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.
Many laryngeal disorders cause dysphonia, which is impairment of the voice. Dysphonia can include a change in the sound of the voice, its stability, or the effort required to produce it, among other features. A persistent change in the voice lasting ≥ 2 weeks requires visual examination of the vocal cords, including their mobility (see also American Academy of Otolaryngology: Clinical Practice Guideline, Hoarseness). Although the voice changes with advancing age, becoming breathy and aperiodic (ie, irregular vibration causing a rough or creaky sound), acute or prominent changes in older patients should not be presumed to result from aging, and evaluation is required.
The examiner should take precautions to prevent COVID-19 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. Examination can be accomplished by indirect mirror examination (see figure Laryngeal disorders), flexible laryngoscopy, or rigid transoral laryngoscopy in the outpatient setting with topical anesthetics, as needed. Rigid operative laryngoscopy under general anesthesia provides the most thorough anatomic examination of the vocal cords, allowing
Visualization of the under surfaces
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). |
