Method of examination of the larynx throat
Throat examination without tools: ask the patient to open their mouth, stick out their tongue and moan ..., the tongue will pull up and the tonsils will appear in a normal position
Asked the disease
Patients when examining throat have many reasons: sore throat, swallowing or hoarseness, difficulty breathing, cough ...
To know about the disease: onset time, progression and status of the disease, what drug was treated? mainly of the symptoms that bring patients to the examination, in addition, it is necessary to ask about the professional and family status to see the causes and related diseases.
The main symptoms to note:
Sore throat is the main symptom of the throat, duration and severity of pain related to the weather.
Hoarseness: changes in hoarseness, volume, and tones related to the profession (for those who have to use voice a lot such as teachers, sales staff, singers ...).
How to examine
Throat examination consists of 3 steps: oral examination, throat examination without tools, throat examination with the instrument.
Oral examination: the mouth and throat are closely related. It is impossible to examine the throat without examining the mouth. Use the tongue to lift the cheeks to see the teeth, gums and the inside of the cheek to see the palate and drapes of value in diagnosis telling the patient to curl their tongue up to see the floor of the mouth and the underside of the tongue.
Examination of the throat without tools: ask the patient to open their mouth, stick out their tongue and moan ..., the tongue will pull up and the tonsils will appear in a normal position. This way of examining the patient is not nauseous.
Throat examination with instruments:
Examination of the throat with tongue pressure:
Want a good examination should local anaesthesia to avoid the vomiting reflex. Have the client open their mouth and not stick out their tongue to breathe gently.
The physician places lightly on the tongue on 2/3 in front of the tongue, then presses the tongue slowly down, should not be left for too long. We need to see: the pharynx, reed, the anterior column, the posterior pillar, the tonsils and the posterior wall of the throat, to see clearly the tonsils can be used to lift the pillar, to the front to the side, pay attention to the movement of the pharynx, chicken tongue.
Normal picture: balanced pharynx, uneven reed, moderate-sized tonsils without pus spots, erythematous mucosa. The anterior and posterior posts are normally not congested red, the posterior wall is clean.
Common pathological picture: the reed is skewed, the tonsils have many pus spots, the lymphoid organization is overgrown in the back of the throat.
Throat examination with brooch: use cotton swab to gently poke the pharynx, the base of the tongue, the back of the throat to see if the patient has vomiting reflex? if no reflexes, it means loss of sensation of line V of line IX and X.
Examination of the nasopharynx by mirror: in the posterior nose examination, holding the left hand holding the tongue and holding the small mirror handle threaded out behind the curtain. Meanwhile, the patient breathes through the nose. We can observe the back door, dome roof, Esutachi nozzle. See if there are no tumours? Is there an ulcer in the nasopharynx? Is there a back door polyp?
Examination of the larynx
How to examine
By mirror (indirectly): the patient sits upright, the physician in the left-hand holds the gauze to pull the patient's tongue, the right-hand holds the laryngoscope mirror handle (depending on age, using different mirror sizes), it is best to anaesthesia first when scanning.
After warming the mirror on the alcohol lamp, the left-hand pulls the tongue and the right-hand pass the mirror through the curtain to tell the patient to moan. Hey. to see the vocal cords movement.
Need to observe: the vestibular larynx, vocal cord (colour, cell, with fibrous seeds? Closed? ...), is the sinus clean?
By Chevalier-Jackson (direct) bronchoscope: this method applies when indirect bronchoscopy has not fully evaluated the lesions, we will better assess the entire larynx.
Inflammation of laryngeal oedema.
Papilloma vocal cords.
A laryngeal tumour (found in laryngeal cancer) ...
X-ray of the throat - larynx
Straight, inclined neck posture
Skewed neck posture: pus bags can be seen before the spine and after the trachea, the water level, the vapour level can be seen, the food sugar can be seen.
Straight neck posture: see foreign objects in contrast.
Evaluate the degree of infiltration of the tumour into the larynx and nearby organs.