Methods of endoscopic diagnosis of diseases of the larynx. Examination of the larynx and trachea
Located on the front of the neck under the hyoid bone. Its boundaries are determined from the upper edge of the thyroid cartilage to the lower edge of the cricoid. The size and location of the larynx depends on gender and age. In children, young people and women, the larynx is located higher than in the elderly.
When examining the area larynx the patient is asked to raise his chin and swallow saliva. In this case, the larynx moves from bottom to top and from top to bottom, the contours of both it and the thyroid gland, which is located slightly below the larynx, are clearly visible. If you put your fingers on the gland area, then at the moment of swallowing, the thyroid gland moves along with the larynx, its consistency and the size of the isthmus are clearly determined.
Then they feel larynx and the area of \u200b\u200bthe hyoid bone, move the larynx to the sides. Typically, there is a characteristic crunch that is absent in tumor processes. Somewhat tilting the patient's head forward, palpate the lymph nodes located on the anterior and posterior surfaces of the sternocleidomastoid muscles, the submandibular, supraclavicular and subclavian regions, and the occipital muscles. Their size, mobility, consistency, soreness are noted. Normally, the lymph glands are not palpable.
larynx
Mirror warmed up so that the vapors of the exhaled air do not condense on the mirror surface of the mirror. The degree of heating of the mirror is determined by touching it. When examining the larynx region, the patient is asked to raise his chin and swallow saliva. In this case, the larynx moves from bottom to top and from top to bottom, the contours of both it and the thyroid gland, which is located slightly below the larynx, are clearly visible.
If we put fingers on the area of \u200b\u200bthe gland, then at the time of swallowing, the thyroid gland moves along with the larynx, its consistency and the size of the isthmus are clearly determined. After that, the larynx and the hyoid bone are felt, the larynx is shifted to the sides. Typically, there is a characteristic crunch that is absent in tumor processes. Somewhat tilting the patient's head forward, palpate the lymph nodes located along the anterior and posterior surfaces of the sternocleidomastoid muscles, the submandibular, supraclavicular and subclavian regions, and the occipital muscles.
Their size, mobility, consistency, soreness are noted. Normally, the lymph glands are not palpable.
Then they begin to inspect the inner surface larynx... It is carried out by indirect laryngoscopy using a laryngeal mirror, heated on the flame of an alcohol lamp and introduced into the oropharyngeal cavity at an angle of 45 ° with respect to an imaginary horizontal plane, with a mirror surface downward.
Mirror heated so that the vapors of the exhaled air do not condense on the mirror surface of the mirror. The degree of heating of the mirror is determined by touching it to the back surface of the examiner's left hand. The patient is asked to open his mouth, stick out his tongue and breathe through the mouth.
Doctor or myself a patient with the thumb and middle finger of the left hand, holds the tip of the tongue, wrapped in a gauze cloth, and slightly pulls it out and down. The examiner's index finger is located above the upper lip and rests on the nasal septum. The subject's head is slightly thrown back. The light from the reflector is constantly directed exactly to the mirror, which is located in the oropharynx so that its back surface can completely close and push up the small tongue without touching the back wall of the pharynx and the root of the tongue.
As in the back rhinoscopy, for a detailed examination of all parts of the larynx, light rocking of the mirror is necessary. Sequentially inspect the root of the tongue and the lingual tonsil, determine the degree of disclosure and the contents of the valecules, examine the lingual and laryngeal surface of the epiglottis, scoop-epiglottis, vestibular and vocal folds, pear-shaped sinuses, the visible trachea under the vocal folds.
Normal laryngeal mucosa pink, shiny, moist. The vocal folds are white with smooth, free edges. When the patient utters a lingering sound "and", the pear-shaped sinuses, located lateral to the arytenoid-supraglottic folds, open, and the mobility of the larynx elements is noted. In this case, the vocal folds are completely closed. Behind the arytenoid cartilage is the entrance to the esophagus. With the exception of the epiglottis, all elements of the larynx are paired, and their mobility is symmetrical.
Over vocal folds there are light depressions of the mucous membrane - this is the entrance to the laryngeal ventricles, located in the lateral walls of the larynx. At their bottom there are limited accumulations of lymphoid tissue. Difficulties are sometimes encountered when performing indirect laryngoscopy. One of them is due to the fact that the short and thick neck does not allow the head to be thrown back enough. In this case, examination of the patient in a standing position helps. With a short bridle and a thick tongue, it is not possible to capture its tip. Therefore, you have to fix the tongue by its lateral surface.
If, when conducting an indirect laryngoscopy difficulties associated with an increased pharyngeal reflex, resort to anesthesia of the pharyngeal mucosa.
Endoscopic research methods are becoming more widespread in clinical and outpatient practice. The use of endoscopes has significantly expanded the ability of an otorhinolaryngologist to diagnose diseases of the nasal cavity, paranasal sinuses, pharynx and larynx, since they allow atraumatic study of the nature of changes in various ENT organs, as well as perform, if necessary, certain surgical interventions.
Endoscopic examination of the nasal cavity with the use of optics is shown in cases where the information obtained with traditional rhinoscopy is insufficient due to the developing or developed inflammatory process. To inspect the nasal cavity and paranasal sinuses, sets of rigid endoscopes with a diameter of 4, 2.7 and 1.9 mm are used, as well as fiber endoscopes from Olimpus, Pentax, etc. Inspection of the nasal cavity is carried out in the patient's supine position, with a preliminary local anesthesia, usually 10% lidocaine solution.
When examining, examine vestibule of the nasal cavity, the middle nasal passage and the places of the natural openings of the paranasal sinuses, and then the upper nasal passage and the olfactory fissure.
Straight laryngoscopy performed in the patient's position either sitting or lying down, in cases of difficulty in carrying out indirect laryngoscopy. On an outpatient basis, examination is carried out most often while sitting with a laryngoscope or fibrolaryngoscope.
To perform straight laryngoscopy it is necessary to anesthetize the pharynx and larynx. The following sequence is followed for anesthesia. First, the cotton wool is applied to the right anterior palatine arches and the right palatine tonsil, the soft palate and uvula, the left palatine arches and the left palatine tonsil, the lower pole of the left palatine tonsil, the posterior pharyngeal wall. Then, with the help of indirect laryngoscopy, the upper edge of the epiglottis, its lingual surface, valecules, the laryngeal surface of the epiglottis are lubricated, the cotton wool is inserted into the right and then into the left pear-shaped sinus, leaving it there for 4-5 seconds.
Later padded probe injected for 5-10 s behind the arytenoid cartilage - into the mouth of the esophagus. Such a thorough anesthesia requires 2-3 ml of anesthetic. 30 minutes before local anesthesia of the pharynx, it is advisable for the patient to inject 1 ml of a 2% solution of promedol and 0.1% solution of atropine under the skin. This prevents tension and hypersalivation.
After anesthesia the patient is seated on a low stool, a nurse or nurse sits behind him on a regular chair and holds him by the shoulders. The patient is asked not to strain and rest his hands on the stool. The doctor grabs the tip of the tongue in the same way as with indirect laryngoscopy and, under visual control, introduces the blade of the laryngoscope into the pharynx, focusing on the small tongue and raising the subject's head upward, the beak of the laryngoscope tilts downward and the epiglottis is found. The root of the tongue, valecules, lingual and laryngeal surface of the epiglottis are examined.
When preparing and conducting an examination of the pharynx and larynx, it is imperative that the principles specified at the beginning of this section be followed. During external examination, attention is paid to the condition of the skin and the configuration of the neck. After that, regional lymph nodes are palpated: submandibular, retromandibular, deep cervical, posterior cervical, pre-laryngeal, pretracheal, located in the supra- and subclavian fossa (Fig. 3.3 a, b). Palpation of the submandibular lymph nodes is performed bimanually, while the patient's head should be slightly tilted forward. The movements of the fingers should be directed from the middle to the edge of the lower jaw, and on palpation of the lymph nodes in the retromandibular fossa - perpendicular to the ascending arch of the lower jaw. Deep cervical lymph nodes are palpated first on one side, then on the other. On palpation on the right, the right hand is placed on the crown of the subject, and the left hand is palpated in front of the anterior edge of the sternocleidomastoid muscle from top to bottom and in a horizontal direction. On palpation on the left, the left hand is placed on the patient's crown, and the right hand is palpated.
The posterior cervical lymph nodes are palpated with the fingertips of both hands from both sides at the rear along the posterior edge of the sternocleidomastoid muscle and to the spine in vertical and horizontal directions. Lymph nodes in the supra- and subclavian fossa are palpated first on one side, then on the other.
Then produce palpation of the larynx, its cartilages (cricoid and thyroid), determine the crunch of the cartilage of the larynx by displacing it to the sides. Normally, the larynx is painless, passively mobile to the right and left.
The pharynx is examined with a spatula; in addition, a special nasopharyngeal mirror is used to examine the upper part of the pharynx. More informative is the examination of the nasopharynx using a rigid endoscope or fiberscope.
The examination of the larynx is carried out in two ways: 1) with the help of a laryngeal mirror inserted into the oropharynx without touching its posterior wall - indirect or specular laryngoscopy; 2) by introducing a straight tube, a special spatula or a special optical endoscope into the laryngeal part of the pharynx or even into the entrance to the larynx, and direct examination with these instruments - direct laryngoscopy. The same study can be performed using a fiberscope.
3.2.1. Oro- and mesopharyngoscopy
This method is available for use by doctors of various specialties. Research is possible not only in a specially equipped examination room, but also at the patient's bedside, as well as at home. The indication is the presence of complaints from the organs of the head and neck, as well as the presence of general symptoms, such as intoxication syndrome.
Examination of the oral cavity and pharynx is performed in the following order. The spatula is taken in the left hand so that the I finger supports it from below, and the II and III (possibly IV) fingers are on top (Fig. 3.4). The right hand is placed on the crown of the subject and asked to open his mouth. Then perform oroscopy - examination of the oral cavity. Illuminating the area under study with a headlamp or Simanovsky reflector and pulling the corner of the mouth with a spatula, examine the vestibule of the oral cavity. Pay attention to the condition of the mucous membrane, teeth, gums, hard palate, tongue and excretory ducts of the parotid salivary glands located on the buccal surface at the level of the upper premolar. The excretory ducts of the sublingual and submandibular salivary glands are located at the bottom of the oral cavity. To examine them, ask the examinee to lift the tip of the tongue or lift it with a spatula.
Then they inspect the mouth of the pharynx - mesopharyngoscopy . Holding the spatula in the left hand, they squeeze the front 2/3 of the tongue downwards, without touching its root. The spatula is inserted through the right corner of the mouth, the tongue is pressed not by the plane of the spatula, but by its end (Fig. 3.5). It should be borne in mind that touching the root of the tongue immediately causes vomiting. The mobility of the soft palate is determined by asking the patient to pronounce the lingering sound "ah ...". Normally, the soft palate is well mobile, the mucous membrane of the uvula, anterior and posterior palatine arches is smooth, pink, the arches are contoured.
To determine the size of the palatine tonsils, the distance between the middle of the palatine tonsil and the line passing through the middle of the tongue and soft palate is mentally divided into three parts. If the amygdala stands due to the arch up to 1/3 of this distance, its hypertrophy of the I degree is stated, up to 2/3 - II degree, more than 2/3 - III degree (Fig. 3.6 a, b). The mucous membrane covering the tonsil is normally pink, moist, and its surface is smooth. To determine the presence and nature of the contents of tonsillar lacunae, take two spatulas - in the right and left hands. With one spatula, squeeze the tongue downwards, with the other gently press on the base of the anterior arch and through it on the tonsil in the region of its upper pole. When examining the right tonsil, the tongue is squeezed out with a spatula in the right hand, the left tonsil in the left hand. Normally, the contents of the lacunae are scanty, non-purulent, in the form of epithelial plugs or absent (Fig. 3.7.). Pressing the tongue, examine the back wall of the pharynx. Normally, the mucous membrane covering it is pink, moist; on the surface, rare granules are visible - accumulations of lymphoid tissue approximately 1 × 2 mm in size. Pay attention to the severity of the lateral lymphoid pharyngeal ridges.
Evaluation of information obtained from examination of the oral cavity and pharynx requires a lot of clinical experience due to the variety of pathological changes in the pharynx. Often, to assess the clinical situation requires the participation of various specialists: an otolaryngologist, maxillofacial surgeon, therapist, hematologist, infectious disease specialist.
A complete examination is required for a diagnosis of a laryngeal involvement. It includes a doctor's examination, an analysis of anamnestic information, on the basis of which additional laboratory and instrumental research is prescribed. The most informative diagnostic method is considered to be an MRI of the larynx, but the examination is also carried out using X-rays and an endoscopic method (direct laryngoscopy).
Benefits of MRI
Due to its high information content, non-invasiveness, and painlessness, the study is widely used in medical practice. The procedure provides the maximum amount of information about the state of soft tissues, blood vessels, lymph nodes, cartilage structures. It is possible to increase the information content with the help of intravenous contrasting, which more clearly visualizes oncological, cystic formations.
Computed tomography of the larynx is prescribed by an otolaryngologist, oncologist, surgeon to determine the treatment tactics of a conservative or surgical direction.
Among the symptoms, when a tomography is prescribed, it is worth highlighting:
- difficulty breathing, swallowing;
- hoarseness of voice;
- neck deformity that is visually noticeable;
- soreness when palpating;
- nasal congestion in the absence of sinusitis, which indicates the possible presence of a Thornwald cyst;
- headaches, dizziness;
- swelling of soft tissues.
Thanks to MRI of the throat, the following pathological conditions and diseases are diagnosed:
- the consequences of injuries in the form of cicatricial changes;
- the presence of a foreign body;
- inflammatory foci, lymphadenitis;
- abscess, phlegmon;
- cystic formations;
- oncological diseases.
In addition, the study of the larynx with a tomograph makes it possible to trace the dynamics of the progression of the disease, to assess the effect of the treatment, including in the postoperative period.
The high resolution of the tomograph makes it possible to identify an oncological focus at the initial stage of development
The advantages of an MRI of the throat are:
Limitations in the use of MRI are associated with the high cost and the need for examining bone structures, when MRI is not so informative.
No preparation for diagnosis is required. Before starting the examination, it is necessary to remove jewelry containing metal. For 6 hours before the study, it is forbidden to eat if the use of contrast is expected.
Among the contraindications to MRI of the throat, it is worth noting:
- the presence of a pacemaker;
- metal prostheses;
- metal fragments in the body;
- pregnancy (1) trimester.
In the presence of metal elements in the human body, when exposed to a magnetic field, they can move somewhat from their place. This increases the risk of injury to surrounding structures and tissues.
Features of laryngoscopy
Laryngoscopy refers to diagnostic techniques that make it possible to examine the larynx, vocal cords. There are several types of research:
- indirect. Diagnostics is carried out in a doctor's office. A small speculum is located in the oropharynx. With the help of a reflector and a lamp, a beam of light hits the mirror in the mouth and illuminates the larynx. To date, such laryngoscopy is practically not used, since it is significantly inferior in informational content to the endoscopic method.
- Direct - performed using a flexible or rigid fibrolaryngoscope. The latter is often used during surgery.
The indications when laryngoscopy is performed include:
- hoarseness of the voice;
- pain in the oropharynx;
- difficulty swallowing;
- feeling of a foreign object;
- an admixture of blood in sputum.
The method allows you to establish the cause of the narrowing of the larynx, as well as assess the degree of damage after injury. Direct laryngoscopy (fibroscopy) is usually done to remove foreign objects, take material for biopsy, or remove polyps.
Indirect laryngoscopy is performed on an empty stomach to avoid aspiration (ingestion of gastric contents into the airways). Removable dentures are also required.
Direct endoscopy of the larynx is performed under general anesthesia, on an empty stomach, after collecting some information from the patient, namely: 
- the presence of allergic reactions;
- regular medication intake;
- cardiac diseases;
- blood clotting disorder;
- pregnancy.
Contraindications include
- ulcerative lesion of the oral cavity, epiglottis, oropharynx due to the high risk of bleeding;
- severe cardiac, respiratory failure;
- severe swelling of the neck;
- laryngeal stenosis, bronchospasm;
- uncontrolled hypertension.
An indirect examination is carried out in a sitting position. The patient opens his mouth, the tongue is held with a napkin or fixed with a spatula.
To suppress the gag reflex, the doctor irrigates the mucous membrane of the oropharynx with an anesthetic solution.
A small mirror is located in the oropharynx, after which the examination of the larynx and ligaments begins. A beam of light is reflected from a refractor (a mirror fixed on the doctor's forehead), then from a mirror in the oral cavity, after which the larynx is illuminated. To visualize the vocal cords, the patient needs to pronounce the sound "A".
Direct endoscopic examination is performed under general anesthesia in an operating room. After the patient falls asleep, a rigid laryngoscope with a lighting device at the end is inserted into the oral cavity. The doctor has the opportunity to examine the oropharynx, ligaments, or remove a foreign body.
When conducting a direct examination, while maintaining the patient's consciousness, the mucous membrane of the oropharynx should be irrigated with an anesthetic, a vasoconstrictor is buried in the nasal passages. After that, the flexible laryngoscope is advanced along the nasal passage.
The procedure takes about half an hour, after which it is not recommended to eat, drink, cough or gargle for two hours. This will prevent laryngospasm and the appearance of choking.
If, during laryngoscopy, surgery was performed in the form of removing a polyp, it is necessary to follow the doctor's recommendations for managing the postoperative period.
After laryngoscopy, you may experience nausea, difficulty swallowing, or hoarseness.
When conducting a biopsy, an impurity of blood in the saliva may appear after the study.
The risk of complications after examination increases with obstruction of the respiratory tract by tumor formation, polyp, in case of inflammation of the epiglottis. After a biopsy, bleeding, infection, or respiratory tract damage may occur.
According to the results of the study, the doctor can diagnose diseases of an inflammatory nature, detect and remove a foreign body, assess the severity of traumatic injury, and take a biopsy if an oncological process is suspected.
X-ray in the diagnosis of diseases of the larynx
To diagnose throat pathologies in otolaryngology, ultrasound and tomography are most often used. Despite the availability of modern instrumental examination methods, an X-ray of the larynx is also used, although it is not a highly informative technique.
Usually, x-rays are performed on patients who cannot use laryngoscopy. X-ray diagnostics does not require preparation. X-rays are taken straight, lateral, anterior and posterior.
Taking into account the need to obtain an image in a certain projection, the patient is placed on his side or chest. The research is carried out as follows:
- x-ray tube generates a beam beam;
- radiation passes through tissues of different density, as a result of which more or less dark shadows are visualized in the image.
Muscles pass the radiation flux well. Bones, having a high density, block their path, which is why the rays do not appear on the film. The more X-rays hit the picture, the more intense their shadow color.
Hollow structures are characterized by a black shade. Bones with low radiological throughput are displayed in white on the image. Soft tissues are projected with a gray shade of varying intensity. According to indications, contrasting is used, which increases the information content of the method. The contrast agent in the form of a spray is sprayed onto the mucous membrane of the oropharynx.
The picture assesses the X-ray anatomy of the larynx. When viewed from the side view, many anatomical structures can be seen, such as the root of the tongue, the body of the hyoid bone, 
the epiglottis, the ligamentous apparatus (vocal, epiglottis-arytenoid), the ventricular fold, the vestibule of the larynx, as well as the Morgagni ventricles and the pharynx, located behind the larynx.
High-quality radiography of the larynx allows the doctor to assess the diameter of the lumen of the hollow organs, the glottis, the motor ability of the ligaments, and the epiglottis.
Cartilaginous structures reflect radiation poorly, therefore they are practically not visualized in the image. They begin to appear during calcification, when calcium is deposited in tissues.
At the age of 16-18, calcification occurs in the thyroid cartilage, then in the remaining laryngeal cartilage. By the age of 80, complete calcification of the cartilaginous structures is noted.
Thanks to x-rays, displacement of the organ, a change in its shape, and a decrease in the lumen are diagnosed. In addition, foreign bodies, cystic formations, oncopathology of benign or malignant origin are visualized.
Among the indications should be highlighted:
- traumatic injury;
- tracheal stenosis with diphtheria;
- chemical, thermal burn;
- violation of the movement of the vocal cords.
Contraindications include pregnancy, however, when using protective equipment, research may be allowed.
Based on the clinical picture, the doctor determines which methods of examining the larynx will be the most informative in this case. Thanks to a comprehensive examination, it is possible to diagnose pathology at an early stage of development. This makes it possible to choose the optimal therapeutic course and achieve complete recovery.
The symptoms of cancer of the larynx of the throat must be confirmed by objective indicators, compared with the test results, then we will have a clear picture of the disease. Such a disease as cancer is frightening with its incurability, the question is raised about how long the patient has to live. In fact, cancer is not yet a death sentence, because in the early stages of the disease they learned to successfully treat it.
Throat cancer causes in women and men include:
- smoking and alcohol abuse (prevention of throat cancer involves giving up these habits);
- professional activity in harmful working conditions (production of chemicals);
- high concentrations of tobacco smoke, phenolic resins, benzene and other carcinogenic substances in the air;
- a number of chronic inflammatory pathologies (pharyngitis, laryngitis, laryngotracheitis, syphilis);
- benign neoplasms (often a papilloma in the throat leads to cancer).
Smoking is a common cause of cancer
It is impossible to say exactly how many people live with throat cancer, since this pathology, when detected early, does not cause a significant reduction in life time. If a patient seeks medical help on time, then he has a high chance of continuing his usual way of life after the condition has been corrected.
Kinds
Symptoms depend on the location of the malignant process.
Depending on the affected area:
- upper throat cancer - the tumor is localized over the vocal cords;
- middle department - the malignant neoplasm is located on the ligaments;
- lower section - localized under the ligaments.
Squamous cell carcinoma is most often diagnosed, which occurs in most cases in smokers, including passive smokers.
What raises suspicions of throat cancer
Oncological diseases, or tumors (see), are divided into benign and malignant, with uncontrolled growth. It is important to notice the symptoms of throat cancer, such as cancer of the larynx, on time.
It is the early detection of this dangerous disease that is the task of otolaryngologists. Then the neoplasms are treated using conservative and surgical methods.
Warning signs
The first symptoms of throat and laryngeal cancer appear in a patient when the tumor is just beginning to form.
It is still unclear what it is, the signs of trouble are manifested in the following:
- hoarseness in voice;
- soreness when swallowing;
- feeling of a foreign body in the throat;
- the appearance of white spots on the mucous membrane.
Subjective sensations
Table. Classification of unpleasant manifestations in the throat:
Cancer of the throat and larynx does not show symptoms immediately, it develops gradually. When such phenomena are observed, you should immediately consult a doctor to confirm or refute suspicions of a tumor.
Clinical picture
What manifestations should be alarming and become a reason to see a doctor? Distinguish between early and late symptoms.
Early
Early clinical signs include:
- constant pain and discomfort when swallowing;
- feeling of a lump;
- perspiration;
- a shooting pain in the throat with irradiation into the ear;
- persistent dry cough or coughing, mostly after eating;
- ulcers and white spots on the lining of the throat that sometimes bleed.
With their own hands, anyone can feel the neck for pain. If, with light pressure, you feel discomfort in the neck area and the presence of a "lump", then it is recommended to undergo an examination.
Late
Unfortunately, not every person immediately seeks medical help if he has a perspiration, even if this uncomfortable condition continues for a long time.
Late symptoms are expressed as follows:
- constant pain when swallowing;
- toothache - this is due to the spread of an oncological neoplasm to the surrounding tissues of the pharynx and oral cavity;
- hoarseness or complete aphonia (absence);
- shortness of breath - this is due to the fact that the neoplasm reaches a large size and compresses the airways;
- feeling of a lump in the throat;
- obstruction in the pharynx - the tumor grows so much and squeezes the lumen of the pharynx and esophagus that it is impossible to take even liquid food, in most cases in such a situation the patient is fed in a hospital through a gastrostomy tube (a tube inserted into the stomach through an incision in the anterior abdominal wall).
The video in this article describes in detail what should alert a person and when to see a doctor if you suspect throat cancer.
Attention! With constant coughing or perspiration, you cannot self-medicate and take any medications without a doctor's prescription. This is also confirmed by the instruction for medicines. The unauthorized use of various drugs lubricates the clinical picture of the disease and delays the correct diagnosis, meanwhile the malignant tissue will continue to grow and progress.
Methods for detecting malignant neoplasms in the throat
A neoplasm of the throat in the form of laryngeal cancer is detected first after the patient's complaints at a doctor's appointment or during preventive examinations. It is important, for the prevention of the development of cancer, regular examinations with an otolaryngologist, which allow you to timely establish the pathology.
Methods of subjective medical examination
The presence of a malignant tumor in the throat is subjectively determined during the initial examination. The doctor, based on his experience and knowledge, determines with his own hands the presence of a tumor or its absence.
Wherein:
- the patient is placed opposite the doctor;
- do local anesthesia by injection or spraying with an anesthetic spray;
- the patient should stick out his tongue, the doctor holds it with a spatula;
- a mirror is inserted into the mouth, asked to pronounce a lingering sound "a" to open the glottis;
- on examination, the size and condition of the tumor is determined;
- the location of the neoplasm relative to other organs;
- assess the nature of breathing and voice functions;
- lymph nodes in the neck are palpated;
- specify the location of the neoplasm, growth features.
Stages of development of throat malignant tumors
Cancer of the larynx and throat gives symptoms at different stages of the disease.
Table 1: Stages of development:
| Stage of development | Signs | Disease prognosis |
| Zero stage | The tumor is small in size, practically not diagnosed at this stage of development, the patient feels well, there are no complaints. | If at this stage the lesion is detected by chance, then the prognosis is favorable. In about 98% of cases, complete recovery occurs. |
| First stage | The neoplasm extends beyond the larynx mucosa. In the early stages, manifestations consist in a slight change in the vibration of the voice, slight hoarseness, tickling | If at this stage the patient goes to the doctor and he is diagnosed with a tumor and immediately begins treatment, then the prognosis is favorable. Survival and recovery of 75% of patients |
| Stage two | At this stage, the tumor progresses in growth, with the spread of the neoplasm to the ligaments, the voice may change, hoarseness sets in, noisy breathing worries | Correct diagnosis and timely started therapy leads to recovery in 70% of cases. Life expectancy in patients with stage 2 exceeds 70% for the next 5 years |
| Third stage | Change in voice or its complete absence, which is due to the growth of a tumor in all parts of the larynx | With timely diagnosis and treatment initiated, the survival rate of patients in the next 5 years is 60% |
| Fourth stage (see) | The neoplasm progresses, invades nearby lymph nodes and spreads to other organs by metastasis | With correctly prescribed treatment, the survival rate with stage 4 in the next 5 years is about 20% |
Important! With progressive cancer, there are no symptoms in the early stages; a person may not pay attention to a tickle or slight hoarseness of the voice. If such sensations persist for more than 1 week, you should consult a doctor for examination as soon as possible.
A medical examination allows you to determine the dangerous signs of the disease, but does not give a full guarantee of the correct diagnosis. Therefore, the patient is sent for additional examination and tests.
Laboratory methods
In order to make sure of the presence of a malignant tumor, a laboratory study of the material obtained with laryngoscopy is carried out. To do this, using the same laryngoscope, a tissue sample is taken from the larynx or lymph node, which is changed by the disease. Further, the selected tissue cells are examined under a microscope.
The biopsy method is quite accurate, they detect cancer cells in 100% of cases. In this way, not only the disease itself is established, but also the stage, type of tumor. To obtain biological material from the lymph nodes, it is used to select it with a needle, which is inserted directly into the node.
Hardware methods
Hardware-based examination methods are necessary not only for the diagnosis of cancer, but also for clarifying the location and size of the tumor, its features.
How hardware diagnostics are performed is shown in the video in this article:
- microlaryngoscopy - allows you to visually determine the appearance and characteristic features of the tumor in its natural form, or select material for biopsy;
- phonetography is a technique for assessing voice recording, its acoustic analysis, which allows you to compare the picture of a "sick" and a healthy voice;
- electroglottography is an ultrasound recording of the vibrations of the vocal cords, it allows you to identify how impaired the vocal function is;
- stroboscopy - obtaining a visual picture of the nature of the vibrations of the vocal cords, which allows you to clarify the diagnosis;
- x-ray is a reliable method that allows you to make a clear picture of the tumor, where its size and location are visible;
- Ultrasound of the neck complements other examination methods and clarifies the picture of the disease;
- MRI tomography, positron emission tomography (PET), are extremely useful for detecting disease in the first and second stages.
Modern hardware methods of examination and diagnostics remain additional, clarifying, since the first and last word when establishing a diagnosis: cancer belongs to the otolaryngologist. The symptoms of cancer of the larynx and throat show convincing.
Laryngeal cancer treatments
In the prognosis of a disease such as laryngeal cancer, diagnosis and treatment are closely interrelated. Early diagnosis of a tumor will prevent its subsequent progression.
To improve the patient's prognosis, there are standardized treatments for laryngeal cancer, which may be called an "algorithm" or "instruction". They represent a clear plan for the management of cancer patients with this pathology.
Attention! None of the protocols include folk remedies for the treatment of laryngopharyngeal cancer; therapy requires the use of only medicines with a solid evidence base.
It:
- Surgical method. The operative method of treating cancer of the larynx occupies a leading position, especially in the initial stages of the oncological process. Its main task is to maximize the removal of the pathological process with minimal damage to the surrounding tissues.
Superficial cancer confined to the free edge of the vocal cord can be successfully removed with limited resection or with a laser. A stage I-II tumor is removed by organ-preserving surgery, but usually, in case of ineffectiveness, perform radiation therapy (the latter allows better preservation of phonation).
In the case of a neglected process or diagnostics in later stages, a radical surgical method is sometimes used - laryngectomy followed by plastic surgery of the larynx.
- Radiation therapy. Usually, inoperable tumors give in to this direction, in which the risk of surgical intervention outweighs the likelihood of a successful operation.
In addition, this type of therapy is used for stage I-II tumors, which are not characterized by serious damage to the vocal cords, and the non-invasive method of treatment, in turn, is able to maintain phonation.
- Chemotherapy. It is used both in combination with radiation and surgical treatment, and as an independent method of palliative therapy.
For this purpose, drugs such as cisplastin, 5-fluorouracil in various combinations are used. More and more attention is paid to drugs that have a specific point of application in the pathological focus, the so-called targeted drugs.
Attention! A disease such as cancer of the larynx and treatment with alternative methods are incompatible things. When diagnosing a malignant neoplasm, do not try to cure it yourself.
Features of prevention
Disease prevention is a worthy investment in your future and health, the price of which is high.
In most cases, doctors shrug their shoulders when the patient asks about the etiology of the onset of the cancer process, they cannot be wrong. The exception is the presence of occupational risks known to the patient, as well as obligate and optional forms of the precancerous process.
These include the following conditions:
- papilloma;
- leukoplakia of the larynx mucosa (dyskeratosis);
- fibroma;
- contact fibroma (develops as a result of increased voice load).
Timely treatment of such diseases, a preventive visit to the family doctor once a year or once every six months in the presence of risk factors for the occurrence of laryngeal cancer, as well as treatment of chronic inflammatory processes can significantly reduce the risk of a malignant tumor in the larynx.
Quitting smoking, limiting or completely eliminating exposure to occupational and household hazards is also included in the list of preventive methods.
Attention! Treatment of the oncological process is a very complex matter, which should only be dealt with by an otolaryngologist-oncologist. You should not consult with friends who have cured cancer of the larynx, since it is impossible to replace the opinion of a specialist.
Prognosis after cancer treatment
The first thing that worries a person who is undergoing treatment for laryngeal cancer or is faced with its diagnosis is the prognosis of his therapy. Undoubtedly, the absence of specific therapy or methods such as the use of wormwood in the treatment of laryngeal cancer cannot improve the prognosis. Cancer must be treated without fail under the supervision of an oncologist.
The average survival time of patients during the first 1, 3 and 5 years after the diagnosis was statistically calculated, and corrected depending on the therapy used.
Conducting radical treatment provides the following five-year survival rate:
- Stage I - 80-94%;
- Stage II - 55-75%;
- Stage III - 45-65%;
- Stage IV - no more than 35%.
Attention! These figures indicate a fairly good prognosis for the patient even in the presence of distant metastases (at stage 4).
Factors negatively affecting the prognosis of a malignant tumor of the larynx:
- low tumor differentiation;
- infiltrative growth;
- cancer of the lower (subglottic) larynx.
Among other things, the presence of metastases in regional lymph nodes worsens the patient's prognosis at least 2 times when using isolated surgical or combined methods of treatment. In conclusion, it is important to say that measures for the prevention of tumor processes should always come first, since it is much more difficult to treat cancer than to try to prevent it.
In medicine, there are several types of this procedure.
Types of laryngoscopy
Indirect laryngoscopy is characterized by the introduction of a special speculum into the pharynx. The study is carried out by an otolaryngologist. A reflector-mirror is installed on the doctor's head, which reflects the light from the laryngoscope and illuminates the larynx. This research method is rarely used in modern otolaryngology, since the advantage is given to direct, or flexible laryngoscopy, during which it is possible to study in more detail the state of the larynx and vocal cords.
Direct laryngoscopy (flexible) - this method of research is performed using a flexible fibrolaryngoscope. It is possible to introduce a rigid (rigid) endoscopic instrument into the larynx, but the latter is more often used during surgery.
Indications for the procedure:
- Hoarseness and hoarseness of the voice, aphonia or dysphonia
- Pain in the ear and throat of unknown etiology
- Difficulty swallowing food and saliva, feeling of a foreign object in the throat
- Hemoptysis
- Airway obstruction
- Laryngeal injury.
Direct laryngoscopy is prescribed to the patient in the presence of foreign objects in the pharynx, in order to extract them, as well as to take material for biopsy, remove polyps from the mucous membranes, and conduct laser therapy. This research method is highly effective for the diagnosis of laryngeal cancer.
Preparation for research
Indirect laryngoscopy - before carrying out this research method, the patient is advised not to eat or drink water, so as not to provoke vomiting during laryngoscopy, and to avoid aspiration of vomit. Before starting the study, dentures are removed, if any.
Direct laryngoscopy - before carrying out this research method, the doctor finds out the following facts:
- History of allergic reaction to any medication
- Taking medications before the procedure
- Presence of bleeding disorders
- Diseases of the cardiovascular system and rhythm disturbances
- Suspected pregnancy.
Direct laryngoscopy with the introduction of a rigid laryngoscope is performed under general anesthesia during surgery. Preparation for the procedure consists in abstaining from food and liquids for 8 hours.
How is laryngoscopy performed
Indirect laryngoscopy
The study is carried out in a sitting position. The subject opens his mouth wide and pulls out his tongue. If necessary, the doctor holds the patient's tongue with a spatula. To avoid gagging, the patient's nasopharynx is sprayed with an anesthetic solution. A special mirror is inserted into the oropharynx, and the larynx is examined. To examine a person's vocal cords, the doctor invites him to say "A-ah-ah."
The procedure itself takes no more than 5 minutes, and the effect of the anesthetic lasts up to half an hour. While the sensitivity of the mucous membranes of the oropharynx is reduced, the patient should refrain from eating.
Direct flexible laryngoscopy
For direct laryngoscopy, flexible instruments are used. Before the procedure, the patient is prescribed medication that suppresses mucus secretion. To avoid gagging, the mucous membrane of the pharynx is sprayed with an anesthetic solution. The laryngoscope is inserted through the nose, after dropping vasoconstrictor drops into the nostrils. This is necessary to prevent injury to the nasal mucosa during the study.
Rigid laryngoscopy
This research method is complex and is performed only under general anesthesia in the operating room. A laryngoscope is inserted into the patient's mouth and examined. During the study, you can take a biopsy material, remove the existing polyps of the vocal cords and foreign bodies from the larynx.
The procedure takes up to half an hour. After a rigid laryngoscopy, the patient is under the supervision of doctors for several hours. To prevent the development of laryngeal edema, an ice pack is placed on the patient's throat.
After performing direct rigid laryngoscopy, the patient should not eat or drink water for 2 hours, so as not to provoke suffocation.
If a biopsy is taken during the procedure, the patient may expectorate sputum mixed with blood. This phenomenon goes away on its own a few days after the study.
Complications of laryngoscopy
Regardless of the type of study, the patient has a risk of developing laryngeal edema and impaired respiratory function. The risk group includes people with tumors and polyps of the respiratory tract, as well as patients with a pronounced inflammatory process of the epiglottis.
If the patient develops obstruction of the airways after laryngoscopy, then the doctor performs emergency assistance - a tracheotomy. This procedure involves making a small longitudinal incision in the trachea through which the person can breathe.
During a laryngeal biopsy, there is an increased risk of bleeding, infection, or injury to the airways.
What does laryngoscopy give?
Laryngoscopy allows you to assess the condition of the mucous membranes of the oropharynx, larynx and the functioning of the vocal cords. With a biopsy, the result can be found a few days after the procedure.
Carrying out this research method allows you to identify the following pathologies:
- Laryngeal tumors
- Inflammation of the larynx lining
- Foreign objects in the oropharynx and larynx
- The formation of papillomas, polyps and nodules of unknown etiology on the mucous membrane of the larynx
- Vocal cord dysfunctions.
For laryngoscopy, modern complex laryngoscopes are used, which are equipped with devices for providing emergency assistance to the patient in case of complications.