When meeting a patient who complains of pain in the throat or difficulty breathing, the doctor first of all assesses his general condition, respiratory function of the larynx, predicts the possibility of the occurrence of stenosis and asphyxia and, with appropriate indications, provides emergency help to the patient.
When examining a patient with a disease of the larynx, important information can be obtained by interviewing the patient. Often, even with the first words on the nature of the sound of the patient's voice (nasal, hoarseness, aphonic, rattling voice, shortness of breath, stridor, etc.), one can form an idea of a possible disease. The most common are cold, allergic and post-traumatic diseases of the larynx. It is more difficult to diagnose specific diseases, especially those that at the initial stages show signs of banal pathological conditions of the upper respiratory tract (syphilitic enanthema, diphtheria, etc.). Special difficulties arise in the differential diagnosis between peripheral and central lesions of the nervous apparatus of the larynx, manifested by disorders of the voice and respiratory functions, as well as by some visually determined motor dysfunction of the vocal folds.
When assessing a patient's complaints, they pay attention to their nature, prescription, periodicity, dynamics, dependence on endo- and exogenous factors, concomitant diseases.
Based on anamnestic data, it is possible to draw a preliminary conclusion about the genesis of the disease (organic or functional) and develop a working hypothesis about the patient's condition, confirmation or refutation of which is found in the objective examination data of the patient.
Special difficulties in identifying neurogenic dysfunctions of the larynx occur when the patient's complaints are confirmed by signs of lesions of nerve trunks or centers of the brain without specifying the patient for the reasons for these complaints. In these cases, along with endoscopy of the larynx, special neurological methods of investigation are used, including angiography of the brain, CT and MRI.
Certain information about the patient has certain significance in the diagnosis: age, sex, profession, availability of occupational diseases, the transferred diseases, working and living conditions, bad habits, the presence of stressful domestic and industrial situations, etc.
Analysis of the causes of diseases of the larynx showed that the noted personal characteristics, which are, in fact, risk factors, can either initiate a functional or organic disease of the larynx, or sharply aggravate it.
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External examination of the larynx
Examination of the exposed area of the larynx, occupying the central part of the front surface of the neck, submandibular and supragastral areas, lateral surfaces of the neck, as well as supraclavicular fossa. The examination assesses the skin condition, the presence of an intensified venous pattern, the shape and position of the larynx, the presence of swelling of the cellulose, unusual solitary swelling, fistula and other signs indicative of inflammatory, tumoral and other lesions of the larynx.
Inflammatory processes revealed during examination may include perichondrites, phlegmon or adenophlegmons, tumors to laryngeal and thyroid gland tumors, conglomerates of soldered lymph nodes, etc. Skin changes (congestion, edema, infiltration, fistulas, ulcers) may occur with tuberculosis and syphilis infection, festering cysts neck and others. When the larynx mechanical trauma (bruise, fracture, wound) on the front surface of the neck may show signs of trauma (hematoma, bruises, wounds, trace compression during strangulation as hemorrhaging, strangulation furrows and t. D.).
In cases of injuries and fractures of the cartilages of the larynx, bleeding can occur from the wound canal with a characteristic bloody bubbling exhalation foam (penetrating wound of the larynx) or internal bleeding with expectoration of blood and signs of subcutaneous emphysema, often extending to the chest, neck, face.
Palpation of the larynx and the anterior surface of the neck is carried out both in the normal position of the head and when it is thrown back, when individual elements of the palpable formations become more accessible.
Guided by this scheme, you can get additional information about the condition of the larynx elements, their mobility and those sensations that arise in the patient with superficial and deep palpation of this organ.
With superficial palpation, the consistency of the skin and subcutaneous tissue covering the larynx and adjacent areas is estimated, their mobility by collecting the skin in the folds and drawing it away from the underlying tissues; a slight pressure determine the degree of swelling of the subcutaneous tissue, evaluate the turgor of the skin.
With deeper palpation, the area of the hyoid bone is examined, the space near the corners of the lower jaw, then descends along the anterior and posterior edges of the sternocleidomastoid muscle, revealing enlarged lymph nodes. Palpate supraclavicular fossa and areas of attachment of the sternocleidomastoid muscle, lateral and occipital surfaces of the neck and then pass to the palpation of the larynx. It is covered on both sides with the fingers of both hands and lightly pressed, sorting out its elements, guided by the knowledge of their location, assessing the shape, consistency, mobility, determine the possible presence of pain and other sensations. Then move the larynx en masse to the right and left, assessing its overall mobility, as well as the possible presence of sound phenomena - a crunch in fractures, crepitation with emphysema. When palpation, the areas of the cricoid cartilage and conical ligament are often identified by the isthmus of the thyroid gland covering them. Feeling the jugular fossa, they ask the patient to take a sip: if there is an ectopic fraction of the thyroid gland ectopic for the handle of the sternum, its push can be felt.
The lymph nodes, infiltrates can be probed on the surface of the lining membrane, symptoms of fluctuations (abscess of the bottom of the oral cavity), volumetric processes on the ventral surface of the root of the tongue and in the pre -adventure area can be detected. Soreness in the palpation of the area of the pharyngeal membrane can be caused by lymphadenitis (and then these lymph nodes are determined by touch) or neuralgia of the superior laryngeal nerve that permeates the membrane.
Soreness in the palpation of the lateral areas of the larynx can be a consequence of a variety of causes - laryngeal tonsillitis, inflammation of the thyroid gland, arthritis of the periarthrosis joint, perichodrite of banal and tubercular genesis, etc. Unlike the listed diseases, syphilitic damage to the larynx, even with significant damage, painless, pain occurs only with superinfection.
Palpation of the lymph nodes along the internal jugular vein is performed by tilting the head forward and slightly to the palpable side. This is achieved more easily by penetrating the fingers into the space between the anterior edge of the sternocleidomastoid muscle and the lateral surface of the larynx. Difficulties in palpation of the larynx occur in individuals with a short, thick and slow-moving neck.
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