Clinical examination of the larynx (喉部臨床檢查)

If symptoms of hoarseness, dysphagia, chronic sore throat or a lump in the neck continue for longer than 6 weeks, careful examination of the upper airway is mandatory.

Listen to the patient’s voice: is it intermittently or permanently dysphonic? 

The former might suggest a functional problem, the latter an organic one. A breathy voice is a typical of a vocal cord palsy. Also, listen for evidence of stridor. A “hot potato” voice is indicative of supraglottic or oropharyngeal pathology.

When assessing the oral cavity and oropharynx, particular attention should be paid to mucosal ulceration or swelling. If the patient has a particularly brisk gag reflex, the palate and oropharynx should be sprayed with Lidocaine prior to attempting indirect laryngoscopy. 

A warmed laryngeal mirror is used to visualize the larynx while the doctor gently holds the patient’s protruded tongue. The patient should mouth breathe. Vocal cord movement is assessed by asking the patient to say “Hey!” or “eeee…”. If the technique is not tolerated, then the patient’s better nasal airway is locally anaesthetized and a fibre-optic scope is used to examine the larynx and pharynx.

Both the nose and neck should be routinely examined as part of the assessment of the upper airway.