Larynx is visualized internally by direct or an indirect laryngoscopy. For an indirect laryngoscopy, the client sits in a chair with his head titled back and is asked to stick out his tongue. The physician grasps the tongue with a gauze piece and pulls its forward and downward. A laryngeal mirror, warmed on a spirit lamp (to prevent fogging) tested on the examiner’s hand for heat, is inserted with its back side against the tip of the uvula. The client is asked to breathe quietly through the mouth to prevent gagging. The larynx is examined at rest and during attempts to speak. If the gag reflex is very sensitive, the throat is sprayed with a local anaesthetic. The light is directed on to the laryngeal mirror, as it is held in the pharynx.
A direct laryngoscopy is performed on children, on adults who are unable to co-operate for an indirect examination, and on clients with suspicious lesions of the larynx. It may be done under local or general anaesthesia. For direct laryngoscopy, the client is placed in a supine position, the head is extended over the edge of the table or a pillow is placed under the shoulders. The laryngoscope is introduced by the doctor through the mouth into the hypopharynx, elevating the epiglottis in order to visualize the interior of the larynx. Minor surgical procedures such as biopsy or removal of a small benign tomour may be performed at this time.
After Care of the Patient
1. Following laryngoscopy the client who had general anaesthesia is kept flat in bed without a pillow under the head. If it is done under local anaesthesia the swallowing reflexes are absent in the client; therefore the client is kept in a sidelying position to drain the saliva.
2. The client is given nothing to eat or drink until the gag relflex returns. Before oral feeds are started, provide sips of water to check the client’s ability to swallow. Water is least dangerous if accidently aspirated.
3. The nurse should see for the safety of the client, if a preoperative sedation was given. The client will be drowsy with the sedation.
4. Watch for the signs of complications. The following signs and symptoms may be looked for, especially if a biopsy was done.
a. Coughing and spitting of blood.
b. Pain in the throat and neck
c. Swelling of the throat and neck.
d. Restlessness and breathing difficulty.
e. Impaired respiration. (have resuscitation equipment ready at hand).
5. Record the procedure in the nurse’s record with date and time.
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Preparation of the Articles for Laryngoscopy (Direct)
1. Laryngoscope with appropriate size of blades.
2. Tongue forceps.
3. Angled tongue depressor.
4. Laryngeal swab holders and small mops.
5. Laryngeal biopsy forceps.
6. Suction tubing, nozzles.
7. Diathermy leads, electrodes.
8. Pharyngeal spray and topical anaesthetic.
9. Specimen tubes with formalin.
10. Kidney tray and paper bag.
11. Adrenaline solution 1:1000 to wipe the site of biopsy and to check bleeding.
12. Dressing towels.
13. Mask, gloves, apron etc., for the doctor.
Preparation of the Client and the Environment
1. Explain the procedure to the client in order to win his confidence and co-operation. In an indirect laryngoscopy, the co-operation of the client is very important.
2. To prevent unnecessary gagging during the inspection of the larynx, the client is approached calmly and gently. The client should be instructed to breathe quietly through the mouth or to “pant like a dog” to prevent gagging.
3. The room should be darkened so that the doctor can see more clearly the structures lighted by the scope. If the laryngeal mirror is used, the spot light is directed to the head mirror which reflects the light of the larynx.
4. For the direct laryngoscopy, the client should be prepared as for a surgical procedure.
a. Food and fluids are withheld for a period of 4 to 6 hours to prevent regurgitation and possible aspiration.
b. The client is given a pre-operative sedation.
c. If the larynoscopy is to be done under general anaesthesia a written consent is taken.
d. If the larynoscopy is done under local anaesthesia the throat is sprayed with a topical anaesthetic.
5. If a biopsy or excision of tissues is expected the necessary articles are kept ready. The procedure is done under strict aseptic technique.
AUTHOR : CHRISTIN VIOLA