Exploration du larynx

Laryngology really started as a speciality in the second part of the 19th century, with the development of instruments for larynx in vivo observation. The understanding of larynx physiology and pathophysiology improved subsequently, parallel with the 20th century technological innovations. Among the means presently available for ENT specialists, laryngoscopy is the most important. Indirect laryngoscopy is the first examination performed in the physician's office. Mirror laryngoscopy is still indicated but it must be completed with telescope or fiberscope examination. Stroboscopy is essential for voice disorders assessment. Owing to the fiberscope, any larynx may be examined in the office, more specially children ones. Analogue or digital video recordings allow reviewing the examination, at normal or slow speed. Video-printers or transmission of digital pictures and video clips make easier exchange of information. Suspension laryngoscopy under general anaesthesia is presently mainly interventional from simple biopsy to microphonosurgery. Contact endoscopy and auto fluorescence permit better detection of epithelial area suspect of malignant transformation. Vocal folds vibration can be grasped with glottography. Glottic movement disorders from neurological or other origin can be assessed with electromyography. Follow-up of laryngeal neurological disorders and location for intramuscular injection are also facilitated with electromyography. Larynx imaging principally consists of computerized tomography and magnetic resonance imaging. These techniques are developed elsewhere in this encyclopaedia. Laryngeal airway and vocal folds movements can be observed with ultrasonography provided the thyroid cartilage is not ossified. This is mainly interesting for children. Video fluoroscopy is very useful for the study of larynx dynamics during swallowing.