Direct Laryngoscopy

Laryngoscopy is a medical procedure that is used for vocal exam to obtain a view of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during cardiopulmonary resuscitation or for procedures on the larynx or other parts of the upper respiratory tract. Direct Laryngoscopy is carried out with the laryngoscope is inserted into the mouth on the right side and flipped to the left to trap and keep the tongue out of the line of sight. This move makes a view of the glottis possible. There are ten different types of laryngoscope used, each with specialized function in otolaryngology and medical speech pathology. Sometimes direct diagnostic Laryngoscopy is done with biopsy. It is extremely uncomfortable and cause pain in larynx and cannot be performed on conscious patients, or on patients with an intact gag reflex.

Direct rigid Laryngoscopy is used as a surgical procedure for the removal of foreign objects in the throat, collect tissue samples, remove polyps from the vocal cords, or perform laser treatment. Direct rigid Laryngoscopy may also be used to help find cancer of the voice box.

Vocal cord polyp removal

Treatment requires modification of voice habits, and a speech therapy may be recommended. Vocal rest for several weeks may permit the nodules to shrink. Children occasionally present with screamer's voice nodules and these can be treated by voice therapy alone. Inhaled steroid spray may be helpful in some cases. Sometimes biopsy and surgical removal are necessary for the polyp removal.

Some preventive practices include; proper use of the voice to eliminate strain, avoid screaming and loud talking, speak at a normal pitch, reduce the neck tension by gently tipping the head forward and to each side while keeping the shoulders down.

Cold steel instrumentation and carbon dioxide laser is the surgical interventions available for the treatment of polyps. But both techniques have the known potential to cause scarring with disruption of the lamina propria. A sub epithelial micro flap resection technique is in use which gives specific attention to the sub epithelial pathology. This method preserves the overlying epithelial cover, while removing the underlying polypoid tissue via a super lateral cordotomy approach.

Removal of Vocal Cord Nodules

Treatment of vocal cord nodules includes medical, behavioral and surgical interventions. Medical problems may be treated to abbreviate their impact on the vocal cords. This includes treatment for gastro-esophageal reflux disease, allergies, and thyroid problems. Medical intervention to stop smoking or to control stress can also be used.

Voice rehabilitation involves vocal training, speech therapy, and vocal rest. Many people receive behavioral intervention, or voice therapy from speech therapist who explains the patient about the need of good vocal hygiene, reducing/stopping vocal abusive behaviors and provides direct voice treatment to alter pitch, loudness, or breath support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

Surgical intervention involves removing the nodule or polyp from the vocal cord. This approach only occurs when the nodules or polyps are very large or have existed for a long time. In rare cases, vocal cord surgery may be required. It is a relatively safe and minor surgery. But it has a disadvantage of affecting the ability to sustain notes, as well as alter the vocal range.

Surgery is rarely done for children. Occasionally, microlaryngoscopic surgery is considered in the management of nodules. The recurrence cannot be prevented by the surgery and the nodules will reform in response to factors that surgery cannot alter. Microlaryngoscopic surgery may be used to remove the tangle of accumulated hardened tissue.

Sometimes, voice therapy alone may fail to improve the voice if the nodules are well-formed as a result of long-standing and repeated phonatory damage. A trail of voice therapy prior to surgery is the best recommended choice.
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