Mirror laryngoscopy is the use of a small, curved mirror to examine the pharynx and larynx. Mirror laryngoscopy is commonly used to assess pharyngeal and laryngeal complaints.
Indications of Mirror Laryngoscopy
Laryngoscopy may be required to assess the condition of the larynx.
- Coughing for a long time
- Dysphagia
- Odynophagia
- Dysphonia is a condition characterized by hoarseness or a change in voice.
- Throat discomfort that persists
- A lump or foreign body sensation in the neck
- Aspiration symptoms
- Hemoptysis is a condition that occurs in some people.
- Patients at high risk of head and neck cancer (for example, heavy smokers or alcoholics) may benefit from a laryngoscopy, especially if they have been suffering from hoarseness, sore throat, or earache for more than two weeks.
Prior to orotracheal intubation, laryngoscopy can be used to assess the airway.
Contraindications
- Suspected epiglottitis
- Ludwig angina
- Angioedema
- Stimulation of the laryngopharynx in such instances may impair the airway even further. If laryngoscopy is required, it should be performed in a controlled environment, such as an operating room, with someone who is experienced in complex airway care (including surgical procedures) present.
Contraindications that are related
- Stridor
- Trismus
- Strong gag reflex
Complications
Mucosal injury, which may result in bleeding.
Airway compromise due to laryngospasm.
Gagging, coughing, and/or vomiting may occur as a result of the surgery.
Equipment
- Curved dental mirror
- Alcohol swab, antifogging solution, or warm water (around body temperature)
- If feasible, utilize a headlamp or another external light source that can be used hands-free.
- Gloves
- Eye protection is a must.
- Pad of gauze 4 in x 4 in (10 cm x 10 cm)
- Depressor of the tongue
- Spray anesthetic for the skin (eg, lidocaine, benzocaine)
Additional Considerations
- Although most patients tolerate mirror laryngoscopy without oropharyngeal anesthesia, a topical anesthetic may be required.
- Flexible laryngoscopy should be used if the patient does not tolerate this operation.
- The subglottic larynx and proximal trachea are only seen by mirror laryngoscopy. If pathology is suspected in certain areas, a different procedure, such as bronchoscopy, should be used.
Relevant Anatomy
The nasopharynx, oropharynx, and hypopharynx are all parts of the pharynx.
The hyoid bone suspends the larynx, which connects the pharynx to the trachea. It consists of three single and three paired cartilage structures: single (epiglottis, thyroid, and cricoid) and paired (epiglottis, thyroid, and cricoid) (arytenoid, cuneiform, and corniculate). The vocal folds are located in the larynx, which spans from the tip of the epiglottis to the inferior aspect of the cricoid cartilage.
Positioning in Mirror Laryngoscopy
The patient should be seated straight, with his or her head resting on a headrest and leaning forward slightly, facing the practitioner. Because the patient looks to be leaning forward as if sniffing a flower, the appropriate position is frequently referred to as the “sniffing position.” It’s not a good idea to cross your legs.
Step-by-Step in Mirror Laryngoscopy
The external light source should be adjusted.
- To avoid fogging, fill the mirror halfway with warm water (around body temperature) (check to make sure mirror is not too hot). Alternatively, use an antifogging solution or alcohol to de-fog the mirror.
- Wrap gauze over the patient’s tongue and grab it with your non-dominant hand. The gauze will keep the tongue from slipping and will protect it from lower incisor tooth harm.
- Pull the tongue gently.
- Instruct the patient to take deep breaths through their mouth to avoid gagging.
- Without contacting the tongue or any mucosa, slide the mirror into the oropharynx.
- Place the back of the mirror against the uvula and gradually slide it in until the larynx is visible.
- Remove the mirror and squirt a topical anesthetic into the posterior oropharynx if gagging develops.
- To view the base of the tongue, valleculae, epiglottis, piriform sinuses, arytenoids, false and real vocal cords, and if feasible, the larynx below the vocal cords, move the mirror softly and as little as possible.
- To see lateral structures, move the mirror from side to side with your thumb and forefinger.
- Examine the vocal cords thoroughly. Instruct the patient to pronounce “eeee,” which will cause the vocal cords to constrict, and evaluate their function.
Aftercare
To avoid aspiration owing to residual laryngopharyngeal anesthesia, instruct the patient to refrain from eating and drinking for at least 20 minutes.
Common Errors and Warnings
Failure to align the light source with the line of sight as nearly as feasible.
Failure to warm the mirror, which will cause it to fog.
Failure to maintain a firm grip on the patient’s tongue so that it remains retracted.
Allowing the patient to lean back, preventing complete visualization.
The mirror is angled incorrectly to observe the larynx.
Tips and Tricks
- Raise the patient so that the mirror is close to the examiner’s eye level to reduce neck strain.
- Elevate the top lip with one finger of the hand holding the mirror.
- Gagging should not occur if only the uvula is touched; nonetheless, avoid contacting the back or sides of the throat.
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