Physical Examination of the Larynx.

Physical Examination of the Larynx

The larynx is examined with reference to its functions (voice, cough, breathing) and the local appearances ; the latter includes the external and internal examination (see also under Sputum).

The Function. The voice is changed in all sections of the larynx.  It may be muffled, rough, hoarse, even to the entire loss of voice or  aphonia.

In severe diseases it may have a whistling or sibilant (strident) quality : This indicates stenosis of the larynx ; or it is very hoarse and deep : this points to deep-seated ulceration.

In diseases of the larynx the cough is hoarse, loud, or barking.  In extensive destruction and in certain paralyses of the crico-aryte- noid muscles, cough is either more difficult or is ^impossible, since the power to close the glottis preceding the cough, as is normally the case, is wanting (see Cough).

Breathing is obstructed in all conditions that narrow the larynx, as in inflammation resulting in hypertrophy, in new formations, in scars with contraction.  Then there is an inspiratory and expiratory dyspncea (which see), and a peculiar noise of stenosis, " stridor laryn- geus."  In marked stenosis, especially Avhen the thorax is weak, as in children, there is a drawing-in of the lower part of the thorax in front, in the region of the insertion of the diaphragm (see the chapter on Anomalies of Respiration).

Laryingeal stenosis

Stenosis only in inspiration, causing inspiratory dyspnoea, is observed in paralysis of the crico-arytenoid muscles, the dilators of the larynx.

Laryingeal stenosis is distinguished from tracheal stenosis at the first glance, in that in the former condition the larynx moves up and down with each breath, and the neck is stretched to the fullest extent, while in the latter the larynx remains quiet and the head is always somewhat bent forward.

Local Examination of the Larynx

 The external examination is made with reference to pain, to deformities revealed to the sight or touch (these are very rare, resulting from destruction by periostitis), and laryngeal fremitus.

Laryngeal fremitus is a trembling of the thyroid cartilage during speech.  It is stronger or weaker on one side in unilateral paralysis.  It has no special diagnostic value.

The internal examination.  By great care, and in the case of patients who have themselves under good control, sometimes the entrance to the larynx and the tissues even as far as the glottis can be touched.  This method, however, has now little value, since it has been entirely superseded by the examination with the laryngeal mirror, which is the best means of examining the larynx.

Pain of the Larynx and Laryngitis

In inflammatory conditions, patients complain of pain in speaking, but sometimes, even with severe disturbances, there is no pain ; now and then there is dyspnoea, especially on exertion.  Pain in swallowing in chronic diseases of the larynx frequently indicates serious conditions : extension of new formation (carcinoma) toward the oesophagus, or destructive suppuration.

The leading symptomatic indications of diseases of the larynx with reference to other possible internal diseases, are as follows : acute laryngitis, with manifestations of an acute infectious disease, points especially to measles, croup (and also to smallpox).  Chronic laryngitis points to tuberculosis and syphilis ; to constriction by scars, to syphilis.  Of paralyses, paralysis of the recurrent nerve is of special diagnostic importance, since it often arises from pressure upon nerves, especially upon the left side from aneurism of the aorta, carcinoma of the oesophagus, tumors of all kinds in the mediastinum.  Certain paralyses indicate hysteria.

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