Pharyngoscope what is in the medicine?
«Open your mouth, stick out your tongue, say «ahh…» – phrase, which begins this diagnostic examination is familiar to all from early childhood. It’s called the pharyngoscope. Visual inspection of the mucous membranes of the oral cavity and pharynx is not only physician or pediatrician. In practice, this simple laringoscopice research may hold the nurse or doctor of any specialization. But most often this procedure is carried out by the gastroenterologists and pulmonologists, as the state of the mucous membranes of these departments is a mirror, reflecting changes in the gastrointestinal and/or pulmonary systems.
Pharyngoscopy is an integral part of the overall initial survey conducted by the otolaryngologist (ENT doctor «ear, nose and throat»). This examination is performed in the following order: inspection of the external nose and anterior rhinoscopy, pharyngoscopy, indirect laryngoscopy, examination of the ear, otoscopy. Laringoscopice examination is also an integral part of the initial examination at the dentist.
- nasal tweezers;
- nasopharyngeal and laryngeal mirror;
- probes – pharyngeal and mindalikovye;
However, this instrumentation should not cause fear. This is a quick and painless examination, which sometimes can cause mild and transitory discomfort in the throat.
Attentive doctor would never use a cold spatula, touch, which can heighten the gag reflex. It pre-warms the tool. If the doctor called to the house, make sure that his parish was ready a clean glass and hot boiled water.
The method and sequence of inspection
The pharynx is an unpaired hollow organ that connects the nasal cavity and mouth to the esophagus and larynx. Its walls are part of the digestive tube and respiratory tract, and consist of muscular fibres and mucous membrane. Aft this, it is in the throat is a lymphoepithelial ring, consisting of one lingual, pharyngeal one, two palatal, and two tubal tonsils. In the lateral walls of the pharynx there are two funnel-shaped openings of the auditory tubes.
The examination begins with an external examination of the neck and labial mucous membranes. Next is palpation of all regional pharyngeal lymph nodes. Then, examine the nasal, oral and laryngeal part of the pharynx. The method of inspection of each part respectively got its name – horoscope, metavariscite and epifeniskaje.
During this part of the procedure with a spatula to inspect the mucosa of the oral vestibule, gums, tongue, hard palate, the ducts of the sublingual, submandibular and parotid glands, the bottom of the mouth.
If horoskopai be sure to estimate the amount of saliva, and health of the salivary glands. This can offer to think about something acidic, e.g. lemon, or drop under the tongue a drop of acetic acid. Normal this manipulation can cause a strong salivation that saliva from the glands can beat fountains.
It was during this part of the examination the patient is asked to pronounce the sound «A». This action helps the doctor to assess the mobility of the soft palate, as well as its symmetry. Here the patient may experience retching. Its strength depends on individual sensitivity and the temperature of the spatula, which is pressed by the tongue. If the patient is aware of his increased-evident gag reflex and if there is no allergic reaction, it is possible to pre-anesthesia with the help of local irrigation with special anesthetic.
Then turn to inspect the mucous membranes and the uvula, size and assess the condition of the mucosa of the tonsils. Using two spatulas checked the content in almond crypts, which normally scarce and may look insignificant epithelial tube.
At the end of mesafesindeki perform analysis of the posterior pharyngeal wall. By the way, normal pink, flat and smooth surface of that part of the pharyngeal wall are rare lymphoid granules with a diameter of 1 mm.
Further laringoscopice inspection is performed using a nasopharyngeal mirror, which, like spatulas, needs pre warming. At this stage of the inspection, which is also called posterior rhinoscopy, assess the condition of the LAN that connects nasal cavity and mouth holes evstafievich tubes connecting the ear and throat, nasal cavities and the nasopharyngeal vault.
From 4-8% of boys and girls aged 3-15 years on the rear section of the roof of the nasopharynx there’s a third (pharyngeal) tonsil.
If the tissue of the tonsils grows and becomes hypertrophied, such education is called adenoids and inflammation of the third pharyngeal tonsils is called adenoids. Adenoids and inflammation of them, rarely, but can occur in adults and children 1-2 years of age.
If necessary, the procedure laringoscopice examination may end in the finger examination of Joan, the pharyngeal tonsil, arch and lateral walls of the nasopharynx. In most cases, such palpation is performed in the examination of children and adolescents, either in the differential diagnosis of malignant neoplasms in adults.
In the vast majority of cases laringoscopice examination immediately followed by an external examination of the larynx indirect laryngoscopy. During this phase, the doctor will ask the patient to pronounce the sounds of «And» and «uh». The main goal of this phase is assessment of the lower divisions and bodies of the pharynx and larynx, as well as the false and true vocal cords.
When shown the inspections?
Pharyngoscopy, as any kind of diagnostic testing, has its indications. In addition to the preventive medical examination, this examination is performed in the following cases:
- wounds or injuries of the pharynx and nasopharynx;
- suspicion of the presence in the throat with a foreign object;
- identification of anomalies in the structure of or abnormal development of the organs of the throat;
- pathology of the vocal cords;
- hypertrophic or atrophic development of the tonsils;
- or retropharyngeal peripharyngeal abscesses;
- acute tonsillitis different etiology (angina);
- laryngitis, paratonzillit, chronic tonsillitis, acute and chronic, including streptococcal pharyngitis;
- stomatitis, pulpitis, gingivitis;
- inflammation of the tongue and of the tongue (glossitis, uvula);
- suspect polyps or cancer.
Requirements for the sterility of the examination
In order not to get infected with HIV or viral hepatitis need to pay attention to the way in which the doctor is preparing to survey and in what condition are the tools with which specifically will conduct your inspection. It is clear that the medical instruments after sterilization shall be in a special medical boxes, and the doctor immediately before inspection must wash his hands, disinfect them with antiseptic and put on sterile gloves.
In case of need and availability of fiber optic laryngoscope, ENT during the passage laringoscopice surveys can use this modern tool to keep a photo of the problem area or for the taking of biological material for subsequent histological analysis.