Diagnosis
The cause of the larynx pain can be clarified by direct or indirect laryngoscopy.In the indirect examination method, a laryngeal mirror is advanced over the mouth to the back wall of the throat and held over the laryngeal entrance. The larynx can then be seen and assessed through the mirror. In addition to the condition of the larynx, the function of the vocal folds is also tested: to assess the breathing position of the vocal folds, the patient is asked to take a deep breath.
To assess the phonation position, the patient must say “hi”. If the indirect examination method is not possible, for example because of a strong gag reflex or restricted mouth opening, direct laryngoscopy is used. In this case, a rigid tube (rigid endoscopy) or a flexible tube (flexible endoscopy) is pushed through the mouth or nose directly to the larynx.
In practice, the examination by endoscope is increasingly replacing the examination by laryngeal mirror. Depending on the cause of the laryngeal pain, a different picture emerges: Initially, the pain may be caused by an external or internal trauma. In this case it is important to pay attention to swelling, bruising and bruise marks in the area of the larynx.
The reflection of the larynx may also show mucous membrane injuries as well as free cartilage parts reaching into the larynx can be detected. If a fracture is suspected in the area of the cartilage framework of the larynx, computer tomography is useful. If it is an acute inflammation of the larynx (laryngitis), a reddened mucous membrane around the larynx, reddened and swollen vocal folds and an increased vascular drawing are visible in laryngoscopy.
Fibrin coatings may also occur in bacterial infections. Chronic laryngitis additionally shows a thickened mucous membrane in the area of the larynx and a rather dry environment. If there is an inflammation of the vocal chords, they are reddened, swollen and covered with a tough mucus.
In the case of a pseudocroup, however, the vocal folds are only slightly reddened. If, however, the real form of the croup (diphtheria) is present, whitish until yellow-green coatings are typical in the pharynx and larynx-area, that are not wipeable. When trying to remove them, bleeding can easily occur.
In addition, a sweetish smell is detectable due to acetone and a swelling of the lymph nodes in the throat area. In the microbiological findings the triggering Corynebacterium diphtheriae can be detected. If the laryngeal mirror shows a glassy swelling of the epiglottis and the base of the tongue and a red throat, it is probably an inflammation of the epiglottis (epiglottitis). If epiglottitis is suspected, no endoscope should be used, as it can lead to a choking attack due to complete obstruction of the airways!
