chapter  12
Common Problems of the True Vocal Folds
ByGlendon M. Gardner and Michael
Pages 56

The larynx can be viewed in several different ways. Indirect laryngoscopy with a mirror is the simplest method and is successful in approximately 2/3 of patients. This is often adequate to rule out many pathologies. The mirror exam also provides a better appreciation of color of the larynx, since no video or lens is involved, which could distort color. For those patients in whom indirect laryngoscopy is not possible, due to an overly sensitive gag reflex, difficult anatomy, the patient’s inability to do the task, or certain anatomy cannot be adequately seen (anterior commissure), flexible fiber-optic laryngoscopes are used. This allows a clear view of all regions of the larynx, with the possible exception of the subglottis. Also, motion of the vocal folds can be best assessed with the flexible scope, since it allows the patient to sniff to maximally stimulate the posterior cricoarytenoid muscles, something not possible, or at least very difficult, with transoral examination with a mirror or rigid scope. The transoral route, which involves grasping the extended tongue, can cause the appearance of excessive tension, which may be induced by the exam and not how the person typically phonates, leading to a misdiagnosis of muscle tension dysphonia.