Initial Evaluation

Hoarseness, stridor, foreign body (globus) sensation, and dysphagia are all symptoms of laryngeal or hypopharyngeal pathology. When a patient presents with any of these persistent symptoms, a complete past medical and social history is essential. In addition, if hoarseness has persisted, laryn-goscopy is indicated. Laryngoscopy can be performed indirectly using a mirror. If the hypopharynx and larynx are not adequately visualized with the mirror because of an excessive gag reflex, direct flexible fiberoptic laryngoscopy can be performed. A topical vasoconstrictor (e.g., 0.5% ephedrine) with a topical anesthetic (e.g., topical lidocaine) can be applied in the nose to improve patient comfort; however, this is not always necessary. The flexible fiberoptic nasopharyngoscope is then passed through the pharynx to visualize the larynx.

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