Laryngoscope

Overview

A laryngoscope is a tool used for performing a procedure known as a laryngoscopy.

A laryngoscopy is a medical manipulation that allows us to get a direct camera view of a patient's larynx. The device should be placed anteriorly from the esophagus and below the pharynx.

While observing this organ, a doctor may obtain different valuable diagnostic information, e.g., patency of the glottis, condition of an organ's parts: mucous membrane, foreign bodies, and others.

At the same time, individuals who operate laryngoscopes, while performing the manipulation, obtain the ability to employ a few treatment techniques, e.g., removing foreign bodies, cleaning the glottis, and trachea intubation

So, if we summarize, it becomes clear that a laryngoscope is a multiple-use-tool that every anesthesiologist, even ambulance worker, and lots of other medical personnel should know how to operate.

This article contains general information about the history of laryngoscopes, types of laryngoscopy techniques, and additional values of the device in practice.

 

History of the Device and Associated Procedure

Benjamin Guy Babington (1794–1866) is credited as the father of laryngoscopy by many different sources, including memoirs of his coeval Morell Mackenzie. He called his device for laryngoscopies a "glottiscope."

Even earlier, a few other physicians, named Garignard de la Tour and Philipp Bozzini, used different mirrors to look into the hypopharynx and oropharynx.

The musical teacher Manuel García became the first man in the world to observe a living human larynx and glottis. In 1854, he performed the first observation in a mirror that simultaneously reflected sunbeams inside the throat, and showed organs on the surface.

Alfred Kirstein (1863–1922) was the first individual who directly visualized the vocal cords and described them. On April 23rd, 1895, he also performed the first documented direct laryngoscopy by using the modified esophagoscope in Berlin, Germany.

Around 20 years later, in 1913, Chevalier Jackson was the first doctor who reported the high success rate associated with intubation of the trachea with the help of direct laryngoscopy.

He also introduced additional features to the standard laryngoscope construction. Among others, there was a source of light on the blade of the tool. This allowed doctors to step away and gave them the ability to get a bronchoscope or an endotracheal tube.

Main Types of Laryngoscopes

Most modern laryngoscopes look exactly like they did in 1895. In some cases, extra modification in construction may exist. For example, there are special tools that were created when the entire intubation process is performed by one person. 

In any case, here is the most straightforward classification of laryngoscopes:


  • Conventional
  • Fiber Optic
  • Video

Every laryngoscope has a part dedicated to lighting (a small lantern usually), and a blade. Other parts are optional and may not be necessary in some cases. 

There are two main types of blades used: straight and curved. Now, there are more than twenty different types of these two main blades. The main differences between them are related to instrument positioning, additional functions (like oxygen supplement), and manipulation techniques. In order to understand the full scope of abilities and uses, it is necessary to understand detailed information about each type of device.

A Conventional Type

This device is most commonly used in general medical practice by a significant number of medical personnel. It looks very similar to the one invented by Alfred Kirstein, but with special lighting and several interchangeable blades. If you need to insert a bronchoscope or an endotracheal tube, then you have to stop holding the laryngoscope, which presents the biggest issue with the device.

A Fiberoptic Type

A fiberoptic-type tool is often used, for example, for performing indirect laryngoscopies. Usually, it is used as an instrument for performing intubations, biopsies of tumor masses, or for other diagnostic purposes. An excellent example of such a tool is a flexible fiberoptic bronchoscope. They are often most useful in anesthesiology, otolaryngology, and pulmonology.

A Video Type

A device most often used for indirect access to the larynx that displays every structure that the small camera on the scope passes. Doctors indirectly see everything happening in the pharynx, larynx, and other organs. Some of the most expensive laryngoscopes with video capabilities also have a video recording function. So, technically, they are generally called fiberscopes as well.

Indicators for Laryngoscope Usage

There are hundreds, if not thousands, of different indications in clinical practice that may present themselves when a doctor uses a laryngoscope. It is important to understand the most common indications that the device allows a physician to see.

Foreign Bodies of the Larynx

Even though the cases are sporadic in mature humans, anybody can exhibit this. It is often found to occur among children.

Usually, that happens because the swallowing reflex of adults is not as active as it is in children. Also, an object which is too big for closing the glottis, usually, can’t pass the epiglottis. Smaller objects can pass the trachea and bronchial tree.

When a doctor sees signs of a dramatically fast-developing mechanical airway obstruction, they need to react quickly. Quickly accessing the larynx to remove foreign bodies from the larynx cavity is often a remedy that is adequate.

Intubation of the Trachea

Tracheal intubation is the process of inserting the elastic, plastic tube into a patient's trachea. Most commonly, intubation is performed on unconscious patients.

The main goal of intubation is a guarantee of air or/and oxygen passage through the respiratory tract. A laryngoscope is used to get access to the glottis and then inserted the endotracheal tube or any other kind of device.

Most commonly, this manipulation is performed before various massive surgeries, when patients need mechanical ventilation, and sometimes during some diagnostic manipulations (biopsy, bronchoscopy, etc.).

General Check-Up

A general view of a patient's larynx may be critical while they suffer from larynx spasms or stenosis. Both of these states often occur in patients that are infants.

The main issue with these states is that the patient greatly suffers from breathing difficulties, which leads to panic, screaming, and takes up a great deal of time for both the doctor and patient. This also makes it hard to determine whether a patient suffers from the first or second state.

In order to determine whether a patient has stenosis or spasms, doctors often use laryngoscopes of different types. The primary treatment of these two conditions is different, so a fast and accurate diagnosis is critical. 

Doctors observe the anatomy of the larynx and see whether it just spasmed or anatomically much wider than it should be on average. These differing indications mean the patient is either spasming or exhibiting stenosis, respectively.

General Specifications of Laryngoscopes

There are numerous tools that are available on the market nowadays, but we decided to show you the specifications for the most traditional, conventional laryngoscope. The specifications are as follows:

  • Blades - 4 blades of different sizes;
  • Handles - at least 2: for adults, and infants;
  • Material - stainless steel;
  • Curved blades - at least 2: for infants, and adults;
  • Battery - included;
  • Extra bulbs – 6 nos.

Along with that, there are also some additional requirements for storing and processing this instrument. For example, doctors should keep them in sterile conditions before the device is used. After using a laryngoscope, the doctor or other medical staff should clean it and put it into sterile conditions.

Also, a doctor cannot use the same device to perform multiple procedures on different patients, especially if they have tuberculosis, pneumonia, or signs of cancer. A doctor always needs to take a new instrument from a sterile tube, or a sterilization cabinet. It is essential for a patient's health and sometimes even their life.

Market Leaders

The modern market is full of laryngoscopes of any kind. Here are some modern devices in today’s market that are manufactured by the most popular brands of these devices:

  • Welch Allyn 68043

  • Defender EMT – 5 piece laryngoscope
  • American Diagnostic Corporation Laryngoscope Kit
  • Adult Macintosh - 3.5v L.E.D. FIBEROPTIC Laryngoscope Set.

Final Thoughts

A laryngoscope is a unique multi-purpose tool for performing a laryngoscopy. Most of the modern devices are so-called conventional laryngoscopes, which are similar to those that were created in 1895 by Alfred Kirstein.

It is an essential tool for almost any physician, and it is a great idea to order one if you don't have it. You never know when you might have the need for this device

On the other hand, you probably do not need to buy expensive video or fiber laryngoscopes unless you are not an endoscopist, anesthesiologist, or interventional diagnostician.