Summery:
Background: Upper airway symptoms are quite common.
Many of these symptoms underlie serious upper airway
pathologies which should be diagnosed at an early stage so
that optimum treatment can be given. Often it seems to be
difficult to diagnose upper air way pathology by
conventional indirect laryngoscopy (I/L), especially when
the lesion is at an early stage. In this situation fiber optic
laryngoscopy (FOL) is very helpful.
Objective: To identify lesions in the larynx in patients with
persistent upper airway disorders and to compare the
diagnostic yield of FOL over I/L.
Method: This was a cross-sectional study conducted partly
in department of ENT and Head & neck surgery, BIRDEM
General Hospital and partly at the same department of
BSMMU during the period of July to December 2012. 100
adult patients were taken having upper airway symptoms.
Study subjects were evaluated by history, physical
examinations, and ENT examinations. All patients
underwent indirect laryngoscopy and FOL. Data were
recorded and analyzed.
Results: Age of the respondents was between 18-72 years.
The mean ± SD was 54 ±11.79 years. Common symptoms
among the participants were hoarseness, sore throat, neck
swelling, breathless ness, cough, odynophagia, earache etc.
On I/L examinations 30% were vocal cord polyps, 14% v.
cord edema, 17% v. cord growths, 11% v. cord nodules, 6 %
v. cord palsy, 4% ulcerated lesions, 13 % poor vision and
5% were normal. On FOL examinations, 30% were vocal
cord polyp, 18% v. cord edema, 21% v. cord growth, 14% v.
cord nodule, 8 % v. cord palsy, 5% ulcerated lesion, 2%
laryngeal web, 2 % were normal study and there were no
poor vision. A comparison was made between the findings
of I/L and FOL which showed that FOL is superior to I/L
in diagnosing upper airway disorders as evidenced by
findings of 2% lesions among 5% patients having normal
I/L findings. Chi-square test was done between I/L and FOL
findings which was statistically significant; (P value was
.002) i.e. FOL procedure is valuable diagnostically in
comparison to I/L.
Conclusion: In many occasions I/L findings are
inconclusive in daily ENT practice. Moreover, in some cases
there is poor vision to identify the lesion. Therefore, Routine
FOL evaluation is valuable in patients with significant,
chronic and progressive upper airway symptoms. It should
always be considered in patients with persisting and
progressive symptoms even though I/L appeared normal.