Indirect laryngoscopy: is a procedure which is used to view the larynx and vocal cords using mirrors and reflected light. It was first performed by Manual Garcia who was a singer. He in fact visualized his vocal cords in a barber shop through a set of mirrors placed on the wall.
1. The mirror used is plane mirror with a long handle.
2. It is held like a pen in the dominant hand with the mirror pointing downwards.
3. The mirror is warmed with a spirit lamp, the temperature is tested on the back of the hand. This is done to prevent fogging of the mirror.
4. The patient is asked to protrude the tongue and it is held with a gauze.
5. The mirror is introduced into the mouth and gently slide under the uvula.
6. The mirror is tilted to get good view of the larynx.
7. The patient is asked to say eee.
8. The mobility of the vocal cord can be tested.
The image of larynx visualized is reversed one, the near parts appear the farthest (antero posterior inversion). The right and left structures are not actually reversed, the right hand structures are seen in the observers left.
To examine the anterior commissure of the vocal cords, the patient is made to crouch / kneel with the head tilted upwards and extended, the examiner stands and holds the mirror nearly vertical over the posterior pharyngeal wall. This position is known as reverse killian's position.