Skip to main content
SpringerLink
Log in

Clinical Examination of the Airways

An Overview

  • Reference work entry
  • First Online:
Airway Diseases

  • 705 Accesses

Abstract

The nasal endoscope permits assessment of the lining of the nose and the sinuses directly and with crystal clear images with magnification. Endoscopy is frequently undertaken in the ENT clinic, where it permits objectivity in assessing the nasal lining, anatomical anomalies, and disease processes occurring within the nose. Endoscopy of the nose utilizes both rigid and flexible endoscopes. If the endoscopist has reasonable experience in performing the procedure, neither rigid nor flexible endoscopy creates undue discomfort for patients. Sınce the flexible, fiberoptic type endoscope is usually of smaller caliber than rigid types, it offers a greater flexibility to reach all the nooks and crannies that make up the nasal cavity. The fact that it is a bimanual instrument does, however, make it complex to use. In the past, the images obtainable were of inferior quality, but this is no longer the case now that digital fiberoptic endoscopes have been developed. The use of the endoscope to evaluate the larynx begins with assessment of several other structures, in terms of both function and anatomical form, namely the nasopharynx and palate, pharynx, lingual base. This is in addition to the larynx itself. The vocal cords are the focus of the most attention and are examined at high magnification using video and stroboscopy. While this procedure mainly aims to allow for diagnosis, the instrument does allow some assessment of whether voice therapy may succeed as it permits evaluation of the patient’s ability to benefit from biofeedback. For pulmonary examination, inspection, shape of the chest, breathing patterns, palpation, percussion, and auscultation are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 949.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 949.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Brook I. Which exams may be helpful supplements to the nasal exam for chronic sinusitis? In: Brusch JL, editor. Medscape. Updated: Jul 01, 2019. https://www.medscape.com/answers/232791-42195/which-exams-may-be-helpful-supplements-to-the-nasal-exam-for-chronic-sinusitis. Accessed 3 Jan 2020.

  2. Hughes AL. Nasal Endoscopy. In: Meyers AD, editor. Medscape. Updated: Feb 08, 2016. https://emedicine.medscape.com/article/1890999-overview. Accessed 3 Jan 2020.

  3. Stammberger H. Functional endoscopic sinus surgery. Philadelphia: BC Decker; 1991.

    Google Scholar 

  4. Kennedy DW, Zinreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery. Theory and diagnostic evaluation. Arch Otolaryngol. 1985;111(9):576–82.

    Article  CAS  PubMed  Google Scholar 

  5. Chia-Hui Chen C, Chyun DA, Li CY, McCorkle R. A single-item approach to screening elders for oral health assessment. Nurs Res. 2007;56(5):332–8.

    Article  PubMed  Google Scholar 

  6. Vargas CM, Arevalo O. How dental care can preserve and improve oral health. Dent Clin N Am. 2009;53(3):399–420.

    Article  PubMed  Google Scholar 

  7. Villa A. Oral Examination. In: Burgess J (Ed). Medscape. Updated: May 02, 2017. https://emedicine.medscape.com/article/1080850-overview. Accessed 3 Jan 2020.

  8. Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent. 2001;85(2):162–9.

    Article  CAS  PubMed  Google Scholar 

  9. Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis. 2002;8(3):117–29.

    Article  CAS  PubMed  Google Scholar 

  10. Kujan O, Glenny AM, Oliver R, Thakker N, Sloan P. Screening programmes for the early detection and prevention of oral cancer. Aust Dent J. 2009;54(2):170–2.

    Article  Google Scholar 

  11. Perry M. Maxillofacial trauma-developments, innovations and controversies. Injury. 2009;(40, 12):1252.

    Google Scholar 

  12. Haddad R, Annino D, Tishler RB. Multidisciplinary approach to cancer treatment: focus on head and neck cancer. Dent Clin N Am. 2008;52(1):1–17.

    Article  PubMed  Google Scholar 

  13. Rosen CA, Murry T. Diagnostic laryngeal endoscopy. Otolaryngol Clin N Am. 2000;33(4):751–7.

    Article  CAS  Google Scholar 

  14. No authors listed. How are the vocal folds and larynx examined? https://voice.weill.cornell.edu/voice-evaluation/how-are-vocal-folds-and-larynx-examined. Accessed 3 Jan. 2020.

  15. Brown CA. Approach to the difficult airway in adults outside the operating room. In: Walls RM, Grayzel J (Eds). UpToDate. Last updated: Aug 06, 2019.

    Google Scholar 

  16. Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth. 1994;41:372.

    Article  CAS  PubMed  Google Scholar 

  17. Bair AE, Panacek EA, Wisner DH, et al. Cricothyrotomy: a 5-year experience at one institution. J Emerg Med. 2003;24:151.

    Article  PubMed  Google Scholar 

  18. Lundstrøm LH, Møller AM, Rosenstock C, et al. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia database. Anesthesiology. 2009;110:266.

    Article  PubMed  Google Scholar 

  19. Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595.

    Article  PubMed  Google Scholar 

  20. Connor CW, Segal S. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubation. Anesth Analg. 2014;118:419.

    Article  PubMed  Google Scholar 

  21. Detsky ME, Jivraj N, Adhikari NK, et al. Will this patient be difficult to intubate?: the rational clinical examination systematic review. JAMA. 2019;321:493.

    Article  PubMed  Google Scholar 

  22. Naguib M, Scamman FL, O’Sullivan C, et al. Predictive performance of three multivariate difficult tracheal intubation models: a double-blind, case-controlled study. Anesth Analg. 2006;102:818.

    Article  PubMed  Google Scholar 

  23. The mnemonics for difficult airway identification cited in this review are reproduced with permission from The Difficult Airway Course™: Emergency.

    Google Scholar 

  24. Brown CA III, Walls RM. Identification of the difficult and failed airway. In: Brown III CA, Sakles JC, Mick N, editors. Walls manual of emergency airway management. Philadelphia: Lippincott Williams & Wilkins; 2017.

    Google Scholar 

  25. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429.

    Article  CAS  PubMed  Google Scholar 

  26. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487.

    Article  CAS  PubMed  Google Scholar 

  27. Lee A, Fan LT, Gin T, et al. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102:1867.

    Article  PubMed  Google Scholar 

  28. Lundstrøm LH, Vester-Andersen M, Møller AM, et al. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. 2011;107:659.

    Article  PubMed  Google Scholar 

  29. Roth D, Pace NL, Lee A, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018;5:CD008874.

    PubMed  Google Scholar 

  30. Green SM, Roback MG. Is the Mallampati score useful for emergency department airway management or procedural sedation? Ann Emerg Med. 2019;74:251.

    Article  PubMed  Google Scholar 

  31. Loudon RG. The lung exam. Clin Chest Med. 1987;8(2):265–72.

    Article  CAS  PubMed  Google Scholar 

  32. Bickley LS, Szilagyi PG. The thorax and lungs. In: Bates’ guide to physical examination. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 241–77.

    Google Scholar 

  33. Schraufnagel DE, Murray JF. History and physical examination. In: Mason RJ, Broaddus VC, Martin TR, et al., editors. Murray and Nadel’s textbook of respiratory medicine. 5th ed. New York: Elsevier; 2010. p. 355–65.

    Google Scholar 

  34. Lone NA. Pulmonary examination technique. In: Mosenifar Z (Ed). Medscape. Updated: Jan 02, 2019. https://emedicine.medscape.com/article/1909159-technique. Accessed 3 Jan 2020.

  35. Maitre B, Similowski T, Derenne JP. Physical examination of the adult patient with respiratory diseases: inspection and palpation. Eur Respir J. 1995;8(9):1584–93.

    Article  CAS  PubMed  Google Scholar 

  36. Cugell DW. Lung sound nomenclature. Am Rev Respir Dis. 1987;136(4):1016. (Medline).

    Article  CAS  PubMed  Google Scholar 

  37. Kraman SS. Lung sounds for the clinician. Arch Intern Med. 1986;146(7):1411–2.

    Article  CAS  PubMed  Google Scholar 

  38. Scott G, Presswood EJ, Makubate B, Cross F. Lung sounds: how doctors draw crackles and wheeze. Postgrad Med J. 2013;89(1058):693–7.

    Article  PubMed  Google Scholar 

  39. Bettencourt PE, Del Bono EA, Spiegelman D, Hertzmark E, Murphy RL Jr. Clinical utility of chest auscultation in common pulmonary diseases. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1291–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Pulmonology, Erciyes University, Kayseri, Turkey

    Burcu Baran Ketencioğlu & Nuri Tutar

  2. Faculty of Medicine, Department of Otorhinolaryngology, Kırıkkale University, Kırıkkale, Turkey

    Nuray Bayar Muluk

Authors
  1. Burcu Baran Ketencioğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nuri Tutar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nuray Bayar Muluk
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskisehir, Türkiye

    Cemal Cingi

  2. Department of Pulmonology, Celal Bayar University, Manisa, Türkiye

    Arzu Yorgancıoğlu

  3. Department of Otorhinolaryngology, Kırıkkale University, Kırıkkale, Türkiye

    Nuray Bayar Muluk

  4. Federal University of Bahia School of Medicine and ProAR Foundation, Salvador - Bahia, Brazil

    Alvaro A. Cruz

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Ketencioğlu, B.B., Tutar, N., Bayar Muluk, N. (2023). Clinical Examination of the Airways. In: Cingi, C., Yorgancıoğlu, A., Bayar Muluk, N., Cruz, A.A. (eds) Airway Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-22483-6_6-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-22483-6_6-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22482-9

  • Online ISBN: 978-3-031-22483-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation