A thorough and detailed laryngeal examination is the heart of every evaluation when a patient complains of a voice related problem, such as hoarseness, vocal fatigue, change in voice quality, and so forth (see the article by Simpson elsewhere in this issue). Advances in technology and improved understanding of vocal fold physiology and sound production have resulted in a dramatic improvement in the ability to visualize the vocal tract, specifically the vocal folds. There is no single method of laryngeal examination that is optimal for all voice patients, thus it is important to recognize the advantages and limitations of a variety of techniques for laryngeal examination and to select the appropriate instrumentation for optimal diagnosis. This article describes the techniques and methods to perform a full anatomic and functional evaluation of the vocal tract, aiding in the diagnostic process of a patient with a voice disorder. Diagnostic laryngeal endoscopy techniques are reviewed with an emphasis on the advantages and limitations of each method. This article focuses on techniques typically done in the office setting and does not discuss operative diagnostic laryngeal endoscopy.

Diagnostic laryngeal endoscopy involves the careful evaluation of both the anatomic and physiologic aspects of the nasopharynx/velum, pharynx, base of tongue, and larynx. Specifically, the vocal folds should be visualized and examined in great detail using high magnification, video recording, and stroboscopy techniques. The examination of the vocal folds, larynx, and vocal tract is predominantly diagnostic; however, flexible laryngoscopy also offers a trial of therapy using biofeedback and enhancing the ability of the clinician to predict a positive response to voice therapy.

The important features to consider of each laryngeal examination method are the ability to visualize the vocal tract in a physiologic position, the image quality, magnification, cost of the procedure, equipment required, and time and skill required to perform the evaluation. Each one of these factors is reviewed with respect to each of the laryngeal examination methods: indirect mirror laryngoscopy, flexible transnasal laryngoscopy, and rigid telescopic laryngoscopy.