Contrast Examination of the Larynx and Pharynx

The radiologist is often frustrated in attempting to record on film his fluoroscopic observations of the pharynx. The rapidity of passage of contrast substances causes great difficulty in recording changes of even a gross degree, much less those too fine to be seen fluoroscopically. The technics utilizing the contrast of intraluminal air and the soft tissues of the region are often inadequate for the demonstration of minor alterations. The persistence of contrast substance within the pharynx and larynx of those patients anesthetized for bronchography suggested to us the use of anesthesia and a contrast material for the examination of these structures. We have accordingly utilized topical anesthesia and contrast media for study of the normal and abnormal anatomy and physiology of the larynx and pharynx. History Jackson was apparently the first to report the use of contrast substances within the bronchial tree, describing insufflation with bismuth in 1918 (17). He also employed Lipiodol as a contrast substance in the larynx and pharynx (18). There are many other scattered references to contrast examination of these organs, particularly in the foreign literature (3, 6, 7, 10, 15, 16, 20, 21, 22, 25), this technic having been applied to the study of tumors and in physiological and anatomical investigations. Brauer (7) recently combined laminagraphy and a contrast substance for the examination of the larynx. In view of the ease and simplicity of the procedure, it is surprising that its use has been so limited. This neglect may result, in part, from the lack of a satisfactory medium and failure to understand the normal and abnormal physiology of the larynx and pharynx. Technics The procedure for the anesthetization of the larynx and the introduction of a radiopaque medium is essentially that used in bronchography. The patient is given premedication consisting of 0.09 gm. Nembutal and 0.0004 gm. atropine one hour prior to examination. The clinical history is elicited, with special questioning in regard to drug sensitivity. The posterior oropharynx is anesthetized with 5 per cent Cyclaine. Anteroposterior and lateral soft-tissue films of the neck are obtained. The hypopharynx and larynx are then anesthetized by spraying with 2 c.c. of 5 per cent Cyclaine. Prior to the introduction of the contrast medium, the patient is examined fluoroscopically and instructed as to the following procedures: quiet inspiration through the nose with the mouth closed, phonating “Eeeeee,” modified Valsalva maneuver with the glottis open and the lips and nose closed, and a true Valsalva maneuver with a closed glottis. He is cautioned not to swallow or cough after the introduction of the radiopaque medium. A syringe attached to a curved metal cannula is used to administer the contrast substance. Five to 10 c.c. are dripped slowly over the back of the tongue intermittently during inspiration. The medium fills the valleculae and the pyriform sinuses and coats the larynx. Postero-anterior and lateral spot-films are exposed while the patient performs the maneuvers mentioned above. Occasionally, laminagrams are taken but these have not contributed any additional information. High kilovoltage is employed to decrease the exposure time. Lipiodol, Dionosil in aqueous suspension, and Dionosil Oily, have been used as contrast media. A uniform coating of the structures to be studied has been obtained with Dionosil.