Acta Scientific Medical Sciences (ISSN: 2582-0931)

Research Article Volume 5 Issue 10

Indirect (Mirror) Laryngoscopy: Valuable Laryngological Skill Going into Extinction?

James E Toblh1, Olusola A Sogebi2, Taiwo O Adedejl3* and Theophilus O Esan4

1Associate Professor and Head of Otorhinolaryngology Department, Ladoke Akintola University of Technology/Teaching Hospital, Osogbo, Nigeria
2Consultant, Otorhinolaryngology Department, Olabisi Onabanjo Teaching Hospital, Sagamu, Nigeria
3Consultant, Otorhinolaryngology, Ladoke Akintola University of Technology/Teaching Hospital, Osogbo, Nigeria
4Otorhinolaryngology Department, Federal Teaching Hospital, Ido-Ekiti, Nigeria

*Corresponding Author: Taiwo O Adedeji, Consultant, Otorhinolaryngology, Ladoke Akintola University of Technology/Teaching Hospital, Osogbo, Nigeria.

Received:July 28, 2021 Published: September 22, 2021

Citation: Taiwo O Adedejl., et al. “Indirect (Mirror) Laryngoscopy: Valuable Laryngological Skill Going into Extinction?". Acta Scientific Microbiology 5.10 (2021): 104-109.


Background: Indirect mirror laryngoscopy despite its relevance in Otorhinolaryngology practice most especially in the sub-Saharan where technology is still not readily available in most centres, appears to be going into extinction.

Methods: Two series of retrospective study were done, First series were patients that underwent indirect mirror laryngoscopy of larynx at a period when laryngeal endoscopy was not available (2011-2015) and the second series were patients that went through laryngeal examination when facilities of laryngeal endoscopy were available(2016-till June,2021). Questionnaires were also administered to the Otolaryngologists (consultants and residents in training)in this centre and three other sister departments in other teaching hospitals (one centre in Uk) to find out their skill and which of the two types of laryngeal examination they prefer and reasons for it. This research was done in a resource limited environment.

Results: In the first series, a total of 72 patients that needed laryngeal examination all had mirror indirect laryngoscopy (IDL) because there was no alternative. For the series 2 study, there were 37 IDL patients and 73 endoscopic patients. There ages and gender distributions were similar among the three groups (M:F were 1:2.1. 1:1.18, 1:1.09 respectively). Laryngitis was the most common specific pathological finding (13.9%), IDL was not successful in 5.6%and 4.2%had over hanging epiglottis. Most patients with hoarseness had laryngeal tumour (33%,) and laryngitis (28.6%,) (X2 = 48.923, p < 0.001). fourteen doctors participated in the study, six were specialists while eight were resident doctors. Ten otolaryngologist still have relevant IDL skillful while four lack adequate skill. All respondent prefer laryngeal examination using endoscope and only 3 (21.4%) still carry out IDL procedure mostly done when there is no electricity.

Conclusion: Examination of the larynx through Indirect laryngoscopy appears to be going into extinction in Otorhinolaryngological practice because of advent of endoscopic facility. The simplicity, non- energy depended, affordability, availability and ability to insulate the surgeon from undue medico-legal tussles makes it invaluable especially in developing countries of the world. It is recommended that every medical student rotating through ORL posting and otolaryngologists in training should be encouraged to master its use as an alternative in cases where scopes are not readily available.

Keywords: Laryngeal Evaluation; Indirect Mirror Laryngoscopy; Valuable Skill; Resource Limited Environment


  1. Holsinger FC., et al. “Examination of the Larynx and Pharynx”. The New England Journal of Medicine 358 (2008): e2.
  2. Ridley MB., et al. “Office diagnostic techniques. The adult patient”. In: Fried MP ed. The larynx; a multidisciplinary approach”. 2nd ed. St. Louis: Mosby, (1996): 57-64.
  3. Eziyi JA., et al. “Tracheostomy in south western Nigeria: Any change in pattern?” Journal of Medicine and Medical Science7 (2011): 997-1002.
  4. Iseh KR and Malami SA. “Patterns of head and neck cancers in Sokoto”. Nigerian Journal of Otorhinolaryngology 3 (2006): 77-83.
  5. Nwawolo CC., et al. “Pattern of head and neck cancers among Nigerians in Lagos”. West African Journal of Medicine 2 (2001): 111-116.
  6. Nwaorgu OG., et al. “Laryngeal carcinoma: clinical features seen at University college hospital Ibadan”. Tropical Doctor 4 (2002): 236-237.
  7. Ahmad BM and Pindiga UH. “Malignant neoplasms of the ear, nose and throat in northeastern Nigeria”. Highland Medical Research Journal1 (2004): 45-48.
  8. Bailey B. "Laryngoscopy and laryngoscopes--who's first? The forefathers/four fathers of laryngology". The Laryngoscope8 (1996): 939-943.
  9. Hirsch NP., et al. “Alfred Kirstein. Pioneer of direct laryngoscopy". Anaesthesia 1 (1986): 42-45.
  10. Szmeja Z and Kruk-Zagajewska A. “Diagnosis of laryngeal cancer”. Otolaryngology Polish5 (1995): 395-409.
  11. Grabas CS., et al. “The relevance of mirror examination in modern Otorhinolaryngology”. UgeskrLaeger47 (2001): 6586-6589.
  12. Fowler C and Dumas C. “Indirect mirror laryngoscopy”. In: Pfenninger JL, ed. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, Pa: Mosby Elsevier (2010): chap 79.
  13. García M. “Observations on the Human Voice”. Proceedings of the Royal Society of London 7 (1855): 399-410.
  14. Radomski T. "Manuel García (1805-1906): A bicentenary reflection". Australian Voice 11 (2005): 25-41.
  15. Koltai PJ and Nixon RE. "The story of the laryngoscope". Ear, Nose, and Throat Journal7 (1989): 494-502.
  16. Rosen CA., et al. “Evaluating hoarseness: keeping your patient's voice healthy”. American Family Physician11 (1998): 2775-2782.
  17. Johnson PR., et al. “Indirect laryngoscopic evaluation of vocal cord functions in patients undergoing transhiatalesophagectomy”. Journal of the American College of Surgeons 6 (1994): 605-608.
  18. Randolph GW and Kamani D. “The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy”. Surgery3 (2006): 357-362.
  19. Olaosun AO., et al. “Mirror Laryngoscopy: a Review of 43 cases”. Surgery Journal2 (2009): 29-34.
  20. Grabas CS., et al. “The relevance of mirror examination in modern otorhinolaryngology”. UgeskrLaeger47 (2001): 6586-6589.
  21. Benjamin B. “Indirect laryngeal photography using rigid telescopes”. Laryngoscope2 (1998): 158-161.
  22. Calhoun KH., et al. “Teaching indirect mirror laryngoscopy”. Otolaryngology–Head and Neck Surgery 1 (1989): 80-82.
  23. Nwaorgu OG., et al. “Hoarseness in adult Nigerians: a University College Hospital Ibadan experience”. Nigerian Journal of Medicine2 (2004): 152-155.
  24. Nwaorgu OGB., et al. “Hoarseness in Children: Clinical Spectrum as seen in the Otorhinolaryngology Department of two Nigerian Tertiary Health Institutions”. Nigerian Journal of Otorhinolaryngology1 (2004): 6-10.
  25. Sayyahmelli M., et al. “Value of Laryngoscopy before and After Thyroidectomy”. RMJ 1 (2009): 89-91.
  26. Barker M and Dort JC. “Laryngeal examination: a comparison of mirror examination with a rigid lens system”. Journal of Otorhinolaryngology2 (1991): 100-103.
  27. Schwartz SR., et al. “Clinical practice guideline: hoarseness (dysphonia)”. Otolaryngology–Head and Neck Surgery 141 (2009): S1-S31.
  28. Baitha S., et al. “Predisposing Factors and Aetiology of Hoarseness of Voice”. IJOHNS3 (2004): 186-190.
  29. Thermann M., et al. “Recurrent laryngeal nerve paralysis after thyroid gland operations. Etiology and Consequences”. Chirurg 9 (1998): 951-956.

Copyright: © 2021 Taiwo O Adedejl., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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