The Breckwoldt Laryngo-reflectoscope By DR. G. H. BRECKWOLDT A s s o c i a t e P r o f e s s o r of S p e e c h , S t . L o u i s U n i v e r s i t y , M i s s o u r i , U . S . A . INTRODUCTION A l t h o u g h t h e B r e c k w o l d t L a r y n g o - R e f l e c - t o s c o p e * s h o u l d p r o v e a u s e f u l i n s t r u m e n t i n t h e c o n s u l t i n g r o o m of t h e m e d i c a l d o c t o r - p a r t i c u l a r l y t h e E . N . T . s p e c i a l i s t - t h e a u - t h o r d e s i g n e d i t e s p e c i a l l y for t h e s p e e c h t h r a p i s t . T h e l a t t e r w o u l d n e v e r a t t e m p t t o t r e a t a n a r t i c u l a t o r y d i s o r d e r w i t h o u t t h o r o u g h l y e x a m i n i n g t h e i n d i v i d u a l ' s s p e e c h m e c h a n i s m . W h y s h o u l d h e e v e r v e n t u r e o r b e f o r c e d t o h a n d l e a v o i c e d i s o r d e r w i t h o u t h a v i n g h a d a s m u c h a s a l o o k a t t h e i n d i - v i d u a l ' s v o i c e m e c h a n i s m ? A v o i c e d i s o r d e r c a n n e v e r b e j u d g e d b y e a r a l o n e ; i t m u s t b e e x a m i n e d v i s u a l l y . T h e t h e r a p i s t h a s t o l e a r n h o w t o e x a m i n e t h e l a r y n x of t h e v o i c e d e f e c t i v e a s w e l l a s h e l e a r n s t o e x a m i n e t h e facial, o r a l , p h a r y n - g e a l , d e n t a l , e t c . , c o n d i t i o n of t h e s p e e c h d e f e c t i v e . A f t e r h a v i n g s t u d i e d t h e a n a t o m y , p h y s i - o l o g y , n e u r o l o g y a n d p a t h o l o g y of t h e v o i c e m e c h a n i s m , h e s h o u l d b e t r a i n e d i n a V o i c e L a b o r a t o r y t o g a i n p r a c t i c a l e x p e r i e n c e i n t h e t e c h n i q u e s of v o i c e e x a m i n a t i o n , w i t h - o u t w h i c h a n y k i n d of t h e r a p y ( u n l e s s g i v e n u n d e r t h e d i r e c t a n d c o n s t a n t s u p e r v i s i o n of a m e d i c a l m a n ) m i g h t b e d a n g e r o u s . O n c e t h e s p e e c h t h e r a p i s t k n o w s n o t o n l y H O W t o l o o k a t a l a r y n x , b u t a l s o W H A T i n d e t a i l t o l o o k for, h e w i l l b e a g r e a t a s s e t t o h i s p r o f e s s i o n . C a s e s w h o c o m e t o t h e t h e r a - p i s t a n d w h o s e v o i c e e x a m i n a t i o n s h o w s o r - g a n i c d e f e c t s w i l l b e r e f e r r e d t o a m e d i c a l d o c t o r O n t h e o t h e r h a n d t h e m e d i c a l m a n w i l l b e a b l e t o s e n d t o t h e V o i c e L a b o r a t o r y * The author could have coined a homogeneous Greek word like "antilamposcope" (from anti- lampo": to reflect light) but preferred to give the instrument the mnemonically more suitable Graeco- Latin name. t h o s e v o i c e c a s e s w h o d o n o t r e q u i r e m e d i c a l t r e a t m e n t , b u t a r e i n n e e d of v o i c e t h e r a p y . T h i s c o - o p e r a t i o n b e t w e e n t h e V o i c e L a b o r - a t o r y a n d t h e m e d i c a l p r o f e s s i o n w i l l e n s u r e t h a t v o i c e c a s e s w i l l r e c e i v e t h e b e s t p o s - s i b l e c a r e . 1. HISTORY OF INDIRECT LARYNGOSCOPY T h e f i r s t s u c c e s s f u l l a r y n g o s c o p i c o b s e r - v a t i o n k n o w n w a s n o t t h e e x a m i n a t i o n of a p a t i e n t o r s u b j e c t b y a d o c t o r , b u t a n A U T O - L A R Y N G O S C O P Y p e r f o r m e d , i n 1854, b y a n a r t i s t . I t w a s t h e f a m o u s S p a n i s h s i n g e r a n d t e a c h e r of s i n g i n g M a n u e l G a r c i a . H e w a s c u r i o u s a b o u t t h e f u n c t i o n i n g of h i s l a r y n x , a n d u s i n g a d e n t a l m i r r o r for o b s e r v i n g , h e w a s t h e f i r s t p e r s o n t o s e e t h e v o c a l folds of a l i v i n g h u m a n b e i n g . I n 1857, t h e p h y s i c i a n C z e r m a k h a d t h e i d e a of p e r f o r m i n g G a r c i a ' s l a r y n x e x a m i - n a t i o n w i t h a n a r t i f i c i a l l i g h t . I n 1858 h e p u b l i s h e d h i s l a r y n g o s c o p i c f i n d i n g s ( i n S i t z - u n g s b e r i c h t , m a t h . - n a t . w i s s . A b t . , XXIX» 5 5 7 · cf. P a n c o n c e l l i - C a l z i a : " Q u e l l e n a t l a s , H a m b u r g , 1940, p . 3 0 ) a n d a p l a t e w h i c h illu- s t r a t e s a n a u t o - l a r y n g o s c o p y , t h e f i r s t p i c - t u r e e v e r p u b l i s h e d of t h i s t y p e of e x a m i n - a t i o n . T w o y e a r s l a t e r , i n I 8 6 0 , C z e r m a k p u b - l i s h e d h i s b o o k " D e r K e h l k o p f s p i e g e l u n d s e i n e V e r w e r t u n g fur P h y s i o l o g i e u n d M e d i - z i n " L e i p z i g , (cf. P . - C a l z i a : Q u e l l e n a t l a s , p . 3 0 ) , i n w h i c h w e find t h e f i r s t i l l u s t r a t i o n of a ' l a r y n g o s c o p y p e r f o r m e d o n a p a t i e n t . S i n c e t h e n , e x c e p t for c h a n g e s i n m a t e r i a l a n d q u a l i t y of t h e l a r y n x m i r r o r , h e a d m i r r o r a n d l i g h t , t h e t e c h n i q u e of i n d i r e c t a u t o - a n d h e t e r o - l a r y n g o s c o p y h a s r e m a i n e d t h e s a m e . T h e o r i g i n a l i t y of t h e B r e c k w o l d L a r y n g o - R e f l e c t o s c o p e , d e s i g n e d b y t h e a u t h o r i n 1962 l i e s i n t h e i n t r o d u c t i o n of a t r a n s - p a r e n t m i r r o r w h i c h e n a b l e s b o t h t h e e x a m - i n e r a n d t h e e x a m i n e e t o h a v e a n e f f o r t l e s s 0 JOURNAL OF THE SOUTH AFRICAN LOGOPEDIC SOCIETY August, 1963 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) a n d p e r f e c t v i e w of t h e l a r y n x . T h e i n s t r u - m e n t c o m b i n e s all a d v a n t a g e s of a u t o - a n d h e t e r o - l a r y n g o s c o p y a n d h a s t h e r e f o r e m u l - t i p l e u s e s . I t c a n b e o p e r a t e d w i t h a c o n t i n - u o u s o r a s t r o b o s c o p i c l i g h t s o u r c e . 2. DESCRIPTION OF THE LARYNGO- REFLECTOSCOPE T h e d i m e n s i o n s of t h e i n s t r u m e n t a r e m a d e t o f a c i l i t a t e t h e r e f l e c t o s c o p i c e x a m - i n a t i o n w i t h t a b l e a n d c h a i r s of a v e r a g e h e i g h t , s o t h a t a p a r t f r o m a b r i g h t l a m p (_|_ 100 w a t t ) * o r a l a r y n g o - s t r o b o s c o p i c l a m p * * n o f u r t h e r e q u i p m e n t is r e q u i r e d . T h e i n s t r u m e n t (cf. F i g 1) c o n s i s t s of:- (1) a r e f l e c t o r ( 3 ^ " d i a m . ) , of t h e t y p e of a m e d i c a l h e a d - m i r r o r , t h e c e n t r a l v i e w - i n g h o l e of w h i c h is b l o c k e d u p ; (2) a p l a n e t r a n s p a r e n t mirror ( 3 " x 6 " ) , of t h e M i r r o p a n e t y p e : (3) t w o ball j o i n t s , o n e a t t a c h e d t o e a c h m i r - r o r ; (4) t w o g o o s e - n e c k a t t a c h m e n t s , ( e a c h 1 2 " i n l e n g t h ) , w h i c h a r e e x t r e m e l y f l e x i b l e b u t r e m a i n s t a b l e in e a c h d e s i r e d p o s i - t i o n ; Fig. 1 The ideal light (i.e. daylight type) is the Burton Lamp (N.1277), made by the Burton Manufac- turing Company, El Segundo, California. With an adjustment to narrow its light beam the Laryngo-Synchronstroboscope KS 3 has proved ideal in conjunction with the Laryngo-Reflecto- scope. The KS 3 instrument is made by R. Timcke, Hamburg, Germany. 1 JOURNAL OF THE SOUTH AFRICAN LOGOPEDIC SOCIETY 1 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) (5) (6) (7) t w o b a l l j o i n t s , o n e a t t a c h e d t o t h e t o p of e a c h g o o s e - n e c k ; t w o j o i n t c o n n e c t o r s , s e c u r i n g t h e m i r - r o r s t o t h e g o o s e - n e c k ; a g o o s e - n e c k h o l d e r d i a m . , h i g h ) , i n t o t h e t o p of w h i c h t h e t w o g o o s e - n e c k s a r e a t t a c h e d a n d t h e b o t t o m p o r t i o n of w h i c h h a s a s h o r t c o a r s e s c r e w t h r e a d p r o j e c t i o n ; (8) a riser b l o c k ( 1 " d i a m . , 3 ' h i g h ) w i t h m a l e a n d f e m a l e c o a r s e t h r e a d ( | " d i a m . ) e n d i n g s t o m a t c h t h e t h r e a d o n t h e b a s e of t h e g o o s e - n e c k h o l d e r ; a n a r m ( 1 3 ^ " l o n g , 1 " w i d e , 3 / 8 " t h i c k ) , w h i c h a t o n e e n d h a s a n u n t h r e a d e d h o l e ( § " d i a m . ; t h e c e n t r e b e i n g f r o m t h e e n d p o i n t of t h e a r m ) a t t h e o t h e r e n d a t h r e a d e d h o l e ( | " d i a m . ; t h e c e n t r e b e i n g f r o m t h e e n d p o i n t of t h e a r m ) , i n t o w h i c h t h e g o o s e - n e c k h o l d e r s c r e w s ; (9) ( 1 0 ) a C - t y p e t a b l e c l a m p , s u i t a b l e t o c l a m p o n t a b l e t o p e d g e s of a t h i c k n e s s b e - w e e n 2 ± " t o f'; ( 1 1 ) a w i n g s c r e w ( 1 " d i a m . ) f i t t i n g i n t o t h e t o p of t h e C - c l a m p a n d h o r i z o n t a l l y s e c u r i n g t h e a r m t o it; (12) a laryngoscopic mirror; (13) a light source. T h e i n s t r u m e n t c a n b e b e n t t o l o w p o s i - t i o n s (cf. F i g . 2) o r c a n b e e x t e n d e d b y m e a n s of t h e r i s e r b l o c k . T h e " l a r y n g o - r e f l e c t o s c o p e " is s t o r e d in a n e s p e c i a l l y t a i l o r e d b o x , w h i c h k e e p s e a c h p a r t s e c u r e l y in p l a c e a n d m a k e s s h i p p i n g p o s s i b l e . Fig. 2 & * - *. ** <«*»*» λ \ ri-v •Π8"' JOURNAL OF THE SOUTH AFRICAN LOGOPEDIC SOCIETY August, 1963 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) Fig. 3 August, 1963 JOURNAL OF THE SOUTH AFRICAN LOGOPEDIC SOCIETY R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 3. USES (a) T h e L a r y n g o - R e f l e c t o s c o p e is u s e d for indirect laryngoscopy and laryngostro- b o s c o p y . T h e r e f l e c t o r , r e p l a c i n g t h e h e a d b a n d a n d m i r r o r , g i v e s t h e e x a m i n - e r m o r e f r e e d o m of m o v e m e n t . T h e t r a n s p a r e n t m i r r o r , a p a r t f r o m i t s r e f l e c - t o s c o p i c u s e , s e r v e s a s a p r o t e c t i n g s h i e l d . (N.B.: F o r t h e e x a m i n a t i o n of i n f e c t i o n - s u s p e c t c a s e s a l a r g e r g l a s s s h i e l d c a n b e m o u n t e d o n t h e i n s t r u - m e n t ) . ( b ) T h e L a r y n g o - R e f l e c t o s c o p e is u s e d t o instruct students of voice science and voice p a t h o l o g y . I t f a c i l i t a t e s : i. t h e f o c u s s i n g of l i g h t ( o n h i m s e l f o r a s u b j e c t ) ; ii. t h e s t u d y of h i s o w n l a r y n x (cf. F i g . 3); iii. t h e s t u d y of h i s o w n l a r y n x , w h i l e o t h e r s w a t c h ; iv. t h e e x a m i n a t i o n of a l a r y n x , w h i l e t h e e x a m i n e e h a s a s i m u l t a n e o u s l o o k ; v . t h e e x a m i n a t i o n of h i m s e l f b y a n o t h e r p e r s o n , w h i l e h e l o o k s a t h i s o w n l a r y n x a t t h e s a m e t i m e ; v i . t h e d e m o n s t r a t i o n of a s u b j e c t ' s l a r y n x , w h i l e a g r o u p of b e t w e e n 6 - 8 p e o p l e l o o k o n . ( c ) I t is i d e a l l y s u i t e d t o s h o w t h e l a r y n x t o certain cases for pedagogic reasons. E x a m p l e s a r e p e o p l e w h o s m o k e , d r i n k o r i n d u l g e in v o c a l a b u s e , f r o m w h i c h t h e y w i l l n o t r e f r a i n , u n l e s s t h e y a r e s h o w n t h e d a m a g e t h e y h a v e d o n e t o t h e i r v o c a l m e c h a n i s m . C o l o u r p h o t o - g r a p h s of l a r y n g e a l n o r m a l i t y a n d a b n o r - m a l i t i e s a r e s h o w n t o m a k e t h e s u b j e c t u n d e r s t a n d h i s / h e r o w n c o n d i t i o n . P e o p l e w h o h a b i t u a l l y p h o n a t e w i t h h a r d g l o t t a l o n s e t s a n d c a n n o t r e f o r m t h r o u g h a u d i t o r y o r k i n e s t h e t i c c o n t r o l w i l l , a s a r u l e , b e n e f i t f r o m t h e v i s u a l a p p r o a c h w i t h t h e L a r y n g o - R e f l e c t o - s c o p e . P r o f e s s i o n a l s p e a k e r s a n d s i n g e r s , v o c a l l y h a n d i c a p p e d b e c a u s e of u n d u e w o r r y a b o u t t h e i r v o i c e s , w h o a r e e x a - m i n e d w i t h t h e i n s t r u m e n t , s p o n t a n e - o u s l y b e c o m e r e a s s u r e d a b o u t t h e i r l a r y n x . I n h i s S p r a c h h e i l k u n d e ( p . 1 6 1 , s e q . ) H . G u t z m a n n s t a t e s t h a t c a s e s of a p h o n i a s p a s t i c a , b o t h of t h e a d d u c t o r a n d t h e a b d u c t o r t y p e , a s w e l l a s s e v e r e d y s p h e m i c s c a n f r e q u e n t l y i m p r o v e r e m a r k a b l y , if t h e y a r e t a u g h t t h e u s e of a u t o - l a r y n g o s c o p i c e q u i p m e n t . 4. CONCLUSION P r a c t i c a l e x p e r i e n c e s h o w s t h a t , t h a n k s t o t h e t r a n s p a r e n t m i r r o r a n d t h e e x t r e m e flexi- b i l i t y of t h e i n s t r u m e n t , t h e L a r y n g o - R e f l e c - t o s c o p e is a p a r t i c u l a r l y e a s y t o h a n d l e , effic- i e n t d e v i c e for v o i c e e x a m i n a t i o n , s t u d e n t t r a i n i n g a n d r e h a b i l i t a t i o n w o r k . SUMMARY T h e L a r y n g o - R e f l e c t o s c o p e is a n i n s t r u - m e n t d e s i g n e d for i n s t r u c t i n g s t u d e n t s in t h e t e c h n i q u e s of v o i c e e x a m i n a t i o n a n d is u s e d for t h e d e m o n s t r a t i o n of t h e l i v e a n a t o m y a n d p h y s i o l o g y of t h e l a r y n x . I t is a l s o u s e d t o s h o w t h e l a r y n x t o c e r t a i n v o i c e c a s e s for p e d a g o g i c a n d t h e r a p e u t i c r e a s o n s . T h e i n s t r u m e n t c a n b e u s e d w i t h a c o n t i n u o u s o r s t r o b o s c o p i c l a m p . NOTE The Laryngo-Reflectoscope was designed by the author and first built in June, 1962. It was shown and/ demonstrated at the Scientific Exhibits of the Con- gress of the International Assocaition of Logopedics and Phoniatrics, at Padua, Aug./Sept., 1962, and of the Convention of the American Speech and Hearing Association, in New York, Nov.1962. JOURNAL OF THE SOUTH AFRICAN LOGOPEDIC SOCIETY August, 1963 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2)