In this procedure the patient protrudes the tongue, which is held gently between the examiner's middle finger and thumb. A warmed laryngeal mirror is introduced firmly against the soft palate in the midline whilst the forefinger is used to hold the upper lip out of the way.
Laryngeal structures can be viewed by tilting the laryngeal mirror. Assessment of the mobility of the cords can be made by asking the patient to say 'EE' - which causes adduction - or to take a deep breath - which causes abduction. Note that the image that is seen using indirect laryngoscopy is reversed.
Indirect laryngoscopy is valuable for rapid assessment of the hypopharynx to exclude or locate a foreign body.
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