Indirect laryngoscopy
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* Greg J. Korzan

I enjoyed the *CMAJ* article by Trottier and colleagues,1 and wish to suggest a possible addition to the initial management of hoarseness algorithm in Figure 3.

Many primary care and emergency physicians are able to perform simple, indirect laryngoscopy with topical anesthesia, a headlamp and a laryngeal mirror. In a cooperative patient, obtaining a decent view of the glottic opening and surrounding area is often possible, and might allow physicians to decide quickly if a patient needs to see an otolaryngologist on an urgent basis. If the physician is unable to obtain a useful view, the algorithm continues as already described.1

Although many emergency physicians have access to and are trained in the use of a fiberoptic nasopharyngoscope, I think the indirect examination may still have a role in certain settings. We should endeavor to pass this skill on to trainees we mentor.

## Reference

1.  Trottier AM, Massoud E, Brown T. A case of hoarseness and vocal cord immobility. CMAJ 2013; 185:1520–4.
    
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