For thousands of years physicians, professors, innovators and a wide array of contributors have been constantly developing better ways to examine and learn more about the throat. There have been many ideas and devices over the last two centuries, utilising mirrors, spatulas and cannulas; sunlight, candles, and headlights; and plenty of angled blades and patient positioning testing and development.

This eventually led to laryngoscopes, which is simply a device that is used to safely view the larynx and aid in intubation. And in this century, we now have video laryngoscopes, which take viewing, recording, and diagnosing problems of the throat to new levels.

The First Efforts To View The Larynx

Here is a quick run through the early discoveries and devices that helped pave the way towards the modern laryngoscope:

• One of the first people to write about airway management, tracheal incubation and supported ventilation was Hippocrates (fifth century BC)[1].
• There are reports of polished metal dental mirrors used to view the mouth and throat during the Roman Empire.
• In the eleventh century, a philosopher/physician by the name of Avicenna introduced the idea of using a cannula to help with tracheal intubation.
• In 1543 Andreas Vesalius, a university professor, performed a tracheotomy on a pig using a reed and was able to demonstrate artificial ventilation.
• Andre Vevret in 1743 developed a speculum to help with the removal of choanal polyps but noted that it lacked sufficient light.

Introducing Light: The first person credited with introducing an external light source is German Philipp von Bozzini in 1807. He developed Lichtleiter (light conductor) which consisted of two tubes with mirrors. One tube used a candle as a light source to help illuminate the throat with the second tube used for viewing.

Glottiscopes to Laryngoscopes: Benjamin Guy Babington presented his Glottiscope to the Hunterian Society in 1829. A speculum was used as a tongue depressor while sunlight and mirrors were used to view the larynx. Strangely, Babington failed to publish any clinical papers on the practical uses of his Glottiscope device. A colleague of Babington was Dr Thomas Hodgkin who is credited with first using the term “laryngoscope” (Dr Hodgkin is well known for his description of a certain type of lymphoma that led to it being labelled Hodgkin’s Lymphoma).

Seeing the Whole Picture: Manuel Garcia II (a singer, teacher and expert in anatomy) is credited with publishing the first paper describing the complete visualisation of the larynx, ‘Physiological Observations on the Human Voice’ in 1855 [2]. Garcia’s paper described the vocal cords, the production of sound and the physiology of the larynx.

Laryngoscopes in Clinical Use

The year 1857 saw the laryngoscope first used in clinical situations. Dr Ludwig Turck of Vienna initially used laryngoscopes in his clinic with little success while later that year Professor Johann Nepomuk Czermak from Budapest successfully used laryngoscopes clinically. Because Czermak was influenced by Turck both were credited with the first clinical use and The French Academy of Sciences divided a medal between them.

The Emergence of Direct Laryngoscopy

The first widely accepted use of direct laryngoscopy is attributed to Alfred Kirstein in 1895, using a bent tongue spatula and sunlight. Soon after, Chevalier Jackson combined direct visualisation of the larynx with endotracheal intubation. His original laryngoscope was used with a headlight, but later versions used a distal light source. The evolution of modern laryngoscopes is based on some of the work from Jackson.

Modern Laryngoscopes

The introduction of fibre optics in the laryngoscopy field occurred in the late 1950s and helped increase the illumination of the larynx. In 1987 Shigeto Ikeda of the Asahi Pentax Corporation developed a prototype for a video bronchoscope. 1988 saw George Berci file a patient for a video endoscope for intubation purposes [3].

The first true commercial video laryngoscope was released in 2001 by John Pacey. The GlideScope used a high-def camera connected via cable to an LCD monitor, was heated to reduce fogging up the camera lens, had a wide viewing angle of 50 degrees and the camera was placed at the point of angulation rather than at the end of the tip [4].

The New Heine visionPRO

Late in 2022, Heine released their first-ever video laryngoscope. As expected from Heine, the product is expertly designed and engineered. The Heine allBRIGHT transflective display shows the working area in true-to-life colours with bright and sharp imagery. A portrait format displays a large field of view, revealing more detail in nearby anatomy. The device has three main components: handle, blade, and display, and can be disassembled and cleaned independently, with Heine smoothSURFACE technology making cleaning even easier. VisonPRO Macintosh blades have been made from upcycled material from discarded refrigerators, making them the first upcycled laryngoscope blades in the world.

For more detailed product information about the Heine visonPRO visit: https://www.sssaustralia.com.au/1491652-heine-visionpro-video-laryngoscope-set-mac-hr1-ds1-cs1

References

[1] https://journals.sagepub.com/doi/pdf/10.1177/0310057X150430S103

[2] http://singerspace.com/articles/chapter-ii-manuel-garcia-ii-the-columbus-of-the-larynx/

[3] https://journals.sagepub.com/doi/pdf/10.1177/0310057X1504300601

[4] https://en.wikipedia.org/wiki/Laryngoscopy