Laryngoscopy

Definition

Laryngoscopy is the visual exam of the voice box (larynx) and the vocal cords. It is also done to remove foreign objects stuck in the throat or to biopsy growth on the vocal cords. There are two main kinds:

Indirect laryngoscopy—uses mirrors to examine the larynx and hypopharynx (a portion of the passageway to the lungs and stomach)

Direct laryngoscopy—uses a special instrument, most often a flexible scope

The Larynx

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Parts of the Body Involved

A laryngoscopy involves the mouth and the throat.

Reasons for Procedure

Laryngoscopy is used to examine and diagnose problems inside the throat. It is most often performed for the following reasons:

  • To diagnose the cause of a persistent cough, hoarseness, throat pain, or bad breath
  • To visualize a mass in the throat
  • To evaluate reasons for difficulty swallowing
  • To remove a foreign object
  • To diagnose suspected cancer
  • To evaluate a possible cause for persistent earache

Risk Factors for Complications During the Procedure

  • Difficulty breathing, hoarseness
  • Infection or inflammation of the throat
  • Bleeding disorder

What to Expect

Prior to Procedure

Your doctor may do some of the following:

  • Physical exam
  • Chest x-ray
  • Barium swallow—a series of x-rays of the larynx and esophagus that are taken after drinking a barium-containing liquid
  • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body

In the days leading up to your procedure:

  • Review your regular medications with the doctor. If you are taking blood-thinners, you may be asked to discontinue them for some time before the laryngoscopy.
  • You'll probably be asked to avoid taking aspirin and ibuprofen for several weeks prior to your procedure.
  • Arrange for a ride to and from the procedure.
  • For a direct laryngoscopy being done under sedation or general anesthesia, you will probably be told not to eat or drink anything for eight hours before the exam. For office procedures under local anesthesia, there is no need to fast.

During Procedure

You will be asked to remove your dentures.

Depending on the type procedure sedation, anesthesia, and medication to decrease secretions may be administered.

Anesthesia

Local or general anesthesia may be used for a direct laryngoscopy.

An indirect laryngoscopy and flexible direct laryngoscopy can be done in the office under local anesthesia.

Description of the Procedure

During either type of laryngoscopy photographs may be taken.

Indirect Laryngoscopy

You sit up straight in a high-back chair with a headrest that pushes your head and jaw forward. The doctor positions a light and mirror to view the back of the throat. The doctor sprays an anesthetic into your throat, which you gargle and spit out. The doctor covers your tongue with gauze and holds it, while you breathe through your mouth as if panting. A warm mirror is held at the back of the throat and tilted to view various directions. You then make an "eee" sound while the doctor watches the larynx. Sometimes foreign objects such as a fish or chicken bone can be removed during the procedure.

Direct Fiberoptic Laryngoscopy

The direct method is most often performed after the more common indirect method to allow for viewing of a greater area, or if your gag reflex did not allow your doctor to do a thorough exam. A rigid angled laryngoscope, a thin, fiberoptic instrument that lights and magnifies images, can provide a more continuous view of the larynx as you breathe. The doctor inserts the scope through your nostril (the flexible scope) or mouth (the rigid angled scope) and into your throat. Through the eyepiece, the doctor examines the larynx. The doctor can then collect specimens, remove benign growths, or retrieve a foreign object trapped in the throat. This method is often done in the operating room under general anesthesia or in the office under local anesthesia.

Direct laryngoscopy can also be done in the operating room under general anesthesia, using a magnifying microscope and rigid laryngoscope. This is done for removal of tumors (benign and Malignant) and for biopsies.

After Procedure

A laboratory will examine the removed tissue.

How Long Will It Take?

An indirect laryngoscopy only takes a few minutes. A direct laryngoscopy takes about 5 to 45 minutes depending on the problem.

Will It Hurt?

Local anesthesia minimizes discomfort during the indirect procedure. With a direct laryngoscopy, you may have a sore throat for a few days.

Possible Complications

  • Cuts on the bottom of the tongue from stretching it over the teeth
  • Anesthesia-related problems
  • Vomiting and gagging
  • Abrasions or bleeding when using a fiberoptic scope
  • Excessive swelling or bleeding
  • Bleeding from the nose if the scope is passed through the nose

Average Hospital Stay

A laryngoscopy is typically an outpatient procedure and requires no hospital stay.

Postoperative Care

  • Do not smoke for 24 hours after the procedure to prevent irritation.
  • Do not try to swallow until your gag reflex returns. Spit out saliva and secretions. Once the gag reflex returns, in about two hours, throat lozenges or a liquid gargle will help decrease hoarseness and throat irritation. Drinking water is encouraged.
  • If a biopsy was taken, avoid clearing your throat or coughing.

Outcome

The doctor performing the exam may discuss the results and treatment options or refer you to a specialist. Biopsy results may take about 3 to 5 days.

Call Your Doctor If Any of the Following Occurs

  • Bleeding, coughing up, spitting out, or vomiting blood
  • Difficulty breathing or swallowing
  • Signs of infection, including fever, chills
  • Hoarse voice
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

American Academy of Otolaryngology- Head and Neck Surgery
http://www.entnet.org/healthinfo/throat/index.cfm

American Cancer Society
http://www.cancer.org/docroot/home/index.asp

CANADIAN RESOURCES:

BC Health Guide, British Columbia Ministry of Health
http://www.bchealthguide.org/

Canadian Digestive Health Foundation
http://www.cdhf.ca/

References:

American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .

Clinical Procedures in Emergency Medicine . 3rd ed. WB Saunders Co.;1998.



Last reviewed March 2008 by Elie Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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