In flexible laryngoscopy, a thin, flexible viewing tube (called a laryngoscope) is passed through the nose and guided to the vocal cords, or larynx. Fiberoptic cables permit a physician to directly inspect the nose, throat, and larynx for abnormalities. Laryngoscopy is typically performed in a doctor’s office using local anesthesia.
Alternatively, a rigid viewing tube may be passed through the mouth for a more thorough inspection, a procedure called rigid laryngoscopy. Instruments may be passed through the scope to obtain tissue samples for microscopic examination, or to perform therapeutic procedures. Rigid laryngoscopy is done in an operating room under general anesthesia.
Purpose of the Laryngoscopy
- To detect laryngeal abnormalities, such as inflammation, lesions, or narrowed passages (strictures)
- To obtain a tissue biopsy in order to confirm suspected cancer of the larynx or to assess the severity of diagnosed cancer
- To help diagnose the cause of a persistent or bloody cough, hoarseness, throat pain, or bad breath
- To determine the cause for difficulty swallowing or a feeling of a lump in the throat
- To determine the cause of other voice problems, such as a breathy voice, weak voice or loss of voice
- Used therapeutically to remove foreign objects or benign lesions such as polyps from the larynx
Who Performs Laryngoscopy
- A physician, usually an ear, nose, and throat specialist (otolaryngologist) or a surgeon.
Special Concerns about Laryngoscopy
- This procedure may be combined with bronchoscopy and esophagogastroduodenoscopy to fully evaluate some people with known head-and-neck cancer; this variation is known as panendoscopy.
Before the Laryngoscopy
- Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You may be instructed to discontinue these agents before the test.
- Tell your doctor if you are pregnant or may be pregnant.
- Tell your doctor if you have had surgery or radiation treatments to your mouth or throat.
- Do not eat or drink anything for 12 hours before the test if you are undergoing general anesthesia, or 8 hours if you are receiving local anesthesia.
- Do not smoke and lose weight if you are overweight.
- You will be instructed to remove contact lenses, dentures, and jewelry and to empty your bladder before the test begins.
- Before you receive general anesthesia, an intravenous (IV) needle or catheter is inserted into a vein in your arm.
- If local anesthesia is to be used, you may be given a sedative medication before the test, but you will remain conscious throughout the procedure. You may also be given a drug called atropine to help dry up your saliva. These drugs may be given orally or through an IV line.
What You Experience during Laryngoscopy
- You will sit upright in an exam chair in your doctor’s office.
- Relax and breathe through your nose. A local anesthetic is sprayed into the back of your nose and throat to numb these areas and suppress the gag reflex (however, you may still gag and feel some discomfort when the laryngoscope is first inserted).
- The doctor inserts the scope through one nostril and closely inspects your nose, throat, and larynx.
- Photographs may be taken with a tiny camera attached to the scope.
- This procedure usually takes 5 to 10 minutes, though the anesthetic may last up to an hour.
- You will lie on your back on an operating room table, and general anesthesia is administered.
- A rigid laryngoscope is inserted into your mouth and the doctor inspects your throat and larynx. Instruments may be passed through the scope to remove tissue samples for laboratory analysis. (In some cases, a special blue dye may be applied to suspicious areas in order to stain abnormal cells and identify areas for biopsy.)
- Photographs may be taken of the larynx with a tiny camera attached to the scope.
- If necessary, therapeutic procedures, such as removal of polyps, may also be done with a rigid scope and specialized instruments.
- This procedure usually takes 30 minutes to 1 hour.
Risks and Complications of Laryngoscopy
- Most patients experience temporary hoarseness and a sore throat. Rare complications include inadvertent injury of the mouth or throat, excessive swelling, bleeding, infection, pain, vomiting and gagging.
- If the procedure was performed under general anesthesia, it will carry all the associated risks.
After the Laryngoscopy
- You will lie down in a recovery room to recuperate from the effects of anesthesia or sedation. (If you received general anesthesia, you will be placed with your head slightly elevated to prevent aspiration of foreign contents into your lungs.) During this time, your vital signs will be monitored, and you will be observed for any signs of complications.
- At first, you will be given a basin and asked to spit out your saliva rather than swallow it. If you had a biopsy, you will also be advised to avoid coughing, clearing your throat, and smoking until it is clear there are no complications.
- You may be given an ice collar to minimize any throat swelling.
- You may be given pain-relieving medication, if needed.
- If you received local anesthesia, you will not be allowed to eat or drink until your gag reflex returns, usually in a few hours. (Touching the back of the throat with a tongue depressor tests for this reflex.)
- You will likely be able to return home in 4 hours if local anesthesia was used; general anesthesia may necessitate an overnight hospital stay. You may then resume your usual activities and (according to your doctor‘s instructions) any medications withheld before the test.
- You may feel hoarse or have a sore throat for several days. Lozenges or a warm saline gargle may provide some relief. You may also cough up small amounts of blood for several days.
- Contact your doctor immediately if you develop excessive bleeding, hoarseness, coughing, , difficulty breathing or swallowing, chest pain, severe nausea, vomiting or a high fever after the test.
Results of Laryngoscopy
- During the visual inspection of your mouth, throat, and larynx, the doctor will note any abnormalities. In some cases, this examination is sufficient to provide a diagnosis.
- If tissue or fluid samples were taken, specimen containers may be sent to several different laboratories for examination. For example, biopsied tissue may be inspected under a microscope for the presence of unusual cells, or may be cultured for infectious organisms.
- This test usually results in a definitive diagnosis. Your doctor will recommend appropriate medical or surgical treatment, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media