What is a laryngoscopy?

Cancers diagnosed or treated: Cancer of the larynx

Why performed: Indirect and direct laryngoscopy are both diagnostic. Direct laryngoscopy is used for close-up, comprehensive examination, biopsy, and surgery.

Patient preparation: Indirect laryngoscopy is performed in the doctor’s office and requires no advance preparation. Patients must remove dentures just prior to the examination. Direct laryngoscopy is performed under anesthesia, so the patient must not eat or drink several hours beforehand. Blood tests may be required several days before the procedure to confirm that anesthesia poses no risk.

Steps of the procedure: For indirect laryngoscopy, the patient sits facing the physician. The physician sprays a topical anesthetic on the patient’s tongue and throat prior to inserting the mirror or rigid telescope into the mouth. If a flexible fiber-optic tube is used for viewing, then the nose is sprayed with topical anesthetic/decongestant before the physician threads the tube through a nostril and into the throat.

In direct laryngoscopy, the patient is anesthetized lying face up to allow insertion of laryngoscope into the throat. Anesthesia is delivered via a line inserted into a vein. The throat and larynx are sprayed with topical anesthetic prior to insertion of a small breathing tube followed by the laryngoscope.

After the procedure: Laryngoscopy is usually performed on an outpatient basis. If extensive surgery is also performed, however, then an overnight hospital stay may be necessary. Patients who have biopsy or surgery with laryngoscopy may experience hoarseness, and slight bleeding is normal. After surgery, patients may be advised not to smoke, to rest the voice, and to avoid coughing or throat clearing.

Risks: Laryngoscopy is a generally safe procedure. Rare complications of direct laryngoscopy are excessive swelling or spasm of the larynx, which are medical emergencies if breathing is hindered. The most common side effects caused by laryngoscope insertion are sore throat, gums, lips, or tongue. Tongue numbness may occur, but feeling usually returns in a few weeks. Rarely, introduction of the laryngoscope may chip a tooth.

Results: Normal vocal cords are symmetrical and move freely. If cancer is present, then cord movement may be reduced or absent on one side or cords may appear asymmetrical. Normal tissues appear pink and smooth. Raised, irregular white or red lesions or ulcerated, bleeding masses are suspicious. Biopsy and pathology are necessary to determine whether lesions are cancerous.

Bibliography

Paolini, Jean-Baptiste, Francois Donati, and Pierre Drolet. "Review Article: Video-Laryngoscopy; Another Tool for Difficult Intubation or a New Paradigm in Airway Management?" Canadian Journal of Anesthesia 60.2 (2013): 184–91. Print.

Paul, Benjamin C., et al. "Diagnostic Accuracy of History, Laryngoscopy, and Stroboscopy." Laryngoscope 123.1 (2013): 215–19. Print.

Puchner, Wolfgang, et al. "Indirect versus Direct Laryngoscopy for Routine Nasotracheal Intubation." Journal of Clinical Anesthesia 23.4 (2011): 280–85. Print.

Sataloff, Robert T., et al. Atlas of Laryngoscopy. San Diego: Plural, 2012. Print.

Ward, Elizabeth C., and Corina J. van As Brooks. Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes. San Diego: Plural, 2014. Print.