About Laryngoscopy

Laryngoscopy is a visual examination below the back of the throat, where the voice box (larynx) containing the vocal cords is located. It is an effective procedure for discovering the causes of voice and breathing problems, throat or ear pain, difficulty in swallowing, narrowing of the throat (strictures or stenosis), and airway blockages.

Laryngoscopy is relatively painless, but the idea of having a scope inserted into the throat can be a little scary for kids, so it helps to understand how a laryngoscopy is done.

Laryngoscopies are performed by ear, nose, and throat specialists (ENT). The three kinds of laryngoscopy are:

1. indirect laryngoscopy
2. fiber-optic (flexible) laryngoscopy
   
3. direct laryngoscopy

The indirect procedure can be performed in a doctor's office using a small hand mirror held at the back of the throat. The doctor will aim a light at the back of the throat, usually by wearing headgear that has a bright light attached, to examine the larynx and vocal cords. Indirect laryngoscopy is not typically used with kids because it tends to cause gagging.

Fiber-optic and direct laryngoscopy examinations allow doctors to see deeper into the throat by using either a flexible or rigid telescope. Rigid telescopes are more often used as part of a surgical procedure in evaluating kids with stridor (a noisy, harsh breathing) and removing foreign objects in the throat and lower airway. They're also used in collecting tissue samples (biopsies), laser treatments, and in locating cancer of the larynx.

Why Is Laryngoscopy Performed?

Laryngoscopy is performed to:

• diagnose a persistent cough, throat pain, bleeding, hoarseness, or persistent bad breath
  
• check for inflammation
  
• discover a possible narrowing or blockage of the throat
  
• remove foreign objects
• visualize or biopsy a mass or tumor in the throat or on the vocal cords
  
• diagnose difficulty swallowing
  
• diagnose suspected cancer
  
• evaluate causes of persistent earache
  
• diagnose voice problems, such as weak voice, hoarse voice, breathy voice, or no voice

Preparation

Talk to your doctor about the kind of test being performed, how it will be done, the risks, and the results. Having your questions answered beforehand will help reduce your concerns and give you and your child a better understanding of how the procedure will go.

In many cases, the doctor will have the child undergo a physical exam, chest X-ray, or CT scan (a type of X-ray that uses a computer to take pictures of the inside of the body). Your child also might be asked to swallow a liquid called barium while a series of X-rays of the larynx and esophagus are taken. Barium liquid is harmless and will pass through the body within a day or two. These measures will help your doctor further understand the physical symptoms your child is having.

For an office laryngoscopy in which local anesthesia is used, your child will not need to avoid eating or drinking beforehand.

If general anesthesia will be used, your doctor will give you instructions about your child not eating or drinking before the exam (this is to prevent vomiting). A direct laryngoscopy might be done if, for instance, your child gags easily or the airway below the vocal folds needs to be examined. This is done using general anesthesia, so it is important for your child to avoid eating or drinking within 8 hours before the procedure.

During Laryngoscopy

Indirect laryngoscopy and fiber-optic laryngoscopies often are performed in the doctor's office, usually using local anesthetic. They usually take only 5 to 10 minutes.

Indirect laryngoscopy will require your child to sit up straight in a high-backed chair with a headrest and open his or her mouth wide. The doctor will spray the throat with an anesthetic or numbing medication (which your child will gargle and spit out), then cover the tongue with gauze and hold it down.

The doctor will hold up a warm mirror to the back of the throat and, with a light attached to his or her headgear, will tilt the mirror to view various areas of the throat. Your child may be asked to make high-pitched or low-pitched sounds so that the doctor can view the larynx and see the vocal cords move.

Fiber-optic laryngoscopy uses a fiber-optic laryngoscope (a thin, flexible instrument that lights and magnifies images) for a better view of the larynx and vocal cords.

This might be done in an operating room under general anesthesia or in the doctor's office, and usually doesn't require a hospital stay. The flexible scope is inserted through a nostril or the mouth, then the doctor examines the throat area through the scope's eyepiece. Sometimes the images are displayed on a monitor so that family members can see what the doctor is seeing.

Direct laryngoscopy is done in an operating room and your child will be put under general anesthesia and not feel the scope in the throat. If needed, the doctor will remove foreign objects from the throat, collect tissue samples, perform laser treatment, or remove growths from the vocal cords. This can take as little as 15 to 30 minutes, but might take much longer if specific treatments are required.

After the Procedure

If a local anesthetic or topical numbing spray was used, it will wear off in about 30 minutes. Your child should not eat or drink anything until the spray has worn off and the throat is no longer numb.

After a direct laryngoscopy, your child will be watched by a nurse until fully awake and able to swallow. This usually takes about 2 hours. In some cases, an overnight hospital stay may be required. Your child may have some nausea, general muscle aches, and feel tired for a day or two.

Gargling and sucking on throat lozenges will help with the soreness, and pain medication will be given, if needed. Your child may sound hoarse or have noisy breathing for a few days after the procedure. This is normal. If the hoarseness persists or your child has difficulty breathing, contact your doctor.

Results

The doctor will explain the findings after the procedure. If a biopsy was taken, a laboratory will examine the tissue and report the results to your doctor, who will discuss the results and treatment options with you. Usually, biopsy results take about 3 to 5 days.

Depending on the outcome of the exam, your doctor might schedule an office visit or a follow-up procedure for 4 to 6 weeks after the initial laryngoscopy.

When your child is having any kind of procedure, it's understandable to be a little uneasy. But it helps to know that a laryngoscopy is considered an extremely effective and routine medical exam and complications are rare. However, as with most procedures, there are some risks, which your doctor will review with you. If you have any questions about laryngoscopy, speak with your doctor.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: March 2013