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Laryngoscopy

Last updated March 28, 2019

Approved by: Maulik P. Purohit MD MPH

DiverDave

Laryngoscopy involves the visual examination of the back of the throat, which includes the larynx (voice box), with a camera.


Background Information:

What are the other Names for the Procedure?

  • Direct Flexible Laryngoscopy
  • Direct Rigid Laryngoscopy
  • Laryngopharyngoscopy

What is the Laryngoscopy surgical procedure?

  • Laryngoscopy involves the visual examination of the back of the throat, which includes the larynx (voice box), with a camera
  • This procedure will not only help in establishing a diagnosis, but also in the treatment of certain conditions involving the larynx

What part of the Body does the Procedure involve?

A Laryngoscopy procedure involves the larynx and surrounding structures within the windpipe that controls the vocal cords.

Why is the Laryngoscopy surgical procedure Performed?

A Laryngoscopy is performed for the following reasons:

  • To examine condition of the vocal cords
  • Removal of laryngeal polyps, individual nodules, and any additional benign abnormalities
  • Removal of abnormal tissue, which is then sent to a pathologist for examination

What are some Alternative Choices for the Procedure?

Currently, there are no alternatives to a Laryngoscopy procedure.

What are the Recent Advances in the Procedure?

Advancement in the camera used in a laryngoscope, with ability to take high definition video and pictures. 

What is the Cost of performing the Laryngoscopy surgical procedure?

The cost of Laryngoscopy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Laryngoscopy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Laryngoscopy surgical procedure:

How is the Laryngoscopy surgical procedure Performed?

A Laryngoscopy procedure may be performed in the following manner:

Indirect Laryngoscopy:

  • This procedure is performed in the physician’s office and usually requires no anesthesia. Sometimes, a local anesthetic agent may be sprayed onto the back of the throat, to prevent the patient from gagging
  • The physician uses a head gear fitted with a mirror, to focus light onto the back of the throat
  • During this examination, the patient may be asked to make sounds, which causes the vocal cords to move. Using a piece of gauze to hold down the tongue, the physician examines the state of the vocal cord with a tiny mirror
  • Direct Flexible Laryngoscopy:
  • Medication may be used to reduce secretions in the nose and throat, prior to the procedure. The examination is done after numbing the nostrils and throat, with a local anesthetic agent
  • An instrument, called the laryngoscope, is then inserted through the nose and passed down the throat, to examine the vocal cords. This instrument is fitted with a camera and the physician views the transmitted images on a monitor

Direct Rigid Laryngoscopy:

  • This procedure is performed under general anesthesia
  • A rigid laryngoscope (an instrument fitted with a camera) is passed into the throat, via the mouth
  • The surgeon can visualize the vocal cords and also use the instrument to collect samples of tissue for examination
  • It may be also used to remove polyps/nodules (types of growths) on the vocal cords, or remove foreign objects lodged in the throat

Where is the Procedure Performed?

A Laryngoscopy is usually performed in a physician’s clinic/office, or at an out-patient surgery center facility.

Who Performs the Procedure?

An otolaryngologist surgeon performs the Laryngoscopy procedure.

How long will the Procedure take?

  • An Indirect Laryngoscopy lasts about 5-10 minutes
  • A Direct Laryngoscopy procedure takes 15-30 minutes for its completion

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Laryngoscopy procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken.
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Remove any dentures prior to the procedure
  • Prior to a direct rigid laryngoscopy procedure, inform the physician about any current medications you are taking, including blood thinning medications
  • For procedures under general anesthesia, avoid drinking or eating for atleast 8 hours prior to a Laryngoscopy

What is the Consent Process before the Procedure?

A physician will request your consent for Laryngoscopy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Laryngoscopy surgical procedure?

Normally, there are no diagnostic tests performed, prior to a Laryngoscopy procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Laryngoscopy?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Laryngoscopy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia, spray, or general anesthesia by injection and inhalation is administered, prior to the procedure, depending on the type of Laryngoscopy procedure employed.

How much Blood will you lose, during the Procedure?

  • There is no blood loss associated with an Indirect Laryngoscopy procedure
  • If tissue samples/nodules/polyps are removed in a Direct Rigid Laryngoscopy procedure, some small amount of bleeding may occur

What are the possible Risks and Complications during the Laryngoscopy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes
  • A few very rare, but possible risks of the Laryngoscopy procedure include:
  • Swelling and airway obstruction
  • Bleeding or infection following the removal of tissue from the vocal cords
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Laryngoscopy surgical procedure?

  • At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise
  • Following a Direct Rigid Laryngoscopy under general anesthesia, the patient may be monitored for a few hours, until there is complete recovery from the anesthesia and swallowing becomes possible

After the Laryngoscopy surgical procedure:

What are the possible Risks and Complications after the Laryngoscopy surgical procedure?

The possible risks and complications that may arise after a Laryngoscopy procedure are:

  • Excessive bleeding
  • Bleeding or infection following removal of tissue from the vocal cords
  • Swelling of the neck tissues

What is the Prognosis after the Surgery?

  • A complete recovery from a Laryngoscopy procedure is normally achieved. The prognosis is usually excellent and no serious complications are noted, if the abnormal growths (if any) are benign
  • If the abnormal growth is malignant, a larynx removal procedure may be required

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

  • Pain that worsens and swelling of the throat
  • Coughing-up of blood
  • Difficulty breathing
  • Signs of an infection
  • Dizziness
  • Muscle aches, headaches
  • Fever, feeling sick

What Post-Operative Care is needed at Home after the Laryngoscopy surgical procedure?

At home, the following post-operative care is recommended, after a Laryngoscopy procedure:

  • Avoid smoking
  • Avoid speaking for some time - individuals are advised to write written messages, in order to communicate
  • Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
  • Keep the head elevated for a period of time
  • Complete the course of prescribed medication, as advised by your physician
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, per the physician’s advise
  • Avoid all activities that are physically strenuous, if breathing is difficult; follow the physician’s advise

How long does it normally take to fully recover, from the Procedure?

If the vocal cords were handled during the Laryngoscopy procedure, some hoarseness of voice is to be expected for about 2-3 weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Laryngoscopy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a hospital
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)
  • A otolaryngologist

The patient is advised to inquire and confirm the type of billing, before the Laryngoscopy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 21, 2014
Last updated: March 28, 2019