Laryngoscopy: Types, Preparation and Recovery

01The examination

What the examination shows

The main purpose of a laryngoscopy, according to East Kent Hospitals, is to examine the voice box and vocal cords, check how they move and diagnose or rule out disease. It can also be used for treatment, for example to remove nodules or objects that have been accidentally inhaled.

MedlinePlus explains that a normal result means the throat, voice box and vocal cords look normal. Abnormal results may be due to acid reflux causing redness and swelling of the vocal cords, vocal cord nodules, polyps (benign lumps), inflammation in the throat, thinning of the muscle and tissue in the voice box with age (presbylaryngis) or, less often, cancer of the throat or voice box. Having a laryngoscopy does not mean that cancer is suspected.

02Reasons

Reasons for examining the voice box

MedlinePlus lists symptoms that may lead to a laryngoscopy:

• voice problems lasting more than 3 weeks, such as hoarseness, a weak, raspy or absent voice
• difficulty swallowing or the feeling that something is stuck in the throat
• a long-term cough or coughing up blood
• breathing problems, including noisy breathing (stridor)
• throat pain or ear pain that does not go away
• bad breath that does not go away
• long-term upper respiratory problems in a smoker
• a lump in the head or neck area

Our guides on hoarseness and the feeling of a lump in the throat explain these symptoms in more detail.

03Flexible

Flexible examination through the nose

MedlinePlus describes fiberoptic laryngoscopy, also called nasolaryngoscopy, as the most common way to examine the voice box. A small flexible telescope is passed through the nose into the throat while you are awake. Numbing medicine is sprayed into the nose first. East Kent Hospitals explains that it is done in an outpatient or emergency clinic by a doctor or experienced nurse, who checks how the voice box moves and examines the vocal cords.

MedlinePlus says it may cause a feeling of pressure and a feeling that you are going to sneeze, and East Kent Hospitals says you may feel slight discomfort. MedlinePlus notes that the scope itself is usually in place only briefly, and that the flexible examination can also be done in children, but the length of the whole appointment varies.

04Direct

Rigid examination and general anesthesia

A direct laryngoscopy uses a tube called a laryngoscope placed at the back of the throat through the mouth. MedlinePlus explains that it lets the doctor see deeper into the throat, take a tissue sample (biopsy) or remove an object blocking the airway, such as a swallowed coin. It is done in a hospital under general anesthesia, so you are asleep and pain-free.

East Kent Hospitals describes it as being carried out in an operating theater with a rigid scope, with biopsies of any suspicious areas. Small operations, such as removing vocal cord polyps, can also be done this way. Terminology differs between sources: MedlinePlus notes that the tube for direct laryngoscopy may be flexible or stiff, so it helps to ask your team exactly which approach and anesthesia are planned.

05Mirror and strobe

Mirror examination and stroboscopy

Indirect laryngoscopy uses a small mirror held at the back of the throat while a light is shone on it. MedlinePlus describes it as a simple procedure usually done in the office while you are awake, sometimes with a medicine to numb the back of the throat. It can cause gagging, so it is not often used in children under 6 to 7 or in people who gag easily. MedlinePlus says it should not be done in infants or very young children, in people with acute epiglottitis (swelling of the flap of tissue in front of the voice box) or in those who cannot open the mouth wide.

Laryngoscopy can also be done with a strobe light, known as laryngeal stroboscopy. MedlinePlus says that using strobe light can give the doctor more information about problems with the voice box, which is why it is used when assessing voice disorders. Like the mirror examination, it can cause gagging.

06Preparation

Confirming preparation and medication instructions

MedlinePlus explains that preparation depends on the type of laryngoscopy. For a procedure under general anesthesia, you may be asked not to eat or drink for several hours beforehand. A clinic examination with a flexible scope or mirror usually needs little preparation, but your team will tell you what applies to you.

East Kent Hospitals asks patients to tell the surgeon before the procedure about any loose or chipped teeth, because instruments placed through the mouth can dislodge or chip them further. Do not stop or change regular medicines, including blood thinners, aspirin or diabetes treatment, unless your team tells you to. Before the appointment, it helps to confirm: which type of laryngoscopy is planned, whether you need to fast, what to do with your medicines, whether someone should accompany you and whether you may need to stay overnight.

07Risks

What discomfort and risks may occur

MedlinePlus describes laryngoscopy as a safe procedure, with risks that depend on the specific type. They may include:

• an allergic reaction to anesthesia, including breathing and heart problems
• infection or bleeding, including nosebleeds
• spasm of the vocal cords, which causes breathing problems
• ulcers in the lining of the mouth or throat
• injury to the tongue or lips

East Kent Hospitals notes that all general anesthetics carry some risk, which the anesthetist discusses beforehand. After a flexible examination with local anesthetic, the back of the throat may feel numb and swollen for about 30 minutes, and the leaflet advises not eating or drinking during that time.

08Recovery

Recovery after different procedures

Recovery depends on what was done. After a clinic examination with a local anesthetic spray, the main precaution in the East Kent leaflet is not to eat or drink until the numbness has worn off. After a direct laryngoscopy, East Kent Hospitals explains that you may have a sore throat for a short time, treated with simple painkillers, some soreness if a biopsy was taken and a small amount of bleeding. Your surgeon may advise an overnight stay in case swelling in the larynx affects breathing.

At home, your doctor may ask you to rest your voice, sometimes for a week. If you need to speak, use a normal voice, since whispering and shouting strain the vocal cords. Healing usually takes 1 to 2 weeks and the voice may not be back to normal until then. East Kent Hospitals also recommends stopping smoking. Ask your team when you can eat, drink and drive, as this depends on the anesthesia used.

09Sources

Where the sources differ

MedlinePlus and East Kent Hospitals agree on the main types of laryngoscopy, but there are differences worth knowing:

• Mirror examination. East Kent Hospitals says it has no side effects and does not hurt; MedlinePlus notes that it can cause gagging and should not be used in some people.
• Direct laryngoscopy. East Kent Hospitals describes a rigid scope; MedlinePlus says the tube may be flexible or stiff. Both place it under general anesthesia.
• Steam. East Kent Hospitals suggests steam inhalations for a dry, sore throat after the procedure and for acute laryngitis. Hot steam can scald, so follow your own team’s advice on whether and how to use it.
• Voice rest and results. Voice rest for a week is something your doctor may recommend, not a rule after every examination. After a biopsy, East Kent Hospitals usually arranges a follow-up appointment within about two weeks, but timing varies between hospitals.

10Summary

In summary

A laryngoscopy examines the voice box and vocal cords. A flexible scope through the nose while you are awake is the most common method; a mirror or strobe light may also be used, and a direct laryngoscopy under general anesthesia allows biopsies and small operations. It is done for symptoms such as persistent hoarseness, swallowing problems, a long-term cough or noisy breathing.

If a biopsy is taken, results are discussed at a follow-up appointment, and you may be referred to a speech and language therapist for voice therapy. In our ENT practice in Bilbao we offer consultations to assess voice and throat symptoms and explain whether an examination of the larynx is needed (consultations are in Spanish). Seek emergency care for breathing problems or bleeding that does not stop after the procedure.