Laryngoscopy

About laryngoscopy

Laryngoscopy is used to find out the cause of voice problems, swallowing difficulties, and throat and ear pain. It can also be used to check for injuries to your throat, narrowing of your throat (strictures), or blockages in your airway.

Laryngoscopy can be done in two ways.

  • Flexible laryngoscopy (also called nasendoscopy) uses a thin, flexible, fibre-optic tube with a light and a camera lens at the end called a laryngoscope. Your surgeon passes the laryngoscope through your nose to the back of your mouth. It’s used for check-ups and to make a diagnosis.
  • Rigid laryngoscopy uses specially designed metal tubes that your surgeon passes through your mouth. He or she can then pass instruments through the tubes to remove a blockage in your throat, take a tissue sample (biopsy), remove polyps (growths) from your vocal cords or to carry out laser treatment.

Both flexible and rigid laryngoscopy procedures are usually performed by an ear, nose and throat (ENT) surgeon.

Preparing for a laryngoscopy

Your surgeon will explain how to prepare for your procedure.

Flexible laryngoscopy is done as an out-patient procedure under local anaesthesia. This completely blocks pain from the inside of your nose and throat and you will stay awake during the procedure. You will usually have the local anaesthetic as a nasal spray, which will also help to decongest your nose.

Rigid laryngoscopy is done as a day-case procedure under general anaesthesia, which means you will be asleep during the procedure.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

At the hospital, your nurse may check your heart rate and blood pressure.

During rigid laryngoscopy your surgeon will apply some pressure at the front of your mouth, on your top teeth, with the laryngoscope. Most surgeons use a gum shield to protect your teeth during the procedure. If you have healthy teeth this won’t usually cause a problem, but it‘s important to let your surgeon know if you have had implants, caps, crowns or other dental work done. It can be a good idea to ask your dentist to make a thin, rigid gum shield for you, which will provide enhanced protection for the procedure.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. You can ask questions about the risks and benefits, and if there are any alternatives to the procedure. This will enable you to give your informed consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a laryngoscopy

Flexible laryngoscopy

This procedure usually takes about 10 minutes.

You will need to be in a seated position for the procedure; often in a dental chair to support your head. Your surgeon will spray the local anaesthetic into your nose. It has an unpleasant taste and will make your throat feel different to normal. These effects last about an hour.

Your surgeon will then pass the laryngoscope through your nose and into the back of your mouth. You will usually be asked to stick your tongue out, talk and blow your cheeks out to allow your surgeon to see your entire throat.

A camera lens on the end of the laryngoscope may be used to send pictures from the inside of your throat to a monitor.

Rigid laryngoscopy

This procedure usually takes about 30 minutes.

You will be asked to remove any dentures or dental plates, contact lenses, glasses and jewellery you have. Then, you will be asked to lie on your back. Once the general anaesthetic has taken effect, your surgeon will carefully pass the laryngoscope down your throat. He or she may look directly into the laryngoscope to examine your throat and larynx.

If necessary, your surgeon will take a biopsy. This is done using special instruments that are passed through the laryngoscope. The biopsy is sent to a laboratory for testing to determine the type of cells and whether these are benign (not cancerous) or malignant (cancerous).

What to expect afterwards

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. After general anaesthesia, you should try to have a friend or relative stay with you for the first 24 hours.

If you have a local anaesthetic, it may take several hours before the feeling comes back into your throat. You shouldn't drink hot drinks until the local anaesthetic has worn off.

If you have a biopsy, your results will be ready several days later and will usually be sent to the surgeon who recommended you for a laryngoscopy. At the hospital, your surgeon may discuss other findings from the laryngoscopy with you before you leave, or you may be given a date for a follow-up appointment.

Recovering from a laryngoscopy

You're likely to have a sore throat for the first few hours after the laryngoscopy. If you need pain relief, you can take over-the-counter medicines, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, always follow your surgeon's advice and contact your motor insurer so that you're aware of their recommendations.

Most people don’t have any problems after a laryngoscopy, but you should seek urgent medical attention if you:

  • cough up or vomit blood
  • have difficulty breathing
  • develop a high temperature

What are the risks?

As with every procedure, there are some risks associated with laryngoscopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example, feeling sick as a result of the general anaesthetic.

Side-effects of a laryngoscopy include:

  • a sore throat
  • loss of voice
  • a stiff neck
  • bleeding from the biopsy site – you may see small amounts of blood in your sputum (phlegm)

Complications

This is when problems occur during or after the procedure. Most people aren’t affected.

Complications of a laryngoscopy can include:

  • difficulty breathing – this can be caused by having the laryngoscope in your throat or because of the effects of the sedative or general anaesthesia
  • reaction to the sedative or general anaesthesia
  • damage to your airway or throat lining – particularly if you have a biopsy taken
  • damage to your teeth – this can happen as the laryngoscope is passed through your mouth

How soon after a laryngoscopy can I eat or drink?

Answer

You will be able to eat and drink as soon as you feel ready, usually the same day as the procedure.

Explanation

After having a laryngoscopy, you’re likely to have a sore throat for a few hours afterwards and may find it difficult to swallow. It's therefore best to start with clear fluids and soft, or liquid food until your throat feels better. Ask your surgeon for advice.

Will having a laryngoscopy affect my voice?

Answer

Your voice may be hoarse for a short while after the procedure, but it's unlikely to have any long-term effects on your voice unless you have a medical problem that affects your voice box (larynx).

Explanation

Your voice is made of tones produced by your larynx. The different sounds you make are formed by your tongue, teeth, lips and nose. Immediately after a laryngoscopy, you may have some swelling in your throat and mouth. This can affect the quality of your voice. Your voice may sound hoarse or you may find you completely lose your voice until the swelling goes down.

If you have a medical condition affecting your larynx then it's possible you may have long-term problems with your voice.

Ask your surgeon to explain the specific risks of the laryngoscopy procedure and how these risks apply to you.

What is an ear, nose and throat (ENT) surgeon?

Answer

An ENT surgeon is trained in the surgical and medical treatment of conditions affecting the ears, nose, throat, head and neck.

Explanation

ENT surgeons manage conditions that affect the ears, nose, throat, head and neck. This includes problems with hearing and balance, sinus infections, snoring and voice and swallowing disorders. They also deal with throat and neck cancers.

ENT surgeons are usually called Mr or Mrs rather than Dr and will have Fellow of the Royal College of Surgeons (FRCS) after his or her name. The Royal College of Surgeons is responsible for the training and examination of surgeons, and supports surgical research in the UK.

If you think you need advice or treatment from an ENT surgeon, contact your GP. He or she will be able to recommend a reputable surgeon or give advice about how to choose where to be treated.