Laryngoscopy is an examination that lets your doctor look at the back of your throat, your larynx and vocal cords with a scope (laryngoscope). There are two types of laryngoscopy, and each uses different equipment.
Indirect laryngoscopy is done in a doctor’s office using a small hand mirror held at the back of the throat. Your doctor shines a light in your mouth and wears a mirror on his or her head to reflect light to the back of your throat. Some doctors now use headgear with a bright light.
Indirect laryngoscopy is not done as much now because flexible laryngoscopes let your doctor see better and are more comfortable for you.
Why It Is Done
An indirect or direct laryngoscopy helps a doctor:
- Find the cause of voice problems, such as a breathy voice, hoarse voice, weak voice, or no voice.
- Find the cause of throat and ear pain.
- Find the cause for trouble swallowing, a feeling of a lump in the throat, or mucus with blood in it.
- Check injuries to the throat, narrowing of the throat (strictures), or blockages in the airway.
Direct rigid laryngoscopy may be used as a surgical procedure to remove foreign objects in the throat, collect tissue samples (biopsy), remove polyps from the vocal cords,
- Are allergic to any medicines, including anesthetics.
- Are taking any medicines.
- Have bleeding problems or take blood-thinning medicine, such as warfarin (Coumadin).
- Have heart problems.
- Are or might be pregnant.
- Have had surgery or radiation treatments to your mouth or throat.
Rigid laryngoscopy is done with a general anesthetic. Do not eat or drink for 8 hours before the procedure. If you have this test in your doctor’s office or at a surgery center, arrange to have someone drive you home after the procedure.
How It Is Done
Indirect laryngoscopy and direct flexible laryngoscopy examinations are generally done in a doctor’s office. Most fiber-optic laryngoscopies are done by an ear, nose, and throat specialist (ENT). You may be awake for the examination.
You will sit straight up in a chair and stick out your tongue as far as you can. The doctor will hold your tongue down with some gauze. This lets the doctor see your throat more clearly. If you gag easily, the doctor may spray a numbing medicine (local anesthetic) into your throat to help with the gaggy feeling.
The doctor will hold a small mirror at the back of your throat and shine a light into your mouth. He or she will wear a head mirror to reflect the light to the back of your throat. Or your doctor may wear headgear with a bright light hooked to it. He or she may ask you to make a high-pitched “e-e-e-e” sound or a low-pitched “a-a-a-a” sound. Making these noises helps the doctor see your vocal cords.
The examination takes 5 to 10 minutes.
If a local (topical) anesthetic is used during the examination, the numbing effect of the anesthetic will last about 30 minutes. You can eat or drink when your throat is no longer numb.
Direct flexible laryngoscopy
The doctor will use a thin, flexible scope to look at your throat. You may get a medicine to dry up the secretions in your nose and throat. This lets your doctor see more clearly. A topical anesthetic may be sprayed on your throat to numb it.
The scope is put in your nose and then gently moved down into your throat. As the scope is passed down your throat, your doctor may spray more medicine to keep your throat numb during the examination. The doctor may also swab or spray a medicine inside your nose that opens your nasal passages to give a better view of your airway.
How It Feels
You may feel like gagging when the mirror is placed in your throat. It may be uncomfortable when the doctor pulls on your tongue. If this becomes painful, signal your doctor by pointing to your tongue, since you will not be able to speak. If a spray anesthetic is used, it tastes bitter, it can make you feel like your throat is swollen, and it may make you feel that it is hard to swallow.
Direct flexible laryngoscopy
It may feel strange to have the doctor put the scope up your nose. But it should not hurt and you will still be able to breathe. If a spray anesthetic is used, it may taste bitter. The anesthetic can also make you feel like your throat is swollen. You can swallow normally but you may not feel it.
All types of laryngoscopy have a small chance of causing swelling and blocking the airway. If you have a partially blocked airway because of tumors, polyps, or severe inflammation of the tissues at the back of the throat (epiglottitis), you may have a higher chance of problems.
If complete blockage of the airway occurs, which is rare, your doctor may need to put a tube in your throat to help you breathe. Or, very rarely, your doctor may have to make a cut (incision) in your neck (a tracheotomy).
If a biopsy was taken, there is a very small chance of bleeding, infection, or a tear in the airway.