Laryngoscopy is a medical procedure that utilizes specialized endoscopic instruments to observe the structures of the larynx. It is primarily used for diagnosing voice abnormalities, breathing difficulties, or suspected laryngeal lesions. This technique allows direct visualization of the laryngeal mucosa, vocal cords, and surrounding tissues, enabling immediate detection of tumors, inflammation, or foreign body obstructions, while also facilitating tissue biopsies or therapeutic interventions. Its minimally invasive design makes the procedure relatively safe and a critical tool in otolaryngology clinical assessment.
This examination can be divided into diagnostic and therapeutic categories. The former mainly involves visual assessment, while the latter combines minimally invasive surgical functions. Physicians may adjust the endoscope angle or spray medication during the procedure to thoroughly observe the laryngeal anatomy and formulate subsequent treatment plans based on findings.
Using a metallic or plastic rigid endoscope inserted through the mouth or nose, often under local anesthesia to prevent gag reflex. This type provides high-resolution images suitable for vocal cord vibration analysis or foreign body removal.
The patient is asked to open their mouth, and the physician reflects the laryngeal image using a handheld mirror. This method requires no anesthesia but demands higher operator skill and is commonly used for initial emergency assessments.
Suitable for diagnosing conditions such as vocal cord nodules, polyps, vocal cord paralysis, as well as evaluating long-term sore throat, difficulty swallowing, or unexplained breathing noises. When patients experience abnormal voice lasting more than three weeks without improvement or imaging shows laryngeal shadows, physicians typically recommend this examination.
Other indications include early suspected laryngeal cancer, post-intubation laryngeal injury assessment, and congenital laryngeal anomalies in children. In emergency cases suspected of laryngeal trauma or foreign body impaction, this examination can quickly confirm the lesion location.
Fasting for 2-4 hours before the procedure and signing informed consent are required. Local anesthesia is usually administered with 1% lidocaine spray or gel, with dosage adjusted based on mucosal sensitivity. The procedure lasts approximately 5-20 minutes, during which the patient should remain seated and cooperate by vocalizing as instructed.
Therapeutic procedures, such as vocal cord polyp removal, involve using micro scissors or laser devices, extending the operation time to within 30 minutes. The physician will adjust instrument parameters according to lesion size, for example, laser power settings between 15-30W.
The dynamic observation capability can assess vocal cord closure, which is crucial for diagnosing vocal cord paralysis. For voice professionals, it enables precise lesion localization to develop rehabilitation plans.
Common temporary discomforts include sore throat (about 20% incidence), difficulty swallowing, or increased saliva production, usually resolving within 24-48 hours. A small number of patients may experience allergic reactions to anesthetic drugs, such as rash or breathing difficulties, requiring immediate medical attention.
Serious risks include mucosal tears (0.5% incidence) or anesthesia-induced arrhythmias. Patients with poorly controlled diabetes should postpone the procedure. Those with a history of laryngeal surgery may face increased difficulty due to tissue adhesions.
Contraindications include acute laryngeal edema, active bleeding lesions, and patients unable to control cough reflex. Detailed medication history, especially steroid or immunosuppressant use, should be provided before the procedure.
Local anesthetics may interact with tricyclic antidepressants, causing blood pressure fluctuations. Patients undergoing radiotherapy should inform their physician to avoid misjudging mucosal inflammation. Compared to bronchoscopy, laryngoscopy is more limited in scope but can be complemented with ultrasound examinations. When using laser therapy, attention should be paid to sequencing with chemotherapy to avoid delayed tissue healing.
Multicenter studies show that laryngoscopy has a diagnostic accuracy of 98% for vocal cord tumors, with a misdiagnosis rate below 2%. Dynamic laryngoscopy has a sensitivity of up to 85% for assessing vocal cord function and is considered the gold standard in voice medicine.
Compared to traditional endoscopy, fiberoptic laryngoscopy reduces the risk of nerve injury by 40% and increases patient acceptance by 30%. Long-term follow-up indicates that patients receiving combined therapeutic procedures have a 60% lower recurrence rate than those treated with medication alone.
Imaging techniques such as pharyngeal and laryngeal MRI can reveal deep tissue lesions but lack immediate therapeutic capability. Acoustic analysis tools can evaluate voice patterns but cannot replace visual diagnosis. Bronchoscopy extends to the trachea but involves higher anesthesia risks. Ultrasound is useful for superficial lesions but cannot assess submucosal structures. For patients unable to undergo endoscopy, pharyngeal and laryngeal CT scans may be considered, keeping in mind radiation exposure concerns.
What preparations are needed before the examination? Is fasting or anesthesia required?
Before laryngoscopy, fasting for 4 to 6 hours is generally recommended to reduce the risk of vomiting. Local anesthesia with spray can be applied 10 minutes prior to numb the throat; for general anesthesia (common in children or highly anxious patients), fasting and transportation arrangements should follow anesthesiology instructions. Avoid anticoagulants on the day of the procedure and inform medical staff of any allergies.
Is sore throat or hoarseness after the examination normal? How long does it last?
Mild sore throat or hoarseness is common and usually resolves within 1-2 days. If pain persists beyond 3 days, or if there is fever or difficulty breathing, medical attention should be sought. It is recommended to avoid hot drinks, spicy foods, and vigorous throat clearing within 24 hours post-procedure. Lozenges can help soothe the throat.
How should I communicate with medical staff if I feel anxious or uncomfortable during the procedure?
Pre-arranged signals (such as raising a hand) can be used to indicate the need to pause or adjust. Deep breathing and relaxing during local anesthesia can help, following the physician’s instructions. If sedatives are used, a family member should accompany the patient, and driving or operating machinery on the same day should be avoided.
When can I resume normal speech after the procedure? Should I rest or stop working?
It is advisable to reduce speaking for 24 hours, using whispering as a substitute, and avoid strenuous activity. If abnormalities are found requiring treatment (e.g., removal of vocal cord polyps), follow the physician’s recommended rest period (usually avoiding singing or long conversations for about a week). Mild cases can typically return to work the next day but should avoid high-stress environments.
What are the differences in indications and risks between local and general anesthesia for laryngoscopy?
Local anesthesia is suitable for cooperative adults, allowing immediate observation of vocal cord movement with quick recovery, but may cause a foreign body sensation. General anesthesia is used for uncooperative patients (such as children or severe phobics), enabling detailed tissue biopsies but involves anesthesia risks and recovery time. The physician will choose the safest option based on lesion location, patient health, and examination purpose.
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