Laryngoscopy (Laryngectomy)

Laryngoscopy (laryngoscopy) is a commonly used examination procedure in otolaryngology. A distinction can be made between direct and indirect laryngoscopy, with indirect laryngoscopy being more commonly performed in ENT practice. When the pharynx and larynx are examined, it is called pharyngo-laryngoscopy. Pharyngo-laryngoscopy allows examination of the function of the larynx during speech and breathing and of the pharynx during swallowing.

Indications (areas of application)

  • Hoarseness
  • Suspicion of acute or chronic laryngitis (inflammation of the larynx).
  • Changes in the vocal cords such as vocal fold polyps (benign neoplasm).
  • Malformations in the area of the larynx
  • Tumors
  • Injuries of the larynx
  • Suspected paralysis of the vocal folds
  • Smokers – these should have regular laryngoscopy, as this is the only way to detect laryngeal carcinoma (cancer of the larynx) in the early stages in time.

The procedures

Laryngoscopy is a procedure to visualize the larynx. A distinction is made between direct and indirect laryngoscopy:

In direct laryngoscopy, the endolarynx (interior of the larynx) is viewed directly by the examiner. The examination is usually performed using microlaryngoscopy (MLS). This procedure allows the endolaryngeal (“located inside the larynx”) to be viewed directly under the microscope in the hyperextended head position. This method is usually performed under anesthesia.Direct laryngoscopy allows for procedures on the vocal cords, such as trial excision (tissue sampling) of the vocal cords, ablation of vocal cord polyps. Note: Visualization of the vocal cord level is facilitated by video laryngoscopy* compared to direct laryngoscopy. In indirect laryngoscopy, the endolarynx is not viewed directly by the examiner. A laryngoscope (laryngeal mirror) is used for this purpose. One hand is used to hold the patient’s tongue, and the other is used to insert the laryngoscope through the mouth and into the pharynx to evaluate the larynx. Indirect laryngoscopy is a simple and quick, non-painful examination method. It can be performed without much preparation and provides important information in the case of the above-mentioned diseases or health risks. Another way to visualize the larynx is the use of flexible or rigid endoscopes (magnifying laryngoscope). These procedures are classified as indirect laryngoscopy. * Laryngoscopy is nowadays preferably performed with a video recording system (= videolaryngoscopy). A distinction is made between transnasal endoscopy (” mirroring through the nose“) and transoral endoscopy (” mirroring through the mouth“).Transnasal flexible laryngoscopy is particularly recommended for testing laryngeal functions. For patients with stronger gag reflex, examination in elbow-knee position is recommended. The use of local anesthesia (local anesthetic) with lidocaine 4% without alcohol facilitates the examination. Microlaryngoscopy is usually performed under general anesthesia (general anesthesia).

Possible complications

  • Injury to the turbinate mucosa (superior nasal concha) or nasal septum with subsequent bleeding (when advancing the endoscope through the inferior nasal access)
  • Tears of the mucous membrane (extremely rare)
  • Mucosal lesions with subsequent scarring and stenosis (narrowing) of the nasal cavity (this extends from the nasal valves to the posterior nasal openings (choanae)), possibly with adhesion (adhesion) of the turbinate to the nasal septum (rare). This can lead to obstruction of nasal breathing.
  • Injury to the mucosa of the laryngeal inlet and lower areas of the pharynx (very rare).
  • Swelling of the mucosa in the area of the laryngeal inlet. This may require inpatient monitoring.

Further notes

  • According to a study of 7743 adult patients who had undergone outpatient direct laryngoscopy with or without biopsy, 232 patients (3.0%) presented again to the treating physician within seven days of laryngoscopy. Reasons for a repeat presentation were:
    • Twenty-one patients (0.27%) had serious respiratory complications (stridor (whistling breathing sound), dyspnea (shortness of breath), or respiratory failure (8 patients), or laryngeal stenosis (narrowing of the larynx) or respiratory edema (6)); no brain damage due to oxygen deprivation was caused or observed in these patients
    • 12 patients (0.15%) had severe complications (syncope/short-term unconsciousness or collapse (4), pneumonia/pneumonia (4), sepsis/blood poisoning (2), wheezing (wheezing), or pain on breathing (2))
    • 58 patients (0.75%) had minor complications (pain, dysphagia (difficulty swallowing), nausea, and dehydration/lack of fluids)

    Two deaths occurred in the seven days after the procedure. The study authors do not provide details on this due to confidentiality.