Flexible Laryngoscopy – An Overview

The physician may position themselves either in front of or towards the side of the patient before inserting the flexible laryngoscope. The patient is position with their chin tilted upwards. The laryngoscope is advanced along the floor of the nose. In cases of septal deviation or large inferior turbinate, the laryngoscope may be advanced above the inferior turbinate.

The physician will then evaluate the nasal chamber for any abnormalities as the laryngoscope is advanced into the nasopharynx and then further for access to the larynx. More maneuvers may be performed to better visualize the features of the larynx.

As the laryngoscope is withdrawn other areas of the hypopharynx and nasopharynx may be viewed.

Direct laryngoscopy can be performed using a flexible fiberoptic camera to evaluate the gross appearance of the nasopharynx, oropharynx, and laryngopharynx. This procedure is deemed medically necessary during the following:
• Assessing the progression of treatment for aerodigestive tract disorders.
• Screening the upper aerodigestive tract for tumor recurrence.
• Monitoring the growth of identified lesions.
• Evaluation of vocal cord function following surgery.

-Acute epiglottitis
-Laryngotracheobronchitis (Croup)

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Before insertion of the flexible laryngoscope a local anesthetic and a decongestant is applied through the nasal passage to numb the area of insertion. To avoid startling, the patient is warned you will be spraying liquid into their nose that may cause irritation. To anesthetize the pathway, the spray should be directed posteriorly and parallel to the floor of the nasopharynx. The applied spray may take several minutes to take effect.

As the laryngoscope is inserted, the size and condition of the nasal septum and turbinates are evaluated. As the laryngoscope is inserted past the soft palate the vocals folds and epiglottis are inspected for any polyps, nodules, leukoplakia, or any other abnormal findings. To exam the base of the tongue and valiculi the patient is instructed to stick out their tongue. The patient may be asked to phonate “EEE” to evaluate complete abduction and adduction of the vocal folds. The patient can be asked to “puff out” their cheeks to inspect the piriform sinuses. During the withdrawal of the laryngoscope other areas of the hypopharynx are inspected such as in cases of sleep apnea. Superiorly the nasopharynx may be inspected to visualize the adenoids and eustachian tube.

Larygoscopy is a commonly done procedure and injuries are highly uncommon. However, risks from this procedure include: nasal irritation, bleeding, infections, and reaction to anesthesia.
This is done on an outpatient basis and performed as part of the physical exam. Recovery time from this procedure is minimal. This procedure should take approximately 3 to 5 minutes. The effects of the anesthesia should last only a few hours.

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