Laryngoscopy and nasolaryngoscopy

Laryngopharyngoscopy; Indirect laryngoscopy; Flexible laryngoscopy; Mirror laryngoscopy; Direct laryngoscopy; Fiberoptic laryngoscopy; Laryngoscopy using strobe (laryngeal stroboscopy)

Laryngoscopy is an exam of the back of your throat, including your voice box (larynx). Your voice box contains your vocal cords and allows you to speak.

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How the Test is Performed

Laryngoscopy may be done in different ways:

Indirect laryngoscopy uses a small mirror held at the back of your throat. Your health care provider shines a light on the mirror to view the throat area. This is a simple procedure. Most of the time, it can be done in your provider's office while you are awake. A medicine to numb the back of your throat may be used.
Fiberoptic laryngoscopy (nasolaryngoscopy) uses a small flexible telescope. The scope is passed through your nose and into your throat. This is the most common way that the voice box is examined. You are awake for the procedure. Numbing medicine will be sprayed in your nose. This procedure typically takes less than 1 minute.
Laryngoscopy using strobe light can also be done. Use of strobe light can give your provider more information about problems with your voice box.
Direct laryngoscopy uses a tube called a laryngoscope. The instrument is placed in the back of your throat. The tube may be flexible or stiff. This procedure allows your provider to see deeper in the throat and to remove a foreign object or sample tissue for a biopsy. It is done in a hospital or medical center under general anesthesia, meaning you will be asleep and pain-free.

How to Prepare for the Test

Preparation will depend on the type of laryngoscopy you will have. If the exam will be done under general anesthesia, you may be told not to drink or eat anything for several hours before the test.

How the Test will Feel

How the test will feel depends on which type of laryngoscopy is done.

Indirect laryngoscopy using a mirror or stroboscopy can cause gagging. For this reason, it is not often used in children under age 6 to 7 or those who gag easily.

Fiberoptic laryngoscopy can be done in children. It may cause a feeling of pressure and a feeling like you are going to sneeze.

Why the Test is Performed

This test can help your provider diagnose many conditions involving the throat and voice box. Your provider may recommend this test if you have:

Bad breath that does not go away
Breathing problems, including noisy breathing (stridor)
Long-term (chronic) cough
Coughing up blood
Difficulty swallowing
Ear pain that does not go away
Feeling that something is stuck in your throat
Long-term upper respiratory problem in a smoker
Mass in the head or neck area with signs of cancer
Throat pain that does not go away
Voice problems that last more than 3 weeks, including hoarseness, weak voice, raspy voice, or no voice

A direct laryngoscopy may also be used to:

Remove a sample of tissue in the throat for closer examination under a microscope (biopsy)
Remove an object that is blocking the airway (for example, a swallowed a marble or coin)

Normal Results

A normal result means the throat, voice box, and vocal cords appear normal.

What Abnormal Results Mean

Abnormal results may be due to:

Acid reflux (GERD), which can cause redness and swelling of the vocal cords
Cancer of the throat or voice box
Nodules on the vocal cords
Polyps (benign lumps) on the voice box
Inflammation in the throat
Thinning of the muscle and tissue in the voice box (presbylaryngis)

Risks

Laryngoscopy is a safe procedure. Risks depend on the specific procedure, but may include:

Allergic reaction to anesthesia, including breathing and heart problems
Infection
Major bleeding
Nosebleed
Spasm of the vocal cords, which causes breathing problems
Ulcers in the lining of the mouth/throat
Injury to the tongue or lips

Considerations

Indirect mirror laryngoscopy should NOT be done:

In infants or very young children
If you have acute epiglottitis, an infection or swelling of the flap of tissue in front of the voice box
If you cannot open your mouth very wide

References

Armstrong WB, Vokes DE, Tjoa T, Verma SP. Malignant tumors of the larynx. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 105.

Mark LJ, Hillel AT, Lester L, Akst SA, Cover R, Herzer K. General considerations of anesthesia and management of the difficult airway. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 5.

Sarber KM, Lam DJ, Ishman SL. Sleep apnea and sleep disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 15

Sidell DR, Messner AH. Evaluation and management of the pediatric airway. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 206.

Syme NP, Hoffman HT, Anderson C, Pagedar NA. Management of early glottic cancer. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 106.

Review Date: 9/10/2023

Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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