Diagnostics: Direct Laryngoscopy (in a clinic setting)
Fiberoptic laryngoscopy is a brief office examination that uses a thin, flexible camera to look at the nose, throat, and voice box (larynx).
What this procedure is
Flexible fiberoptic laryngoscopy, also called nasolaryngoscopy, is a common office examination that allows a clinician to look directly at the inside of the nose, the throat, and the voice box (larynx). It uses a very thin, flexible tube called an endoscope with a tiny light and camera at its tip. The scope is passed gently through one nostril and guided down the back of the nose into the throat. The images are usually displayed on a video screen so that the clinician, and often the patient, can watch in real time.
The examination is performed with the person awake and sitting up. It does not require general anesthesia, sedation, or an operating room, and it is one of the most frequently performed procedures in ear, nose, and throat (ENT) care.
Why it is performed
The procedure provides a clear view of areas that cannot be seen by looking in the mouth or nose alone. Common reasons an examination may be ordered include:
Hoarseness or voice changes that do not go away
Chronic cough or throat clearing
Difficulty or pain with swallowing, or a sensation of something stuck in the throat
Persistent nasal blockage, drainage, or postnasal drip
Throat or ear symptoms without a clear cause, including symptoms that may be related to acid reflux
Suspected growths, masses, or lesions in the nose, throat, or voice box
Evaluation of the vocal cords, including how well they move
Nosebleeds or evaluation of a possible foreign object
How it is done in the office
The examination is brief and follows a few steps:
Preparation of the nose. A spray or gel is usually placed in the nostril. This often combines a numbing medicine (a topical anesthetic such as lidocaine) with a decongestant that shrinks the lining of the nose to open up more room and improve comfort. With very thin scopes, some clinicians perform the examination with little or no spray.
Passing the scope. After a few minutes for the medicine to take effect, the flexible scope is passed through the more open nostril, along the floor or middle passage of the nose, and into the throat.
What is examined. As the scope advances, the clinician views the nasal passages, the area behind the nose, the base of the tongue, the epiglottis, and the voice box with its vocal cords. The person may be asked to breathe through the nose, say certain sounds (such as "eee"), swallow, or hold the breath so that movement of the structures can be observed.
Video and stroboscopy. The view is typically recorded on video. In some voice-focused examinations, a special flashing light called stroboscopy is used to view the vocal cords in slow motion, which helps detect subtle problems in how they vibrate.
What it feels like
Most people tolerate the examination well, and studies consistently rate it as causing little discomfort. Common sensations include:
A feeling of pressure or fullness in the nose as the scope passes
A brief urge to gag, cough, or "tear up"
An unpleasant taste from the numbing spray
These sensations are temporary and usually settle as soon as the scope is removed. Feeling nervous beforehand is common.
How long it takes
The examination itself typically lasts only a minute or two, though it can be extended when a finding needs closer inspection. Counting the time for the numbing spray to take effect and a short discussion of the findings, the office portion of the visit is usually completed within several minutes.
What can be seen or diagnosed
Because the scope provides a direct, well-lit view, it can identify a wide range of conditions, such as:
Swelling or irritation from allergies, postnasal drip, or acid reflux
Vocal cord problems, including nodules, polyps, swelling, or reduced movement (see voice conditions)
Growths or masses, some of which may need a biopsy (see pathology) or further testing such as CT imaging
Structural issues such as a deviated septum or enlarged tissues, as well as nasal polyps
Signs of infection or inflammation in the throat and voice box
Foreign objects or sources of bleeding
Findings from the examination help guide the next steps in evaluation and care and, in some situations, allow evaluation to proceed without more invasive testing.
Possible risks or side effects
The procedure is generally considered very safe, and serious problems are rare. Most side effects are mild and short-lived:
Gagging or coughing during the examination
Mild sore throat or nasal irritation afterward
A small amount of nosebleeding, which is uncommon and usually stops on its own
Brief lightheadedness or fainting (a vasovagal reaction), which is rare
Throat spasm (laryngospasm), which is very rare and typically resolves quickly
A history of frequent nosebleeds, significant nasal blockage, or an allergy to numbing medicines are among the details a clinician considers before the examination.
What happens after
Recovery is quick. When a numbing spray has been used, the nose and throat may feel unusual or slightly numb for a short time, and eating or drinking is commonly delayed until normal sensation returns to reduce the chance of choking. Because no sedation is involved, return to normal activities, including driving, is typically possible right away.
The clinician often reviews the findings immediately, sometimes using the recorded video, and discusses the results, any additional tests, and follow-up.