Microlaryngoscopy - adult

Before you agree to have a microlaryngoscopy operation on your voice box it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your voice box treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You may have a problem in your larynx, which is commonly called your voice box. An examination under a general anaesthetic is needed to find out what is wrong. So that we can see a clear, detailed view of your larynx we magnify it using a microscope so that it appears to be larger. This examination is called a microlaryngoscopy.

What is the larynx?

Your larynx is deep inside your throat just behind your Adam's apple. It contains your vocal cords, which you use when speaking. It leads into your trachea, or windpipe, which goes down into your lungs.

What has gone wrong?

You may have problems with your voice, swallowing or breathing. We use a microlaryngoscopy to look for the cause of the following conditions:

• Nerve or structural injury

• Voice problems, such as a hoarse voice, weak voice or no voice
• Throat pain
• Bloodstained saliva or sputum
• Difficulty in swallowing
• A sensation of a lump in the throat
• Injuries to the throat
• Narrowing of the throat
• Obstructions or masses in the throat

We can perform some surgical procedures during the microlaryngoscopy, these include:

• Removing foreign objects
• Taking a biopsy, which is a small tissue sample
• Removing polyps from the vocal cords
• Performing laser treatment, which uses a tiny intense, focused beam of light to cut tissue.

The aims

In the outpatient department, you will probably have had an indirect laryngoscopy, where your surgeon looks into your throat using a mirror or a Fibre-optic nasolaryngoscopy where a fine flexible telescope is passed through your nose to look down your throat. For a microlaryngoscopy we look directly into your larynx using a special telescope, called a laryngoscope. We then focus an operating microscope through the laryngoscope. This is carried out under a full general anaesthetic while you are unconscious.

If you have a swelling we either carefully remove it or take a sample of it, this is called a biopsy. We take biopsies using very fine instruments or we may use a laser to remove a swelling and stop any bleeding. Any removed tissue is sent to the laboratory for tests to find out what it is. You will not need stitches as the area heals quickly.

The benefits

Examining your larynx in this way will help us find out what has gone wrong. Being unconscious with a general anaesthetic will stop you coughing or gagging on the laryngoscope during the procedure. Removal of a swelling through the laryngoscope is quick and recovery after the operation is fast.

Are there any alternatives?

A swelling inside your voice box may show up on x-rays or scans. However, these will not usually tell us what the swelling is or whether it is serious.

Occasionally, in special situations, it may be possible to take a biopsy from a swelling using a small flexible telescope passed through your nose into your throat. We can do this without a general anaesthetic by numbing the lining of your nose and throat with a local anaesthetic.

What if you do nothing?

You may have a problem with your larynx that would go unrecognised if you do not have this procedure. You could miss out on essential treatment. A problem in your larynx might cause serious problems with your voice, swallowing or breathing.

Who should have it done?

If you have throat problems where there is doubt about the cause, you should have a microlaryngoscopy.

Who should not have it done?

If you have another medical condition that makes a general anaesthetic unsafe you should not have one.

Author: Mr Robert Ruckley MB. ChB.  F.R.C.S.  Consultant ENT surgeon.

© Dumas Ltd 2006

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