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

Laryngopharyngoscopy; Indirect laryngoscopy; Flexible laryngoscopy; Mirror laryngoscopy; Direct laryngoscopy; Fiberoptic laryngoscopy

Laryngoscopy may be done in three ways:

• Indirect laryngoscopy uses a small mirror held at the back of your throat. The doctor shines a light on the mirror to view the throat area. This simple and fast procedure is most often done in the doctor's office while you are awake. A medicine to numb the back of your throat may be used.
• Fiberoptic laryngoscopy uses a small flexible telescope, which 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.
• Direct laryngoscopy uses a tube called a laryngoscope, which is placed in the back of your throat. The tube may be flexible or stiff. This procedure allows the doctor to see deeper in the throat and to remove a foreign object or sample of 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 depends on which type of laryngoscopy is done. If it is being 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 depends on which type of laryngoscopy is done.

Indirect laryngoscopy using a mirror can cause gagging. For this reason it is not often used in children under age 6 - 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.

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

• Bad breath that does not go away
• Breathing problems, including noisy breathing (stridor)
• 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, if a child swallowed a marble or coin

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

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)

Laryngoscopy is considered a relatively 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

Indirect mirror laryngoscopy should NOT be done:

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

Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guidelines: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009;141:S1-S31.

Fowler C, Dumas C. Indirect mirror laryngoscopy. In: Pfenninger JL, ed. Pfenninger and Fowler's Procedures for Primary Care. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 79.

Courey MS. Complications of laryngoscopy. In: Eisele DW, Smith RV, eds. Complications in Head and Neck Surgery. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 30.