n flexible laryngoscopy, a thin, flexible viewing tube (called a laryngoscope) is passed through the nose and guided to the vocal cords, or larynx. Fiberoptic cables permit a physician to directly inspect the nose, throat, and larynx for abnormalities. Laryngoscopy is typically performed in a doctor’s office using local anesthesia.

Alternatively, a rigid viewing tube may be passed through the mouth for a more thorough inspection, a procedure called rigid laryngoscopy. Instruments may be passed through the scope to obtain tissue samples for microscopic examination, or to perform therapeutic procedures. Rigid laryngoscopy is done in an operating room under general anesthesia.

Purpose of the Laryngoscopy

To detect laryngeal abnormalities, such as inflammation, lesions, or narrowed passages (strictures)

To obtain a tissue biopsy in order to confirm suspected cancer of the larynx or to assess the severity of diagnosed cancer

To help diagnose the cause of a persistent or bloody cough, hoarseness, throat pain, or bad breath

To determine the cause for difficulty swallowing or a feeling of a lump in the throat To determine the cause of other voice problems, such as a breathy voice, weak voice

or loss of voice Used therapeutically to remove foreign objects or benign lesions such as polyps from

the larynx

Who Performs Laryngoscopy A physician, usually an ear, nose, and throat specialist (otolaryngologist) or a surgeon.

Special Concerns about Laryngoscopy

This procedure may be combined with bronchoscopy and esophagogastroduodenoscopy to fully evaluate some people with known head-and-neck cancer; this variation is known as panendoscopy.

Before the Laryngoscopy Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-

inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You may be instructed to discontinue these agents before the test.

Tell your doctor if you are pregnant or may be pregnant. Tell your doctor if you have had surgery or radiation treatments to your mouth or

throat. Do not eat or drink anything for 12 hours before the test if you are undergoing general

anesthesia, or 8 hours if you are receiving local anesthesia.

Do not smoke and lose weight if you are overweight. You will be instructed to remove contact lenses, dentures, and jewelry and to empty

your bladder before the test begins. Before you receive general anesthesia, an intravenous (IV) needle or catheter is

inserted into a vein in your arm. If local anesthesia is to be used, you may be given a sedative medication before the

test, but you will remain conscious throughout the procedure. You may also be given a drug called atropine to help dry up your saliva. These drugs may be given orally or through an IV line.

What You Experience during LaryngoscopyFlexible laryngoscopy:

You will sit upright in an exam chair in your doctor’s office. Relax and breathe through your nose. A local anesthetic is sprayed into the back of

your nose and throat to numb these areas and suppress the gag reflex (however, you may still gag and feel some discomfort when the laryngoscope is first inserted).

The doctor inserts the scope through one nostril and closely inspects your nose, throat, and larynx.

Photographs may be taken with a tiny camera attached to the scope. This procedure usually takes 5 to 10 minutes, though the anesthetic may last up to an

hour.

Rigid laryngoscopy:

You will lie on your back on an operating room table, and general anesthesia is administered.

A rigid laryngoscope is inserted into your mouth and the doctor inspects your throat and larynx. Instruments may be passed through the scope to remove tissue samples for laboratory analysis. (In some cases, a special blue dye may be applied to suspicious areas in order to stain abnormal cells and identify areas for biopsy.)

Photographs may be taken of the larynx with a tiny camera attached to the scope. If necessary, therapeutic procedures, such as removal of polyps, may also be done

with a rigid scope and specialized instruments. This procedure usually takes 30 minutes to 1 hour.

Risks and Complications of Laryngoscopy Most patients experience temporary hoarseness and a sore throat. Rare complications

include inadvertent injury of the mouth or throat, excessive swelling, bleeding, infection, pain, vomiting and gagging.

If the procedure was performed under general anesthesia, it will carry all the associated risks.

After the Laryngoscopy

You will lie down in a recovery room to recuperate from the effects of anesthesia or sedation. (If you received general anesthesia, you will be placed with your head slightly elevated to prevent aspiration of foreign contents into your lungs.) During this time, your vital signs will be monitored, and you will be observed for any signs of complications.

At first, you will be given a basin and asked to spit out your saliva rather than swallow it. If you had a biopsy, you will also be advised to avoid coughing, clearing your throat, and smoking until it is clear there are no complications.

You may be given an ice collar to minimize any throat swelling. You may be given pain-relieving medication, if needed. If you received local anesthesia, you will not be allowed to eat or drink until your gag

reflex returns, usually in a few hours. (Touching the back of the throat with a tongue depressor tests for this reflex.)

You will likely be able to return home in 4 hours if local anesthesia was used; general anesthesia may necessitate an overnight hospital stay. You may then resume your usual activities and (according to your doctor‘s instructions) any medications withheld before the test.

You may feel hoarse or have a sore throat for several days. Lozenges or a warm saline gargle may provide some relief. You may also cough up small amounts of blood for several days.

Contact your doctor immediately if you develop excessive bleeding, hoarseness, coughing, , difficulty breathing or swallowing, chest pain, severe nausea, vomiting or a high fever after the test.

Results of Laryngoscopy During the visual inspection of your mouth, throat, and larynx, the doctor will note

any abnormalities. In some cases, this examination is sufficient to provide a diagnosis. If tissue or fluid samples were taken, specimen containers may be sent to several

different laboratories for examination. For example, biopsied tissue may be inspected under a microscope for the presence of unusual cells, or may be cultured for infectious organisms.

This test usually results in a definitive diagnosis. Your doctor will recommend appropriate medical or surgical treatment, depending on the specific problem.

Source:

The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

LaryngoscopySkip to the navigation

Test Overview

Laryngoscopy is an examination that lets your doctor look at the back of your throat, your voice box (larynx) , and vocal cords with a scope (laryngoscope). There are two types of laryngoscopy, and each uses different equipment.

Indirect laryngoscopy

Indirect laryngoscopy is done in a doctor's office using a small hand mirror held at the back of the throat. Your doctor shines a light in your mouth and wears a mirror on his or her head to reflect light to the back of your throat. Some doctors now use headgear with a bright light.

Indirect laryngoscopy is not done as much now because flexible laryngoscopes let your doctor see better and are more comfortable for you.

Direct fiber-optic (flexible or rigid) laryngoscopy

Direct laryngoscopy lets your doctor see deeper into your throat. The scope is either flexible or rigid. Flexible scopes show the throat better and are more comfortable for you. Rigid scopes are often used in surgery.

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Why It Is DoneAn indirect or direct laryngoscopy helps a doctor:

Find the cause of voice problems, such as a breathy voice, hoarse voice, weak voice, or no voice.

Find the cause of throat and ear pain. Find the cause for trouble swallowing, a feeling of a lump in the throat, or mucus with blood

in it. Check injuries to the throat, narrowing of the throat (strictures), or blockages in the airway.

Direct rigid laryngoscopy may be used as a surgical procedure to remove foreign objects in the throat, collect tissue samples (biopsy), remove polyps from the vocal cords, or perform laser treatment. Direct rigid laryngoscopy may also be used to help find cancer of the voice box (larynx).

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How To PrepareIndirect laryngoscopy and direct flexible laryngoscopy

If you wear dentures, you will remove them just before the examination.

Direct rigid laryngoscopy

Before a rigid laryngoscopy, tell your doctor if you:

Are allergic to any medicines, including anesthetics. Are taking any medicines. Have bleeding problems or take blood-thinning medicine, such as warfarin (Coumadin). Have heart problems. Are or might be pregnant. Have had surgery or radiation treatments to your mouth or throat.

Rigid laryngoscopy is done with a general anesthetic. Do not eat or drink for 8 hours before the procedure. If you have this test in your doctor's office or at a surgery center, arrange to have someone drive you home after the procedure.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is DoneIndirect laryngoscopy and direct flexible laryngoscopy examinations are generally done in a doctor's office. Most fiber-optic laryngoscopies are done by an ear, nose, and throat specialist (ENT). You may be awake for the examination.

Indirect laryngoscopy

You will sit straight up in a chair and stick out your tongue as far as you can. The doctor will hold your tongue down with some gauze. This lets the doctor see your throat more clearly. If you gag easily, the doctor may spray a numbing medicine (local anesthetic) into your throat to help with the gaggy feeling.

The doctor will hold a small mirror at the back of your throat and shine a light into your mouth. He or she will wear a head mirror to reflect the light to the back of your throat. Or your doctor may wear headgear with a bright light hooked to it. He or she may ask you to make a high-pitched "e-e-e-e" sound or a low-pitched "a-a-a-a" sound. Making these noises helps the doctor see your vocal cords.

The examination takes 5 to 10 minutes.

If a local (topical) anesthetic is used during the examination, the numbing effect of the anesthetic will last about 30 minutes. You can eat or drink when your throat is no longer numb.

Direct flexible laryngoscopy

The doctor will use a thin, flexible scope to look at your throat. You may get a medicine to dry up the secretions in your nose and throat. This lets your doctor see more clearly. A topical anesthetic may be sprayed on your throat to numb it.

The scope is put in your nose and then gently moved down into your throat. As the scope is passed down your throat, your doctor may spray more medicine to keep your throat numb during the examination. The doctor may also swab or spray a medicine inside your nose that opens your nasal passages to give a better view of your airway.

Direct rigid laryngoscopy

Before you have a rigid laryngoscopy, remove all your jewelry, dentures, and eyeglasses. You will empty your bladder before the examination. You will be given a cloth or paper gown to wear.

Direct rigid laryngoscopy is done in a surgery room. You will go to sleep (general anesthetic) and not feel the scope in your throat.

You will lie on your back during this procedure. After you are asleep, the rigid laryngoscope is put in your mouth and down your throat. Your doctor will be able to see your voice box (larynx) and vocal cords.

The rigid laryngoscope may also be used to remove foreign objects in the throat, collect tissue samples (biopsy), remove polyps from the vocal cords, or perform laser treatment.

The examination takes 15 to 30 minutes. You may get an ice pack to use on your throat to prevent swelling. After the procedure, you will be watched by a nurse for a few hours until you are fully awake and able to swallow.

Do not eat or drink anything for about 2 hours after a laryngoscopy or until you are able to swallow without choking. You can then start with sips of water. When you feel ready, you can eat a normal diet.

Do not clear your throat or cough hard for several hours after the laryngoscopy. If your vocal cords were affected during the laryngoscopy, rest your voice completely for 3

days. If you speak, do so in your normal tone of voice and do not talk for very long. Whispering or

shouting can strain your vocal cords as they are trying to heal. You may sound hoarse for about 3 weeks after the laryngoscopy if tissue was removed. If nodules or other lesions were removed from your vocal cords, you may have to follow

total voice rest (no talking, whispering, or making any other voice sounds) for up to 2 weeks.

LaryngoscopySkip to the navigation

How It Feels

Indirect laryngoscopy

You may feel like gagging when the mirror is placed in your throat. It may be uncomfortable when the doctor pulls on your tongue. If this becomes painful, signal your doctor by pointing to your tongue, since you will not be able to speak. If a spray anesthetic is used, it tastes bitter, it can make you feel like your throat is swollen, and it may make you feel that it is hard to swallow.

Direct flexible laryngoscopy

It may feel strange to have the doctor put the scope up your nose. But it should not hurt and you will still be able to breathe. If a spray anesthetic is used, it may taste bitter. The anesthetic can also make you feel like your throat is swollen. You can swallow normally but you may not feel it.

Direct rigid laryngoscopy

You will be asleep and feel nothing during the laryngoscopy. After the procedure, you may have some nausea, general muscle aches, and may feel tired for 1 to 2 days. You also may have a sore throat and sound hoarse. Suck on throat lozenges or gargle with warm salt water to help your sore throat.

If your child is having this procedure, the same is also true. If your child has a sore throat and is age 4 or older, you can give him or her throat lozenges. Also, a child age 8 or older can gargle with warm salt water.

If a biopsy was taken, it is normal to spit up a small amount of blood after the laryngoscopy. Talk to your doctor about how much bleeding to expect and how long the bleeding may last. Call your doctor immediately if:

You have a lot of bleeding or if the bleeding lasts for 24 hours. You have any trouble breathing.

RisksAll types of laryngoscopy have a small chance of causing swelling and blocking the airway. If you have a partially blocked airway because of tumors, polyps, or severe inflammation of the tissues at the back of the throat (epiglottitis), you may have a higher chance of problems.

If complete blockage of the airway occurs, which is rare, your doctor may need to put a tube in your throat to help you breathe. Or, very rarely, your doctor may have to make a cut (incision) in your neck (a tracheotomy).

If a biopsy was taken, there is a very small chance of bleeding, infection, or a tear in the airway.

Results

Laryngoscopy is an examination that lets your doctor look at the back of your throat, your voice box (larynx), and vocal cords with a scope (laryngoscope). If a biopsy was done, it may take several days for your doctor to know the results.

Laryngoscopy

Normal: The throat (larynx) does not have swelling, an injury, narrowing (strictures), or foreign bodies. Your vocal cords do not have scar tissue, growths (tumors), or signs of not moving correctly (paralysis).

Abnormal: Your larynx has inflammation, injury, strictures, tumors, or foreign bodies. Your vocal cords have scar tissue or signs of paralysis.

LaryngoscopySkip to the navigation

What Affects the TestIf you gag easily, your doctor may need to do a direct rigid laryngoscopy.

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What To Think About Direct rigid laryngoscopy is generally recommended for:

o Children.o People who gag easily because of abnormalities in their throat structure.o People who may have symptoms of laryngeal or pharyngeal disease. o People who have not responded to treatment for laryngeal symptoms.

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ReferencesOther Works Consulted

Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Weinberger PM, Terris DJ (2010). Otolaryngology—Head and neck surgery. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 224–258. New York: McGraw-Hill.

Kemoterapi

Penggunaan obat untuk menangani kanker disebut kemoterapi atau agen

antineoplastik.Obat ini digunakan untuk membunuh sel kanker dan menghambat

perkembangannya.Semua sel baik normal maupun sel kanker berjalan mengikuti

siklus sel. Agen kemoterapi bekerja pada fase siklus sel berbeda disebut siklus non

spesifik, kebanyakan agen kemoterapeutik paling efektif ketika sel-sel secara aktif

sedang membelah.

Kemoterapi terutama digunakan untuk mengobati penyakit sistematik daripada lesi

setempat dan dapat diatasi dengan pembedahan atau radiasi.Kemoterapi mungkin di

kombinasi dengan pembedahan atau terapi radiasi, atau kedua-duanya untuk

menurunkan ukuran tumor sebelum operasi, untuk merusak sel-sel tumor yang masih

tertinggal pasca operasi. Tujuan dari kemoterapi ( penyembuhan , pengontrolan,

paliatif ) harus realistic, karena tujuan tersebut akan menetapkan medikasi yang

digunakan dan keagresifan dari rencana pengobatan.

Agen kemoterapi yang digunakan pada Ca laring atau anti metabolik membunuh sel-

sel kanker dengan memblok sintesis DNA dan RNA. Mereka melakukan ini dengan

meniru struktur metabolik esensial secara kimiawi, yaitu : Nutrien esensial untuk

metabolisme sel normal, Agen umum meliputi : Cytarabine ( ARA-C ), Floxuridine

( FUDR ), 5-Fluorourasial ( 5-FU ), Hydroxyurea ( Hydrea ), 6-Merkaptopurine ( 6-

MP ), Methotrexate ( mexate ) dan 6-Thieguanin. Efek samping yang paling umum

adalah meliputi stomatitis supresi sum-sum tulang dan diare.

a.       Rute pemberian

Obat-obat kemoterapeutik mungkin diberikan melalui rute topical, oral, interval,

intramuskuler, subkutan, arteri, intrakavitasi dan intratekal.Rute pemberian biasanya

bergantung pada tipe obat, dosis yang dibutuhkan dan jenis, lokasi dan luasnya tumor

yang diobati.

b.      Dosis

Dosis preparat anti neoplastik terutama didasarkan pada area permukaan tubuh total

pasien, respon terhadap kemoterapeutik atau terapi radiasi dahulu, fungsi organ utama

dan status kinerja fisik.

 Key Glossary Terms

Rigid LaryngoscopyAn examination of the voice box in which a rigid telescope is used; this examination provides the clearest magnified detail of the voice box, but the patient is unable to speak or sing during the exam

Flexible LaryngoscopyAn examination of the voice box in which a flexible fiberoptic scope is used; this examination allows the physician to view the voice box in action (i.e., while the patient is producing sound)

StroboscopyAn examination in which a strobe light is combined with rigid or flexible laryngoscopy, allowing an examination of vocal fold vibration and vocal fold closure

Glossary In Brief

Since many voice disorders are caused by problems in the voice box and/or throat, a careful and detailed examination of the voice box and throat is key to the identification of the cause or causes of voice disorders. Several methods can be used to examine the throat and voice box. 

Viewing the Voice Box Through Specialized Tube (Endoscope)Rigid laryngoscopy: This examination provides the clearest magnified view of the voice box. A rigid telescope-tube is passed through the patient’s mouth. The examiner then holds the patient’s tongue while viewing the voice box. Images are usually recorded on video.

Also called: telescopic laryngoscopy, transoral laryngoscopy Flexible laryngoscopy: This examination allows for viewing the voice box in action.

Flexible laryngoscopy provides a magnified view of the voice box while the patient produces sound (speaking, singing, etc.). Viewing is done through a flexible viewing-tube passed through the patient’s nose to the back of the throat, thus allowing the examiner to view the voice box while the patient speaks, sings, coughs, sniffs, etc. Images are usually recorded on video.

Also called: fiberoptic laryngoscopy, fiberoptic flexible endoscopy, nasopharyngoscopy, transnasal laryngoscopy

Laryngeal stroboscopy: This examination is a specialized viewing of vocal fold vibration. Laryngeal stroboscopy involves controlled high-speed flashes of light timed to the frequency of the patient’s voice. Images acquired during these flashes provide a slow motion-like view of vocal fold vibration during sound production.

Also called: videostroboscopy, laryngostroboscopy, laryngo-videostroboscopy, stroboscopic laryngoscopy, strobolaryngoscopy

AdvantagesThese technologies provide valuable practitioner and patient information. They allow images to be recorded on video or other media formats, permitting examiners to review the images of the voice box frame by frame, capture still and close-up images, and re-review images with members of the voice care team. Patients can also view the recorded images and see the reason(s) for their voice problems. (For more information, see Voice Care Team.)

Who performs laryngoscopy and stroboscopy?An otolaryngologist or speech-language pathologist typically performs laryngoscopy and/or stroboscopy. The examiner’s training and background experience is critical in performing and evaluating laryngoscopy and stroboscopy findings.

In certain situations, stroboscopy may be performed by a nurse practitioner or a physician assistant under the supervision of a physician.

Recording Laryngoscopy and Stroboscopy Findings Flexible laryngoscopy, rigid laryngoscopy, and stroboscopy are frequently recorded on some type of playback media: videotape or DVD. The reasons for this are:

“Instant replay” review of examinations critical: The recorded images allow the clinician to review the examination repeatedly, often for a frame by frame analysis. This review of the examination of the voice box, vocal fold structure, vibration, and closure is analogous to the instant replay method used in televised sporting events. Playback media recording is especially important in stroboscopy because of the intricacy and rapid speed of vocal fold vibration.

Records for comparison over time: Recording the laryngeal examination on video allows comparison of voice box structure and function over time. By comparing old examinations of the voice box with a current examination, the voice care team can monitor the success or failure of various treatments and also observe any changes over time.

Advisory Note Patient education material presented here does not substitute for medical consultation

or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.

Endoscopic biopsy

The larynx and hypopharynx are deep inside the neck, so removing samples for biopsy can be complex. Biopsies of these areas are done in the operating room while you are under general anesthesia (asleep), rather than in a doctor’s office. The surgeon uses special instruments through a rigid laryngoscope (or other type of endoscope) to remove small tissue samples.

Fine needle aspiration (FNA) biopsy

This type of biopsy is not used to remove samples in the larynx or hypopharynx, but it may be done to find the cause of an enlarged lymph node in the neck. A thin, hollow needle is placed through the skin into a mass (or tumor) to get cells for a biopsy. The cells are then looked at under a microscope. If the FNA finds cancer, the pathologist (doctor examining the samples with a microscope) can often tell what type of cancer it is. If the cancer cells look like they might have come from the larynx or hypopharynx, an endoscopic exam and biopsy of these areas will be needed as well.

If the FNA does not find cancer, it only means that cancer was not found in that lymph node. Cancer could still be present in other places. If you are having symptoms that might be from a laryngeal or hypopharyngeal cancer, you could still need other procedures to find the cause of the symptoms.

FNA biopsies may also be useful in some patients already known to have laryngeal or hypopharyngeal cancer. If the person has a lump in the neck, an FNA can help determine if the mass is due to spread of the cancer. FNA may also be used in patients whose cancer has been treated by surgery and/or radiation therapy, to help find out if a neck mass in the treated area is scar tissue or if it is a return (recurrence) of the cancer.