Having a laryngoscopy or Endoscopic evaluation can be a confusing and scary process. At the Voice Care Centre we recommend Declan Costello ENT, one of the finest voice surgeons in the world who can assess and diagnose vocal pathology in your appointment. Once a formal, biomedical diagnosis has been made, then a treatment plan may be put together by our fantastic team, or you may be referred for other therapeutic or surgical interventions.
Why would I need to have a laryngoscopy?
Singers and professional voice users need to keep their instrument in tip-top condition, and the clearest and safest way to determine laryngeal health is by having a laryngoscopy. The ability to see the larynx clearly is determined by the skill of the surgeon undertaking the examination, and also the quality/ type of the camera, so it is extremely important that when having a laryngoscopy, you have a Consultant Voice Specialist ENT surgeon (or “Laryngologist”) examining you.
What are the different types of laryngoscopy?
When having a laryngoscopy (laryngeal endoscopy), the key for singers is to insist on stroboscopic laryngeal endoscopy. This means that the vocal folds can be viewed in slow motion, which allows the laryngologist to assess for the pliability (suppleness) of the vocal folds. There are two ways of examining the vocal folds:
You may have a nasedoscopy, which is a flexible tube with a camera and a light on the end of it which will pass through the nose to enter the back of the throat. This flexible endoscope is used mostly for professional voice users because it allows the patient to sing/speak while the endoscope is in situ. It does not obstruct the articulation of the tongue and hence is very useful for assessing “dynamic” laryngeal function.
The other option is rigid laryngeal endoscopy. A rigid “rod-like” tube is rested on the tongue and looks over the back of the tongue at the vocal folds. The picture quality is slightly better with the rigid endoscope, and hence can be used to assess very detailed vocal fold appearance. However, with the rigid endoscope in the mouth, it is not possible to sing/speak, so there is less opportunity to assess “dynamic” laryngeal function.
What happens at a laryngology appointment??
At your appointment, which lasts between 30-45 minutes, you will chat through your condition with the Surgeon, have a numbing spray for your nose (if you are having a nasendoscopy) and have a laryngoscopic examination. The pictures and video from the scope will be recorded for later use, and a diagnosis made then and there, with a discussion of a forward plan.
What happens if I have pathology?
If you have what we call a ‘mucosal pathology’ (i.e. a problem with the surface lining of the vocal folds such as Nodules, Polyps, cyst or Haemorrhages etc,) then surgery may be suggested, but this is by no means always required. Often, voice therapy or changes in vocal technique can halt the progress of a condition such as nodules or reverse the process entirely. The goal is to avoid operation if we can, as the less invasive the procedures for your voice, the better.
What happens if I don’t have a visible pathology but I’m either in pain or have a hoarse voice?
This is the most common presentation we see in the Voice Care Centre, as professional vocalists are more susceptible to Muscle Tension disorders or dysphonia than mucosal pathology. This is where the holistic multidisciplinary team steps in to your journey. Vocal Massage and Manual Therapy interventions will help manage muscle tension, as well as speech therapy for your ongoing vocal health. Your presentation will be a culmination of biopsychosocial factors, so although you may have experienced a sudden onset of pain whilst doing a particular gig, the situation, environment and psychology leading up to that will have all contributed to your dysfunction.