Name of the Procedure:

Laryngoscopy, Direct, with Injection into Vocal Cord(s), Therapeutic

Summary

A direct laryngoscopy with injection is a medical procedure used to examine the larynx (voice box) and deliver therapeutic injections directly into the vocal cords to treat various voice disorders or structural abnormalities.

Purpose

The procedure is used to diagnose and treat conditions affecting the vocal cords, such as vocal cord paralysis, scarring, or certain growths. The goal is to improve vocal function, reduce symptoms, and restore normal voice quality.

Indications

• Hoarseness or voice changes that persist for more than a few weeks
• Difficulty speaking or a weak voice
• Vocal cord paralysis or paresis
• Vocal fold lesions such as cysts, nodules, or polyps
• Scarring of the vocal cords

Preparation

• Fasting for several hours before the procedure, typically 6-8 hours.
• Adjustment or temporary discontinuation of certain medications, as advised by the physician.
• Pre-procedure assessment may include a physical examination, voice assessment, and imaging studies like a CT scan or MRI.

Procedure Description

1. The patient is given local anesthesia, which may be combined with mild sedation.
2. A laryngoscope, a specialized endoscope, is gently inserted through the mouth and into the throat to visualize the vocal cords.
3. Under direct vision, a fine needle is used to inject therapeutic substances directly into the vocal cords. These substances might include steroids, fillers, or other medications aimed at reducing inflammation, adding bulk, or correcting abnormalities.
4. After the injection, the laryngoscope is carefully removed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic or a surgical center equipped with the necessary endoscopic tools.

Personnel

• Otolaryngologist (ENT specialist)
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

Common risks:

• Mild discomfort or soreness in the throat
• Hoarseness or temporary changes in voice
• Bleeding or infection

Rare risks:

• Allergic reaction to anesthesia or injected substances
• Damage to the vocal cords or surrounding structures
• Difficulty breathing (very rare)

Benefits

• Improved vocal quality and reduced symptoms
• Increased vocal strength
• Rapid improvement in voice function, typically noticeable within a few days to weeks

Recovery

• The patient may rest for a few hours post-procedure in the clinic.
• Temporary dietary restrictions, such as avoiding hot or spicy foods.
• Voice rest for a specified period, usually a few days, followed by gradual return to normal speaking activities.
• Follow-up appointments to monitor progress.

Alternatives

• Voice therapy and rehabilitation exercises
• Medications to address underlying causes of vocal cord issues
• Surgical procedures such as microlaryngoscopy for lesion removal Pros of alternatives:
• Less invasive (voice therapy)
• Non-surgical options can have fewer risks

Cons of alternatives:

• May be less effective for certain structural issues
• Longer duration to achieve results compared to direct injection

Patient Experience

During the procedure:

• The patient may feel mild discomfort or pressure in the throat.
• Sedation can help minimize anxiety or discomfort.

After the procedure:

• Mild throat soreness or hoarseness, which typically resolves in a few days.
• Pain management with over-the-counter pain relievers as needed.
• Instructions for voice rest to ensure optimal recovery and outcome.