Name of the Procedure:

Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope Common names: Direct Laryngoscopy with Vocal Cord Injection

Summary

Direct laryngoscopy with vocal cord injection is a procedure where a surgeon examines the vocal cords using a laryngoscope and then injects medication directly into the vocal cords using specialized instruments, often with the aid of an operating microscope or telescope.

Purpose

This procedure addresses various vocal cord issues, such as vocal cord paralysis, nodules, polyps, or other lesions.

Goals:

• Restore or improve vocal quality.
• Reduce symptoms like hoarseness, pain, or breathiness.
• Treat vocal cord lesions or provide therapeutic effects.

Indications

• Chronic hoarseness
• Vocal cord paralysis or weakness
• Vocal cord nodules or polyps
• Recurrent respiratory papillomatosis
• Precancerous or non-cancerous lesions on the vocal cords

Preparation

• Fasting: Patients may need to fast for several hours before the procedure.
• Medication Adjustments: Some medications may need to be paused or adjusted as directed by the doctor.
• Diagnostic Tests: Pre-procedure evaluation may include laryngeal imaging, voice assessments, and sometimes biopsy.

Procedure Description

1. Anesthesia: The patient is usually put under general anesthesia.
2. Laryngoscope Insertion: A laryngoscope is gently inserted through the mouth to provide a clear view of the vocal cords.
3. Microscope/Telescope: Using an operating microscope or telescope, the surgeon gets a detailed and magnified view of the vocal cords.
4. Injection: Therapeutic agents are then injected directly into the vocal cords using fine instruments.
5. Observation: Post-injection, the area is observed to ensure proper placement and effect.

Duration

The procedure typically takes around 30-60 minutes.

Setting

This is usually performed in a hospital or a specialized surgical center.

Personnel

• ENT Surgeon (Otolaryngologist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common: Mild throat discomfort, temporary hoarseness, or swelling.
• Rare: Bleeding, infection, injury to vocal cords, or adverse reaction to anesthesia.

Benefits

• Improved vocal quality and function.
• Relief from symptoms like pain and hoarseness.
• Potentially immediate effects can be observed in some cases.

Recovery

• Post-procedure Care: Patients may need to rest their voice and avoid strenuous activities for a few days.
• Recovery Time: Most patients can resume normal activities within a week.
• Follow-up: Routine follow-up appointments to monitor healing and vocal quality.

Alternatives

• Voice Therapy: Non-invasive with benefits for specific conditions.
• Medication: Oral or injectable steroids.
• Laser Surgery: For certain types of vocal cord lesions.

Pros and Cons of Alternatives:

• Voice therapy is non-invasive but may be slower.
• Medications and laser surgery have different risk profiles and suitability depending on the condition.

Patient Experience

• During: Under general anesthesia, so the patient will be unconscious and should not feel anything.
• After: Expect mild soreness or discomfort in the throat. Pain medication and voice rest can help ease any discomfort.

Pain Management: Post-operative pain is usually manageable with over-the-counter pain relievers or prescribed medications.