What is a Microlaryngoscopy & Oesophagoscopy

Microlaryngoscopy is an operation in which your larynx (voice box) is examined very carefully whilst you are under a general anaesthetic. Microlaryngoscopy is done primarily to diagnose and subsequently to treat problems of the larynx, such as the many different causes of a hoarse voice.

Oesophagoscopy is an operation to examine the throat and oesophagus (i.e. food pipe into the stomach) in more detail. It is often required in patients with difficulty swallowing or in people with a feeling that something is stuck in the throat, where there is no obvious cause identified on examination in clinic. Your ENT specialist may therefore recommend a more complete and thorough examination under anaesthetic.

Why do I need a microlaryngoscopy?

It is likely that you have had a problem with your voice. Most often patients describe a hoarse or rough sounding voice, others have a weak or breathy voice. Your specialist will have examined your larynx with a flexible nasendoscope in clinic to gain an initial idea as to what might be wrong, however it is not always possible to be certain as to the cause of the hoarseness in the outpatient clinic and a more thorough examination under a GA in the form of a microlaryngoscopy may be required.

Why do I need an oesophagoscopy?

You may have a problem swallowing food and/or drink, or alternatively you may experience a feeling of something stuck in the throat. This can feel very real, although often the feeling disappears or reduces when you eat and drink. This condition is called ‘globus pharyngeus’ and is extremely common. The problem is that it is acutely affected by stress and anxiety. Therefore, if you experience a feeling of globus, many patients become concerned that there is something serious such as a growth, which increases stress and anxiety levels, which in turn makes the feeling of globus worse. A vicious cycle then develops where it is extremely difficult to treat the problem until you have been properly and thoroughly examined by a specialist. Other factors that can make globus worse are gastric acid reflux or indigestion.

What do a microlaryngoscopy and/or oesophagoscopy entail?

Microlaryngoscopy is performed whilst you are asleep under a general anaesthetic. It is not a particularly long operation, taking on average around 20-30 minutes. A metal instrument called a rigid laryngoscope is passed through your mouth into your voice box. A microscope is then sometimes used to magnify the view of the voice box to enable a more detailed examination of the problem and to allow precise biopsies to be taken. Surgery to remove any lumps or swelling can also be undertaken. If a biopsy is taken it is sent off to the laboratory for pathological analysis. Occasionally it may be necessary to use a laser as part of the procedure.

Oesophagoscopy proceeds along similar lines to microlaryngoscopy above in that the procedure is performed under a general anaesthetic, and a metal tube is passed into the throat and oesophagus. A microscope is rarely used; instead a rigid endoscope may be passed in order to take close photographs of the area in question. Again biopsies can be taken if required.

How will I feel after a microlaryngoscopy / oesophagoscopy?

After either microlaryngoscopy or oesophagoscopy, you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box, and also the plastic tube that is passed into your throat by the anaesthetist to help you breathe during the operation. Any discomfort settles quickly with simple painkillers and does not usually last more than a day or so.

Occasionally you may experience some neck stiffness after the operation, particularly if you have a pre-existing history of neck discomfort or musculoskeletal problems prior to the operation. It is important to mention this to your surgeon and anaesthetist as they will be able to take steps to minimise the movements of your neck during the procedure.

After microlaryngoscopy, your voice may sound hoarser than before hand. This will especially be the case if any biopsies have been taken. This worsening should however be temporary until such time that the inflammation of the lining of the voice box caused by the biopsies heals. As a result, most surgeons recommend that you should refrain from using your voice where at all possible for 48 hours after the operation.

After both procedures, you can usually eat and drink later the same day. It is usual for the operations to be performed as a day case so you should be able to go home later the same day.

What can go wrong after a microlaryngoscopy or oesophagoscopy?

Both procedures are generally extremely safe. A slight sore throat afterwards is to be expected by most patients. Whilst bleeding and infection can happen after any operation, they are unusual after microlaryngoscopy or oesophagoscopy.

There is a risk of chipping or damage to your lips, teeth or gums caused by the metal tubes. Your surgeon uses a gum guard to help prevent this happening, although even with the most careful technique, problems can still occasionally occur particularly if there are any caps, crowns or poor dentition.

After oesophagoscopy, there is a very small chance of a small tear occurring in the mucosa (inner lining) of the oesophagus, caused either by one of the metal tubes or the biopsy. In the worst case scenario, this can lead to a nasty chest infection and septicaemia. The warning signs of this are if you experience severe back pain, if air appears under the skin of your neck, if your pulse rate increases suddenly or if you develop an early temperature. Your surgical and nursing teams will be alert to this possibility after the procedure and routine observations will be taken to monitor this. However such a complication is extremely rare. As a precaution however, you may be asked not to eat anything for a few hours and then only sips of sterile water until it is clear that there is no tear, after which you will then be able to gently reintroduce a normal diet.

What happens after I have gone home?

Depending on your job and level of activity, you may need a few days off work. You will then be seen by your surgeon in clinic who will let you know what was found during the operation and give you any results from the biopsies. If any further treatment is advised this will be discussed with you.

After microlaryngoscopy you may require a course of speech therapy if the hoarse voice persists. This will be arranged by your specialist.

After oesophagoscopy, any other conditions contributing to the symptoms can be treated. For example, if you have evidence of gastric acid reflux, you may require a course of medicine to suppress excess stomach acid such as lanzoprazole, or an anti-acid liquid or tablet such as Gaviscon AdvanceTM.