Direct Flexible Laryngoscopy

Cartoon image of a doctor looking in a patients throat by doing a laryngoscopy. At UPMC Children's Hospital of Pittsburgh, we believe parents and guardians can contribute to the success of this test, and we invite you to participate. Please read the following information to learn about the test and how you can help.

Fast Facts About Flexible Laryngoscopy

Flexible laryngoscopy (lare-en-GOS-ko-pee) is a quick, effective way for the ENT doctor to get a look at your child’s airway, including the nose, the throat and the voice box.
Most older children can handle the flexible laryngoscopy, but it can be difficult for very young children to cooperate with the test. If your child is unable to tolerate the flexible laryngoscopy, the doctor might have you schedule an upper aerodigestive tract endoscopy that is done under general anesthesia, which is medication to make your child sleep.
Your child’s doctor might order a flexible laryngoscopy if your child has:

Problems swallowing, hoarseness or reflux (GERD)
Noisy and difficult breathing (stridor) not related to tonsils or asthma
Inhaled a foreign object or swallowed a caustic liquid
Had a surgery to the nose and/or throat
A tumor in his or her airway
A neck breathing tube, also called a tracheostomy (tray-kee-OST-oh-mee) or "trach" (TRAKE) tube, to check the size and position

In a flexible laryngoscopy, the ENT doctor uses a thin tube with a fiber-optic camera called a "scope" to thoroughly examine the child’s airway, including the larynx (LARE-inks) and the nasal (nose) passages.
If your child already has a trach tube in place, the ENT doctor might pass the scope through the trach to look at the lower windpipe and the bronchi (BRONK-eye) to the lungs. This procedure is called a tracheoscopy.
The ENT doctor might use a topical anesthetic — a medication applied directly inside the nose to numb it — and/or a decongestant to reduce swelling in the nasal passages for this test.
The test takes about 15 minutes.

Flexible laryngoscopy enables the doctor to get an immediate look at your child’s throat and nasal passages. Flexible tracheoscopy through a pre-existing tracheostomy tube enables the doctor to get an immediate look at your child’s windpipe.

The flexible laryngoscopy often can be done without any medication at all, but sometimes a topical anesthetic and/or a decongestant may be used. The topical anesthetic is applied directly to the nose to numb it. The decongestant helps open up swollen (stuffy) nasal passages. Because the anesthetic and/or the decongestant are the only medications that might be needed, the flexible laryngoscopy can be done right in the doctor’s office during your child’s ENT appointment.

The doctor will be looking for inflammation (swelling), infection, foreign objects or other abnormal conditions in order to determine the best treatment for your child.

The flexible laryngoscope or "scope" consists of an eyepiece and a fiber-optic light enclosed in a thin, flexible tube. The scope looks like a strand of black spaghetti with a tiny light on the end of it. The scope is inserted through the nose, and can be moved around to help the doctor see all areas of a child’s nasal passages and throat.

Laryngoscopy is a safe way for doctors to examine these internal body parts; however, there are some risks involved. Although rare, these risks include possible swelling in the voice box requiring special treatment and overnight observation; voice box injury; or infection, requiring surgical drainage and antibiotics. A nosebleed is also possible from the passing of the scope. Your child’s doctor will discuss these risks with you prior to your child’s test.

Because flexible laryngoscopy may trigger your child’s gagging reflex, your child should not have the test done on a full stomach.

For all children: In the 2 hours before your scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte^®, Kool-Aid^® and apple juice.
Do not give your child any medication containing aspirin or ibuprofen for the 10 days before the test.
Do not give your child any natural supplements or homeopathic therapy for the 10 days before the test.
Make sure you have children’s pain reliever and a thermometer at home for after the test.
Buy juices, clear soups, and soft, bland foods like bread, rice and oatmeal to have at home after the test.

The most important role of a parent or guardian is to help your child stay calm and relaxed before the test. The best way to help your child stay calm is for you to stay calm.

You may stay with your child and hold his or her hand for reassurance during the test.
Your child may bring along a "comfort" item, such as a stuffed animal or "blankie," to hold during the test.

The test

The doctor might give a medication to dry up any swollen lining in your child’s nose and throat, and may suction the nasal cavities with a thin, flexible suction catheter. Depending on your child’s age, a topical anesthetic might be sprayed in your child’s nose to numb it.

When your child’s anterior (front) nasal cavities are numb, the doctor will put the thin, flexible scope into your child’s nose and thread it down the throat.
The doctor also might swab or spray a medication inside your child’s nose that dilates the nasal passages to provide a better view of the airway.
The doctor will thoroughly examine your child’s nasal passages, throat and voice box.
Your child might gag for a moment as the scope is passed down his or her throat.
Special instruments may be used to remove foreign objects or to take tissue samples (biopsies).
After the test, the doctor will discuss the results with you and, together, you will plan for the best interests of your child. The plan may include additional tests, X-rays, surgery, hospitalization, office visits, medication, a special diet or consultations with other specialists.

After the test

Your child may resume normal activities after the test. After a flexible laryngoscopy, you might notice some of the following signs. These symptoms are normal:

Your child might have a sore throat and some hoarseness and or a cough for a few days. Sucking on Popsicles^® or gargling with warm, mildly salty water might help.
Your child might have some mild throat pain. You may give your child pain medication as directed by your surgeon.

Although most children have no problems after the flexible laryngoscopy, you should immediately call your child’s ENT doctor, pediatrician or Children’s Hospital test nurse if your child has any of these symptoms:

Large amounts of blood, or bleeding for 24 hours
Fever higher than 101˚ F
Severe pain
Severe nausea or vomiting, or can’t keep clear liquids down
Breathing trouble
Rashes anywhere on his or her body

If your child has any special needs or health issues you feel the doctor needs to know about, please call the Division of Pediatric Otolaryngology (ENT) at Children’s Hospital before the test and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.