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Endoscopy

An endoscopy involves using a long, thin tube with a camera at the end to examine hard to reach places.

Endoscopes may be flexible or rigid, and come in various sizes according to the part of the body being visualized. There are a range of endoscopic techniques for head and neck patients. Some of these procedures require the patient to be asleep under general anesthesia, while others can be done in the office while the patient is awake. It is natural to have questions about an endoscopic procedure, and learning more is key. 

Different types of endoscopes are used depending on the part of the body that needs to be examined. For head and neck cancers, laryngoscopes, hypopharyngoscopes, bronchoscopes, and esophagoscopes are used to evaluate various portions of the upper aerodigestive tract or throat. In particular, a laryngoscopy is an endoscopy that allows visualization of the larynx and pharynx, which are parts of the throat. A laryngoscopy may be combined with a biopsy in order to obtain a definitive diagnosis of a suspicious growth in the throat. 

What to Expect from an Endoscopy

Endoscopy in the Doctor’s Office

Before the endoscopy, the doctor may apply a decongestant or numbing spray inside the nose. Once the area is numb, the doctor will use the endoscope to look for any concerning lesions or growths. If the doctor sees an area that requires further analysis, he or she may want to take a small sample of the tissue. This is known as a biopsy. (It is important to note, however, that in-office endoscopies rarely include biopsies, and are typically used for visualization only). 

Before the biopsy, the doctor can spray numbing medicine directly onto the concerning area, or apply it topically. Then they use forceps to remove a tiny piece of tissue. This is sent for pathologic analysis with the hope of gaining more information about the tumor. However, because the samples are very small, sometimes a diagnosis cannot be made. In this case, a direct examination in the operating room may be needed.

Endoscopy in the Operating Room

For endoscopy procedures done in the operating room, patients will be put to sleep under general anesthesia. Using a long, rigid camera projected onto a large screen for visualization, the surgeons will numb the area and obtain pieces of tissue for biopsy. These samples will be analyzed under the microscope by pathologists in order to learn more about the nature of the lesion.

In the operating room, surgeons may have a better view of the lesion and may be able to remove more tissue for analysis. Occasionally, the surgeon may decide to remove the entire lesion at the time of the biopsy, but this is not very common. Instead, the surgeon will usually wait for final pathology results before deciding on further management.

Types of Examinations

Indirect Mirror Examination (Laryngoscopy)

This is the simplest means of evaluating the vocal cords and the base of tongue and can be done without any numbing medicine and with the patient in a seated position. For this examination, a doctor will place a small mirror into the back of the throat through the mouth. The mirror will allow the doctor to see the larynx (voice box). The doctor will ask the patient to remain still, and may request that the patient cough, swallow, or make certain sounds or noises. In addition, the doctor will likely ask the patient to stick out their tongue in order to improve visualization of the throat. 

Laryngoscopy - Salivary gland
Example of an indirect mirror exam or laryngoscopy

Transnasal Flexible Laryngoscopy/Biopsy

  • Does not require general anesthesia and can be done in the office.
  • Inserted through the nose to view the voice box area.

“Transnasal” means through the nose. In this type of exam, a thin and flexible fiber optic endoscope attached to a camera will be inserted through the nose and into the throat in order to visualize the anatomy more directly than with a mirror examination through the mouth. The camera will have a special attachment through which the doctor can spray medicine directly onto the area of concern to numb it. If a biopsy will also be performed, the doctor can pass a thin forceps (“pincher”) through the same attachment and remove a tiny piece of tissue to send to pathology. This technique can be conducted in the office and does not require a trip to the operating room or administration of general anesthesia. Only small pieces of tissue can be obtained this way, however, which might not be enough to establish a diagnosis. In addition, this method does not provide as good a view as direct examination in the operating room.

Head and neck cancer - Tumor
Example of a transnasal flexible laryngoscopy Using this method a physician may also perform a biopsy if needed

Flexible Sinonasal Endoscopy

This method uses a tiny flexible camera which is inserted into one of the nostrils. The doctor will move the camera along the nasal septum (the wall between the two nostrils), as well as the floor, side wall, and roof of the nasal cavity. The doctor will also be able to look at the openings of the sinuses and the back wall of the nasopharynx.

Rigid Sinonasal Endoscopy

A thin steel rod with a camera at the tip will be inserted into one of the nostrils. Then the exact same examination as a flexible sinonasal endoscopy will be performed. This technique makes it easier for biopsy samples to be taken.

Direct Laryngoscopy

  • Takes place in the operating room under general anesthesia.
  • Rigid tube inserted through the mouth to see the throat and vocal cords.

A rigid, hollow tube with a light attached is inserted through the mouth and into the larynx under general anesthesia. This type of procedure allows visualization of the larynx. A doctor may use this procedure to remove small growths, get samples of tissue for testing or remove polyps from vocal cords. This procedure is also conducted in emergency situations where a tube needs to be inserted into the windpipe to help someone breathe in cases such as surgery.

Types of Esophagoscopy

  • Inserted either through the nose or mouth to view inside the throat. May be flexible or rigid.
  • Very similar to laryngoscopy, except it uses a longer lens to visualize the esophagus.

Rigid Esophagoscopy

A stiff, inflexible tube will be inserted through your mouth and into your esophagus. The tube typically includes an eyepiece, a light, and lenses to allow the doctor to see inside the throat. This technique allows doctors to perform minor surgical procedures and diagnose certain conditions.

Flexible Esophagoscopy 

A thin, flexible tube will be inserted into one of the nostrils, down your throat and into the esophagus. Electrical cables within the tube allow light to shine into the esophagus and send images back to a monitor. 

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