Laryngoscopy is the medical term for any examination in which the larynx (voice box) is visualized. Laryngoscopy may be performed in the office or in the operating room.

Laryngoscopy in the office is usually performed by passing a flexible endoscope (a camera) through the nose into the throat to visualize the throat (pharynx) and voice box (larynx). Therefore, this procedure is often called Flexible Nasopharyngolaryngoscopy. The examination is recorded for review by the doctor and the person being examined. Laryngoscopy in the office may also be performed by passing a rigid endoscope through the mouth.

Laryngoscopy in the operating room is performed by passing a rigid surgical instrument called a laryngoscope through a person’s mouth to visualize the throat (pharynx) and voice box (larynx) under general anaesthesia. This procedure is called direct laryngoscopy, or microlaryngoscopy.

This examination is crucial in the evaluation of people with voice or throat problems.

 

Videostroboscopy (or stroboscopy) is a specialized examination of the vocal folds using an endoscope placed through the nose or mouth to examine the larynx (voice box) and the vocal folds, using both a normal light source and a strobe light source.

The strobe light source allows detailed assessment of the function of the vocal folds and gives valuable information about the vibration of the vocal folds and about how the vocal folds close against one another.  

The examination is recorded, and then reviewed straight after, so that the Laryngologist can describe the results of the videostroboscopy to the person undergoing the examination to enhance their understanding of both the diagnosis and the treatment of their condition. These video examinations are stored and can be used to follow a person’s progress.

David undertakes videostroboscopy at his main office in Remuera to assess the function of the vocal folds in detail and has extensive experience in the interpretation of this examination.

PROCEDURES

EVALUATIONS

Laryngoscopy Videostroboscopy/Stroboscopy Transnasal Tracheoscopy Transnasal Oesophagoscopy Laryngeal Botox Injection Laryngeal Laser Procedure Salivary Gland Botox Injection Voice Care Voice & Swallow Therapy

Laryngoscopy

Laryngoscopy is the medical term for any examination in which the larynx (voice box) is visualized. Laryngoscopy may be performed in the office or in the operating room.

Laryngoscopy in the office is usually performed by passing a flexible endoscope (a camera) through the nose into the throat to visualize the throat (pharynx) and voice box (larynx). Therefore, this procedure is often called Flexible Nasopharyngolaryngoscopy. The examination is recorded for review by the doctor and the person being examined. Laryngoscopy in the office may also be performed by passing a rigid endoscope through the mouth.

Laryngoscopy in the operating room is performed by passing a rigid surgical instrument called a laryngoscope through a person’s mouth to visualize the throat (pharynx) and voice box (larynx) under general anaesthesia. This procedure is called direct laryngoscopy, or microlaryngoscopy.

This is a crucial examination in the evaluation of people with voice or throat problems.

Videostroboscopy/Stroboscopy

Videostroboscopy (or stroboscopy) is the specialised examination of the vocal folds using an endoscope placed through the nose or mouth to examine the larynx (voice box) and the vocal folds with both a normal light and a strobe light. The strobe light source allows detailed assessment of the vibration and closure of the vocal folds. The examination is recorded, and then reviewed by David with the person undergoing the examination to enhance their understanding of both the diagnosis and the treatment of their condition. These video examinations are archived to follow a person’s progress.

David uses high definition Olympus videoendoscopes and stroboscopy in his office in Remuera to assess the function of the vocal folds in detail and has extensive experience in the interpretation of this examination.

Transnasal Tracheoscopy

Transnasal Tracheoscopy (TNT) is a procedure to examine the airway (the breathing passages) from the nose to the lungs, including the trachea (the airway between the voice box and the lungs) using a flexible endoscope that is passed through the nose.

This examination is underatken to evaluate people with stridor (noisy breathing) or unexplained shortness of breath.

This examination has traditionally been performed under general anaesthetic (rigid tracheoscopy or bronchoscopy) or under intravenous sedation (bronchoscopy). With modern channelled videoendoscopes this procedure can now be performed using local anaesthetic only, without the need for a general anesthetic or sedation, making the procedure fast and simple. There is no prolonged recovery time.

David performs TNT at his Remuera office.

Transnasal Oesophagoscopy

Transnasal oesophagoscopy (TNO) is a procedure to examine the lining of the oesophagus (the part of the digestive tract between the throat and the stomach) using a flexible endoscope that is passed through the nose and then the throat, before entering the oesophagus. A flexible endoscope is a thin tube-like instrument, about 5mm thick, that has a miniature video camera in its tip.

This examination has traditionally been performed under general anaesthetic (rigid oesophagoscopy) or under intravenous sedation (gastroscopy). New ultrathin endoscopes allow us to perform this procedure using local anaesthetic only.

Why is TNO performed?
TNO is performed to determine if there are any abnormalities of the lining of the oesophagus of people with:

  • Dysphagia (difficulty swallowing)
  • Globus (the sensation of a lump in the throat)
  • Chronic cough
  • Reflux
  • Head and Neck Cancer

Advantages of TNO

  • TNO is a safe and simple technique to examine the oesophagus.
  • TNO does not require a general anesthetic or intravenous sedation.
  • TNO can be performed in the office, eliminating the need for admission.
  • to a daystay facility or a hospital.

TNO is a quick and convenient procedure with no prolonged recovery time afterwards.

Laryngeal Botox Injection

Botulinum Toxin (BTX) is a medicine used to treat some neurological disorders of the larynx (voice box), including Spasmodic Dysphonia (SD) (also known as Laryngeal Dystonia (LD)) and Vocal Tremor (VT). SD/LD and VT affect the control of the voice, causing voice problems such as a strained voice, a voice that breaks, or a tremulous voice.

Botulinum Toxin is also used to treat other disorders of the larynx including muscle tension dysphonia (that has not responded to voice therapy) and arytenoid granuloma.

How does BTX work?

  • BTX weakens muscles. In SD/LD, BTX alters the feedback loop between the muscles of the larynx and the brain, leading to an improvement in the control of the muscles of the larynx by the brain. The BTX only affects the vocal cords – it does not spread throughout the body.

How is BTX given?

  • BTX is a medicine that must be injected into the larynx. There are different techniques and approaches that may be used to undertake the injection. Sometimes, it may take several injections before the best technique for injecting a person is decided on.
  • The injection is usually done in the clinic, and the person receiving the injection is awake. They have the injection in an upright seated position or lying flat on their back.
  • The BTX is usually injected by inserting a needle through the skin of the neck. The needle is usually passed through the skin of the neck either below or above the vocal cords (vocal folds). Sometimes both sides of the larynx are injected (a bilateral injection), but sometimes only one side of the larynx is injected (a unilateral injection).
  • Local anaesthetic may be injected into the airway before the BTX is injected, but many people do not require this, and avoid this, as it is an additional injection.
  • Rarely, the BTX may need to be injected when the person is asleep (under a general anaesthetic) by inserting a very long needle through the mouth.
  • To ensure that the injection is given to the correct part of the larynx, a special needle with an electrode connected to an EMG machine (a machine that detects the electrical activity of muscles) may be used. Flexible laryngoscopy (looking at the larynx with an endoscope or camera placed through the nose) may be used instead of the EMG, or with the EMG.

The injection itself is usually quick, taking less than 10 minutes.

Laryngeal Laser Procedure

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Id neque aliquam vestibulum morbi blandit. Ut tortor pretium viverra suspendisse potenti. Quisque id diam vel quam elementum pulvinar etiam non. Nec tincidunt praesent semper feugiat nibh sed pulvinar proin. Purus in mollis nunc sed id semper risus in hendrerit. Egestas pretium aenean pharetra magna ac placerat vestibulum lectus. Mauris nunc congue nisi vitae suscipit tellus mauris a. Blandit turpis cursus in hac habitasse platea dictumst. Libero id faucibus nisl tincidunt eget nullam non nisi est. Viverra accumsan in nisl nisi scelerisque eu ultrices vitae.

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Salivary Gland Botox Injection

Botox can be used to treat other disorders such as:

Frey’s Syndrome (excessive facial sweating after parotid surgery)
Excessive salivation/Poor salivary control

Voice Care

Here are some tips about looking after your voice:

Maintain a healthy lifestyle

  • Ensure that you get adequate sleep.
  • Check that your diet is healthy.
  • Exercise regularly.
  • Ensure that you manage your stress well.

Stay Well Hydrated

  • Drink plenty of fluids [6-8 glasses daily] not including coffee/strong tea/coke/alcohol and caffeinated sports drinks.
  • Sip water when making presentations.
  • Avoid dairy products if you suspect that they cause an increase in mucus.

Minimise Overuse/Misuse of Your Voice

  • Do not smoke as smoke is a major irritant to the vocal cords. Also avoid fumes, pollutants, dust including chalk. Where possible wear a mask when using chemicals, sanding surfaces etc.
  • Avoid excessive alcohol. For every alcoholic drink you have drink a glass of water.
  • Do not clear your throat or cough habitually. Instead swallow slowly with or without water; or use an air cough (a singer’s cough) that is a huff to clear mucus from the vocal cords. Only if absolutely necessary give a single, short, gentle cough. Throat clearing/coughing damages the larynx owing to the hard contact of the vocal cords.
  • Avoid talking over background noise [music, parties, machines, etc] or over a long distance. Lessen the distance between you and the listener.  Only speak to those within touching distance.  If noise is excessive and you have to talk keep talking to absolute minimum, planning to communicate more fully outside the noisy environment.
  • Avoid shouting, screaming and whispering.
  • Do not speak to a large audience without a microphone.
  • Avoid using your voice too loudly, or for too long.
  • Take a regular break from using your voice. For example, teachers should avoid noisy staff rooms between teaching sessions; and singers should avoid socialising between performances. Try to rest your voice for 15 minutes of every hour.
  • Ensure your voice is not monotone. Use variety in the tone of your voice.
  • Avoid singing outside of your range (either too low or too high).
  • Avoid speaking beyond your normal breath support. Speaking more slowly may help this.

When you have a cold / sore throat / laryngitis:

  • Don’t use your voice more than absolutely necessary, but do not whisper. A gentle, quiet voice is better for your larynx.
  • Cancel any non-essential commitments.
  • Inhale steam twice a day.
  • Drink plenty of fluids.
  • Drink hot beverages to soothe the throat.
  • Chew sugar free gum or sugar free lollies, rather than medicated lozenges.

Voice & Swallow Therapy

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