Medical personnel who perform laryngoscopies have an increased risk of COVID-19 exposure. Using a high-quality laryngoscope increases the efficiency and accuracy of the procedure. This can reduce the time of exposure related to prolonged attempts to perform the task.
Laryngoscopy has been a frequently used procedure for decades. It serves as an adjunct to other medical treatment plans. It’s also an important part of diagnosing and treating a variety of symptoms.
Keep reading this comprehensive overview to learn more about laryngoscopes.
Diseases of the Larynx
Many conditions can cause problems with the larynx (voice box), vocal cords, and back of the throat. Examples of some of these diseases include:
- Abnormal movement of the vocal cords
- Airway problems
- Autoimmune diseases
- Benign (non-cancerous) lesions on the vocal cords
- Cancerous vocal cord lesions
- Inflammatory or infectious conditions
- Neurologic problems
- Precancerous vocal cord lesions
Individuals may have problems with their larynx after surgical procedures and/or intubation. Intubation describes the placement of an endotracheal (breathing) tube into the trachea (windpipe).
This is commonly done for patients having general anesthesia for surgery. Placement of an endotracheal tube is also needed to receive mechanical ventilation.
Some surgical procedures have higher incidences of impacting the larynx. Examples include cardiac, spinal, thoracic, thyroid, and vascular surgery.
Overuse, misuse, or abuse of the vocal cords can lead to a strain or injury. Excessive talking, screaming, singing, coughing, throat clearing, and smoking can cause this. Speaking too loudly or quietly can damage the vocal cords as well.
Vocal cord injury or strain can result in:
- Dysphasia (trouble swallowing): increases when the vocal cords don’t close during swallowing
- Hemorrhage: bleeding from one or more tiny blood vessels in the vocal cord’s soft tissue
- Laryngitis: swelling of the vocal cords
- Laryngopharyngeal reflux: vocal cord damage from acid reflux or gastroesophageal reflux (GERD)
- Motion disorder: may result from surgery, viral infection, or intubation
- Nodules: callus-like growths on the vocal cords
- Paralysis or low movement: one or both vocal cords don’t open or close in a normal way
- Polyps: small growths on the vocal cords
- Spasmodic dysphonia: rare involuntary tightening of the larynx and vocal cord muscles
- Stenosis (narrowing): caused by scarring of inability to move vocal cords
Laryngeal papillomatosis describes non-cancerous, wart-like tumors. They may occur in the larynx, respiratory tract, or vocal cords.
What Is a Laryngoscope?
In general, there are three parts of the laryngoscope. They include a handle, blade, and light source.
Standard laryngoscope blades are either curved or straight. They come in different sizes to fit children to adults. Some blades have a flexible tip.
The practitioner holds the laryngoscope by the handle. Next, they position the blade to move the epiglottis which covers the vocal cords. The blade’s light allows a clear view of the vocal cords, larynx, and throat.
Types of Laryngoscopes
There are two primary types of laryngoscopes. They include direct and video styles.
Direct Laryngoscope
The direct version has a lens and a light on the end of the blade. This gives the practitioner a detailed image for examination.
An intubation laryngoscope is one type of direct laryngoscopy. This is used to place an endotracheal tube (ETT) into the trachea.
Before intubation, a stylus is placed inside the flexible ETT to create a bend as needed. The laryngoscope gives a clear view so the provider can slide the ETT between the vocal cords.
The ETT has a balloon around the end of the tube. When inflated, this creates a seal around the ETT inside the trachea.
This allows for the controlled pushing of oxygenated air into and out of the lungs. Without this seal, air escapes and prevents the full inflation of the lungs.
Video Laryngoscope
Video laryngoscopes have a tiny video camera on the end of the blade or scope. This allows the doctor to view real-time images on a screen. The clearer image optimizes accurate and efficient diagnoses.
The Infinium ClearVue® laryngoscope uses state-of-the-art video imaging technology. This model has a full-view 2.0-megapixel camera and a high-resolution view screen. It features anti-fog capability and a rechargeable li-ion battery.
This type of video laryngoscope increases intubations on the first attempt. Thus, patient risks associated with repeated or difficult intubation decrease.
What is a Laryngoscopy?
A laryngoscopy describes the procedure in which a doctor uses a laryngoscope. Physicians use this procedure to examine the larynx, vocal cords, and back of the throat. The following describes examples of reasons for performing a laryngoscopy:
- Assist and improve breathing during surgery or while treating health problems
- Test speaking or breathing difficulty
- Diagnose the cause of prolonged or bloody cough, throat pain, hoarseness, or bad breath
- Assess for the cause of chronic earaches
- Check and biopsy (take tissue sample) of throat masses
- Remove foreign objects the patient swallowed
- Remove throat polyps and send for further examination
This procedure is usually performed under sedation. The exception includes emergency situations requiring immediate restoration of breathing.
Risks Associated with Laryngoscopy
In general, laryngoscopies are a safe procedure. Yet, as with all medical interventions, there can be negative side effects. The risk also depends on the specific procedure performed.
The following gives some examples of side effects or consequences of a laryngoscopy:
- Allergic reaction to the medications used for the anesthesia
- Any invasive procedure carries the risk of developing an infection
- Nosebleeds if the procedure involved passing a tube through the nose
- Major bleeding
- Trouble breathing due to spasms in the vocal cords
- Ulcers in the mucous lining of the mouth or throat
- Tongue or lip injuries
If you experience any problems after your procedure, notify your healthcare provider. Be sure to ask about expected side effects before you have the procedure. This can help reduce your anxiety by knowing what is normal and what needs reporting.
Impact of Laryngoscopy Findings on the Plan of Care
When you see a provider for ongoing throat problems, they develop a plan of care. They will complete a history looking for risk factors associated with throat issues. The next step is to determine if tests, such as laryngoscopy, are needed for a diagnosis.
Once the provider reaches a diagnosis, the next step is treatment. If the test shows that you’re experiencing vocal overuse, abuse, or misuse, they may order vocal rest. You may work with a vocal or singing therapist or speech-language pathologist.
When the physician finds masses or polyps, they often perform a biopsy or remove them. The tissue is then sent for further testing. For results showing infection, pre-cancer, or cancer, the doctor may order further treatment.
Laryngeal cancer treatment can include surgery, chemotherapy, and/or radiation therapy. The care plan is individualized based on your age, medical condition, and profession.
COVID-19 Risks for Medical Personnel During Laryngoscopy
Medical practitioners have taken precautions for decades when performing laryngoscopies. Not surprisingly, evidence shows an elevated risk for COVID-19 exposure during this procedure. The following guidelines address the staff precaution for flexible laryngoscopy:
- Pre-screen and test for COVID-19 before performing this procedure
- Limit diagnostic procedure to critical cases where findings will immediately impact patient care
- Consider other modalities including ultrasound and CAT scans as an alternative
- Limit the staff that are present to only essential personnel
- Perform this procedure in a designated isolation room or negative pressure room
- Wear a powered, air-purifying respirator (PAPR) or N95 mask for confirmed or suspected COVID-19
- Standard staff personal protective equipment (PPE) includes gown, gloves, and eye protection
- Use anesthetic gels instead of atomized or nebulized versions to reduce aerosolization
- Practitioners should maintain as much distance as possible before and during the procedure
- All staff must practice proper glove donning and doffing and hand hygiene
After the procedure, the laryngoscope must be handled according to infection control protocols. Transport the scope in a closed container to prevent direct or fomite transmission.
It’s then disinfected using the approved facility procedures. Examples include:
- Automated reprocessing
- Chlorine dioxide
- Ethylene oxide gas sterilization
- Glutaraldehyde
- Isopropyl alcohol chemical reprocessing
- Ortho-phthalaldehyde
These methods provide high-level disinfection to eliminate virus transmission.
The room must undergo thorough sanitization of all exposed surfaces. The effectiveness of chemical agents against the SARS-CoV-2 virus is not yet available. Thus, use an Environmental Protection Agency (EPA) registered disinfectant.
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