Continuous Laryngeal Endoscopy - Newcastle Hospitals NHS Foundation Trust

The upper airway consists of:

The nasal cavities
The oral cavity
The pharynx (throat)
The larynx (the voice box, including the entrance to the trachea or windpipe)

Upper airway disorders at Newcastle Hospitals are managed by a specialist multidisciplinary team (MDT) who share expertise in the management of breathing difficulties. The team includes:

Respiratory doctors
ENT doctors
Specialist nurses
Lung Physiologists
Speech and Language Therapists
Physiotherapists

If you have a disorder of the upper airway, you may need a continuous laryngeal endoscopy assessment with provocation of your symptoms. This assessment will take place either in the ENT department or as part of an asthma clinic. Depending on your symptoms and previous assessments, you may see a few different healthcare professionals on the same day or if you only require an assessment for inducible laryngeal obstruction and/or coughing, you may just see the speech and language therapist.

Diagnosis

Upper airway disorders are diagnosed by looking at the larynx (voice box) with laryngeal endoscopy. For an accurate diagnosis, you should be symptomatic of your upper airway difficulties whilst the endoscope is in place.

Laryngeal Endoscopy

A small camera will be gently passed up the nose to the top of the throat. The camera does not go into the windpipe and does not compromise your breathing. Your doctor has stated that this procedure is safe for you.

Whilst the camera is in place, the speech and language therapist will check for signs of injury in the throat. The movement of the muscles in your throat will be observed whilst you breathe at rest, and during an episode of breathing difficulty or coughing.

Your breathing difficulties or cough may be triggered with vocal tasks, food, exercise or environmental irritants, such as air freshener, vinegar or bleach. We have a standard set of irritants, an exercise bike and treadmill but it may be beneficial for you to bring in any specific triggers that you know can cause breathing difficulties or can trigger a cough.

Are there any risks?

With laryngeal endoscopy, some people have reported a feeling of light headedness, nose bleeds or coughing and spasm of the vocal cords. These risks occur in less than one in every 100 people. Any effects are temporary.

Are there any alternatives?

There is no other way for your speech and language therapist to get this level of information about your upper airway. We want to involve you in all the decisions about your care and treatment. If you are unsure or have questions at any time, please let us know.

Will it hurt?

The procedure may feel uncomfortable, but it should not hurt. Sometimes, if you have a strong gag reflex or if your nose is particularly narrow, it can feel more uncomfortable. If needed, some local anaesthetic spray can be applied to your throat or the entrance to your nose. For an airway assessments, it is better not to use the nasal anaesthetic if this can be avoided, as it can skew the assessment results.

The examination works best if you are relaxed and continue to breathe normally throughout.

Immediate management of symptoms

If breathing difficulties or a dry, irritable cough are observed, you will be given throat exercises and techniques to improve airflow through your upper airway which will reduce shortness of breath and can suppress a non-productive cough. If you have already seen a Speech and Language Therapist, you may be aware of these techniques already.

If you have an asthma inhaler that typically helps to reduce shortness of breath symptoms, please bring this to your assessment.

Follow up Management

Findings may be reviewed by the specialist multidisciplinary team and an outpatient appointment may be scheduled to discuss findings and ongoing management options.

Preparing for the test

Clothing

If your symptoms are triggered by exercise, please wear comfortable, loose-fitting clothing and flat shoes that will not slip off, ideally trainers, if you have them.