From the Guidelines
Laryngoscopy is indicated in viral respiratory infections when there are concerns about airway compromise, persistent or severe symptoms, or complications affecting the larynx, particularly if symptoms persist beyond 2-3 weeks or if there are signs of serious underlying conditions. The decision to perform laryngoscopy should be based on the severity of symptoms and the potential impact on the patient's quality of life, as highlighted in the clinical practice guideline for hoarseness (dysphonia) 1.
Indications for Laryngoscopy
- Stridor
- Voice changes lasting more than 2-3 weeks
- Severe throat pain unresponsive to treatment
- Suspected epiglottitis
- Croup not responding to standard therapy
- Progressive respiratory distress
- Prolonged hoarseness, difficulty breathing, or swallowing problems in cases of viral infections like COVID-19
Procedure Considerations
The procedure should be performed with appropriate personal protective equipment, including N95 masks, face shields, gowns, and gloves, to prevent transmission 1. Flexible laryngoscopy is generally preferred as it causes less discomfort and can be performed under local anesthesia.
Timing of Laryngoscopy
The timing of laryngoscopy depends on symptom severity, with immediate evaluation for acute respiratory distress and delayed evaluation for mild voice changes to allow for spontaneous resolution of uncomplicated viral laryngitis. This approach balances the need to identify serious complications while avoiding unnecessary procedures for self-limiting viral infections. According to the guideline, initial observation for most patients with new-onset dysphonia is reasonable, but dysphonia persisting beyond 2-3 weeks raises concerns for other pathologies less likely to resolve spontaneously 1.
Quality of Life Considerations
The impact of dysphonia on the patient's quality of life should also be considered, particularly for professional voice users, where dysphonia may significantly impair their ability to work or reduce voice-related quality of life 1. In such cases, more immediate evaluation of the larynx is warranted to prevent delay in diagnosis and treatment of underlying conditions.
From the Research
Indications for Laryngoscopy in Viral Respiratory Infections
The following points highlight the indications for laryngoscopy in viral respiratory infections:
- Acute laryngitis is most often caused by viral illnesses, and laryngoscopy may be used to rule out other conditions such as bacterial infections or chronic laryngitis 2
- In cases of suspected epiglottitis, laryngoscopy is a helpful diagnostic tool, especially when combined with radiography of the neck 3
- Laryngoscopy and bronchoscopy (DLB) may be used to assess and intervene in pediatric patients with stridor and respiratory distress, particularly when there is concern for structural pathology or upper airway obstruction 4
- Viral laryngitis can present in various forms, and laryngoscopy may be necessary to diagnose and manage less common conditions such as chronic cough or postviral vagal neuropathy, varicella zoster infection of the larynx, and idiopathic ulcerative laryngitis 5
- Laryngoscopy can also be used to diagnose and manage epiglottitis associated with intermittent e-cigarette use, highlighting the importance of considering vaping toxicity in patients with respiratory symptoms 6
Key Considerations
- Laryngoscopy should be performed by skilled personnel to avoid complications such as airway obstruction 3
- The use of antibiotics or decongestants should be discouraged in cases of viral laryngitis, and vocal rest is often the best treatment for acute and chronic overuse symptoms 2
- A thorough history and physical exam are necessary to diagnose viral laryngitis and other conditions, and referral to other subspecialties may be necessary in certain cases 5