Who performs laryngoscopies?

Who Performs Laryngoscopies

Laryngoscopies are primarily performed by otolaryngologists (ENT surgeons), but may also be performed by other trained clinicians including speech-language pathologists under otolaryngologist supervision in certain settings. 1

Types of Clinicians Who Perform Laryngoscopies

Primary Providers

• Otolaryngologists (ENT surgeons): The primary specialists who perform diagnostic laryngoscopy for voice disorders and dysphonia 1
• Speech-Language Pathologists (SLPs): May perform laryngoscopy in some settings, particularly for evaluating vocal function, but their findings should be reviewed by an otolaryngologist 1

Other Providers

• Anesthesiologists: Perform direct laryngoscopy for airway management and intubation 2
• Emergency Medicine Physicians: May perform laryngoscopy for airway management in emergency settings
• Critical Care Physicians: May perform laryngoscopy in intensive care settings for intubation

Referral Process for Laryngoscopy

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines specify that clinicians who cannot perform laryngoscopy themselves should refer patients to those who can when:

1. Dysphonia fails to resolve or improve within 4 weeks 1, 3
2. A serious underlying cause is suspected, regardless of duration 1
3. The patient is a professional voice user 3
4. Before prescribing voice therapy 1

Indications for Immediate Laryngoscopy

Expedited laryngoscopy is indicated in patients with:

• Recent surgical procedures involving the head, neck, or chest
• Recent endotracheal intubation
• Presence of concomitant neck mass
• Respiratory distress or stridor
• History of tobacco abuse
• Professional voice users 1, 3

Clinical Importance of Proper Laryngoscopy

Diagnostic accuracy of history and physical examination alone for laryngeal pathology is extremely poor (only 5%), while the accuracy increases substantially to 68.3% with laryngoscopy 4. This demonstrates the critical importance of visualization in making an accurate diagnosis.

Interdisciplinary Approach

In specialized voice centers, an interdisciplinary approach may be used:

• The SLP may perform the examination in collaboration with an otolaryngologist
• The otolaryngologist reviews the findings to ensure proper diagnosis
• This approach is time-saving in certain settings 1
• The otolaryngologist ensures that conditions not treatable with voice therapy (such as laryngeal cancer) are managed appropriately 1

Documentation Requirements

When laryngoscopy is performed:

• Results should be documented and communicated to the SLP prior to voice therapy
• Documentation should include detailed diagnosis/description of laryngeal pathology
• Visual images may help in treatment planning 1, 3

Common Pitfalls to Avoid

1. Delayed Diagnosis: Waiting too long before performing laryngoscopy can delay diagnosis of serious conditions like laryngeal cancer 1, 4
2. Inappropriate Treatment: Prescribing voice therapy without prior laryngoscopy can lead to inappropriate therapy 1
3. Empiric Treatment: Prescribing medications (antibiotics, corticosteroids, antireflux medications) without first visualizing the larynx 3
4. Missed Diagnosis: Relying solely on history and physical examination has a very high miss rate for laryngeal pathology, including cancer 4

The evidence clearly demonstrates that proper laryngoscopy by appropriately trained clinicians is essential for accurate diagnosis and management of voice disorders, with otolaryngologists being the primary specialists responsible for this procedure.