A flexible laryngoscopy is a very small 2.7mm flexible tube with a camera on the end. This tool provides an excellent view of the larynx (or voice box). When this test is performed the image will be seen by the family on the monitors as well, and Dr. Shirley will go over all normal and abnormal images seen. This exam may be indicated to evaluate, diagnose, and/or rule out significant anatomic or dynamic problems. This exam can cause some anxiety to the parent and child but is very easily and quickly performed. As the scope passes through the nose it can cause some mild discomfort and pressure but normally it is only the nature of a strange procedure that causes any fear or anxiety. Dr. Shirley has performed many thousands of these exams on children of all ages in the office setting. With a verbal child we will make every effort to explain and describe the procedure in ways the child will understand. Many children will have miminal difficulties with the exam and those children still having some anxiety and fear will normally quickly overcome such feelings as soon as the exam is finished. This procedure will only be done with the full consent of the parent. Flexible laryngoscopy offers the best and most detailed view of the upper airway and is often necessary for a correct diagnosis and treatment plan. we believe it is preferable to proceed with such an exam in clinic as it will often give enough information to make a diagnosis possible without having to make a visit to the operating room.
The flexible scope is also the best way to assess for any posterior nasal or nasopharyngeal obstruction. The most common reason for nasal obstruction is adenoid hypertrophy. Adenoidectomy is a common and sometimes necessary and beneficial surgery but prior to any decision on surgery it is necessary to know whether the adenoids are enlarged and, therefore, whether or not any intervention will be successful in relieving nasal obstruction. Clinical history is important but definitive visualization is frequently necessary. Oftentimes an x-ray is recommended by physicians to visualize the adenoids. However there are several drawbacks to this recommendation, first of all there is the radiation exposure of the x-ray, the image can be affected by movement of the child, sometimes requiring a second x-ray and further radiation exposure, and sometimes the image is obscured and a false impression of enlargement is given by the presence of thick mucous and secretions in the nasopharynx. The flexible scope provides an immediate definitive answer and provides confirmation about whether or not surgery will be beneficial. The child sometimes may cry briefly during the exam but oftentimes the child will cry just as much while attempting to hold them still for an xray.