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n flexible laryngoscopy, a thin, flexible viewing tube (called a laryngoscope) is passed

through the nose and guided to the vocal cords, or larynx. Fiberoptic cables permit a
physician to directly inspect the nose, throat, and larynx for abnormalities. Laryngoscopy is
typically performed in a doctors office using local anesthesia.
Alternatively, a rigid viewing tube may be passed through the mouth for a more thorough
inspection, a procedure called rigid laryngoscopy. Instruments may be passed through the
scope to obtain tissue samples for microscopic examination, or to perform therapeutic
procedures. Rigid laryngoscopy is done in an operating room under general anesthesia.

Purpose of the Laryngoscopy

To detect laryngeal abnormalities, such as inflammation, lesions, or narrowed


passages (strictures)

To obtain a tissue biopsy in order to confirm suspected cancer of the larynx or to


assess the severity of diagnosed cancer

To help diagnose the cause of a persistent or bloody cough, hoarseness, throat pain, or
bad breath

To determine the cause for difficulty swallowing or a feeling of a lump in the throat

To determine the cause of other voice problems, such as a breathy voice, weak voice
or loss of voice

Used therapeutically to remove foreign objects or benign lesions such as polyps from
the larynx

Who Performs Laryngoscopy

A physician, usually an ear, nose, and throat specialist (otolaryngologist) or a surgeon.

Special Concerns about Laryngoscopy

This procedure may be combined with bronchoscopy and


esophagogastroduodenoscopy to fully evaluate some people with known head-andneck cancer; this variation is known as panendoscopy.

Before the Laryngoscopy

Tell your doctor if you regularly take anticoagulants or nonsteroidal antiinflammatory drugs (such as aspirin, ibuprofen, or naproxen). You may be instructed
to discontinue these agents before the test.

Tell your doctor if you are pregnant or may be pregnant.

Tell your doctor if you have had surgery or radiation treatments to your mouth or
throat.

Do not eat or drink anything for 12 hours before the test if you are undergoing general
anesthesia, or 8 hours if you are receiving local anesthesia.

Do not smoke and lose weight if you are overweight.

You will be instructed to remove contact lenses, dentures, and jewelry and to empty
your bladder before the test begins.

Before you receive general anesthesia, an intravenous (IV) needle or catheter is


inserted into a vein in your arm.

If local anesthesia is to be used, you may be given a sedative medication before the
test, but you will remain conscious throughout the procedure. You may also be given a
drug called atropine to help dry up your saliva. These drugs may be given orally or
through an IV line.

What You Experience during Laryngoscopy


Flexible laryngoscopy:

You will sit upright in an exam chair in your doctors office.

Relax and breathe through your nose. A local anesthetic is sprayed into the back of
your nose and throat to numb these areas and suppress the gag reflex (however, you
may still gag and feel some discomfort when the laryngoscope is first inserted).

The doctor inserts the scope through one nostril and closely inspects your nose, throat,
and larynx.

Photographs may be taken with a tiny camera attached to the scope.

This procedure usually takes 5 to 10 minutes, though the anesthetic may last up to an
hour.

Rigid laryngoscopy:

You will lie on your back on an operating room table, and general anesthesia is
administered.

A rigid laryngoscope is inserted into your mouth and the doctor inspects your throat
and larynx. Instruments may be passed through the scope to remove tissue samples for
laboratory analysis. (In some cases, a special blue dye may be applied to suspicious
areas in order to stain abnormal cells and identify areas for biopsy.)

Photographs may be taken of the larynx with a tiny camera attached to the scope.

If necessary, therapeutic procedures, such as removal of polyps, may also be done


with a rigid scope and specialized instruments.

This procedure usually takes 30 minutes to 1 hour.

Risks and Complications of Laryngoscopy

Most patients experience temporary hoarseness and a sore throat. Rare complications
include inadvertent injury of the mouth or throat, excessive swelling, bleeding,
infection, pain, vomiting and gagging.

If the procedure was performed under general anesthesia, it will carry all the
associated risks.

After the Laryngoscopy

You will lie down in a recovery room to recuperate from the effects of anesthesia or
sedation. (If you received general anesthesia, you will be placed with your head
slightly elevated to prevent aspiration of foreign contents into your lungs.) During this
time, your vital signs will be monitored, and you will be observed for any signs of
complications.

At first, you will be given a basin and asked to spit out your saliva rather than
swallow it. If you had a biopsy, you will also be advised to avoid coughing, clearing
your throat, and smoking until it is clear there are no complications.

You may be given an ice collar to minimize any throat swelling.

You may be given pain-relieving medication, if needed.

If you received local anesthesia, you will not be allowed to eat or drink until your gag
reflex returns, usually in a few hours. (Touching the back of the throat with a tongue
depressor tests for this reflex.)

You will likely be able to return home in 4 hours if local anesthesia was used; general
anesthesia may necessitate an overnight hospital stay. You may then resume your
usual activities and (according to your doctors instructions) any medications withheld
before the test.

You may feel hoarse or have a sore throat for several days. Lozenges or a warm saline
gargle may provide some relief. You may also cough up small amounts of blood for
several days.

Contact your doctor immediately if you develop excessive bleeding, hoarseness,


coughing, , difficulty breathing or swallowing, chest pain, severe nausea, vomiting or
a high fever after the test.

Results of Laryngoscopy

During the visual inspection of your mouth, throat, and larynx, the doctor will note
any abnormalities. In some cases, this examination is sufficient to provide a diagnosis.

If tissue or fluid samples were taken, specimen containers may be sent to several
different laboratories for examination. For example, biopsied tissue may be inspected
under a microscope for the presence of unusual cells, or may be cultured for
infectious organisms.

This test usually results in a definitive diagnosis. Your doctor will recommend
appropriate medical or surgical treatment, depending on the specific problem.

Source:
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor

Laryngoscopy
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Test Overview

Laryngoscopy is an examination that lets your doctor look at the back of your throat, your
voice box (larynx) , and vocal cords with a scope (laryngoscope). There are two types of
laryngoscopy, and each uses different equipment.
Indirect laryngoscopy

Indirect laryngoscopy is done in a doctor's office using a small hand mirror held at the back
of the throat. Your doctor shines a light in your mouth and wears a mirror on his or her head
to reflect light to the back of your throat. Some doctors now use headgear with a bright light.
Indirect laryngoscopy is not done as much now because flexible laryngoscopes let your
doctor see better and are more comfortable for you.

Direct fiber-optic (flexible or rigid) laryngoscopy

Direct laryngoscopy lets your doctor see deeper into your throat. The scope is either flexible
or rigid. Flexible scopes show the throat better and are more comfortable for you. Rigid
scopes are often used in surgery.

Laryngoscopy
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Why It Is Done

An indirect or direct laryngoscopy helps a doctor:

Find the cause of voice problems, such as a breathy voice, hoarse voice,
weak voice, or no voice.

Find the cause of throat and ear pain.

Find the cause for trouble swallowing, a feeling of a lump in the throat, or
mucus with blood in it.

Check injuries to the throat, narrowing of the throat (strictures), or


blockages in the airway.

Direct rigid laryngoscopy may be used as a surgical procedure to remove foreign objects in
the throat, collect tissue samples (biopsy), remove polyps from the vocal cords, or perform
laser treatment. Direct rigid laryngoscopy may also be used to help find cancer of the voice
box (larynx).

Laryngoscopy
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How To Prepare
Indirect laryngoscopy and direct flexible laryngoscopy

If you wear dentures, you will remove them just before the examination.
Direct rigid laryngoscopy

Before a rigid laryngoscopy, tell your doctor if you:

Are allergic to any medicines, including anesthetics.

Are taking any medicines.

Have bleeding problems or take blood-thinning medicine, such as warfarin


(Coumadin).

Have heart problems.

Are or might be pregnant.

Have had surgery or radiation treatments to your mouth or throat.

Rigid laryngoscopy is done with a general anesthetic. Do not eat or drink for 8 hours before
the procedure. If you have this test in your doctor's office or at a surgery center, arrange to
have someone drive you home after the procedure.
You will be asked to sign a consent form that says you understand the risks of the test and
agree to have it done.
Talk to your doctor about any concerns you have regarding the need for the test, its risks, how
it will be done, or what the results will mean. To help you understand the importance of this
test, fill out the medical test information form (What is a PDF document?).
How It Is Done

Indirect laryngoscopy and direct flexible laryngoscopy examinations are generally done in a
doctor's office. Most fiber-optic laryngoscopies are done by an ear, nose, and throat specialist
(ENT). You may be awake for the examination.
Indirect laryngoscopy

You will sit straight up in a chair and stick out your tongue as far as you can. The doctor will
hold your tongue down with some gauze. This lets the doctor see your throat more clearly. If
you gag easily, the doctor may spray a numbing medicine (local anesthetic) into your throat
to help with the gaggy feeling.
The doctor will hold a small mirror at the back of your throat and shine a light into your
mouth. He or she will wear a head mirror to reflect the light to the back of your throat. Or
your doctor may wear headgear with a bright light hooked to it. He or she may ask you to
make a high-pitched "e-e-e-e" sound or a low-pitched "a-a-a-a" sound. Making these noises
helps the doctor see your vocal cords.
The examination takes 5 to 10 minutes.
If a local (topical) anesthetic is used during the examination, the numbing effect of the
anesthetic will last about 30 minutes. You can eat or drink when your throat is no longer
numb.
Direct flexible laryngoscopy

The doctor will use a thin, flexible scope to look at your throat. You may get a medicine to
dry up the secretions in your nose and throat. This lets your doctor see more clearly. A topical
anesthetic may be sprayed on your throat to numb it.
The scope is put in your nose and then gently moved down into your throat. As the scope is
passed down your throat, your doctor may spray more medicine to keep your throat numb

during the examination. The doctor may also swab or spray a medicine inside your nose that
opens your nasal passages to give a better view of your airway.
Direct rigid laryngoscopy

Before you have a rigid laryngoscopy, remove all your jewelry, dentures, and eyeglasses. You
will empty your bladder before the examination. You will be given a cloth or paper gown to
wear.
Direct rigid laryngoscopy is done in a surgery room. You will go to sleep (general anesthetic)
and not feel the scope in your throat.
You will lie on your back during this procedure. After you are asleep, the rigid laryngoscope
is put in your mouth and down your throat. Your doctor will be able to see your voice box
(larynx) and vocal cords.
The rigid laryngoscope may also be used to remove foreign objects in the throat, collect
tissue samples (biopsy), remove polyps from the vocal cords, or perform laser treatment.
The examination takes 15 to 30 minutes. You may get an ice pack to use on your throat to
prevent swelling. After the procedure, you will be watched by a nurse for a few hours until
you are fully awake and able to swallow.

Do not eat or drink anything for about 2 hours after a laryngoscopy or until
you are able to swallow without choking. You can then start with sips of
water. When you feel ready, you can eat a normal diet.

Do not clear your throat or cough hard for several hours after the
laryngoscopy.

If your vocal cords were affected during the laryngoscopy, rest your voice
completely for 3 days.

If you speak, do so in your normal tone of voice and do not talk for very
long. Whispering or shouting can strain your vocal cords as they are trying
to heal.

You may sound hoarse for about 3 weeks after the laryngoscopy if tissue
was removed.

If nodules or other lesions were removed from your vocal cords, you may
have to follow total voice rest (no talking, whispering, or making any other
voice sounds) for up to 2 weeks.

Laryngoscopy
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How It Feels

Indirect laryngoscopy

You may feel like gagging when the mirror is placed in your throat. It may be uncomfortable
when the doctor pulls on your tongue. If this becomes painful, signal your doctor by pointing
to your tongue, since you will not be able to speak. If a spray anesthetic is used, it tastes
bitter, it can make you feel like your throat is swollen, and it may make you feel that it is hard
to swallow.
Direct flexible laryngoscopy

It may feel strange to have the doctor put the scope up your nose. But it should not hurt and
you will still be able to breathe. If a spray anesthetic is used, it may taste bitter. The anesthetic
can also make you feel like your throat is swollen. You can swallow normally but you may
not feel it.
Direct rigid laryngoscopy

You will be asleep and feel nothing during the laryngoscopy. After the procedure, you may
have some nausea, general muscle aches, and may feel tired for 1 to 2 days. You also may
have a sore throat and sound hoarse. Suck on throat lozenges or gargle with warm salt water
to help your sore throat.
If your child is having this procedure, the same is also true. If your child has a sore throat and
is age 4 or older, you can give him or her throat lozenges. Also, a child age 8 or older can
gargle with warm salt water.
If a biopsy was taken, it is normal to spit up a small amount of blood after the laryngoscopy.
Talk to your doctor about how much bleeding to expect and how long the bleeding may last.
Call your doctor immediately if:

You have a lot of bleeding or if the bleeding lasts for 24 hours.

You have any trouble breathing.

Risks

All types of laryngoscopy have a small chance of causing swelling and blocking the airway.
If you have a partially blocked airway because of tumors, polyps, or severe inflammation of
the tissues at the back of the throat (epiglottitis), you may have a higher chance of problems.
If complete blockage of the airway occurs, which is rare, your doctor may need to put a tube
in your throat to help you breathe. Or, very rarely, your doctor may have to make a cut
(incision) in your neck (a tracheotomy).
If a biopsy was taken, there is a very small chance of bleeding, infection, or a tear in the
airway.

Results

Laryngoscopy is an examination that lets your doctor look at the back of your throat, your
voice box (larynx), and vocal cords with a scope (laryngoscope). If a biopsy was done, it may
take several days for your doctor to know the results.
Laryngoscopy
Normal:
The throat (larynx) does not have swelling, an injury,
narrowing (strictures), or foreign bodies. Your vocal cords
do not have scar tissue, growths (tumors), or signs of not
moving correctly (paralysis).
Abnormal:
Your larynx has inflammation, injury, strictures, tumors, or
foreign bodies. Your vocal cords have scar tissue or signs
of paralysis.

Laryngoscopy
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What Affects the Test

If you gag easily, your doctor may need to do a direct rigid laryngoscopy.

Laryngoscopy
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What To Think About

Direct rigid laryngoscopy is generally recommended for:


o

Children.

People who gag easily because of abnormalities in their throat


structure.

People who may have symptoms of laryngeal or pharyngeal


disease.

People who have not responded to treatment for laryngeal


symptoms.

Laryngoscopy
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References

Other Works Consulted

Pagana KD, Pagana TJ (2010). Mosbys Manual of Diagnostic and


Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Weinberger PM, Terris DJ (2010). OtolaryngologyHead and neck surgery.


In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed.,
pp. 224258. New York: McGraw-Hill.

Kemoterapi
Penggunaan obat untuk menangani kanker disebut kemoterapi atau agen
antineoplastik.Obat ini digunakan untuk membunuh sel kanker dan menghambat
perkembangannya.Semua sel baik normal maupun sel kanker berjalan mengikuti
siklus sel. Agen kemoterapi bekerja pada fase siklus sel berbeda disebut siklus non
spesifik, kebanyakan agen kemoterapeutik paling efektif ketika sel-sel secara aktif

sedang membelah.
Kemoterapi terutama digunakan untuk mengobati penyakit sistematik daripada lesi
setempat dan dapat diatasi dengan pembedahan atau radiasi.Kemoterapi mungkin di
kombinasi dengan pembedahan atau terapi radiasi, atau kedua-duanya untuk
menurunkan ukuran tumor sebelum operasi, untuk merusak sel-sel tumor yang masih
tertinggal pasca operasi. Tujuan dari kemoterapi ( penyembuhan , pengontrolan,
paliatif ) harus realistic, karena tujuan tersebut akan menetapkan medikasi yang

digunakan dan keagresifan dari rencana pengobatan.


Agen kemoterapi yang digunakan pada Ca laring atau anti metabolik membunuh selsel kanker dengan memblok sintesis DNA dan RNA. Mereka melakukan ini dengan
meniru struktur metabolik esensial secara kimiawi, yaitu : Nutrien esensial untuk
metabolisme sel normal, Agen umum meliputi : Cytarabine ( ARA-C ), Floxuridine
( FUDR ), 5-Fluorourasial ( 5-FU ), Hydroxyurea ( Hydrea ), 6-Merkaptopurine ( 6MP ), Methotrexate ( mexate ) dan 6-Thieguanin. Efek samping yang paling umum
adalah meliputi stomatitis supresi sum-sum tulang dan diare.

a. Rute pemberian
Obat-obat kemoterapeutik mungkin diberikan melalui rute topical, oral, interval,
intramuskuler, subkutan, arteri, intrakavitasi dan intratekal.Rute pemberian biasanya
bergantung pada tipe obat, dosis yang dibutuhkan dan jenis, lokasi dan luasnya tumor

yang diobati.
b. Dosis

Dosis preparat anti neoplastik terutama didasarkan pada area permukaan tubuh total
pasien, respon terhadap kemoterapeutik atau terapi radiasi dahulu, fungsi organ utama
dan status kinerja fisik.

Key Glossary Terms

Rigid Laryngoscopy
An examination of the voice box in which a rigid telescope is used; this examination
provides the clearest magnified detail of the voice box, but the patient is unable to
speak or sing during the exam

Flexible Laryngoscopy
An examination of the voice box in which a flexible fiberoptic scope is used; this
examination allows the physician to view the voice box in action (i.e., while the
patient is producing sound)

Stroboscopy
An examination in which a strobe light is combined with rigid or flexible
laryngoscopy, allowing an examination of vocal fold vibration and vocal fold closure

Glossary

In Brief
Since many voice disorders are caused by problems in the voice box and/or throat, a
careful and detailed examination of the voice box and throat is key to the
identification of the cause or causes of voice disorders. Several methods can be used
to examine the throat and voice box.

Viewing the Voice Box Through Specialized Tube (Endoscope)


Rigid laryngoscopy: This examination provides the clearest magnified view of the
voice box. A rigid telescope-tube is passed through the patients mouth. The examiner
then holds the patients tongue while viewing the voice box. Images are usually
recorded on video.

Also called: telescopic laryngoscopy, transoral laryngoscopy

Flexible laryngoscopy: This examination allows for viewing the voice box in action.
Flexible laryngoscopy provides a magnified view of the voice box while the patient
produces sound (speaking, singing, etc.). Viewing is done through a flexible viewingtube passed through the patients nose to the back of the throat, thus allowing the
examiner to view the voice box while the patient speaks, sings, coughs, sniffs, etc.
Images are usually recorded on video.

Also called: fiberoptic laryngoscopy, fiberoptic flexible endoscopy,


nasopharyngoscopy, transnasal laryngoscopy

Laryngeal stroboscopy: This examination is a specialized viewing of vocal fold


vibration. Laryngeal stroboscopy involves controlled high-speed flashes of light timed
to the frequency of the patients voice. Images acquired during these flashes provide a
slow motion-like view of vocal fold vibration during sound production.

Also called: videostroboscopy, laryngostroboscopy, laryngo-videostroboscopy,


stroboscopic laryngoscopy, strobolaryngoscopy

Advantages
These technologies provide valuable practitioner and patient information. They allow
images to be recorded on video or other media formats, permitting examiners to
review the images of the voice box frame by frame, capture still and close-up images,
and re-review images with members of the voice care team. Patients can also view the
recorded images and see the reason(s) for their voice problems. (For more
information, see Voice Care Team.)

Who performs laryngoscopy and stroboscopy?


An otolaryngologist or speech-language pathologist typically performs laryngoscopy
and/or stroboscopy. The examiners training and background experience is critical in
performing and evaluating laryngoscopy and stroboscopy findings.

In certain situations, stroboscopy may be performed by a nurse practitioner or a


physician assistant under the supervision of a physician.

Recording Laryngoscopy and Stroboscopy Findings


Flexible laryngoscopy, rigid laryngoscopy, and stroboscopy are frequently recorded
on some type of playback media: videotape or DVD. The reasons for this are:

Instant replay review of examinations critical: The recorded images allow the
clinician to review the examination repeatedly, often for a frame by frame analysis.
This review of the examination of the voice box, vocal fold structure, vibration, and
closure is analogous to the instant replay method used in televised sporting events.
Playback media recording is especially important in stroboscopy because of the
intricacy and rapid speed of vocal fold vibration.

Records for comparison over time: Recording the laryngeal examination on video
allows comparison of voice box structure and function over time. By comparing old
examinations of the voice box with a current examination, the voice care team can
monitor the success or failure of various treatments and also observe any changes
over time.

Advisory Note
Patient education material presented here does not substitute for medical consultation
or examination, nor is this material intended to provide advice on the medical
treatment appropriate to any specific circumstances.

Endoscopic biopsy
The larynx and hypopharynx are deep inside the neck, so removing samples for biopsy can be complex.
Biopsies of these areas are done in the operating room while you are under general anesthesia (asleep), rather
than in a doctors office. The surgeon uses special instruments through a rigid laryngoscope (or other type of
endoscope) to remove small tissue samples.

Fine needle aspiration (FNA) biopsy


This type of biopsy is not used to remove samples in the larynx or hypopharynx, but it may be done to find the
cause of an enlarged lymph node in the neck. A thin, hollow needle is placed through the skin into a mass (or
tumor) to get cells for a biopsy. The cells are then looked at under a microscope. If the FNA finds cancer, the
pathologist (doctor examining the samples with a microscope) can often tell what type of cancer it is. If the
cancer cells look like they might have come from the larynx or hypopharynx, an endoscopic exam and biopsy of
these areas will be needed as well.
If the FNA does not find cancer, it only means that cancer was not found in that lymph node. Cancer could still
be present in other places. If you are having symptoms that might be from a laryngeal or hypopharyngeal cancer,
you could still need other procedures to find the cause of the symptoms.
FNA biopsies may also be useful in some patients already known to have laryngeal or hypopharyngeal cancer. If
the person has a lump in the neck, an FNA can help determine if the mass is due to spread of the cancer. FNA
may also be used in patients whose cancer has been treated by surgery and/or radiation therapy, to help find out
if a neck mass in the treated area is scar tissue or if it is a return (recurrence) of the cancer.