Transnasal Flexible Laryngoscopy (TFL) is an office-based diagnostic procedure which uses Transnasal Flexible Laryngoscopes to examine the inside of the larynx, or vocal folds. TFL may be used in evaluating people with vocal fold tumors or paralysis of the vocal cords. Since the individual is wide awake during TFL, assessment of the mobility of vocal cords can be readily performed during speech or singing. Surgeons may pass surgical instruments through the scope for performing procedures such as biopsies of suspicious masses. TFL can also be utilized in conjunction with a tiny strobe light and video camera to obtain detailed, magnified views of the vocal folds; this procedure is called videostrobolaryngoscopy.
Rigid laryngoscopes are scopes that allow physicians to look directly into the vocal folds through the mouth (direct laryngoscopy). Direct laryngoscopy is generally reserved for the operating room. Surgeons may pass surgical instruments through the scope for performing procedures such as biopsies of suspicious masses or excision of polyps or cysts. Assessment of the area below the vocal folds can also be carried out with a rigid scope in order to assess patients with glottic stenosis. Surgeons frequently use an operating microscope in conjunction with rigid laryngoscopes to gain magnified views of the larynx. This is essential when performing microsurgery on the vocal folds, for it allows surgeons to remove vocal fold masses while minimizing damage to the vocal folds themselves. This type of procedure is known as laryngeal phonomicrosurgery. Because rigid laryngoscopes elicit a gag reflex, and because the patients must be extremely still when microsurgery of the vocal folds is being performed, patients must receive general anesthesia during their use.