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Can A Microlaryngoscopy Take Swabs And Biopsies?
Question: Can a microlaryngoscopy take swabs as well as biopsies? I have had a sore throat for 10 months, had my tonsils out and still have irritation. I am thinking of asking my gastro, for another endoscopy with biopsies, but they said they cannot do this of the throat. If I asked my ENT to do this, would they be able to go down as far as the bottom of my throat near my trachea?
Brief Answer:
Yes, it is possible to take the swabs and biopsies.
Detailed Answer:
Hi,
Thank you for your query.
1. Yes, it is possible to take swabs as well as biopsies from deep down in the throat during a MicroLaryngoScopy (ML'Scopy). In most centres this will be under general anaesthesia.
2. I would recommend a VideoLaryngoScopy (VL'Scopy) or a Flexible NasoPharyngoLaryngoScopy (FNPLScopy) under local anaesthesia for swabs, though biopsies are difficult, especially near the vocal cords or trachea.
3. The tonsil tissue removed represents barely 23-30% of the total lymphoid tissue in the throat. For example, the posterior one-third of the tongue is covered with a large lingual tonsil and there are innumerable islands of lymphoid tissue spread through-out the throat and oral cavity. These tissues may be inflamed and causing your sore throat. Upload images of the endoscopy for an accurate assessment.
4. There will be a combination of inflammation, infection, allergy and reflux involved. Hence all these have to be covered under medication before you get relief. A short course of steroids will help.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Yes, it is possible to take the swabs and biopsies.
Detailed Answer:
Hi,
Thank you for your query.
1. Yes, it is possible to take swabs as well as biopsies from deep down in the throat during a MicroLaryngoScopy (ML'Scopy). In most centres this will be under general anaesthesia.
2. I would recommend a VideoLaryngoScopy (VL'Scopy) or a Flexible NasoPharyngoLaryngoScopy (FNPLScopy) under local anaesthesia for swabs, though biopsies are difficult, especially near the vocal cords or trachea.
3. The tonsil tissue removed represents barely 23-30% of the total lymphoid tissue in the throat. For example, the posterior one-third of the tongue is covered with a large lingual tonsil and there are innumerable islands of lymphoid tissue spread through-out the throat and oral cavity. These tissues may be inflamed and causing your sore throat. Upload images of the endoscopy for an accurate assessment.
4. There will be a combination of inflammation, infection, allergy and reflux involved. Hence all these have to be covered under medication before you get relief. A short course of steroids will help.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You are so helpful!
Why don't you recommend the microlaryngoscopy? Is this because of the general anesthesia, and can you actually see a lot more for the other two scopes? I've had a video fluoroscopy, and many trans-nasal laryngoscopies before, but no swabs or biopsies were taken.
What steroid dose do you recommend, what type and for how long. I have had this for 10 months now, and hoping to find something that will just wipe this out.
Thank you, XXXXXXX
Why don't you recommend the microlaryngoscopy? Is this because of the general anesthesia, and can you actually see a lot more for the other two scopes? I've had a video fluoroscopy, and many trans-nasal laryngoscopies before, but no swabs or biopsies were taken.
What steroid dose do you recommend, what type and for how long. I have had this for 10 months now, and hoping to find something that will just wipe this out.
Thank you, XXXXXXX
Brief Answer:
ML'Scopy has specific indications only.
Detailed Answer:
Hi,
Thank you for writing back.
1. ML'Scopy under General Anaesthesia (GA) is used as a therapeutic or operative procedure. To do this procedure with a suspension laryngoscope, microscope or endoscope under GA is not justified for a normal looking larynx unless all other options are exhausted.
2. You can see everything with the other endoscopies. It is difficult to take blind biopsies and swabs when you don't know what you are looking for. Hence I suggest that you upload images (preferably videos) from your previous endoscopies which I can go through. I have been doing this for overseas patients online where their doctors send a history, examination note and an endoscopy video for evaluation.
3. The maximum dose recommended is 1 mg/kg/day tapered over 9 days. I usually start with 0.25 to 0.5 mg/kg/day tapered over 9 days. So a patient starts with either 6 mg of deflazacort or 10 mg of prednisolone thrice a day for 3 days, then twice a day for 3 days and then once a day for 3 days. This course can be repeated depending upon the response. This is addition to antibiotic coverage and other supportive medication such as anti-allergic, mucolytics, anti-inflammatory medications (with anti-reflux medication), steam inhalation and hypertonic saline nasal washes.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
ML'Scopy has specific indications only.
Detailed Answer:
Hi,
Thank you for writing back.
1. ML'Scopy under General Anaesthesia (GA) is used as a therapeutic or operative procedure. To do this procedure with a suspension laryngoscope, microscope or endoscope under GA is not justified for a normal looking larynx unless all other options are exhausted.
2. You can see everything with the other endoscopies. It is difficult to take blind biopsies and swabs when you don't know what you are looking for. Hence I suggest that you upload images (preferably videos) from your previous endoscopies which I can go through. I have been doing this for overseas patients online where their doctors send a history, examination note and an endoscopy video for evaluation.
3. The maximum dose recommended is 1 mg/kg/day tapered over 9 days. I usually start with 0.25 to 0.5 mg/kg/day tapered over 9 days. So a patient starts with either 6 mg of deflazacort or 10 mg of prednisolone thrice a day for 3 days, then twice a day for 3 days and then once a day for 3 days. This course can be repeated depending upon the response. This is addition to antibiotic coverage and other supportive medication such as anti-allergic, mucolytics, anti-inflammatory medications (with anti-reflux medication), steam inhalation and hypertonic saline nasal washes.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Bhatti,
I had a sedated endoscopy in September, and a video fluoroscopy in August. Would this be sufficient, or should I repeat this? How do I send these to you? Or do you have a website for your practice, and could XXXXXXX me for this service?
Again, you have been so so helpful. I feel like Canadians have no concept of LPR, and the chronic low grade nature of this.
Also, concerning the antibiotics, which one would you take, and for how long? With the steroids and antibiotics is there a risk that this medication could make the LPR worse? Would probiotics at different intervals help this? Is it best to get this infection under control, or just wait this out, until the Gaviscon and PPI's control the LPR better?
Thank you again! XXXXXXX
Also, what anti inflammatory?
I had a sedated endoscopy in September, and a video fluoroscopy in August. Would this be sufficient, or should I repeat this? How do I send these to you? Or do you have a website for your practice, and could XXXXXXX me for this service?
Again, you have been so so helpful. I feel like Canadians have no concept of LPR, and the chronic low grade nature of this.
Also, concerning the antibiotics, which one would you take, and for how long? With the steroids and antibiotics is there a risk that this medication could make the LPR worse? Would probiotics at different intervals help this? Is it best to get this infection under control, or just wait this out, until the Gaviscon and PPI's control the LPR better?
Thank you again! XXXXXXX
Also, what anti inflammatory?
Brief Answer:
Share the existing videos and images before any new endoscopy.
Detailed Answer:
Hi,
Thank you for writing back.
1. You can use a free file sharing site such as dropbox or contact YYYY@YYYY
2. There will be no additional charge for this service.
3. The concept of LPR and granular pharyngitis is important for effective treatment.
4. A penicillin (beta lactam) group (such as Augmentin), or a macrolide group antibiotic (such as azithromycin, clarithromycin) should be fine.
5. To control the acid reflux while on antibiotics and steroids, take a combination of rabeprazole (8 to 12 weeks) and levosulpiride. Muciane gel is an alternative to Gaviscon. Rule out h.pylori and hiatus hernia.
6. An anti-inflammatory containing trypsin, bromelain and rutoside should be taken.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Share the existing videos and images before any new endoscopy.
Detailed Answer:
Hi,
Thank you for writing back.
1. You can use a free file sharing site such as dropbox or contact YYYY@YYYY
2. There will be no additional charge for this service.
3. The concept of LPR and granular pharyngitis is important for effective treatment.
4. A penicillin (beta lactam) group (such as Augmentin), or a macrolide group antibiotic (such as azithromycin, clarithromycin) should be fine.
5. To control the acid reflux while on antibiotics and steroids, take a combination of rabeprazole (8 to 12 weeks) and levosulpiride. Muciane gel is an alternative to Gaviscon. Rule out h.pylori and hiatus hernia.
6. An anti-inflammatory containing trypsin, bromelain and rutoside should be taken.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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