Endoscopy
Endoscopy means to “look within,” in our case either the larynx (voice box), windpipe, esophagus, and throat. This might be done for many different reasons:
- Just to see and feel something
- Take a biopsy
- Try to widen the airway
- To remove something
Some common kinds of endoscopy include microlaryngoscopy and esophagoscopy.
Example of Microlaryngoscopy:
Primary laryngeal amyloidosis (1 of 11)
An example of primary laryngeal amyloidosis of the larynx. In this case, the yellowish, “candle-wax” proteinaceous material is being deposited just below the margin of the vocal cords (arrows).
Phonation (making voice) (2 of 11)
When this person produces voice, the bulky swelling just below the margin of the vocal cords is concealed but it creates turbulence, incomplete match, and a rough voice quality.
Initial Surgical View (Photo 3 of 11)
In the operating room, the view is inverted. The amyloid deposit bulges from underneath the vocal cords, especially on the right. Dotted lines mark the free margin of each cord.
Dissection Begins On The Left (Photo 4 of 11)
An incision is made and the submucosal amyloid deposit is being dissected out of the left vocal cord.
Conclusion of Surgery (Photo 5 of 11)
Amyloid deposits have been debulked. It is impossible to remove them all.
2 Weeks Post-op (6 of 11)
The vocal cords match much better and voice is dramatically improved.
Amyloidosis (7 of 11)
Eight years later, the patient reappeared. She said voice had been good for many years but had been getting increasingly hoarse for the prior couple of years. Here you see major re-deposition of amyloid material.
Amyloid deposits (8 of 11)
At very close range, the yellowish color typical of amyloid deposits is better seen.
Vocal cords cannot close completely (9 of 11)
During voice production under strobe light, the amyloid deposit under the left vocal cord (see arrow) prevents closure.
Amyloid Remain (10 of 11)
A year after her second laser debulking, the patient continued to have a very good voice, and only reappeared due to an unrelated question. As expected, smally amyloid deposits remain.
Voice remains clear (11 of 11)
When she produces voice, match and vibratory ability are very good, explaining her normal voice. It remans to be seen if amyloid will gradually reaccumulate over the next many years and need another debulking.
Example of Esophagoscopy
Esophagoscopy (1 of 4)
View into left pyriform sinus and post-arytenoid area.
Esophagoscopy (2 of 4)
Similar view at initiation of swallow, with opening of the upper esophageal sphincter (cricopharyngeus muscle) to allow admission of the tip of the scope.
Esophagoscopy (3 of 4)
View within esophagus, using mild air insufflation.
Esophagoscopy (4 of 4)
Within hiatal hernia.
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