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One of the fundamental innovations in laryngology and voice care is the ability to treat a multitude of disorders in the office without anesthesia. Interestingly, many laryngeal procedures were done in this manner historically, but were moved to the operating room to achieve greater precision once general anesthesia became safer. Recent improvements in optics, illumination and instrumentation have allowed laryngologists to once again treat laryngeal disorders safely in the conscious patient.

Office procedures are typically performed with local anesthesia, applied to the nose (to allow insertion of a flexible laryngoscope) and to the site of the procedure, but not with intravenous sedation or other anesthetic. The larynx is visualized using a flexible laryngoscope, as it would be for a normal diagnostic examination, and instruments are inserted through the laryngoscope itself into the patient’s mouth or skin. The patient is discharged either immediately after the procedure, or following a brief period observation.

There are three basic types of office procedures:

• Vocal fold injection
• KTP laser treatment
• Botulinum toxin injection