microlaryngoscopy and laryngeal medialisation injection

Laryngeal Medialisation Injection (LMI) is an injection into one of your vocal cords in order to improve your voice. This is given during mircolaryngoscopy, which is the examination of your larynx (voice box) while you are under general anaesthetic. You will therefore be asleep for the procedure.

Your surgeon has recommended that you have this operation in order to improve the quality and tone of your voice. Microlaryngoscopy gives a very detailed view of the voice box that allows for the LMI to be given.

Before your operation, you will be seen at pre-assessment clinic and will be screened for MRSA with swabs from your throat, nose, armpit or groin. If you have other medical problems, you might also have an appointment arranged for you to see an anaesthetist (the doctor that puts you to sleep for the operation).

Some useful tips.

• Avoid irritants of the voice box eg. Smoking, alcohol, caffeine.

• Make family and friends aware that you will not be able to speak for 2 days. Bring a pen and pad of paper with you to the hospital.

• If you have been prescribed reflux medication, make sure you take it regularly.

• Arrange time off work (up to two weeks).

On the day of your operation, you will arrive on the ward where nursing staff will go through some paperwork with you, check your vital signs (blood pressure etc.) and give you a gown and stockings to wear (to prevent blood clots).

Before your operation, you will see your surgeon who will go through the operation and consent form with you.

You will also see your anaesthetist who will go through how you are put to sleep and answer any questions you may have about this.

The operation involves putting an instrument (laryngoscope) into your mouth to get a good view of the voice box. A microscope is then used to magnify this view.

One of the vocal cords is then injected with a substance to bulk it out and bring it into the midline to allow for the vocal cords to meet. As the operation is done through your mouth you will not have any scars from the procedure.

It is generally quite a short operation and usually takes about 30 minutes. It is likely to be done as a day case, so you should be able to go home the same day.

Microlaryngoscopy is generally a very safe procedure. However, you should be aware of the following risks.

• Pain. You may have a sore throat afterwards but this will settle in a few days and is helped by simple painkillers such as paracetamol.

• Voice change. This could be temporary or permanent and will be discussed with you before the operation.

• Infection. This is very uncommon but is treated with antibiotics if required.

• Difficulty swallowing. While rare, this may be temporary or permanent. l Bleeding - this is typically minimal and controlled during the operation.

• Difficulty breathing. This can occur due to swelling after surgery. When severe, it requires immediate attention.

• Damage to your lips/teeth/gums from the instruments used (a gum guard is used to prevent this).

0-2 days.

• Do not talk, whisper, cough or clear your throat for 48 hours. Use a pen and pad of paper to communicate.

• Use steam inhalation 4-5 times a day for 10 minutes. Put boiling water into a large bowl, place your head over the bowl with a towel on top, and breathe in the steam through your mouth.

• Keep well hydrated, drinking lots of water everyday. Otherwise, you can eat and drink normally.

• Avoid smoking.

3-14 days.

After the first two days of complete voice rest, you may start using the voice gently and sparingly over the next 10 days. After 2 weeks you can use the voice as normal.

You should also

• Avoid shouting or straining your voice.

• Rest your voice between speaking.

• Use the steam inhalation twice a day.

The voice box will take 3-4 weeks to fully heal after microlaryngoscopy.