Joan Rivers and Laryngoscopy

Published: September 5th, 2014

Category: UAD Student Blog

Endoscopic view of larynx

Laryngoscopic view of the voice box using indirect flexible laryngoscopy.

Over the past week and a half, the topic of Joan Rivers and her recent need for medical attention has seemingly taken over the realm of celebrity news reporting. From having her picture spread across magazines like People, OK! and Star to special TV coverage of tearful well-wishes on E! News, the media cannot get enough of this growing story concerning the 81-year-old entertainment icon. Sadly, Ms. Rivers passed away on Thursday September 5th, 2014.

According to several media sources, Rivers’ current medical problems began August 28th while she was being treated at Yorkville Endoscopy on the Upper East Side of Manhattan. The details of this procedure are unknown, although it has been reported as “a procedure on her vocal cords,” “throat surgery,” and “a minor endoscopic procedure.” Despite this discrepancy, it is known that she was rushed to Mount Sinai Hospital after going into either cardiac or pulmonary arrest during the procedure. It has since been reported that she was in a medically induced coma requiring intensive care and life support.

In the wake of Rivers’ death, there is a need to address some potentially misleading speculations concerning this type of endoscopic procedure. Based on limited details, it is likely that Rivers was undergoing one of a few possible procedures that fall under the category of laryngoscopy (larynx “voice box” + endoscopy). A laryngoscopic evaluation is generally performed by either otolaryngologists (ENTs) or speech-language pathologists (SLPs), and allows the clinician to view the structures deep in the throat. The procedure can be performed with the patient awake, in an office-based environment, or under sedation or general anesthesia. In the office based setting, the endoscopic camera is passed through either the nose or mouth, and into the throat where the larynx and surrounding structures can be visualized. Either an ENT or SLP can perform this type of laryngoscopy. Only an ENT physician performs the more invasive procedure involving sedation or general anesthesia. From the information released, it is not clear which type of procedure Ms. Rivers underwent.

The most commonly performed type of laryngoscopic procedure is the awake, office based procedure termed ‘indirect laryngoscopy,’ which can be done with either a flexible or rigid scope. A rigid scope is used to pass the cameral through the mouth, and a flexible scope is passed through the nose. In some cases, a numbing spray to the nose may be used to minimize gagging and discomfort. The most common side effects are throat soreness and nosebleeds. As with most medical procedures, there is potential for more serious side affects that includes airway blockage leading to breathing difficulties and lightheadedness or fainting; however, serious side effects as a result of the laryngoscopy procedure are very rare.

The procedure that would require sedation or general anesthesia, is termed ‘direct laryngoscopy.’ Direct laryngoscopy is used for surgical procedures (e.g. removing polyps or collecting a tissue sample for biopsy), and carries additional risks associated with the surgery itself as well as the anesthesia.

The take-home message here is not to get caught up in the sensationalism created by the media. Should you be aware that there are certain risks/benefits, as with any other medical treatment or procedure? Yes. Should you remember that every patient has his/her own unique medical profile and thus, will handle the procedure differently? Yes. Should you worry that you will share the outcome of Joan Rivers? No. Laryngoscopic procedures occur on a daily basis at many facilities and have been refined to an art by the clinicians who practice them. The death of Joan Rivers is obviously unfortunate, but her experience is not typical. Let your medical team (not stories from the media) be your guide when it comes to making medical decisions.

Rest in peace Joan.


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